LETTER FIRST. INTRODUCTORY.

IN compliance with your wishes, and in return for the communication with which you lately favored me, relative to the diseases which prevailed in the neighborhood where you reside, for the last three years, I have put together all the scanty information I possess, respecting the fever which was the occasion of so much distress to this City, in the last summer and autumn.—I regret my inability to communicate a more minute and specific statement of facts; and the more, as there seems little probability, at present, that any person, qualified for the task, will undertake it. Various circumstances conspired to narrow the sphere of my observation; and this may have led me into erroneous conclusions, which more extensive practice and wider observation would have corrected in me, and may have corrected in others. But, how faulty soever my reasonings may be thought, I must demand absolute and entire credit for my facts. In these, I cannot well have been deceived: for the very circumstances which rendered them few, made me more attentive, and gave me leisure to be accu­rate. There is but one possible way in which any falsity can be chargeable on them; and this might be, were I to pretend to decide that the course of the disease was always such, as when it came beneath my notice. But you will understand me strictly. I [Page 66] describe what I saw; and mean only then to make a remark general, when I sow express it, and when I find a concurrent opinion on the part of many. In my reasonings on facts, you will not blame me for taking a range somewhat wider; for, should I, in my way, light on some truth, interesting and important, it will well repay you for the fatigue of accompanying me; and, should I not, your friendship will excuse me, in this instance, as it has often done before. Of one thing further you ought to be forwarned: That, con­cerning every thing connected with the fever of 1795, where opinion may be exercised, there is va­riety of opinion. And as, in this contest of jarring and hostile opinions, but one can have justice on its side, I would have you follow mine, with diffidence, into the field of controversy. Victory does not always incline the balance on the side of right; but even should mine deserve defeat, it will suffer in the com­pany of myriads.

LETTER SECOND. An account of the situation and peculiarities of that part of the City in which the Fever most prevailed, in 1795.

THOUGH the fever continued to extend itself, to the last, yet it never became general over the city; and, for a long time, it was mostly confined to a par­ticular district. As the season advanced, the pecu­liarities of this district may be supposed to have be­come common to a larger portion of the city; and their extension to the whole only prevented by the setting in of winter. To the district alluded to, the East river, from Long-Island ferry to Mr. Rutgers's, [Page 67] forms the eastern boundary; the northern reaches from thence to Division-street; thence westerly, down Division-street, Chatham-street, the extremity of Pearl-street, into William-street, to Franckfort-street, down this last to Gold-street, through that to Beek­man-street, along which the line proceeds to Pearl-street, as far as the Market, down which it should be continued to the river.—The space included in these bounds, is all over which the fever, according to the best of my remembrance, exerted any power, till after it had reached its height; when it extended down Water-street, a little below Wall-street, and proved very mortal. It is true that there were a few persons affected in various other parts of the town; but, during the great part of the prevalence of the fever, it was principally active in the north-eastern and middle parts of the district comprehended as above: and, as a thorough knowledge of the peculiarities of this portion of our city is, in my opinion, indispensa­ble to the history of the disease which afflicted it, I cannot doubt your patience with the minute descrip­tion I think it necessary to give.

The first and most obvious remark, on the greater part of the district, just pointed out, is, that it is the lowest, flattest, and most sunken part of the whole city. Some places are much more sunken than others; but the whole space is evidently so, compared with the adjacent ground; and appears to have an in­clination, more or less observable, in different streets, to the East river. This inclination is very consider­able in Dover-street; a street which is said always to have suffered from fevers of this kind, during the hot season. From the division of Pearl and Cherry-streets, down the latter, the descent is rapid, to some where near James's-street; about which is the lowest part of the street, and from whence it is nearly level [Page 68] to the northern boundary. Beyond this bound, the ground rises again; and the made ground, by the river side, is also somewhat elevated: so likewise, is the whole of the ground over which the westerly line passes through Division, Chatham, &c. streets. Thus you will perceive, that the part of the city where the fever was most active, for the longest period, forms, as it were, a bason, having its side, nearest the water, a little inclined. Within this bason, there are several smaller cavities; one of which, in particular will re­quire a further description. Those streets, also, which are not included in this hollow, but which lie along the river, will require some attention; which shall be given them.

The extreme irregularity in the disposition of the streets, and the narrowness of the greater number of them, are great obstacles to a free ventilation of this city. This misfortune, common to every part of it, falls with peculiar heaviness on that district which has just been spoken of. The comparatively high and neighboring lands of Morrissania and Long-Island, receive almost solely the benefit of breezes from the north-east and east: The Sound, which divides them from the city, being too narrow to add much force and freshness to a breeze nearly spent on their heights. North, the island rises into little hills, from which the wind passes on to the high parts of the city; rarely visiting the low and intervening space; unless it may be the topmost rooms of the houses: and, as the houses are generally low, the effects of a wind from this quarter must be inconsiderable.— North-westerly, there is somewhat more of an open­ing; but even this is small. West, south west, and south, the other parts of the town, which are higher, and thickly settled, break the force of the gales from these points. So that, thus situated, this quarter of [Page 69] the city, though it were perfectly well laid out, would have but little chance for a free ventilation: irregu­larly disposed and narrow as the streets are, we must be convinced of the impossibility of its receiving the necessary supply of fresh air. You will understand me as speaking of a thorough ventilation, and in the sultry season, when it is most necessary: a partial supply of air, equal to the support of a feverish exis­tence, it undoubtedly obtains.

Much of the ground, in the northern part of this district, is swampy, and abounds with little pools and puddles of stagnant water. This was especially true last summer and autumn; there being great rains, and no adequate means for conducting off the water. Indeed, so flat are some of the paved streets, in this quarter, that the rains did not run down the gutters, but continued in little puddles, and were evaporated from the places whereon they fell. In the new streets, which are unpaved, and without any gutters, numer­ous imperfect ditches assisted the disposition of the water to stagnate. These places were often mud­dy, when the southern part of the town was dry; and the steams from them very offensive, when the dry streets, towards the North river, were perfectly sweet.

Several of the paved streets, and indeed the greater number, in the district of which I am speaking, are narrow and crooked; some with neither side walks nor gutters, and by far the largest portion of them, miserably built. Most of those which are unpaved, are, in all respects, still worse; the buildings chiefly wooden, and placed on the ground; the old ones falling to decay; the new, but imperfectly finished. Of them all, it may be remarked, that they are much exposed, some of them more than others, to the full [Page 70] influence of the docks, whatever that may be, and it cannot be salutary; or to that of a boiling sun, from early in the morning, till the middle of the afternoon; and some of them, to both.

So much for the streets, generally: a few particu­lars, concerning some of them, are necessary to the formation of a perfect idea of this district.

A line, drawn from the corner of Ferry and Pearl-streets, up the latter, to where William street enters it; then down William to Franckfort, and through that, a part of Gold and Ferry-streets, to Pearl-street again, will form the ridge of a new cavity (included in the principal boundaries above mentioned) which seems contrived, by art, for the dwelling place of fever. This court-yard of the palace of death, is di­vided by several dismal lanes, courteously denomi­nated streets; such as Vandewater, Rose and Jacob-streets, &c. which form the borders to innumerable tan-vats. The whole is one vast tan-yard, the firm parts of which seem to have been constructed by art in the midst of an extensive quagmire. To this place, as far as I can discover, there is no outlet. Think what must be the condition of it, in the months of August and September!—Yet human beings live here; and habit renders its noxious exhalations, in some sort, harmless to them. It is remarkable that few persons, regularly inhabiting this hollow, died of the fever last year. To those, whose evil destiny led them to seek a new dwelling place there, it proved highly pestilential.

