THE epidemic fever which made its ap­pearance in this city, at the latter end of the month of July last year, and which occasioned a degree of mortality among the people never experienced in so short a space before, afforded matter of much serious conversation, and gave rise to a great di­versity of opinion. An idea was entertained by some, and this idea was, by others, in­dustriously propagated abroad, that the dis­ease was imported from the West-Indies, and that it was contagious: while, on the other hand, many contended that a con­currence of local circumstances, which de­rived an uncommon activity from a pecu­liar constitution of the air, were alone suf­ficient to account for its production.

[Page 6] It is the main object of the writer of this pamphlet to lay before the public a few facts on this important subject; and in do­ing this, he is conscious that the chief merit of these will consist in the diligence with which they were collected, and the fidelity with which they are detailed. He shall purposely avoid attacking any particular doctrines in medicine, relatively to the na­ture of the fever in question; and the same temper will incline him to pass, without animadversion, the practice of those who have stood deservedly high in their profes­sion. He will therefore hold himself re­sponsible only for a faithful narrative.—It has, indeed, been thrown together under circumstances very unfavourable to regular composition; but as it sprung from no vain conceit of ability to render that clear, which has long been involved in obscurity, he thinks he may rely on the purity of his motive for publishing it, as a shield against the severity of criticism. The motive, as [Page 7] it first suggested itself to his mind, was none other, than a desire to point out the real causes, as they appeared to him, of the late epidemic, and thereby, in some degree, to moderate individual apprehension, and quiet popular alarm.

At the first appearance of the disease, the following reports were diligently circu­lated, and very generally credited, viz. that Dr. Treat, then health officer of the port of New-York, had visited the brig Zephyr, just arrived from Port-au-Prince; that he found the crew sickly; that several men had died on the passage; that a boy had died the morning of her arrival; that Dr. Treat had incautiously opened the dead body; that it was very generally tinged with a yellow colour; and that it was ex­tremely offensive to the smell.

How correspondent these reports were with truth, will hereafter appear, from a statement of facts, substantiated by the tes­timony of indubitable authority.

[Page 8] A few days after Dr. Treat visited the brig Zephyr, about the 20th of July, he was seized with fever. The manner of the attack, the nature and severity of the sub­sequent symptoms, attended with a yellow countenance, and a similar tinge of the skin generally, were supposed to constitute the disease the yellow fever.

About the same time that Dr. Treat be­came indisposed, a fever, resembling that of which he died, made its appearance on board the ship William, said to be then lying at Fitch's wharf, nearly opposite Dover-street. Shortly after, August 1st, the family of Mr. Jenkins, living in Water-street, near Dover-street, was attacked with fever, which was supposed to have been communicated from the ship William.

At first it seemed rather extraordinary, that the ship William, which had sailed directly from Liverpool to this place, and whose men had been healthy during the passage, should have contained matter of [Page 9] a contagious nature, which only operated upon the crew in producing fever several weeks after her arrival.

This difficulty, however, was soon made to vanish, and the explanation became easy, when it was alledged that the brig Zephyr, on board of which no one was supposed to doubt that the yellow fever existed, had hauled along-side the ship William, and thus communicated the disease to the sailors.

This account, plausible in appearance, obtained almost universal credit, and though highly erroneous, as will hereafter be proved, was in a hasty and unauthoriz­ed way conveyed to Philadelphia, and, no doubt, afforded a considerable ground upon which the regulations that took place in that city, relative to this, were founded.

At this period the public mind laboured under great apprehensions. A new disease was supposed to have made its appearance. Several deaths had already happened, the [Page 10] nature of which, judging from the adven­titious circumstance of colour, had an as­pect extremely formidable. The progress, also, of the complaint, was supposed to be such, that to those who took things for granted, there remained but little doubt that the city would soon be overspread with contagion: and it cannot be sufficiently regretted, that the supposed contagious na­ture of the disease was too much urged by those who ought to have been more re­served in their opinion: for as yet no cir­cumstances had really occurred to counten­ance or justify the violent and exaggerated accounts which were circulated upon this subject.

In this state of affairs the torrent of opi­nion became irresistible. Fear and dismay pervaded every mind; and those of the in­habitants who were most alarmed, as well as many of those who had no particular motive for remaining in the city, sought refuge in the country.

[Page 11] In all situations in which our safety be­comes a matter of considerable doubt, it is natural for us, after the panic, with which at first we are apt to be seized, has a little subsided, to enquire what the chances are that we escape the danger. Accordingly, those who remained in the city, and were at the trouble of investigating the subject, found, that many examples had offered, where the sick had been attended with im­punity: neither physicians, nor friends, nor attendants had imbibed any infection: and the circumstances attending the very few instances which were supposed to favour the idea of contagion, were so extremely obscure and doubtful, that nothing could be collected from them, of a nature at all satisfactory. In confirmation of this, we have the declaration of the Medical Socie­ty, in answer to a letter from Governor Jay, dated 24th of September, 1795:—‘The collective opinion of this Society, as the result of attentive observation, is, that [Page 12] the fever is not specifically contagious; and we are confirmed in this opinion from the following powerful considera­tions, that neither relatives, nurses, nor physicians have, save in one or two doubtful cases, been infected by attend­ing on those who have either recovered or died of the disease.’

Much was daily urged from these facts; and finally, the terror with which the sup­posed contagious nature of the disease had filled people's minds, was in a great mea­sure done away: and the confidence which took place, between the patient and physi­cian, as a consequence of this conviction, was, I have no doubt, in many instances, a mean which greatly contributed to the recovery of the sick.

Thus it would appear, from what has already been said, that a difference of opi­nion had existed, as well among the citizens as the physicians, with respect to the real origin and character of the late epidemic.

[Page 13] The object I have in view is to reconcile those opinions, as far as that can be effected, by bringing into one view all the facts I have been able to collect upon the subject. These shall form the principal data upon which any future reasoning may be found­ed; and if the sentiments I may advance are found to differ from the opinion of others, I hope that a liberal and candid communication may tend to our mutual in­formation, and that the public may be bene­fited by our attempts to arrive at truth.

We shall, therefore, in the next place, proceed to examine the validity of the opinion, that the brig Zephyr introduced a contagious fever into this city. And the following letters from Messrs. Armstrong and Barnwell, and Miller and Hoope, are, in my mind, very explicit.

The foregoing letters afford an unequi­vocal testimony of the condition of the crew of the brig Zephyr, on her arrival in this port. They afford, also, a complete refutation of the assertion, that the Zephyr communicated a contagious fever to the ship William, the two vessels having never been near one another: and, in short, they shew, that, excepting the death of the boy, [Page 18] the reports circulated concerning the Ze­phyr, at the first appearance of the fever, and indeed believed by many during its continuance, were altogether without foundation.

When it was discovered that the brig Zephyr had not been nearer the ship Wil­liam than half a mile, so wedded were in­dividuals to the idea of imported contagion, that they fixed on the brig Active, which had just arrived from Martinique, as the contagious vessel. But the following letters from Messrs. Lawrence and Van Zandt will be found to contain facts as little fa­vourable to the opinion, that contagion had been communicated from the Active, as has been proved with respect to the brig Zephyr.

We are indebted to Mr. Strong for the following:—

The preceding letters leave little doubt with respect to the healthful state of the brig Active. It appears that she arrived in port on the 22d of July: on the 23d she laid on the outside of a vessel at the end of Fitch's wharf: on the 24th she hauled into the slip; and on the 25th of July she broke bulk.

[Page 23] Hitherto it has been supposed, that the ship William also laid at Fitch's wharf; but the truth is, that this vessel did not, at any period this season, lie at that wharf. Her situation, at first, was at the wharf of Lawrence and Kipp, about fifty yards west­ward of Fitch's; and on the 24th of July she removed to Rutgers' wharf, distant about half a mile from her first station.

Upon a comparison of these statements it will appear, 1st, that the vessels above named were never nearer one another than fifty yards; and, 2dly, that the day before the Active began to unload, the William was removed to the distance of half a mile. Thus it is shewn how little foundation there was for a report of a fever being com­municated from the brig Active to the ship William.

The next subject of suspicion was a par­cel of cotton, which had been imported in the brig Caroline, and which was deposited in the store of Lawrence and Mott, at the [Page 24] foot of Dover-street. It was reported that a man had thrust his arm into a bag of da­maged cotton, and that, when he withdrew it, the arm, from the virulence of the con­tagion, was of a livid colour. However extravagant this declaration may seem, there were not wanting those who sub­scribed to its credit. In short, so infatuated were some of the inhabitants with the be­lief of imported contagion, that they sus­pected every vessel, which had arrived from the West-Indies previous to the late epide­mic, to have brought contagion in her.

With regard to the suspected cotton, the following certificates will give the neces­sary information:—

‘I, John Church, master of the brig Caroline, of New-York, do certify, that the fifty-one bales of cotton, shipped on board the said brig Caroline, about the 20th of June, 1795, was purchased by me in the neighbourhood of Lance and Veau, and was never on board any vessel [Page 25] but the said Caroline, until landed from on board her in New-York, about the 22d of July, 1795.’