Dover-street is a short, narrow street, running from the beginning of Cherry-street, down to the East river; and contains near twenty buildings.— The descent, from Cherry into Water-street, is very [Page 71] rapid. As the exposure is nearly to the east, it re­ceives the whole effect of the sun, from 6 A. M. to 3 P. M. in the summer. The descent makes it easy to keep the surface of the street clean; though it pre­vents a free ventilation. But it has been raised, se­veral feet, since the buildings, which are mostly low, were erected; so that the road is, in many in­stances, up to the middle of the lower story windows; leaving the cellars to the houses, and cellar kitchens, without a communication with the street. The yards remaining as before, are, of consequence, much lower than the street; without vent; and, of neces­sity, all the water, and filth of every kind, which gathers [...]n them, must there stagnate, ferment and putrify. Add to this, some of these yards are capa­cious, and contain little, decayed, wooden huts; sometimes built directly on the ground; and contain­ing, oftentimes, several families.

Water-street, above Dover-street, is chiefly com­posed of low, decayed and dirty wooden buildings. This street being either made-ground entirely, or raised like Dover-street, the same is true of the situ­ation of the houses and yards. And, lest any of the filth, or water, should drain off, from any of the yards, the western side of Water-street has been kindly converted, by the enlightened zeal of the directors of these affairs, into a perfect dyke; which answers its design, most completely, by preventing even the slightest leakage. Beside, as this street lies directly on the water, it has the benefit of the whole force of the sun, the greater part of the day; and of the exhalations from the docks; which are here in great number, and in the highest state of their per­fection. There is, however, a better opportunity for fresh air, in this, than in some other streets. Yet even this is an advantage which the rage for im­provement [Page] threatens to transfer to a new street, still further out in the river; which, if completed, may form another dyke, to the increased pleasantness and health of this quarter of the town.

Of Roosevelt, Catharine, James, Oliver, &c. streets, nearly the same remarks are true as of Dover and the upper part of Water-street: for though they are somewhat wider, straighter, and have more good and new buildings in them, yet they are raised in the same manner, have sunken yards, and under-ground apartments; and Roosevelt street has an open sink, where the drippings of the tea-water pump, after having gently collected all the filth in their way, are received; and being just enough to keep up a con­stant dropping, and not enough to wash the gutter, or the sewer, the stench is most intolerable, during the sultry months.

To many other of these streets the same remarks will apply; and to some with aggravated force: but what has been said, will, perhaps, be sufficient to aid your imagination in the conception of a just idea of their condition: I mean of their necessary and una­voidable condition.

Of the Docks, it may be enough to mention, ge­nerally, that they are badly contrived in every part of the town; and worst of all, in this part; being broken up into numerous little wharves, thus form­ing narrow slips, where the ground is left bare at ebb tide; and where vegetable, animal, and excremen­titious matters, being thrown in, at all times, instead of being cast into the stream, ferment, putrify, and render the stench truly pestiferous. Indeed, this is so much the case, with all of them, in the summer, that, except to persons habituated to their exhala­tions, [Page 73] they are absolutely intolerable; exciting, in persons of a delicate make, immediate vomiting; and in others nausea, indigestion, head-ach, or some tem­porary illness, when exposed to them but a short time.

In addition to the above-related facts, concerning the condition of the streets, in that part of the city where care was most needed, it may be remarked that, at no time, was there ever so great an apparent inat­tention to preserving them clean. Besides the impe­diments which the level nature of the streets, in many parts of the town, presented to the draining off of the filth which is constantly accumulating in large towns like this, artificial impediments were permitted; as if death were not sufficiently active, and needed the aid of the magistrate. In all the streets where buildings were going forward, the workmen were allowed to restrain the course of the water, in the gutters, by forming little dams, for their convenience in making their morter. The effect of this stoppage of water was so great, that even in Broadway, one of the streets the best calculated of any in the city for free ventilation, in that part of it where the new Tontine Tavern was building, the stench was exceed­ingly offensive. And in this condition was it allowed to remain for near two months; though it was al­most under the windows of the principal magistrate of the city. If this were true of the widest, and one of the best aired and cleanest streets, of New-York, what think you was the state of those narrow, crook­ed, flat, unpaved, muddy alleys, mentioned above? No one can form even a faint idea who has not walked through them, in the middle of some one of those deadly, suffocative days, which we experienced in September last.

[Page 74]But this is not all: beside those masses of semi­putrid vegetable and animal matters—cabbage, tur­nips, the heads and entrails of fish, &c. which, at all times of the year, out of compassion to men who might be usefully employed as scavengers to the city, are allowed to complete the putrefactive process, un­disturbed, in the middle of the streets,—the sight and the smell were shocked, at every turn, by dead rat [...], fowls, cats, dogs and pigs. So remarkably was this the case, that I question whether there could have been found a single street, alley, or even bye-lane, of any tolerable length, which did not lend its aid to render this exhibition full and frequent.

The preceding statement, melancholy as it may appear, will convey a very inadequate idea of our misfortune, in respect to situation, without special information concerning the season, as it appeared here, during the reign of the fever; and a knowledge of the people who mostly inhabited these parts of the city, and on whom the severity of the disorder was inflicted. With this knowledge I shall en­deavor to furnish you; but the length which this letter has already acquired will excuse me, to you, for postponing the attempt, to a future opportunity.

LETTER THIRD. Some Account of the Season of 1795.

PHYSICIANS, from the earliest ages of medical re­cord, have remarked that great peculiarities and irre­gularities of season, have exercised an unfriendly influ­ence on human health: And Hippocrates, himself, takes [Page 75] notice of the difficulty, which hence arises, of forming a proper judgment, and adopting a suitable method of cure, in those diseases which occur under such cir­cumstances. The importance of this division of my subject, makes me regret that it is in my power to fur­nish you with no other than general information. You will be the more ready to overlook this defect, when you recollect that I do not pretend to deliver a history of the fever, and are informed that there is some probability that this particular defect will be supplied by another hand.

Generally, then—every one knows that the sum­mer and autumn of 1795 were excessively sultry and excessively wet. Every article of household furni­ture, or in use about a house, susceptible of mould, was speedily and deeply covered with it. It seemed to penetrate places where we should have deemed its appearance impossible. A friend of mine found a pocket-book of Morocco leather quite mouldy; though it was in the drawer of a private desk, inclosed within a large desk—both of which were usually locked—and covered by papers. Boots and shoes hung up by a wall, near a fire-place, heated every day, contracted mould within twenty-four hours.

Meats spoiled in the market-place uncommonly quick; and those which were brought home, appa­rently fresh and good, in the morning, were often found unfit to be eaten, when cooked and brought upon table.