[Page 26] I have thus advanced such documents, upon the subject of imported contagion, as, from a careful enquiry, I have been able to collect. From this investigation the public is in possession of such information, as may be made the basis of a tolerably ac­curate judgment; and I have little hesita­tion in believing, that the conclusion na­turally resulting from the premises, will be extremely unfavourable, if not absolutely against the opinion which some have so warmly embraced, that the cause of the late epidemic was imported contagion.

We must now take the liberty of recur­ring to a further consideration of circum­stances relative to the brig Zephyr.

From the statements contained in the letters already inserted, regarding this ves­sel, several facts of considerable importance are made to appear, viz. that no person died on board the Zephyr, during the whole of her voyage, except the boy already men­tioned; that all those of the crew who had [Page 27] been taken sick at Port-au-Prince, and had become convalescent, soon got well after her arrival in this harbour; and that nei­ther the wardens of the port, the consignees, nor any other person who had been tran­siently on board the Zephyr, except Doctor Treat, suffered any bad consequences from their visits.—The question then occurs, Did Doctor Treat take the disease, of which he died, from the Zephyr?

It was a circumstance well known, that the health of Doctor Treat was generally impaired. His stomach was in a state of constant disorder; and this, independent of other effects, was, at particular periods, ac­companied with such extreme dejection of spirits, that he did not, as he had often as­sured me, expect to live from one day to another. The Doctor had been complain­ing more than common for several days before he visited the Zephyr. He embarked in a small open boat at mid-day, with a black hat on his head, and without an um­brella, [Page 28] which he had always been accus­tomed to use, to defend him from the sun's rays. The day was calm, extremely hot, and the vessel at least one mile and a half from the place of his departure. It is also stated, that he was much fatigued, upon Governor's Island, in searching for the commanding officer.

Thus, then, it would appear as matter of fact, first, that Doctor Treat was indis­posed at the time he visited the Zephyr: secondly, that in performing that duty he was exposed, for several hours, to the ex­treme heat of the sun; and, thirdly, that he encountered considerable bodily fatigue. If these circumstances are well considered, and that peculiar state of the weather, which predisposes to fever, is taken into the estimate, is it unreasonable to suppose that the fever with which Doctor Treat was attacked, might have originated from the operation of such a combination of causes? Every candid physician will give [Page 29] a negative answer to the question. But we shall not be very solicitous to prove, that Doctor Treat did not contract his disease in this manner—We grant that he might have received infection from the Zephyr; but does it necessarily follow, that it should have caused a contagious fever? A consi­deration of the consequences, in a variety of parallel cases, will contribute much to the formation of an opinion upon this sub­ject.—The following is considered illustra­tive of this point.

At the termination of the late war be­tween the United States and Great-Britain, Colonel William Smith, of this city, was appointed, by General Washington, to re­side in New-York, with the consent of Sir Guy Carlton, for the purpose of superin­tending the evacuation of the country, and to see that it was performed agreeably to the treaty. In the exercise of this duty, he had frequent occasion to go between the decks, and into the holds of vessels. In [Page 30] the course of these visits, he was seized with (what is commonly denominated a ship-fever) a bilious remitting fever. After a few days, the fever happily intermitted, and Colonel Smith soon recovered a toler­able share of strength.

It was thought proper to caution him against the danger he would incur by re­peating his visits on board ship. He an­swered, that the duty was indispensible. The consequence was, he contracted a se­cond fever. The first of the attack was attended with a sense of coldness, which was soon succeeded by violent pain in the head. His countenance was flushed, and his eyes were very red. The third day his neck and breast took on a yellow appear­ance; and in forty-eight hours, the whole of his body became as yellow as an orange. From the accession of his fever to its ter­mination, his heat was so considerable, that on feeling his pulse, or grasping his wrist, the sensation communicated was similar to [Page 31] the sting of nettles, or very fine needles pricking the hand.

Colonel Smith lodged at Mr. Depeyster's in Pearl-street, and notwithstanding the unremitting attention he received from the family, the disease was not communicated to one of his attendants.^*

I have twice, in the pursuit of my avo­cations, imbibed infectious fevers—once on ship-board; and again on visiting a prison. I was handled very severely in both instances, and deprived of my senses several days during each confinement. My attendants were numerous, and vigilant; [Page 32] yet no one suffered from contact with my body, or from breathing the air of my chamber.

As favourable to the same conclusions with the above instances, and tending to illustrate the doctrine we are endeavouring to establish, we shall here introduce the history of a fever which raged among the men of Mons. De la Motte's fleet, in 1757.

A fleet, under the command of Mons. De la Motte, sailed from Brest on the third day of May, 1757, for Louisburg, in Nova-Scotia. A number of sailors (about two hundred) who had been confined in Roch­fort hospital, with putrid fever, and had become convalescent, were embarked on board the Glorieux and Duc de Burgogne, ships of war. These ships had been two years in a state of equipment, and most of that time at sea; they, therefore, could not be supposed to have been very clean. The other ships of the fleet had lain some time in the harbour of Brest, and were not in a [Page 33] very healthy condition. On board the different vessels were also distributed four hundred sailors, who had just returned from confinement in the English prisons. The ships' companies became sickly on their passage, particularly those of the Glorieux and Burgogne; and on the 20th of June they arrived at Louisburg. The wind was fair during the passage, blowing mostly from the south-east; and the weather was so favourable and temperate, that it was found unnecessary to shut the port-holes or close the hatch-ways.

As soon as the fleet arrived at Louisburg, the different ships had their tents pitched on shore, for the accommodation of the sick; and they were accordingly disem­barked immediately. The tents were pitched too near one another, and hence the sick did not receive all the advantages which they might have derived from their situation.

[Page 34] The particular state of the sick during the months of July and August, their number, or the mortality which prevailed, is not mentioned. But it is observed, that the number of the sick was greatly aug­mented during the latter part of September. This arose from two causes; first, from the necessity they were under of collecting all their strength from the different vessels, to finish works, in order to defend the city: secondly, from a severe gale of wind, which happened on the 25th of September, and threatened destruction to the whole fleet. Several ships were in particular danger, to save which, the united exertions of officers and sailors were required; and in perform­ing this duty, the men were unavoidably exposed to excessive labour and extreme bad weather. After this, the sick became more numerous; and by the 30th of October, the day on which the fleet left Louisburg for Brest, the sick amounted to fourteen hundred. Of this number, four hundred [Page 35] of the worst cases were left at Louisburg, in bad lodgings, and under the management of few, and those unskilful attendants.

The fleet had not been at sea more than six days, before most of those who were sick at the time of sailing, with many others, died. The passage was attended with very boisterous weather; and the sea ran so high, that the ports were obliged to be kept shut. Under circumstances so uncomfortable, the malady spread with great rapidity, and on the arrival of the fleet at Brest, which hap­pened on the 22d of November, the num­ber of the sick amounted to four thousand.

Fifteen days before the return of De la Motte's fleet, the two ships of war, Bizarre and Celèbre, arrived in Brest harbour from Canada. The crews of these ships were affected with a complaint similar to the one which prevailed on board the Louisburg fleet; and they had already sent one thou­sand men to the hospitals at Brest. The hospitals, therefore, were found crouded; [Page 36] and for the accommodation of the sick newly arrived, temporary hospitals were erected. Into these the sick were hurried from the ships, in cold and wet weather, and thrown together in heaps(entassé pélé mélé). Under these circumstances, little benefit was obtained from the means em­ployed for their relief.

The disease raged, with unrelenting violence, from the 22d of November to the last of February. It began to diminish in the month of March, and ceased entirely in April. But it was remarked, that this cruel disease did not cease until it had de­stroyed so many men, that those who re­mained had, in consequence, an opportu­nity of enjoying all the advantages of breathing a pure air, of cleanliness, and good attendance.

The number that died in the hospitals at Brest, at this period, was not less than ten thousand, besides a considerable number in the city.

[Page 37] Of the four hundred men left at Louis­burg, who appeared to be in a condition from which a recovery could not be ex­pected, badly accommodated, and worse attended, three hundred and eighty were cured.

The foregoing is an epitomized narra­tive of a voyage from Brest to Louisburg, in which is related the prevalence and mortality of a fever, which the author of the account denominates PUTRID, MA­LIGNANT, CONTAGIOUS, and PESTILEN­TIAL.

A consideration of the circumstances at­tending this expedition, and the state of a considerable part of the men employed on the occasion, will readily, I apprehend, explain the fatality attending it, without recurring to the supposition of the disease being, in its nature, essentially contagious or pestilential.

It will have been perceived before this, that we have been somewhat solicitous to [Page 38] establish a distinction between diseases which are infectious, and those which are contagious. By contagion we understand something peculiar and specific, possessing properties essentially different from any thing else. Thus the contagion of the small-pox, the measles, &c. Those diseases do not require the concurrence of certain causes to render them contagious; they are so under all circumstances. But other dis­eases may, or may not be infectious, according to the conditional state in which they are placed. Thus a fever shall continue days, or even weeks, without giving rise to the least suspicion that it has, in any instance, been the cause of fever in any person, who may have been, either a frequent visitor, or constant attendant: whilst a fever, ac­companied with the same symptoms and appearances, and not more violent in de­gree, shall be communicated from one to another, and extend to incalculable lengths, so long as the circumstances exist which [Page 39] favour its propagation. Agreeably to this difinition, may be explained the slow, or rapid progress of the fever of the Louisburg fleet, at different periods.

To illustrate this more fully, we shall take a review of the circumstances attend­ing that fleet, from the time of its sailing from Brest harbour, to its return to that port, and the after disposal of the men.

The convalescents from Rochfort hos­pital received on board the fleet, had been weakened by a previous disease; the na­ture of which we presume not to have been contagious, because no mention is made of it. They were ordered into ships which had been the greatest part of two years at sea, and in a condition, it is stated, not very favourable to the re-establishment of health. The consequence was, that most of these unfortunate men had a return of fever, and this fever became in­fectious. The fever, it is said, was com­municated to some of the ships' company [Page 40] during the passage to Louisburg. We have no doubt of the fact. But we by no means admit this as a proof of the contagious nature of the disease. It is very common for fevers to become infectious, when a number of sick are crowded together in confined apartments; and on ship-board they are particularly liable to become so, from the impossibility of ventilation in some instances, and the neglect of it in others. Here, too, it often happens, that, for want of room, the well are compelled to lie with, or near the sick, and to breathe an air rendered extremely noxious from the abstraction of that part which is essen­tial to animal vigour, and from a combi­nation of the different effluvia arising from the sick, the dying, and perhaps the dead. Hence a cause appears why ship-fevers are often communicated with so much facility, and are a cause of so great a mortality.

But in the case now more immediately under consideration, the extension of the [Page 41] fever, beyond those who came on board in a debilitated state, did not take place in many instances; and the reason is evident:—The weather, during the passage from Brest to Louisburg, was so mild, that the port-holes (the windows of a ship they might be called) and hatch-ways were permitted to be generally open, by which means a circulation of air was kept up be­tween decks, and thus the causes of infec­tion were, in a great measure, carried away. The fine weather, also, allowing the men to be chiefly on deck, was another reason why the crews were not more sickly.

The narrative does not mention the state, nor the number of the sick during the months of July and August. It says, "On a perdît quelqu'un."

If this fever had been contagious, ought it not to have spread more generally during the summer months? "Il repandit tres peu." I presume that a contagious disease among so many people would have been so [Page 42] generally experienced, that a particular account of it would have been kept, and reported in the general statement.

To promote the object of the expedition, it was thought necessary, some time in Sep­tember, to collect all the men of the fleet, and throw up works, in order to defend the town. The exertions that were made on this occasion greatly augmented the num­ber of the sick; and this effect was attri­buted to the contagious nature of the dis­ease. But I apprehend the cause to have been over-fatigue, and of that sort to which the men had not been accustomed: to which we may add, exposure to inclement weather, and a scarcity of provisions, and those of a bad quality.

On the 25th of September, a severe gale of wind happened. This necessarily occa­sioned a great degree of exposure, and much fatigue. From these causes the sick be­came more numerous; and the number increased till the period of their departure [Page 43] from Louisburg, which was on the 30th of October, when fourteen hundred were upon the list. Of these it was thought that four hundred of the most desperate and hopeless cases should remain at Louis­burg.

The fleet had not been at sea more than six days before most of those who were ill at the time of sailing, with many others, were dead; and by the time that the fleet arrived at Brest, which was on the 22d of November, four thousand sailors were con­fined with fever.

If we consider the circumstances of the passage, viz. the state of the men taken on board the fleet; the condition of them af­terwards, owing to boisterous weather, which rendered close confinement necessa­ry, and a proper ventilation impracticable, we need not be surprised that the fever should have prevailed so generally, nor that the mortality should have been so consider­able. The air between decks, in a stagnant [Page 44] state, and in which so many sick were crouded together, could not fail of be­coming infectious: and the heat, as well as the moisture, which must necessarily exist in such situations, would give a parti­cular activity and virulence to the infec­tion. And in this way we may account for the propagation and fatal tendency of the disease, without supposing it to have had any thing in its nature specifically contagious.

After the arrival of the fleet at Brest, the men were placed under circumstances as little favourable to their recovery, as they were before their debarkation. They were sent to hospitals, too small to contain them, save in a state extremely crouded; and there were not attendants in sufficient number to take proper care of the sick, and to preserve cleanliness.

In this situation, so confined was the air, and so impregnated with the foul vapours, arising from the sick, that, on entering the [Page 45] hospital, it is observed, a person found him­self surrounded by an air so extremely warm, and possessing a cadaverous odour, so disagreeable to breathe, that one who had not been accustomed to it, could not remain exposed to its operation but for a few mi­nutes, without feeling a pain in the head.

When, from the great numbers who died, the hospital became so thinned, and the sick so few, that they received all the advantages of pure air, good attendance, a due observance of cleanliness, proper me­dicines, &c. the progress of the disease was soon arrested, and in a short time it finally disappeared.

Now, when the preceding history is well considered, together with the conclusions drawn from the facts therein stated, it will appear, that the fever of De la Motte's fleet ought to be arranged under the head of in­fectious diseases, and not that of a conta­gious one.

[Page 46] But if it should still be urged, that there was contagion in the case, and at the same time we admit, (which facts compel us to grant) that a free air, and other circumstan­ces, will stop the progress of a contagious disease, nay, destroy its contagious property, the concession is all we wish to obtain, in order to establish our doctrine of the nature of infectious fevers.

As a corroborating fact to our opinion, it will be proper to remark the astonishing recovery of three hundred and eighty, out of the four hundred worst cases, that were left at Louisburg. The history of contagious disorders no where, I believe, furnishes any thing like a parallel example of so large a proportion of sick getting well.^*

[Page 47] We find upon record, numberless ex­amples of people having received infection of the most serious nature, from going out of the healthy air of the common atmos­phere, into confined places; such as dun­geons, crouded prisons, or between the decks of vessels, where fevers have pre­vailed. But there is not an instance within my recollection or observation, where a person, having imbibed such infection, and where cleanliness, keeping the room well aired, and other proper attentions have been observed, has communicated the dis­ease, either to occasional visitors, nurses, friends, or relatives: and the particulars of Doctor Treat's case will furnish another analogous fact.

He went on board the Zephyr, and, as his duty required, descended into the hold, or between decks, to ascertain the state of the vessel, as it regarded infection. In doing this, we will suppose that he exposed himself to foul and stagnant air, rendered [Page 48] particularly noxious by the exhalations which passed off before and immediately after the boy's death.

A day or two afterwards he began to complain. Where he resided, there was a family about him. His sister, particularly during his illness, was a constant attendant at his bed-side. His numerous friends were pressing around him to his last moments. Several of them assisted in the execution of the means prescribed for his relief, when they had direct contact with his body, and were more immediately exposed to what­ever arose from it:—Yet the fever was in no instance communicated to a second per­son.

If, then, the Doctor's disease had been specifically contagious, ought we not to have expected an unequivocal manifestation of it, in some of those who were placed under circumstances so favourable for receiving contagion?

[Page 49] Many people were confirmed in the opinion, that the fever was contagious, from the vague reports of examples having occurred, where persons were infected with fever in the country, in consequence of having had a communication with those who had carried the disease from the city. Now, I believe, there are not any well au­thenticated cases of this sort: and if a few solitary instances are offered in support of the contagious nature of the disease, which, however, are very obscure, they prove very little when compared with the uniform confinement of the disorder to those who were immediately exposed to the first causes which produced the complaint.

We have already admitted that the air of a room in which a person is lying with a bilious remitting fever, may become in­fectious, if ventilation is not performed; if all excrementitious matter is not speedily removed, and if the bedding and clothing of the patient are not in due time changed. [Page 50] And if the fever has arisen in the country, in the manner the reports above stated ex­press, I presume infection has been the cause, and not contagion; for all that has hitherto been alledged is, that one or two instances have happened, where people have taken the disease, from the many of those who have sickened in the country after leaving the city; not that the disease has spread through a neighbourhood or a village.

I presume it is sufficiently proved by this time, that the late epidemic fever was not brought here from abroad; and, also, that there exists in nature, and that there ought to be made, a distinction between infectious and contagious disorders. Much more might be said upon these subjects, and a variety of testimony added; but, without fatigu­ing the reader, by entering into a farther discussion of these questions, I shall proceed to enquire into those causes which may, [Page 51] with great probability, be considered as productive of the late epidemic.

During the months of January and Feb­ruary, 1795, the weather was unusually variable; the lowest degree to which the thermometer fell was five degrees of Fa­renheit's scale, and it rose as high as forty-six degrees.

The weather of the succeeding spring, during the months of March and April, was also very variable, and was attended with a greater degree of cold and wet than common. This was remarkably evidenced by their effects upon vegetation. Trees put forth their buds, and blossomed later, than is usual in ordinary seasons.

As the season advanced, the weather became warmer; but the moisture of the air was in no degree diminished. This state of the atmosphere continued during the summer months. The accession of heat was slow, but by the latter end of July it became excessive, and continued so [Page 52] generally during August and the first part of September. The effects of this hot and moist air was remarkable in the production of mould.