Esculent vegetables, in general, and especially fruits, were unusually poor, tough and tasteless. The peach, particularly that called the cling-stone, was scarcely digestible; and often occasioned temporary [Page 76] illnesses, quite severe, while it doubtless aided in the production, or aggravation, of the fever.^*

Flies were very numerous and troublesome, in every part of the city, in the beginning of summer; but they suddenly disappeared, about the middle of July, from the more airy parts of the town, collecting in swarms, in the less healthy parts, and succeeded, every where, by clouds of musketoes, incredibly large and distressing: and these continued to afflict us, long after the time when they commonly depart. Almost every person suffered exceedingly from the bites of these insects; and foreigners especially. In some they occasioned universal swellings, and erup­tions, somewhat like Pemphigus; and in others nu­merous little ulcers. These last, a physician of my acquaintance, saw even in a native American. The irritation, restlessness, and consequent watchfulness and fatigue, occasioned by these animals, no doubt predisposed the well to be affected by the fever; while they extremely harrassed the sick, and retarded their recovery.

During the whole of this season, I remember but one thunder-storm; and this was very gentle. There was but a single hard clap of thunder, for more than four months, that I remember; and very little thun­der and lightning, at any time.

[Page 77]Our rains, excessive in quantity and frequency as they were, seemed to have lost their wonted power of cooling the air. In those streets, most unhealthy, and least ventilated, this effect was, in a degree, ob­servable; but, in the airy and healthy parts of the town, on the contrary, they never failed to render the heat more intolerable; and the steams from the hot pavement were like those of a vapor bath. The clouds, too, seemed to shut out every kind of breeze. —One of these heavy rains, which continued two or three days, seemed to possess all the qualities of steam. It pervaded every recess of the houses, and dissolved the best glue—so that furniture, in many instances, which had been long standing, fell in pieces.

Fogs, which Dr. Lind enumerates among the signs of an unhealthy climate, and causes of diseases—page 134 of his Essay on hot climates, &c.—prevailed in the city, and spread over all the most unhealthy parts, in particular, in a remarkable manner,—in the even­ings—for a considerable part of September and Oc­tober. The oppression, thickness, stench, and un­comfortableness in every respect, of these fogs, was very uncommon. In a physician, who, in the per­formance of his professional duty, was exposed to their influence several hours, one night, they pro­duced bleeding from the gums and fauces, and black and fetid stools.—On the city watchmen, however, they had no such effects. About the first of Octo­ber but one person had died out of their number; and he was a man who returned to the city, a little before, and resumed this occupation, after having been some time absent in the country.—Whether this security of the watchmen is to be attributed—as it is by Dr. Rush, to the influence of the cool night-air [Page 78] ^*, or to that of habit, I leave others to decide. It is not impossible but that both may concur in pro­ducing this insensibility to the cause of disease in others.

To this imperfect account of the season, which, de­fective as it is, appeared to me too important to be omitted, I have one fact to add, on the authority of a gentleman distinguished for his attention to meteo­rological phenomena. He informs me, that no Aurora Borealis has been seen, of any magnitude, in our country, north of Pennsylvania (as far as he can learn) for near four years, till the latter end of Sep­tember 1795; and adds, that his father, a respectable clergyman, now about 70 years of age, who noticed the same absence of these appearances, remarks, that, according to his uniform observation, some uncom­mon sickness has never failed to follow a long conti­nued disappearance of these phenomena. How far the experi [...]ce of other observers will tend to con­firm this statement, I have had neither time nor op­portunity to inquire. And, if it be admitted as in­disputable, it may still be questionable, whether this is to be regarded as a cause of disease, or whether this disappearance and disease, be not co-ordinate effects of a common cause.

LETTER FOURTH. Some circumstances relative to the principal sufferers by the Fever of 1795.

IT is a fact, generally admitted, I believe, that, of those who were sick and who died of the Fever of 1795, the greater number were foreigners: persons, either just arrived from other States, from the West-Indies, and from Europe; or who had not been many months, or years, settled in this city. It is probable that the proportion of citizens, who died, to strangers, did not exceed one to seven. Of these strangers, it is thought, a large number were Irish; and there are some reasons why this should be true; but I cannot pretend to know it to be so, from my own observa­tion. The causes productive of disease in foreign­ers, in those of this nation in particular, are numer­ous, and some of them deserve particu [...]r attention. This I design to bestow upon them, after remarking, that, both among natives and foreigners, the severity of the disease was experienced by the poor.

I. Dr. Blane, in his observations on the diseases of seamen, remarks, ‘that it sometimes happens, that a ship, with a long established crew, shall be very healthy; yet, if strangers are introduced among them, who are also healthy, sickness will be mu­tually produced;’ and Dr. Rush, in th [...] first vo­lume of his "Medical Observations and Inquiries" takes notice of this remark of Dr. Blane's, and con­firms it, by a reference to the experience of our coun­try, during the late war. These are his words— ‘The history of diseases furnishes many proofs of the truth of this assertion.—It was very remarkable, that, while the American army at Cambridge, in [Page] the year 1775, consisted only of New-England men (whose habits and manners were the same) there was scarcely any sickness among them. It was not till the troops of the eastern, middle and southern states, met at New-York and Ticonderoga, in the year 1776, that the Typhus became univer­sal, and spread with such peculiar mortality in the armies of the United States.’

It is unnecessary to enlarge, in this place, on the oppressions and distresses of what are called the lower order of the people in Europe. War, which doubles the burthens upon every rank in society, exercises an aggravated violence upon the poor. This violence, severely felt by all, in England, chiefly falls upon the manufacturing poor; who are, at the same time, the most ignorant, abject and depraved: in Ireland, its effects are more general, including in its circle of wretchedness, the cultivator, as well as the mechanic. The present war in Europe, unparalelled as it is for the number of men involved in it, has given birth to oppressions and calamities equally new and destruct­ive. Under these circumstances, and when men of fortune and respectability, disgusted and disheartened at the enormous mass of misery which every day and every hour presented to their view, turned their thoughts towards another hemisphere, it is not to be wondered at, that the wretched and depressed poor should pant for a settlement in a country, where li­berty is t [...] portion of every man, and independence the sure crown of all his honest labors; and which had been, fallaciously, represented as courting their ac­ceptance, and loading their untoiling hands with every gift of fortune.—The real blessings of our go­vernment and country are precious and inestimable; but they are of a nature not to be felt and enjoyed by minds depraved by ignorance and debased by slavery. [Page 81] That temperate enjoyment of the goods of life, and moderate exercise of the blessings of independence, which, alone, enlightened liberty sanctions, can neither be conceived of, nor relished, by those who have been accustomed to crouch beneath the iron rod of despotism. Liberty, according to their ideas, was the reverse of all they felt; and independence, the unlimited gratifica­tion of all their appetites. The misrepresentations, too, of speculating and unprincipled men, who were inte­rested in the sale of large tracts of unsettled territory, had fostered and extended these erroneous concep­tions. Hence, when the poor and miserable emi­grants, on their arrival here, found that neither gold, nor farms, solicited their acceptance; that, in Ame­rica, as well as in Europe, their life was alike destined to be a life of toil; when they perceived that licen­tiousness, the only liberty of which they had any no­tion, brought punishment along with it; the disappoint­ment, new and unexpected, became a powerful ag­gravation to every other cause of disease. You will not understand me as extending these last remarks to all emigrants to this country, nor suppose that de­ceived hope was present, or active, in every case. On some, even of the better sort, it undoubtedly had a very pernicious influence; on the poor and friendless, effects still more melancholy.—But to return:—Two motives, then, poverty and oppression at home, and the hope of independence and wealth abroad, con­curred to draw to the United States, an astonishing number of the inhabitants of Europe; and as these motives were mostly active among the very poor and very wretched, people of this description emigrated in the greatest number. Of these, the largest portions fell to the share of the States of Pennsylvania and New-York; and the most worthless and profligate, proba­bly, rested in the capitals of those States.

[Page 82]The distresses in the West-Indies, especially those occasioned by the destruction of Cape Francaise, obliged numbers of the islanders, white, mulatto and black, to take refuge here. This circumstance, harmless, in great measure, to the people them­selves, can scarcely be considered as so, in relation to the whole. Whatever effect it may have had, all things considered, it seems irrational to suppose it to have been good.

This collection of strangers, from various parts of Europe and America, which had been rapidly form­ing for two or three years, was greatly increased by repeated arrivals of large importations from Great-Britain and Ireland, during the fall of 1794, and the spring and summer of 1795. One or two ships came into this port, after the commencement of the fever, filled with emigrants.

If, then, the opinion of Dr. Blane, corroborated by the testimony of Dr. Rush, be founded in truth; that the sudden intermingling of people of various and discordant habits, climates and nations, be a circum­stance favoring the production of disease; this cause of fever was certainly present, in New-York, in the year 1795.

II. ‘Men who exchange their native, for a distant climate, may be considered’—says Dr. Lind, page 2d, of his Essay on the diseases incidental to Euro­peans in hot climates—‘as affected in a manner somewhat analogous to plants removed into a foreign soil; where the utmost care and attention are required to keep them in health, and to inure them to their new situation; since, thus trans­planted, some change must happen in the consti­tutions of both.’

[Page 83]"Some climates"—he continues—‘are healthy and favorable to European constitutions, as some soils are favorable to the production of European plants. But most of the countries beyond the limits of Europe, which are frequented by Europeans, un­fortunately, prove very unhealthy to them.’

The healthiness and unhealthiness of a climate, or the effect wrought on the human constitution by a change of climate, must be more or less considerable, according to the extent of its connection with other circumstances. How far such a connection was ob­servable in this city, in respect to the Fever of 1795, will appear by and bye.

Two remarks may be made, concerning the emi­grants from the West-Indies. The first is, that they generally bear the first winter, after their arrival in the middle and northern states, better than the na­tives, while they are less incommoded by the sum­mer heats. The second is, that they suffer less from Fevers, during the sultry season, than Emigrants from Europe. It seems difficult to explain the first men­tioned fact; the second I shall attempt to account for, hereafter.

The climate of this part of America differs from that of Great-Britain and Ireland in the intenser cold of its winters; more extreme and longer continued heat of its summers; and the greater variableness of its temperature.

The great body of emigrants come over to Ame­rica in large companies, crouded together in one ship, and ill-accommodated in every respect. After a long voyage, under such circumstances, they must be sensible, in an uncommon degree, to the influence of a new climate, and to every sudden variation of [Page 84] temperature. If they arrive, as is often the case, in the sultry season, the effects of a change of climate must be felt in all their force. The heats of the summer must render them less able to cope with the ruggedness of the following winter; as the severity of the winter makes them more unfit to endure the scorching sun of the succeeding summer. This will account for the suffering of many who had passed a season in the country before.

To this it may be added, that, in 1795, the cli­mate must have been particularly bad; since it may be supposed to have preternaturally affected the na­tives of the country. This being admitted, it is not difficult to conceive of its having had a pernicious influence on strangers; and being, therefore, fairly enumerable among the causes predisposing to the fever of this season.

III. An animal diet, or a great use of animal food, especially in summer, and when there is general dis­position to fevers, is thought by many physicians, of our own and other countries, to favor their produc­tion; and a vegetable diet, on the contrary, to be a preventative, or preservative, against them. This, also, was the opinion of the humane and celebrated Howard, who is known to have abstained from the use of flesh, for many years previous to his death.— Both theory and fact seem to concur in establishing the truth of this doctrine; for a satisfactory illustra­tion of which I may safely refer you to the publica­tions of Drs. Rush and Mitchill.

The proportion of animal, to vegetable food, eaten at the best provided tables in America, is so great as to astonish a European. This may be said of the country generally—but is especially true [Page 85] of the cities of New-York and Philadelphia. An objection, too, has been made by Europeans, particu­larly by the French, to our mode of cooking meats. They complain, and with apparent justice, of the im­perfect action which fire is allowed to exert upon them; and represent us as little better than the Aby­sinians, who devour a part of the ox, while he is yet expiring.—It is certain that a great change is observ­able in the appearance and kind of diseases, in the United States, since our citizens have substituted fresh meats, for salted, in summer.—Some reasons may be assigned for this effect, which would countenance the opinion of the French; but they will suggest themselves to your own mind, and would require more room than I can allow them, in this place.— But, surely, if meats be prejudicial to health, in our hot seasons; if they expose us, by their use, to diseases of the kind, which prevailed here, last year; how pe­culiarly must this evil have been felt by us, when they were in a condition so uncommonly bad as the year 1795—If the wealthy often had meats brought upon their tables, in a state of incipient putrescency, what must have been the state of those which were consumed by the poor?—Add to this, that the vege­tables principally used among us, are not distinguished for their ascescency.—These remarks apply to all ranks of our inhabitants; and plainly shew that the situation of our city, the last year, was unusually bad, in this respect, for natives, as well as foreigners. Other circumstances assisted to heighten the evil, in relation to these last.

The poor of Europe, and especially of Ireland, are but sparingly accustomed to the use of meat. In that island, it is not uncommon for people to pass through life, without ever having tasted it, except by stealth, accident, or on holydays.—In this country, the great [Page 86] use of meat produces a comparative scantiness in the supply of vegetables; and a proportionate poorness and dearness of them. This is sufficient to determine the choice of the poor towards the use of meat; and produce, in the emigrant poor, an almost total and sudden change, in their aliment. When, too, we re­collect that animal food is more gratifying to a de­praved taste; that it provokes to greater repletion, than vegetable food; that it is more necessary to hard laborers; and that it is most craved by those who in­dulge in the habitual use of ardent spirits; we are alive, at once, to the full perception of the mischiev­ous effects arising from such a substitute, to their for­mer bland and scanty meals. In those, with whom this change of diet took place the last year, for the first, the consequences must have been still more per­nicious. For we ought to consider that if the poor always consume the worst provisions, those who were strangers, as well as poor, were least likely to procure those which were good; and the slightest observation is sufficient to convince us, that their bad qualities could not have been much obviated by the prepara­tion common among the consumers.

May we not, then, conclude—that the aliment used by the citizens, generally, was favorable to the production of disease—and that the great and sudden change of diet, among the emigrants, considering the nature of their food in 1795, must have disposed them, in a particular manner, to be affected by the fever of the country?