It was a very common complaint, that hardly any thing could be kept without be­coming mouldy. Books, which had re­mained for years in libraries and other places, became covered with this sub­stance. Shoes and boots, thrown aside only a day or two, contracted an abundance of mould; and the wooden floors, and pa­pered walls of family rooms which were closed a few days only, and even in some instances where the rooms were daily ex­posed to a free access of air, which before had always remained perfectly dry, now generated a great quantity of mould.

The prevailing constitution of the air produced remarkable effects upon cab­bages. It was observed, that this vegeta­ble grew with uncommon rapidity to its usual size, and with the appearance of [Page 53] great health and vigour; it would then suddenly assume an unhealthy aspect, which, on examination, was found to de­pend upon some disease at the juncture of the head with the trunk; and this, on many occasions, proceeded so far as to cause a complete separation, and the head would fall to the ground. It was also a common observation, that the cabbages which were brought to market, were found damaged about the center: and, further, that some species of cabbages would not form into a head as usual.

The effects of a peculiar season were shewn also upon different kinds of fruit. It was remarked that cherries did not come to that perfection in which we commonly have them, and that they very soon shewed a disposition to decay. Early in the season the apple-trees were very generally ex­tremely productive, and promised a large supply of their fruit in the autumn; but the expectations of the husbandman on this [Page 54] head were greatly disappointed: the ap­ples began to fall at least a month before the usual time, and in a very imperfect state; and those which came to maturity could not be kept so long as it is common for them to be preserved.

In a letter from John Kemp, Esq pro­fessor of natural and experimental philoso­phy, &c. &c. in Columbia college, dated April 12th, 1796, it is stated, "that in his observations upon the state of the atmos­phere during the last summer, the mercury in the thermometer was, on an average, three degrees of Farenheit's scale higher than it has been, at the same season, during the ten preceding years; that the moisture, as indicated by the best hygrometers, was much greater than usual; that the quantity of active electricity was so small, as to be frequently imperceptible by very sensible electrometers, connected with an exploring rod; that the quantity of rain was much greater than usual, and thunder storms less [Page 55] frequent; and that, for the most part, the wind was between south-east and north-east."

The first being established, that the state of the air, during the winter of 1794—5, and particularly during the succeeding spring and summer, has differed very ma­terially from its usual temperature and disposition, can there be any good reason assigned why the diseases to which our cli­mate is liable in a greater or less degree, every season, should not receive a particu­lar character, or be variously modified by a peculiarity of weather? The influence of climate upon the human constitution has been remarked in all ages; and not a year passes that we do not hear of particu­lar diseases, being attended with some un­common appearances, arising from pecu­liarity of season.

At a meeting of the Medical Society of the State of New-York, held on the second Tuesday in July, it was remarked by one [Page 56] of the members, that he had seen several cases of angina trachealis, which were attended with anomalous symptoms, and also a few cases of dysentery in adults, which proved obstinate: and as these dis­eases were not unsual at that season of the year, he concluded that they would become epidemic, or be found the forerunner of one. He was led to this opinion from the history of epidemics; diseases of that kind being almost always anticipated by some particular previous disorder: and he fur­ther remarked, that there was something in the state of the air which predisposed to complaints.

At the same time it was observed by ano­ther member, that he had also seen several cases of angina trachealis, and he found the disease attended with less danger of suf­focation than usual. Bleeding served ra­ther as a check to the symptoms than to af­ford that manifest advantage which is its effect on common occasions. The disease [Page 57] yielded to emetics, warm bathing, moderate bleeding, and liberal bowels.

It was further remarked, that febrile complaints had occurred more frequently than usual at that season, and especially among children; and that in the use of an­timonials, the evacuations were extremely bilious in their appearance. From what had been observed, therefore, there would remain little doubt that there was some circumstance in the season, which predis­posed to complaint, and on many occasions attended with a superabundance of bile.

Several members of the society had met with instances of cholera, and also with obstinate constipation of the bowels. It was also noticed, that the diarrhoea and dysentery, to which children are so liable here in the summer season, and which is sometimes a cause of great mortality among them, were very rare diseases.

The Medical Society came to a resolu­tion to be particular in noticing the diseases [Page 58] which might take place in the interval be­tween the then present meeting and their next monthly meeting. But the report of a contagious yellow fever, which began to prevail in the city about the 25th of July, was a cause of so much hurry and hasty declaration of opinions, that a comparison of notes, and a friendly discussion of a question of so much importance, at the time appointed, was entirely superseded. But, however widely individuals differed in sentiment on this interesting occasion, it is but justice to mention, that no exer­tions were wanting, on either side of the question, to lessen the calamity with which our city was threatened.

If we carefully peruse the history of diseases, we shall find, that those which have proved most fatal to the human race, have proceeded, either directly or indi­rectly, from some acknowledged peculiari­ties of the state of the air.

[Page 59] Of this truth, every author, who has written on epidemic diseases, bears abun­dant testimony: and notwithstanding that some countries are more exposed to changes than others, few have been found altoge­ther exempted. Nor can it be expected, from the nature of things, that the people of North-America, who inhabit a climate which may be said to participate of all the climates in the world, should not, in their turn, experience the operation of similar causes.

In order the better to understand why the fever arose in a particular part of the city, and was more prevalent, as well as malignant, in that part, it will be necessary to take a general view of the situation of New-York, and the disposition of the ground.

New-York is situated in north latitude forty degrees and an half, longitude seven­ty-four degrees west from the meridian of London. It is built on a south-west point [Page 60] of land, the highest elevation of which, above the level of high water mark, is near forty feet, and which is continued, through the city, near a mile lengthways. From this elevation in the original state of the ground, there was a pretty bold descent continued, in opposite ways, to the water's edge. But it has been the policy of the corporation of this city, at different times, to make new ground, as it is called, or to sell to others the privilege of doing so; which has considerably increased the di­mensions of the city, both on the east side, and on the north.

The new made ground is nearly a level, or the descent is so gradual, that it is drained with difficulty; and we may add, that the level of the new made ground is but very little above the mark of high water. In­deed, it is sometimes entirely overflowed by the spring tides; and from the loose na­ture of the ground, the water frequently finds its way into the cellars of the houses [Page 61] in Front and Water streets, and sometimes even into those of Pearl-street.

The new made ground from Whitehall to Catharine-street, along the East-river, is, on an average, four hundred feet in breadth, creating, if one may so speak, fifty acres of ground, all of which is built upon. The ground made on the west side of the city is about ten acres. The consequences of this mode of extending the city are, no doubt, extremely injurious to the health of the inhabitants; and it is much to be re­gretted, that measures are not taken to prevent an increase of the evil: for we shall presently see, that the late epidemic was rendered particularly malignant and fatal, from causes arising in this plan of inlarging the city. To render this appa­rent, we must take a more particular sur­vey of that part of the city where the epi­demic first made its appearance.

We shall begin at the river on the east side of Peck-slip: from thence to Water-street [Page 62] the ground is nearly a level: proceed up the slip, and after leaving Water-street a few paces, the ground ascends until you arrive at Pearl (late Queen) street: from this to Dover-street the ground is rising, but gradually descends again as you proceed along Cherry-street as far as Roosevelt-street: from this to the New-slip it is nearly a level. The ground at the top of Dover-street may be considered as the highest spot in the range between Peck and the New-slip, by the way of Pearl and Cherry streets, and extending east and west, maintains a general height, which may be computed at fifteen, twelve, ten, &c. feet above the level of Water-street.

The houses on the high grounds are prin­cipally three stories high, and built of brick, between which and those lowly situated on the north side of Water-street, there is a space of ground constituting the different yards of the above houses, measuring about one hundred feet.

[Page 63] Water-street, extending from Peck to New-slip, in many places has been raised two feet, or more, above the ordinary level of the ground on the north side of the street. From those grounds to the river there are no drains to convey off the water, &c. which renders an accumulation of filth, in the rear of the houses upon those lots, almost a necessary consequence. Water will frequently become stagnant, and this containing animal and vegetable matters, exposed to a hot sun, must prove a fruitful source of noxious vapours. Under these circumstances, it is natural to expect that those who are exposed to the influence of such foul air, should feel its effects, espe­cially in a state of predisposition, arising from a peculiar constitution of the air.

The grounds on the south of Cherry-street are so arranged, that they are more immediately exposed to the sun; for they may be considered as on the south side of a considerable hill; and no one is ignorant [Page 64] of the powerful effects which the sun pro­duces on a surface of this exposure.

In a very correct map of this city, by Benjamin Taylor, it will appear, that a line drawn from Whitehall to the bottom of Dover-street, will run in the direction of north-east; and from the bottom of Dover-street to Corle's-hook, the course is nearly east. An attention to this fact, also, is of consequence, if it produces the effect upon the tides it is said to do, viz. that of creating different eddies, which furnish a vast quantity of floating, perishable matter, to the slips in the vicinity of the ground which we have been describing.

From this arrangement of the shores along the East-river, the salutary effects of those winds which blow during the hot months, from the different points of the compass, between south-west and north-east, and which so often afford refreshment to the inhabitants of the elevated situations, and at the west end of the town, are little [Page 65] or not at all experienced by those who re­side at the east end: for the air is so chang­ed in its temperature and qualities, before it arrives there, by passing over a large part of the city, that it loses that vivifying principle so essential to health.

From all these circumstances it is plainly discoverable, that the south-east part of the city is placed under circumstances not very conducive to the health of its inhabitants; especially as a great number of them are of the poorer kind, and in many places very much crouded together in small con­fined apartments. To strengthen this opi­nion, I will give an extract of a letter from a gentleman of great candour and respect­ability in the neighbourhood of Dover-street:—‘Although the docks in the vici­nity of the store which I occupy may be less offensive than in many other parts of the city, yet many of them are in a very exceptionable situation. The pond­ing of water, by running a bulk-head [Page 66] across an unfinished dock, and leaving the vacancy, for several years, to be filled with every species of filth and pe­rishable matter, is an object worthy the attention of the police. The situation of the grounds between Water and Cherry streets is rendered very noxious, by Water-street being raised above a certain level, and thus preventing those grounds from being drained. The effect of such a nuisance on the health of the inhabitants of a crouded part of the city cannot be imaginary.’

It is not to be understood, that the lati­tude of a place is always to determine its temperature; nor is it uniform in giving a similar character to the diseases most pre­valent under a similar parallel. Local cir­cumstances will have a much more power­ful operation, and, in general, are found to produce the characteristic distinctions which exist between the prevalent diseases [Page 67] of countries upon or near the same line of latitude.

The country bordering upon the sea­coast, from the Province of Main to the Neversink, or Highlands of Shrewsbury, is rough and irregular, and almost every where covered with hardy oaks and hick­ories; and the soil is generally as irregular as the face of the country. Most of the different capitals, on the coast, are situated upon eminences, or high ground, and so near the sea, that the rapid currents which wash their harbours, may be considered almost as pure as the sea itself; and this is particularly the case with the harbour of New-York.

The nearness of New-York to the sea, the ready access which the tides have to its harbour, and the elevation and boldness of the shores, must doubtless be a great secu­rity to the health of the inhabitants. I believe it may be said, with great truth, that few cities enjoy so many natural ad­vantages, [Page 68] arising from situation, as New-York; and I make no doubt, that a vigilant and determined police would render it as healthy a city as any under the sun.

The country, on the sea-coast, for many hundred miles to the west and south of the Highlands of Neversink, is low, with very few elevations, and those not considerable. The principal cities are mostly situated at a distance from the sea, and on the margin of some river, the navigable waters of which are a mixture of fresh and salt water; and the freshets which take place in those rivers, at particular seasons of the year, often overflow their banks, and have, no doubt, a considerable agency in produc­ing the epidemic diseases which so often prevail in those climates, of which Doctor Jackson has given a very particular and interesting description. ‘We learn from experience (says the Doctor) that fe­vers are little known in rough and hilly countries, where waters flow with a rapid [Page 69] course: while we also know, that they are common in low and champaign countries, where water stagnates, or has only a sluggish motion. Independent of which, those situations which are in the neighbourhood of large swamps, or near the oozy banks of large rivers, have always been observed to be particularly liable to such diseases.’

Winterbotham, on the climate of North-Carolina, remarks, that "in the flat coun­try, near the sea-coast, the inhabitants, dur­ing the summer and autumn, are subject to intermitting fevers, which often prove fa­tal, as bilious or nervous symptoms prevail. These fevers are seldom immediately dan­gerous to the natives who are temperate, or to strangers who are prudent. They, how­ever, if suffered to continue any length of time, bring on other disorders, which greatly impair the natural vigour of the mind, debilitate the constitution, and ter­minate in death. The countenances of the [Page 70] inhabitants, during these seasons, have ge­nerally a pale yellowish cast, occasioned by the prevalence of bilious symptoms. They have very little of the bloom and freshness of the people in the northern states."

The plague, which often rages in Egypt, appears, upon good authority, to be occa­sioned by similar causes. ‘En Egypte ou' la peste est trois, ou quatre mois l'année, a cause des disbordmens du Nil. Leur mauvais effet, se fait surtout sentir, quand un vent chaud & humide, souffle, ou being quand il est mêlé avec des vapeurs corrompues.’ The effect of low situations, attended with moisture, in producing fever, is well illustrated in the following detail:—"In the year 1748, upon the breaking up of the British camp in Flanders, the cavalry were cantoned upon the unhealthy ground, about Bois le Duc, and were soon after attacked with a general sickness, occasioned by a late inun­dation of that part of the country. Doctor [Page 71] Horne, then surgeon to Cope's dragoons, observes (Dissertat. Medica. Inaug. de Fe­bre Remittente) that the troops suffered in proportion to their proximity to the marshes; and that, universally, the nearer to Bois le Duc, the more violent was the distemper; the number of sick, by very accurate observations, being found exactly to correspond with the dampness of their situations and of the air.

To put the matter beyond all doubt, this ingenious gentleman provided himself with a good hydroscope, by which he carefully measured, every day, the degree of mois­ture and dryness of the air.

Upon comparing his tables with the re­gister he kept of the sick, he found that the progress of the disease kept an exact pace with the humidity of the air.

On the 29th of June they left the camp, and from that day to the 12th of July, the air being dry, not one soldier was affected with an ailment.

[Page 72] On the evening of the 20th, the hygro­meter indicated a great degree of moisture in the air; and that very night the epidemic sickness (viz. the remittent fever) began among the troops, three dragoons of Cope's regiment being seized with it.

During eight days afterwards the air continued extremely moist, and the num­ber of the sick was proportionably increased. The ten following days being dryer, the number of the infected visibly diminished: but two very moist days succeeding, the patients were again greatly increased.

In a word, the same quality of the air which differently affected the instrument, did also, every day, in like manner, affect the health of the men.

Sir John Pringle, on the diseases of the army, has also the following observations. Speaking of the diseases of the low and marshy parts of the Netherlands, which are considerably to the northward of our situa­tion; "It is to be remarked, (says he) [Page 73] that the sickness never begins till the heats have continued so long as to give time for putrefaction, and evaporation of the water; the commencement, therefore, of the epi­demics, may be dated from some time in July, or the beginning of August, under the canicular heats; their sensible decline about the falling of the leaf; and end when the frost begins."

Speaking of the garrison of Ghent, he observes,—"The battalion of the guards was a remarkable instance of the difference of quarters: two of its companies were sta­tioned on St. Peter's hill; the remaining eight in the lower part of the town, in rooms so very damp, that the men could hardly keep their shoes and belts from moulding. In the month of July, the sick of this one battalion amounted to about one hundred and forty; of which number only two men belonged to the companies on the hill, and all the rest to those in the lower town. But in the middle of August, [Page 74] upon changing the barracks, the sickness suddenly abated."

Can any thing shew more satisfactorily than this short description of Sir John Prin­gle, the unfailing influence of situations in determining the extent of diseases under particular constitutions of the atmosphere? And might not any one suppose, that Doc­tor Horne's hydroscopical observations were made in New-York, during the prevalence of the late epidemic? For my part, I can­not refrain from comparing Broadway, and the higher situations of New-York, to St. Peter's hill; and the upper end of Water-street, to the lower part of the city of Ghent.

It is a fact, then, well established, that while an epidemic has raged among the inhabitants of flat and low situations, those who have lived on high grounds, in the neighbourhood, have not, in the smallest degree, felt its influence: but they need only descend to the low ground, and they [Page 75] will there sicken in common with the in­habitants.

If the preceding circumstances are con­sidered, they afford a sufficient explanation why the effects of the late epidemic were so partially felt by the inhabitants of this city.

It will be proper to remark here, that the epidemic of last year is not a new dis­ease. It is established upon respectable authority, that a disorder, in every respect similar to the one which made its appear­ance in this city in July last, and in one instance attended with the symptom of black vomiting, occurred in Water-street, in the neighbourhood of Dover-street, four or five years ago, and more or less every year since; and was particularly confined to that part of the city: but being unaided by a particular state of the air, and under the influence, perhaps, of exciting causes of a less active nature, it was neither so ge­nerally felt, nor so fatal in its operation.

Agreeably to this opinion is the declara­tion [Page 76] contained in a letter we before have had occasion to quote; the author of which observes,—‘I am convinced that the dis­order has originated from local causes, because it has appeared in this quarter of the city, at the same season, for several years past.’

Nor has this disease been confined to New-York. It is a fact beyond contro­versy, that during the warmer parts of the year 1795, a fever, in all essential circum­stances resembling the epidemic of this place, appeared in many places in this state and in the state of Connecticut. The same causes, we should naturally expect, would produce similar effects. Accordingly, we have it upon the evidence of several very respectable characters, that a peculiar con­stitution of the air, the sensible qualities of which were excessive heat and moisture, was generally prevalent. This state of the atmosphere, operating with the exhalations arising from the decomposition of dead [Page 77] animal and vegetable matters, in low and damp situations, were a frequent cause of bilious remitting fever.

In confirmation of this truth, we are fortunate in being enabled to present our readers with the following interesting communication from Doctor Williams.