IV. If unwholesome aliment assisted in the produc­tion, or aggravation, of the fever of 1795, improper drinks were scarcely less active, to the same end.— The use of ardent spirits, among all classes of citi­zens, and especially among the laboring classes, is as­tonishingly [Page 87] great and general, throughout the United States. No country in the world, in all probability, consumes an equal quantity, in proportion to its po­pulation. In vain has the eloquence of the most en­lightened physicians and moralists been exerted against them, for centuries: governments constitute it the interest of individuals to prepare and circulate them; they withhold from men that knowledge which would teach them to shun, or elevate them above the use of, intoxicating liquors; and prejudices are excited and fostered in their favor, that the igno­rant and depraved, to whom they form a congenial gratification, may continue to consume them; to the destruction of morals, the emolument of distillers, and the augmentation of the revenue. As they are more easily and cheaply obtained in America, than in Eu­rope; as the wages of laborers are more considerable here, than there, and therefore permit them greater indulgences; as there is every encouragement from example; and as a fiercer sun, according to common notions, justifies a more prodigal use of them; it is naturally supposeable that the emigrants of the la­boring class indulged in them, to an unusual degree. Unquestionably, the use of intoxicating liquors was highly pernicious to those most accustomed to them; to those not so habituated, it was, as unquestionably, still more pernicious. In Philadelphia in 1793, when the fever was prevalent, Dr. Rush remarks that—‘a plentiful meal, and a few extra glasses of wine, sel­dom failed of exciting the fever.’ With us the disease was less ferocious and less active; but, as if no means of causing it to become more so were to be neglected, an idea was, most unhappily circulated —and, it should seem, was countenanced by persons bearing the title of physicians,—that free living, the plentiful use of vinous and ardent liquors, was a pow­erful [Page 88] preventative of the fever. The dreadful con­sequences which a belief of this sort produced, were numerous, and shocking to the last degree. The fear of death, so active in ignorant minds, when once aroused; idleness, the parent of every vice, and list­lessness, the consequence of want of employment▪ all conspired, with this pernicious doctrine, to effect the ruin of numbers. Never, I believe, was drunkeness so common. Not a day passed that I did not meet per­sons reeling through the streets, or stretched on the pavement—sometimes in the noon-day sun, unshel­tered, and sometimes exposed to the heaviest rains. I have seen three men, lying in this condition, in one little street. These were all, as you may suppose, among the most depraved of our poor; and most of them were foreigners.

Is it possible that conduct such as this should fail of giving new activity to every other cause of disease?

V. I have, in a former letter, given you some ac­count of the condition of that part of the town, where the Fever most prevailed; it is now to be no­ticed that it is in that district that the greatest num­ber of the poor, especially the emigrant poor, reside. In those numerous miserable dwellings, were these wretched people crowded together; many families in one house; and not infrequently many families of different nations. In some instances, a single room in one of those half-under-ground huts, served as bed­room, kitchen and shop, to a whole family; while underneath them, a cellar, half filled with mud and water, sent up its pestilential steams; and under their window, a yard in the same condition, was rendered still more noxious, by receiving the offals cast out from every part of the house.

[Page 89]VI. But, if the sordid and almost unavoidable fil­thiness of their dwellings were promotive of the dis­ease, under which the wretched inhabitants lan­guished or suffered, still more so, in some instances, must have been their inattention to personal cleanli­ness.

It was well remarked, formerly, by a foreigner, of the English ladies, and is applicable, with but little de­duction to our own fair country-women,—That they were whited sepulchres; beauteous and clean, without; but within—You know the rest.—

Were our country-women disciples of Zoroaster, they could not more studiously hold sacred the ele­ment of water.—How many of those house-wives, how many of those maidens, the cleanliness of whose houses, and the neatness of whose apparel, we often have occasion to admire and commend, think you, have applied to any other parts of their persons, than their hands and faces, this purifying element?^*—The infrequency of bathing among both sexes and all conditions, especially among females and the poor, in America, is surprizing.—In this respect, the emi­grant poor are in no wise more commendable; and, in every other kind of cleanliness, still more back­ward. The French, alone, exhibit a laudable con­duct, in every grade of life, as personal ablution is re­garded.

[Page 90]To every physician, who knows the importance of cleanliness to health, and how rigid an attention to it is necessary, in Fevers, especially in those which are called malignant, it is useless to insist on the con­sequences of negligence in this particular.

I shall conclude this letter with a few remarks, which the subject naturally inspires.

The preceding statement is strictly applicable, in all its extent, to great numbers of those who were sick of the Fever of 1795. Your own mind will sug­gest to you that there must have been many excep­tions; and, likewise, among whom those exceptions were to be found.

You will learn, from it, that circumstances un­friendly to foreigners were more numerous and for­cible, in more instances, than to natives; and will perceive, at the same time, what is appropriate to each, and what common to all.

It will, further, be evident, that, though some of these causes may have been sufficient, singly, to create a predisposition to disease,—and probably did, in some instances, create it; yet, that predisposition must have been more considerable, and the disease which followed more severe, in proportion to the combination of two, or more, of them.

It now remains to take a comprehensive view of the results furnished to us by this letter, in connection with the two immediately preceding it; but this I shall defer to another opportunity.

LETTER FIFTH. Recapitulation of Facts, and an Opinion concerning the Origin of the Fever of 1795.

FROM the statements contained in the proceeding letters it appears, that the Fever of 1795 was most active in

SITUATIONS—where—

There was the least chance for free ventilation;

Where the sun exerted the greatest and longest influ­ence;

• there was the least drain for water and filth;
• the rains which fell stagnated;
• there were, constantly, stagnant pools;
• the streets narrow, crooked, unpaved;
• the houses partly under-ground, wooden, de­cayed or slight;
• there were considerable collections of vegeta­ble and animal matters suffered to re­main and putrify; and
• where the exhalations from the sewers and docks extended:—

The fever first appeared and continued to be mor­tal in a SEASON—

• which was unusually sultry and wet;
• throughout which esculent vegetables were scanty and poor;
• [Page 92]meats tended rapidly to putrefaction, and were often consumed in a state of inci­pient putrescency;—

During which—

• Insects were very numerous and nox­ious;
• there was scarcely any thunder and lightning;
• there were several violent and sudden alternations of heat and cold; and
• the city was, in the evening, often im­mersed in a very peculiar and per­nicious fog:—

The Fever proved most fatal—

• to the poor;
• to emigrants more than natives;
• to the emigrant poor most of all;—and they—
• lived in situations, mostly, such as above-men­tioned;
• were, often, crowded together, in such houses;
• mingled, without distinction of nation, climate and habits;
• changed a mild vegetable, for an animal diet; perhaps a semi-putrid animal diet;
• were chiefly laborers in the open sun;
• were unusually intemperate; and
• were inexcusably inattentive to the cleanliness of their houses and persons.