[Page 81] The existence of a bilious remittent fever, resembling the late epidemic of this place, at a distance from the city, is further confirmed by the testimony of a gentleman, of high estimation, and extensive practice in his profession, in the city of Hartford, in the state of Connecticut, who writes, in a letter to Doctor Wright Post, dated January 12th, 1796, as follows:—

We cannot forbear to remark on the facts contained in the above letters, how analogous the circumstances were, under which the bilious fever arose in different parts of the country: and by comparing these facts, more especially as they relate [Page 86] to the city of Hartford, with what hap­pened in this place, we see a very strong analogy indeed. Now, were it necessary to inlarge any further upon the subject of imported contagion, we might, with great propriety, adduce the existence and preva­lence of a fever at Hartford, and especial­ly in the family so particularly mentioned, the same as our late epidemic, which no one ever entertained a suspicion to have arisen from any causes than those perfect­ly local.

It would be difficult to ascertain with accuracy, what proportion the different descriptions of people bear to one another, who were attacked with the late epidemic fever. It may be taken for granted, how­ever, upon the testimony of those whose opportunities best enabled them to judge, that the number that were taken sick, living on the new made ground, particu­larly at the south side of the city, and in other low places, compared with those [Page 87] residing in more elevated situations, may be computed as twenty to one; and if we were to make a calculation of the number of inhabitants who died, compared with visitors, or transient persons, we might say five of the latter to one of the former.

This disproportion may be accounted for: firstly; visitors, especially those from the northward, where the air is generally purer, are more susceptible of an epidemic influence than the inhabitants, who are accustomed to the circumstances of their situation: for there cannot remain a doubt, that the human constitution acquires, by habit, the power of resisting, to a certain degree, the effects of those causes which have a tendency to produce disease.

We find this fact particularly noticed by most writers on the bilious or yellow fever, which so commonly makes its appearance on board the shipping in the different har­bours in the West-Indies. It is described as most fatal to those lately from the north­ern [Page 88] latitudes. So, in New-York, the first appearance of the fever was on board the ship William, from Liverpool, the 25th of July, four of whose crew died. On the 26th of July the fever appeared in the ship Connecticut, from Liverpool: she also lost four of her men. These vessels, it must be remarked, laid at the wharfs in front of that part of Water-street, where the dis­ease first appeared among the inhabitants. Their men, without doubt, were frequently on shore, and having lately arrived, were more susceptible of the causes producing the fever, than the residents of that situation, who had become gradually habituated to its action.

The men of many other vessels from the northward, which were stationed at different wharfs in the east river, felt more or less the effects of the epidemic influ­ence: whereas the crews of those ves­sels which arrived during the summer months from the West-Indies, and other [Page 89] warm latitudes, all remained well; and such individuals among them as had been sick on their passage, recovered very soon after their arrival in this harbour.

Secondly; of the visitors who were seiz­ed with the epidemic fever, a great propor­tion were emigrants from England, Ireland and Scotland; and they were more exposed to its effects from the very crouded and confined situations in which they were unavoidably placed.

The miserable condition of that class of unfortunate people, is well shown in a candid and very interesting communica­tion from the Rev. Mr. O'Brien, pastor to the Catholic congregation in this city, from which the following is an extract:—

‘As soon as the above causes had pro­duced their malignant effects in the part of the city which was previously disposed to receive them, I was constantly employed, insomuch that I might with some truth say, that I lived in the centre of the disease; [Page 90] and for nearly two months, never laid in bed one whole night. I found in most pla­ces, a total want of every necessary of life. Numbers of poor sufferers, confined in subterraneous apartments, which admit­ted no light, but from their hatch-doors; so that when shut down at night, it might literally be said of them that they were buried alive. In the progress of visiting the sick, I was much disgusted at the abo­minable, uncleanly state of their misera­ble habitations, and a total want of ne­cessaries: for in most places, they had not even a stool to sit on, nor a bed to lie upon. On inquiry, I found the much greater part of them to be emigrants of that very summer; insomuch that out of four hundred and sixty-two of my con­gregation, who sunk under the disorder, nineteen twentieths were totally un­known to me.’

To this deplorable condition of the poor emigrants who arrived in this city during [Page 91] the prevalence of the epidemic fever, is to be ascribed, humanly speaking, the ex­tent of its mortality. It is a circumstance, moreover, well known to many, that numbers of them were obliged to remain on board ship for some time after their ar­rival in this port, as well from their want of means to procure comfortable lodgings, as from the very crouded state of the city; and at last they exchanged their confined holds for those subterraneous apartments which have just been so emphatically de­scribed by Mr. O'Brien. This may account for the fact, that out of nearly eight hun­dred persons who died, not more than one hundred and fifty were citizens of New-York; and of this number but a small pro­portion until the disease had prevailed a considerable time, perhaps one half during the last four weeks.

If the above statement be true, what a lesson does it convey, as well to the peo­ple as to the magistracy! Ought it not [Page 92] to inspire the citizens with a proper degree of confidence, and stimulate those who have the regulation of our city police to adopt such measures as are within their authority, in order to obviate, as far as possible, the fatal effects of another visita­tion?

I shall now dismiss this part of the subject, in order to lay before my readers the symptoms which served to character­ize the fever in question, as far as they came under my observation.

The first and the most constant of these, as well as the most severe, was a pain ordi­narily fixed in the fore part of the head; and this was usually attended with a dif­fused redness of the eyes, and a pain in the back. These symptoms have been known to exist, in a moderate degree, seve­ral days previous to the attack of fever.

A sense of coldness did not always take place at the beginning of the fever; and [Page 93] much less frequently was any thing like rigors experienced. The loss of strength, also, in the beginning, was very variable. Many did not complain of any particular weakness; whilst others felt so great a degree of prostration, as to be unable to support themselves.

The patients sometimes complained of a general soreness of the muscles, and particularly those of the thighs and legs; and in some this affection continued a trou­blesome symptom.

It did not frequently happen that the stomach was much affected at the com­mencement of the disease; yet instances occurred where the fever was ushered in with great sickness, frequent retchings to vomit, oppression and pain about the prae­cordia, with excessive anxiety and restless­ness.

The tongue often at first appeared na­tural, but it most commonly looked white. After the fever had continued some days, [Page 94] the matter collected upon its surface, as­sumed a brown colour, but continued moist. At length it became dark, sometimes black, dry, and rough.

The pulse was generally frequent at the beginning of the fever, but varied, as to fulness and strength, according to the ha­bit and constitution of the patient. It sometimes happened, after the fever had made considerable progress, that the pulse remitted, and was commonly a symptom of great danger. A rare pulse, also, was in some instances met with. In a boy who had had the fever six or seven days, and in whom the number of pulsations in a minute had been, for the most part, about one hundred and twenty, the fre­quency was suddenly diminished, and did not exceed fifty-five strokes in a minute. In this state they continued, with very little variation, for two days, while the pa­tient appeared to be getting well. The pulse then suddenly became as frequent [Page 95] as before, and two days after the accession, he died. It happened also in the instance of a gentleman, whose attack was very violent; whose pulse was frequent, full, and strong, and who had been freely and repeatedly bled; that after eight days, the number of pulsations were reduced be­low the usual standard, and seemed to be attended with a general change for the better. These appearances; however, were fallacious: a recurrence of violent symptoms soon put a fatal termination to the disease. The same circumstance we find taken notice of by Doctor Hunter and others.

Yellowness of the skin was by no means a constant concomitant of the disease. Sometimes it appeared partially about the face and neck; at other times a little tinge of the eyes was the only yellowness to be observed. In some instances it made its appearance about the third day, but more commonly not until the fifth, sixth, or se­venth [Page 96] day. When it came on early, it was generally attended with violent symp­toms, and denoted danger: and yet pa­tients recovered, whose skin was univer­sally as yellow as saffron.

The temperature of the skin varied very considerably. In some cases it was hot and dry, and communicated a very disa­greeable sensation to the touch. In others it was moist and cool from the first attack, and continued so during the disease.

Although the fever frequently ran high, it was seldom attended with much thirst; except in some few cases, where it was difficult to satisfy the demands of the sick for drink.

When the pain in the head was very considerable, the eyes were commonly a good deal inflamed, suffused with tears, and very impatient of light: and it now and then happened, that the patients com­plained of a sensation, as if the eyes were endeavouring to escape from the sockets.

[Page 97] The respiration was seldom much af­fected at the beginning. On some occa­sions, however, it was difficult, attended with a sense of fulness in the chest, which was sometimes a cause of great anxiety, and frequent deep sighing. Doctor Hunter observes, that ‘there is no difficulty in distinguishing those symptoms from la­borious respiration, that depends upon a local affection of the lungs. In the lat­ter the difficulty of breathing is uniform; whereas, in the former, both the expira­tions and inspirations will, for two or three times, be natural and easy, and immediately after become laborious and unequal, and so on, alternately.’

The urine, in general, underwent very little change. It was sometimes a little increased in quantity, and at other times ra­ther diminished. But in those cases where the skin became yellow, the urine put on that dark brown appearance which is com­mon [Page 98] in diffusions of bile. In some in­stances of black vomiting, and in two or three cases, previous to the occurrence of that symptom, the urine became exceed­ingly turbid, and deposited a dark coloured matter.

These were the ordinary train of symp­toms, which attended the fever, we have endeavoured to describe; and though in particular cases, no doubt, some deviations might be noticed, yet it is believed there were none which could be thought to af­fect essentially the character of the disease.

In the treatment of the late epidemic fever, my first care was to have the pa­tient placed in a room as large, and well ventilated as possible. The advantages arising from an attention to this part of practice, must appear obvious to all who reflect, that while a cause which may have produced a disease continues to act, or while circumstances exist, which tend very much to aggravate the symptoms, the [Page 99] efficacy of our remedies is rendered, if not of no avail, at least extremely doubtful.

When the patient was placed in a situa­tion as eligible as could be procured, the leading object was to evacuate the stomach and bowels. If this important point could be effected at the first attack, it was often found to cut short the course of the disease: and when it did not do this, it for the most part rendered the subsequent symptoms so moderate, that they more readily yielded to the means of art.

In general it was not thought of much consequence, what purgative medicine was used, except in instances where the stomach shewed signs of particular disor­der. A solution of salts and manna, in such doses as circumstances seemed to in­dicate, was very commonly prescribed. In most cases it sat easy upon the sto­mach; and even when the first doses were rejected, by persevering in its use, in final­ly passed downwards, and, upon the whole, [Page 100] was found to operate with more certainty and effect, than any other medicine.

The bowels being emptied, with salts and manna, it was thought expedient to continue the evacuation in a moderate degree; and for this purpose, a solution of manna and cream of tartar was employed, so as to produce its effect three or four times a day. This was a favourite medi­cine. It was found not disagreeable to take, and generally remained upon the stomach, without producing any sickness, or other uneasiness. When the disease was extended beyond the sixth or seventh day, and purgatives were indicated, there was a manifest advantage derived from equal parts of rhubarb and magnesia, in mint-water, over any other medicine, given in small and repeated doses; or a strong watery infusion of rhubarb, with the addition of a little manna, and sp. lavend. comp. to render it agreeable to the taste. These medicines answered the pur­pose [Page 101] of gentle aperients, whilst they in­duced no debility by their operation.

If jalap and calomel were prescribed at the beginning of the complaint, it was seldom thought necessary to repeat them. To preserve the bowels soluble, a solution of manna and cream of tartar was found better to answer the intention.

When a disordered stomach did not ap­pear among the primary affections, but, on attempting the use of purgatives, they were thrown up again, a few grains of ipecacu­anha, with a free use of camomile tea, has sometimes emptied the stomach to advan­tage. After allowing the stomach to rest a few hours, purgatives could then be employed with the usual success.

A disordered stomach, with frequent retchings and efforts to vomit, was now and then met with at the beginning of the fever, and sometimes, with other matters thrown up, there was an appearance of bile. Glysters, frequently repeated, very [Page 102] commonly moderated this symptom. Oc­casionally an infusion of camomile, or, where the patient preferred it, warm wa­ter, was used to cleanse the stomach; and as soon as there was a probability that the stomach would retain it, recourse was had to the purgative solution.

When a sense of weight and oppression at the stomach, a tenderness or soreness of the praecordia upon pressure, a vomiting of a bilious matter, of a dark poracious appearance, extreme restlessness, a dejec­tion of spirits, were met with among the primary symptoms, the case wore an a­larming aspect, and called for the utmost skill and exertions of the physician. To allay the vomiting, frequent glysters, and the application of a blister to the region of the stomach, were found most effectu­al; and to these was added the occasional use of effervescing draughts. If this me­thod did not succeed, the feet and legs were wrapt in large flannel cloths, wrung very [Page 103] dry out of hot water. This expedient, by relaxing the vessels on the surface, and in­ducing perspiration, sometimes relieved the distressing symptoms just enumerated.

When the vomiting could not be sub­dued, the patient at length threw up a dark coloured matter, resembling the grounds of coffee, and sometimes little dark coloured flakes were found mixed with it. To this affection of the stomach, succeeded coldness of the extremities, with a livid appearance of the hands and feet, intermitting pulse, excessive anxiety, op­pression about the region of the stomach, and hiccough, with difficult and laborious respiration. These symptoms continuing in a high degree, commonly indicated the near approach of death, which was seldom protracted to more than two or three days. I am happy to add, however, that there were not wanting instances of the recovery of persons who had laboured under black vomiting, accompanied with all the distres­sing [Page 104] symptoms peculiar to this stage of the disease.

It likewise happened during the pro­gress of the foregoing symptoms, but at no certain period, that a haemorrhage took place from the nose, mouth, or gums, and sometimes from all three sources at once. In one instance, a friend of mine inform­ed me, that the blood trickled from the in­ternal parts of the ears. But in the course of my visiting the sick, I seldom met with considerable haemorrhages, that the ap­plication of ice to the bleeding vessels, or to the neighbouring parts, did not most certainly check the discharge.

The severe train of symptoms above enumerated, according to my observation, generally occurred in what might be called the second stage of the disease, and some­times after a free use had been made of the lancet.

At the first of my attendance upon the epidemic fever, I was impressed with an [Page 105] idea that an early recourse to the bark was essentially necessary to the successful treat­ment of it. Under the influence of this opinion, after the contents of the stomach and bowels were carried off, I directed the bark to be used, either in powder, decoction, or the cold infusion, as circumstances ap­peared to indicate. In every instance it was found to disagree with the first passages. In some it occasioned a fulness and straightness about the praecordia: in others it offended the intestines, producing a fulness and sore­ness in the abdomen: whilst in others it excited the system, increased the head-ach, and brought on an accession of fever. Nor did I ever see the bark do good, until an entire solution of the disease took place. That it might not have been beneficial, I shall not assert. If, however, an opportunity of a similar kind unfortunately occurs, I shall prescribe it, under particular circum­stances, in a manner very different from that in which I have before used it.

[Page 106] The bad effects of the bark, which so invariably followed the use of it, under my direction, were commonly removed by the use of purgatives. Whilst the pa­tient was taking laxative medicines, I made it a common practice to give freely of sp. minderer. and evidently with good effects.

If the heat and fever were considerable, and the stomach retentive, small doses of antimonials, particularly James's powder, sometimes joined with camphor, were found useful. The sp. minderer. also, was a useful medicine in this state of the disease.

The diaphoresis which it commonly in­duced afforded great relief, and general­ly brought on a remission, if not an in­termission of the fever. When a free perspiration took place on the second or third day, it was considered as a favoura­ble event, and denoted a happy termina­tion of the disease. But sweating did not [Page 107] always prove serviceable. Instances hap­pened, where this evacuation was pro­fuse from the first attack, without seeming to benefit the patient in any degree. When it came on thus early, the tempera­ture of the skin generally, and particularly of the extreme parts, was so altered as to communicate a considerable sense of cold to the touch.

With respect to calomel, which many have prescribed with that freedom and constancy, as if it possessed some specific qualities, I can say little from my own ex­perience. I never could induce my mind to believe that it possessed any advantages over many other purgatives; and from the account given of its effects by some of my friends, I am disposed to favour a be­lief that its operation, as a purgative, was very limited. It produced frequent stools, but the quantity discharged was very small; and during the use of it, the patient fre­quently complained of a sense of fulness [Page 108] and constriction in different regions of the abdomen. These feelings were commonly soon relieved by the more copious evacua­tions procured by either of the purgative solutions before mentioned. That calomel has nothing specific in its nature, seems pretty clearly evinced by those cases in which it has been taken as a preventive. Instances of this sort were not unfrequent during the prevalence of the late epidemic in this city. But the fever was known to attack persons under the influence of this medicine; while others, who did not take mercury, and were living precisely under the same circumstances, have escaped the disease.

Three persons out of four, of the same family, had taken mercury for some time, with a view to guard themselves against the fever; but they were, notwithstanding, seized with the epidemic. In one, a sali­vation had been produced, and in this situation, he was attacked with fever. [Page 109] As soon as the fever came on, from a conviction that the mercury had not been of any service to him, he omitted the use of it, and with the assistance of mild pur­gatives, soon got well. The fourth per­son, who had not taken any calomel, and who nursed the other three, escaped the disease.

A number of other instances might be mentioned, in which calomel had been taken as a preventive, where the persons, notwithstanding, took the disease.

In the management of the late epidemic, the cold bath was frequently resorted to. As a general application, I can say no­thing of it from my own observation. I have been, indeed, in the habit of washing the hands, arms, face, neck, and breast, with cold vinegar and water, in cases of fever, and always found it a very grateful refreshment to the patient. I according­ly employed it freely, and as extensively as conveniences would allow. But I know [Page 110] that the general bath was also employed for the late fever, with great advantage, but under what particular circumstances I cannot speak with precision. Doctor Charlton, of this city, a physician of much experience, who had in many instances witnessed its good effects, favoured me with the following communication: ‘I experienced the happiest effects from cold bathing, in a variety of cases. I used river-water, and had the patient placed in a large tub, and a couple of pails-full thrown over him. It happened in one instance only, that the patient did not feel so much refreshment, as to be impatient for a repetition of it. In this case the patient grew chilly after using the bath, which I thought a sufficient reason for discontinuing it. In every other instance I found no method so effectual for reliev­ing the extreme distress of the head and stomach, so generally attendant on that disease.’