Such are the facts:—what inferences would rea­son, unperverted by prejudice, interestedness, or ig­norance, deduce from them? How would she decide [Page 93] on the so-much-agitated question of domestic, or fo­reign, origin?—Were a rational being to see hundreds of men, women and children, removed from a tem­perate and equable climate, to a climate subject to the extremes of heat and cold, and to sudden and ex­cessive alternations of temperature; were he to observe this removal to take place in crowded, ill-provided, ships, which were a long time at sea, and whose ar­rival was at such a time as to subject them to the ri­gors of a winter, severe beyond their knowledge, and under all the inconveniences attendant on poverty, ignorance, and vice in a strange land—or to the terrors of a summer equally intolerable to them, from its inexperienced sultriness; were he to view them, af­ter sustaining, one, or more, such seasons, or immedi­ately, exposed to the influence of a season sultry and moist beyond the common course, in this new climate; should he learn that they exchanged oppression for li­centiousness, and, in some cases, found all their hopes illusory; that they substituted a scanty supply of wretched vegetables and a gluttonous use of semi-putrid, ill-cooked, meats, for a sparing consumption of mild and healthy vegetable food; that they were often persecuted by swarms of insects, whose bites raised swellings or caused ulcers, when, till now, they had been unaccustomed to any; should he see them indulging, habitually, in the use of intoxicat­ing liquors, to which many of them had hitherto been strangers; were he to find them dwelling in narrow, unpaved, sunken, and illy-ventilated streets, in which large collections of putrid matter were allowed to remain, where there were puddles of stagnant water, or open sewers, and in the neighborhoods of pools or docks, whose noxious qualities were heigh­tened by the admixture of putrefying vegetable and animal substances;—were he to discover the houses in which they dwelt, to be decayed or slight, and [Page 94] sometimes pervious to sun and rain,—in part, below the surface of the earth, and with yards equally low, and in the condition of the pools and docks above-mentioned; should he, on entering these habi­tations, find them mingled with emigrants from va­rious other climates, or with natives of that to which they had removed, equally debased, and perhaps still more so, than themselves—with people of discordant habits, colours, languages and countries,—and all, alike, inattentive to personal and household cleanli­ness;—I say, were a rational being to observe all this, and perceive all the circumstances, just enume­rated, to be concurrent, in respect to time, would he, think you, find it necessary to recur to the East or to the West-Indies, for causes of disease? Would he deem it of much importance whether a single man died on board this, or that, vessel? Or whether con­tagion might, or might not, be imported?—Would not these circumstances, of themselves, when viewed in connection with each other, and compared with the known and established laws of health and disease, impress on his mind, with all the force of intuition, a conviction of the domestic origin of the Fever of 1795? Is it possible that he should have any other opinion than that the causes, cure, and prevention, are equally local, and disconnected with the preva­lence or absence of similar diseases in other countries? But, certain as I feel that this must be the inevitable conclusion from a candid attention to the facts above-displayed, I am pleased to be able to declare that it is unnecessary to trust to their testimony, alone, for support to the opinion derived from their considera­tion.—No direct, no clear, evidence, ever has been, or can be, produced, in favor of the opinion that the Fever was imported.—I shall defer the attempt to substan­tiate this assertion, to a future opportunity; in the mean time, permit me once more to remark—That, [Page 95] though all the circumstances, enumerated in this let­ter, as concurring to produce the Fever, did, often­times, in reality concur, it is not to be supposed that they did so uniformly. So much is true, beyond dispute—A concurrence of the greater number of some, or other, of them, was observable in a vast majority of the cases of sickness. More than this was not necessary:—for, expose the most temperate and cleanly native, to the full influence of all the causes predisposing to this fever, beside those which his birth, cleanliness, and temperance, would disarm, and his chance for continued health must have been small; especially, after the additional aid which they, questionless, derived from great numbers of sick and dead, and from the reign of terror. The number of na­tives, of this description, who died, was very inconsi­derable; and, of those few, perhaps there was not an individual whose situation, constitution, or office, did not peculiarly expose him to the attacks of the Fever. To which may be added, the chance of his falling a sacrifice to an inert, or destructive practice.

LETTER SIXTH. On the Evidence of the Importation of the Fever of 1795.

‘No direct, no clear evidence ever has been, or can be produced, in favor of the opinion that the Fever was imported.’

The authority on which the advocates of importa­tion chiefly rest, for the support of their doctrine, is, as far as I can discover, the letter of the Health Com­mittee to the Governor, of the 8th of September [Page 96] 1795; or, more properly, on what is there reported to be the fact.—I shall quote, from this letter, the passage referred to.

‘On the 20th day of July, Doctor Malachi Treat, the late Health-Officer of this port, visited the brig Zephyr, from Port-au-Prince; on board of which he found three persons ill of fever, and the corpse of one who died that morning. The Doctor calls the Fever, in his report, a Bilious-remitting Fever. The brig was ordered to ride quarantine. On the 22d day of July, Dr. Treat was taken ill, and died on the 30th, of a fever marked by a yellow skin, hemorrhages, vomiting of black matter, resembling coffee-grounds, and all such symptoms as charac­terize bilious fevers of the malignant kind.—On the 25th day of July, four persons, from on board the ship William, from Liverpool, which arrived here several weeks before (all the crew having, previous to that day, and during the voyage, been perfectly healthy) were taken ill of Fever, attended with similar symptoms; and all died within seven days.’

‘This ship lay at a wharf at the foot of Dover-street, in the south-easterly ^* part of this city, which lies exceedingly low, is much of it made-ground, has an eastern exposure, and (from the streets hav­ing been raised, about three years ago, which threw the lots and yards into hollows of considerable depth) is almost unavoidably liable to great collec­tions of offal, and filth of all kinds; is a part of the town very much crowded by poor inhabitants, and contains a great number of lodging-houses, in which seamen and strangers of the poorer class, com­monly [Page 97] reside; and ever has suffered most from the regular autumnal diseases, as well as from any new and uncommon complaint. From all which cir­cumstances, we entertain no doubt but that the seamen of the ship William contracted the disease, of which they died, here, and did not introduce it into the city.’

‘A little before, and immediately after, the attack of the seamen of the ship William, which first called the attention of this Committee, several other persons, in Water and Front-streets, and in the neighborhood of Dover-street, were seized with fever, which, especially in those cases which proved mortal, was marked by severe vomitings, a yellow skin, hemorrhagy, and, in some cases, a vomiting a black matter, resembling coffee-grounds,—and which generally terminated within seven days, and proved fatal to more, in proportion to the number seized, than is usual in the ordinary complaints of the season, in this city.’

Two remarks of considerable importance are natu­rally suggested by a careful examination of the above quotation: First, that the Committee appear to have supposed Dr. Treat, alone, to have received the dis­ease of which he died, from the Zephyr; and, se­condly, that they have, in some sort, admitted the possibility of such a disease as the Fever of 1795, originating here, in their statement of the circum­stances relative to the ship William. It is true that they are inexplicit, in both instances; and the only absolute conclusion which we are justified in deduc­ing from what they say is, that the disease was not introduced into this city by the ship William. This, however, narrows the ground of controversy, consi­derably; for no vessels beside the William and the [Page] Zephyr, as far as I can learn, have ever been suspected of introducing any disease, of this kind, into this city. It is necessary, therefore, only to disprove the asser­tion, in respect to the Zephyr, and the whole founda­tion of the doctrine of importation is destroyed.— But, even were we to admit that Dr. Treat did actu­ally derive the fever of which he died, from the Ze­phyr, as no other person is known to have been in­fected by that vessel, and as the doctor communi­cated it to no person, the advocates for importation would not be greatly benefited by our concession. But, no such concession is necessary. The following papers, copies of which I am kindly permitted to transmit to you, appear to me, to establish it, beyond contradiction, that neither Dr. Treat, nor any other person, contracted a Fever, such as prevailed in New-York, in 1795, from any sick, or dead, man, or any thing else, connected with the vessel in question.

OF the undoubted veracity of Captain Bird I am assured by Dr. Dingley, who is personally acquainted with him, and attended him, at the time, for the dysentery mentioned in the deposition. The opinion, therefore, that the Yellow Fever, or a contagious disease, was brought into the city, last year, by the brig Zephyr, seems wholly unsupported by evidence. Neither is it necessary that any imputation should rest on the memory of Dr. Treat. He saw the mariners after they had been long affected by the Fever and ague, and perhaps with some fever upon them at the time; and from the yellowness of the skin, common to the ad­vanced state of that disease, especially in hot climates, might be easily induced to suppose it a remittent. This, however, is mere conjecture, and not necessary to be admitted, since the fact of the men having been sick seventeen days, previous to their embarking for our coast, is ample proof that their could not have been affected by the fever which prevailed and was [Page 101] so mortal, here.—Indeed, the whole testimony in favor of the idea of importation, is too loose and slight to build any rational opinion upon. The very words of the Committee are calculated to strengthen a con­trary opinion, if rightly considered; for they not only countenance the idea that the people of the ship Wil­liam became sick from the unhealthiness of the place where they dwelt, but, also, that the Fever had made its appearance, in various other of the neighboring houses and streets, previous to their being seized with it. And what confirms the truth of this opinion is, that persons were taken with the distemper, about this time, in other parts of the city, who had no connection with the brig Zephyr, nor with any other vessel, and whose illness may be satisfactorily ac­counted for from their situation, in other respects. An instance of this kind fell under my own observa­tion, the last of July; several similar cases have been related to me; and one, if I am not misinformed, occurred in the New-York Alms-house, where the disease was distinctly marked, before Dr. Treat's ill­ness.—The following statement of facts, too, will convince every candid mind, that we ought to look at home, for the cause of this Fever.

The ship Connecticut came to Fitch's wharf, about the 20th of July—I think it was on the 21st: she had just arrived from some part of England, and the people were perfectly healthy. No vessel suspected of being infected, came to this wharf, during the season; though the ship William lay at the next wharf, at the distance of about two hundred feet,—and Mr. Fitch gives the most positive assuran­ces that all the articles in his store, at this time, were in good condition. At this wharf the ship Connec­ticut continued till after the middle of August. The owner was employed about the ship, great part of [Page 102] the day; but ate and slept in an airy part of the town. The people of the ship either stayed on board, or at public houses near by.—On the evening of the 25th of July, the owner was seized with the fever; I saw him the 27th; he had good accommodations, was in a favorable part of the town, in the third story of the house, and recovered after an illness of about ten days, which was never very dangerous, though the attack was severe.—About this time, one of the mates, the steward, and two of the mariners, of the ship Con­necticut, were seized in the same way, and with the same symptoms, as the owner. They continued in the ship, or its neighborhood, and all died. I did not see them, but was informed, by the owner, that the mate, in particular, vomited large quantities of blood, and expired delirious.

Three persons, who were in Mr. Fitch's store, were taken sick, and two died, of the Fever. One sickened on the 26th of July, one on the 6th, and the other on the 9th of August. It was common for all these persons to sit ‘several hours, in the morn­ing, in the store, with empty stomachs,—inhaling the effluvia of the night.’

One of the first persons, who died of the Fever, was one ‘who lived at the head of the wharf, and had been confined for several months with a rheu­matic complaint.’

For the facts contained in the two last paragraphs, I am indebted to a communication from Mr. Fitch to Dr. Dingley, which that gentleman has allowed me to make use of on this occasion. The account which it contains of the condition of the wharves in his neighborhood, adds new force to the other testimony in favor of the opinion that the Fever originated here; and is too much to the purpose to be omitted. These are his words:—

[Page 103] ‘I am positive that the disorder has originated from local causes—because, it has appeared in this quarter, at the same season, for several years past: the cause why it has is, to me, mysterious; but what appears to me most probable is, the central situation, and the motion of the tides. The tide of flood sets directly into these wharves; col­lecting all the vapors and effluvia of the city.— The situation of the ground, between Water and Cherry-streets, is rendered noxious by raising Water-street, and confining the stagnant waters.— The emptying of tubs into the head of the docks, instead of the end of the wharves, although not peculiar to this part of the city, is a horrible nui­sance; particularly in time of sickness.—The pon­ding of water, by running a bulk-head athwart a dock, and leaving the vacancy for years, to be filled up with every species of filth and putridity, is an object worth your attention.’

A confirmation of the facts, and some of the opi­nions, contained in this extract, may be found in a very singular epistle from the late Dr. W^m. Pitt Smith, to Dr. Duffield sen. of Philadelphia, dated Septem­ber 1st, 1795; which I presume you have seen and are possessed of.

On the whole, though I am not prepared to main­tain that infectious diseases, and the Yellow Fever among others, may not be, and have not been, im­ported, and thus spread over parts of our country, yet this is the most that can be allowed to the coun­tenancers of the doctrine. For, after all, the testi­mony of numerous facts furnishes clear, indubitable, and decisive evidence, that other and peculiar cir­cumstances must concur with such importation, to [Page 104] effect any general distribution, circulation, or influ­ence of the disease. Frequent instances have occurred, nay do occur every year, of persons returning, from the West-Indies, sick with the Yellow Fever; lan­guishing, for some time, in the houses of their pa­rents, or friends; recovering, or dying; attended by numbers, during their illness; their very clothes, where they have died, afterwards worn by their re­lations; and yet no ill effects following therefrom.— While I resided at Wethersfield, in Connecticut, I had opportunity of obtaining precise information of several such cases; and it is a well-established fact, in many instances during our Fever, and especially dur­ing that of Philadelphia, in 1793.

The whole, therefore, that can be granted, or ought to be assumed by those who maintain the dis­ease which prevailed in New-York in 1795, to have been imported is,—That infection may be brought into any place (and therefore into this city) from abroad; that, under certain circumstances of the place, where it is introduced, it becomes very active and destructive; but that, when these circumstances do not exist, however the person immediately af­fected,—if it be introduced by a sick person—may suffer, it is harmless, so far as the general health of that place is concerned.—If the subject were viewed in this light, as most assuredly it ought to be, the question of importation, or non-importation, would sink into it's merited insignificance; the efficient cause, the causa fine qua non, of such Fevers, would be clearly discerned as depending on local circum­stances, capable of being wholly changed; the abso­lute madness of further delay, in effecting such a change, would be distinctly and deeply felt; a becom­ing spirit would animate the citizens; and suitable exertions speedily place us beyond the possibility of [Page 105] being subjected to a misfortune, similar to that which has been already sustained. For it is inconceivable that the nature and extent of the evil should be un­derstood, and the remedy not be applied: and a comparatively slight and temporaly sacrifice of pro­perty, would render this city, in reality, what the mistaken policy, or pride, of some of its inhabitants now falsely represent it,—as healthy as any in the world; and leave nothing to fear, either from the Fevers of the Indies, or the Plague of the Levant.—But, while people continue to foster a ridiculous vanity, con­cerning the city in which they reside; while they fear that its reputation will be wounded, by permitting an idea to get abroad, that it is unhealthy; while those engaged in commerce cherish the error, from an apprehension that their interests would suffer from a disclosure of the truth; while men, invested with the sacred character of physicians, countenance false opinions, either through ignorance, a reprehensible ti­midity, or that they may gather undeserved popularity and wealth; and while the magistracy are more actuated by a mean regard for offices dependent on popular opi­nion, and maintained by a compliance with it, at all hazards, than by a just and enlightened zeal for the safety and happiness of their fellow-citizens; Truth may be spoken, but there is no hope that it will be attended to. Considerations of supposed interest, so various and so forcible, take deep root in the minds of men who look only to the present moment, and are either incapable of comprehending the whole of a subject, or unwilling to bestow on it the necessary consideration. Thus circumstanced, they strive to banish from others, and to smother in their own breasts, those convictions which irresistible evidence forces upon them: as if it were possible that truth could be noxious.—Nothing can be more melancho­ly than to observe this wilful blindness, this obsti­nate persistency in error, the consequences of which [Page 106] have been so dreadful already, and threaten to be still more so hereafter.—Were it possible to impress the truth vividly on the minds of the great body of citizens; to rouze men into action; to excite a generous disregard for temporary advantages, and a lively interest for the future welfare of themselves and their posterity; a few weeks might enable us to bid defiance to death, in many of the forms in which he now assails us.