[Page 111] We find a similar practice recorded by Mr. Bruce, who says, that the inhabitants of Masuah are subject to violent fevers, which ‘generally terminate the third day in death. If the patient survives till the fifth day, he very often recovered by drinking water only, and throwing a quantity of cold water upon him, even in his bed, where he is permitted to lie, without attempting to make him dry, or change his bed, till another deluge adds to the first.’

In the use of cordial medicines, or drinks of that nature, much circumspec­tion was necessary. In the first stages of the disease, they were altogether inadmis­sible. They were prescribed in some in­stances, after considerable remissions had taken place, but manifestly to the injury of the sick. Even after complete inter­missions had formed, they sometimes pro­duced a state of excitement, which ren­dered the patient's situation much less [Page 112] comfortable. These observations apply particularly to those cases, where the re­missions took place at an early period, or where the disease did not run out beyond the fifth, sixth or seventh day. When the fever was of longer continuance, the debility it induced made the use of cordials not only allowable, but particularly necessary.

Porter, more or less diluted, was found to agree better with the sick than any other drink of the cordial kind: but its salutary effects appeared very much to depend upon a liberal state of the bowels. When given conjointly with some mild purgative, it in­creased the strength, and very often super­seded the use of any other tonic.

In the latter stages of the complaint an infusion of snake-root was also made use of with advantage. On many occasions it composed the stomach, supported the strength of the patient, without exciting him, and seemed productive of very happy effects.

[Page 113] Much has been said and written re­specting the use of the lancet, and the ef­fects of bleeding in this disease. On this part of practice I shall advance nothing, but what is the result of experience and ob­servation. In general, the indications of cure were not supposed to include this operation; it was, therefore, but seldom had recourse to. In some of those cases, in which the lancet was used, the good effects of bleeding were obvious, more es­pecially in relieving the distressing pain in the head; whereas in other instances, and, where the symptoms seemed to ren­der it peculiarly proper, it did not afford the relief that was expected from it; but, on the contrary, although the quantity of blood drawn was copious, and the bleeding frequently repeated, the patient sunk un­der the disease.

If I were to say in what cases bleeding would probably be useful, it would be where the fever seizes upon healthy, robust con­stitutions, [Page 114] where the pain in the head was extremely violent, and where the eyes, (to use a frequent expression of the sick) seem­ed ready to leap from their sockets, and especially if such a subject had just arrived from the purer and cooler air of the country. In a person of this description, the attack, and all the subsequent symptoms, are com­monly violent indeed; to moderate, there­fore, the excessive action of the system, bleeding would probably be necessary and useful. Under circumstances like these, I have accordingly bled, and to good pur­pose; but I have, previously to blood-let­ting, directed my patient to drink freely of warm water; by which means I have observed, that not only the action of the vascular system was much abated, but al­so that the whole body more readily yield­ed to a copious perspiration. But if a person is attacked with this fever, whose body has been previously debilitated, per­haps by a sedentary manner of living, and [Page 115] from having resided some time in the epidemic constitution of the air, it could hardly be supposed that the same remedies would be required as in the former instance.

An attention to the above distinction of causes, as far as respects the remedy of bleeding particularly, may be of greater importance in the treatment of this disor­der, than has been commonly imagined.

Opium was rarely admissible in this fe­ver, and never in the first stage of it. But after the contents of the stomach and bow­els were freely evacuated, and the exces­sive action of the system moderated, the use of it was justified in many instances of successful practice. Indeed, particular cases occurred, in which great irritation, restlessness, and want of sleep, could by no other means be so well alleviated. When given under such circumstances, it was commonly conjoined with some sudorific, and most frequently with sp. mind. When, also, in the advanced stage of the disease, [Page 116] the vomiting became excessive, opium was administered with the best effects.

Blisters were occasionally employed; they were found most useful in removing local affections. If the head-ach continu­ed severe, after free evacuations, a blister, applied between the shoulders, often re­moved the pain. When the sickness at the stomach was great, attended with oppres­sion and pain, a blister to the praecordia has often proved of advantage. Doctor Blane found nothing so successful in remo­ving irritability of the stomach, as a blis­ter applied externally to the part. When there has been a general soreness and ful­ness of the abdomen, which has not sub­sided after a free use of purgatives, the application of a blister has produced the happiest effects. A friend of mine had a young clergyman under his care, whose disease, from its continuance, had become very formidable. He was covered with petechiae; his stomach was easily ex­cited; [Page 117] his stools were generally of a dark colour, and sometimes black. The bark had been tried, but it did not agree with him. Upon examining the abdomen, it was found universally tender to the touch, but not painful. A large blister was applied to the affected part, the ope­ration of which put an immediate check to the progress of the disease. His drink was porter, to which water was occasion­ally added; and with the assistance of an easy diet, such as sago, gruel, &c. his re­covery was soon completed.

The drinks which seemed the most grateful to the sick, and were considered as the most proper during the fever, were lemonade, water with toast in it, water alone, molasses and water, balm-tea, &c.

The diet commonly recommended was sago, tapioca, panado, and occasionally weak broths. The latter, however, fre­quently produced uneasiness at the sto­mach, which made it necessary to desist [Page 118] from their use. A gruel made with In­dian-meal, or oat-meal, appeared, upon the whole, to agree better with the sick than any other food; and, in many in­stances, it constituted the whole diet and drink of the patient.

The use of animal food was uniform­ly attended with bad effects; the smallest quantity, taken in the intermission, has hastened the accession of fever, and in­creased its violence. Even after the dis­ease had entirely subsided, and debility only remained, a too early recurrence to animal food has brought on a renewal of fever.

I shall only add, that through the whole course of the disease, the strictest attention was paid to cleanliness, especially to the immediate removal of all excrementitious matter. The patient's linen, bed-cloaths, and often the bed itself, were frequently changed, and the refreshment it always af­forded was a sufficient proof of its utility.

[Page 119] The foregoing exhibits an unvarnished view of the history of the late epidemic, as far as it came under my notice; and of the practice, as far as it seemed ra­tional, and was successful under my ma­nagement: and I have purposely avoided, as much as possible, all theoretical or controversial grounds.

Indeed, I have been anxious about no­thing so much as to fix upon the mind, the great and obvious distinction betwixt con­tagious diseases, and those which, under very peculiar circumstances, may assume much of that character.

The utility of this distinction is so well shewn by Doctor John Hunter, in his En­quiry into the Nature and Causes of the Remittant Fever, that I cannot do better than give his own observations upon the subject. ‘There is hardly any part of the history of a disease (says the Doctor) which it is of more consequence to ascertain with accuracy, than its being [Page 120] of an infectious nature or not. Upon this depends the propriety of the steps that should be taken, either to prevent it, or to root it out. It is productive of great mischief to consider a disease as infectious that really is not so; it exposes such as labour under it to evils and in­conveniences, which greatly aggravate their sufferings, and often deprive them of the necessary assistance: they are neg­lected, if not shunned; and at the time they require the greatest care and at­tention, they have the least. I have had occasion to observe, that the remit­tant fever, whether with its usual, or more uncommon symptoms, with the yellow colour of the eyes and skin, or without them, was never found to be infectious. The strongest proofs of this, in my opinion, were to be met with in private families, where the son, the bro­ther, or the husband, labouring under the worst fevers, were nursed with un­remitting [Page 121] assiduity, by the mother, the sister, or the wife, who never left the sick by day or by night, yet without be­ing infected. That such near relations should take upon them the office of a nurse, is matter of the highest commen­dation in a country, the diseases of which require to be watched with greater care and attention than can be expected from a servant.’

Why the late epidemic, in many in­stances during its destructive progress in this city, wore the dreadful aspect of con­tagion, may be gathered, in a good degree, from the few following particulars, with­in the knowledge of us all, viz. The last summer, and a great part of the au­tumn, were marked by an uncommon degree of heat, combined with moisture. The atmosphere, which, at that season, is ordinarily loaded with the electric fluid, seemed destitute, for weeks together, of this vivifying principle. The intense [Page 122] heats which we often experience in the forenoons of July and August, are gene­rally allayed by thunder and lightning, and the refreshing rains, which follow towards the evening; but in the season re­ferred to, this precious relief from the lan­guor induced by a verticle sun, was sel­dom felt.

Now, when we reflect that a great ma­jority of those who fell victims to the late epidemic fever were not only foreigners, but poor persons, many of whom had been only a few weeks in the country, arrived after a long voyage, and predisposed to sickness by hard and scanty fare; hud­dled together, in a great many instances, in the most uncomfortable apartments, and these situated in the most unhealthy parts of the city; frequently without the early at­tention of a physician, destitute of friends, and often without the most common com­forts of life; under such distressing cir­cumstances, notwithstanding the huma­nity [Page 123] of the citizens, were numbers placed; and what consequences, but those which followed, could reasonably have been ex­pected?^*