LETTER SEVENTH. Was the Fever of 1795 an Epidemic? Was it Con­tagious?

HAVING determined, to my own satisfaction at least, what were the remote or predisposing causes of the Fever of 1795, I might now proceed to a description of the disease itself, were it not proper to take some notice of two questions, which have been considera­tion agitated, viz. Whether the Fever was, as the Health Committee term it, an Epidemic?—And, as some suppose, Contagious?—On both these questions, I shall deliver my opinion, in as succinct a manner as the subject will permit.

Was the Fever epidemic?—A principal difficulty oc­curs in the very outset of this enquiry; for different writers have made use of the term Epidemic, diffe­rently; some giving it a general, others a more particu­lar and precise signification. Thus Van Swieten, in his Commentary on the 1380th Aphorism of Boerhaave, places epidemic in contradistinction to endemic; while Cleghorn, a writer of deserved authority, in the In­troduction to his Observations on the Diseases, &c. [Page 107] of Minorca, p. 74. constitutes a class of endemic dis­eases, which he divides into epidemic and sporadic.— Examples of like dissimilarities, in the use of these words, are frequently to be met with, in authors of equal credit. And thus it may possibly happen, in the present instance, as on many former occasions, that the whole contention arises from different con­ceptions of the import of a particular word.—But our business is rather with facts, than with definitions; I shall state to you, therefore, what appears to me to have been the truth; and, perhaps, in the conclusion of my statement, a definition will be found.

In the first place, every person conversant with the practice of physic in New-York, knows that a Fever, generally of the remittent or continued kind, and va­riously denominated by medical writers, prevails in this city, to a greater or less degree, every year; per­haps I may say throughout the year—but, certainly, in every part of it, except the winter, and particularly from July to December: its greatest height being in the months of August, September and October. The violence of this disease is increased or diminished by constitutional peculiarities, and by the particular situ­ation of the patient in respect to air, temperature, &c. &c. Its universality, likewise, may be considered as dependent, in a degree, on the same causes.—Cir­cumstances, peculiar to some situations or individuals, occasion it to prove mortal, with high marks of ma­lignity, in certain instances, almost every year. That an extension of these peculiarities, so as to make them common to the citizens generally, would pro­duce the same effects on the many, as on the few, seems hardly controvertible. Now, this appears, to me, to have been the case, the last year; and I have no doubt of the identity of the Fever which then raged here, with that which has prevailed here in [Page] former years; and consider it only as a higher grade of the same disease.—Compare the history of Fevers, in Sheffield, with that of Fevers in New-York.—We have a Fever, every year, at a particular season, usu­ally called the bilious-remitting Fever: in Sheffield, at the same season, a Fever prevails, called the inter­mitting Fever. This last evidently depends on the peculiarities of Sheffield—such as its ponds, marshes, &c.—So, in my opinion, does the former arise from the peculiarities of New-York.—The season of 1795 was a remarkable one: Was there any apparent change in the Fever of Sheffield? Yes: the symp­toms were remarkably heightened; some new ap­pearances were observable; and the disease astonish­ingly obstinate. And was not this, also, true of New-York? Who will venture to deny it?—Were either of these Fevers propagated to other, or neighboring, places? No. You have certified this of the Fever in Sheffield; and I have heard of no instance of the kind, in relation to that of New-York. Both Fevers, then, were proper to the places in which they prevailed; and the inference which it would be natural to deduce from this is, that both were endemic, and not epidemic: for the term epidemic seems to include in it the ca­pability of diffusion or propagation, without respect to the situation and constitution of the patient; which the term endemic certainly does not. But, which­ever of these titles may be regarded as most appropri­ate, the fact will not be varied by the use of either; and that you will understand to be, according to my belief, as above-stated. That the Fever of 1795 was no other than a higher grade of that which prevails here, in the same season, every year; deriving its se­verity entirely from the peculiarities of the season, &c. as related, at large, in the preceding letters.

[Page] Was the Fever contagious? Concerning the answer to be made to this, as well as to the former question, there has been some dispute; but, in this case, as in that, as much difficulty has arisen in settling the im­port of the phraseology, as in determining the fact.

If by the question it is meant to inquire, whether the well became affected with the Fever, in conse­quence of the contact of a sick person, or the cloath­ing of a sick person, or from the performance of the offices of friendship, charity, and meniality, to those who were sick,—I answer that no such cases have come to my knowledge; whereas numerous instances of such contact fell under my observation, and have been related to me, to which no ill effects succeeded.

A number of persons, not less than ten or twelve, removed, with the Fever on them, from New-York to Stamford, 40 miles; but no person in Stamford, beside them, ever had the disorder.

Mr. Fitch, the gentleman mentioned in the pre­ceding letter, attended the young men who had the disease with him, and to use his own words, ‘lodged in the bed, warm with the effluvia of the body of the young man who died at his house’—and ne­vertheless, he had no Fever.

Dr. Treat, according to the account of the Health-Committee, and of his physicians, died of the very worst degree of the Fever; yet he communicated it to nobody.

A patient of Dr. Dingley's, in Ferry-street, who was seized with the disease, without any previous communication with any sick person, and as early as the 17th of August, and who died with it, commu­nicated it to none of his attendants. And the same is true of several other patients of the same gentle­man.

[Page]The writer of some ingenious strictures on Dr. Mitchill's Pamphlet, remarks, in a note subjoined to his first paper, that he has, ‘in common with many of his fellow-practitioners, indulged, without the smallest ill effect, a much more frequent intercourse with his patients, in this disease, than usual,’ &c. And the Doctor himself, though he admits the possibility of such fevers becoming contagious, or being propagated by contact, &c. expressly denies the Fever of 1795 to have been so.

But there would be no end to an enumeration of similar facts; I shall only add, therefore, that I made use of no precaution whatever, in respect to such com­munication with patients; that I have been, for more than two hours, shut up in a small room, with a per­son laboring under the worst symptoms of the Fever; have watched several nights, and performed the most servile offices, with a near friend, who was sick with it; and never sustained the least inconvenience from such exposures^*.

But, perhaps the advocates for the Contagious, or Infectious, nature of the disease under consideration, do not intend to confine the meaning of the term Con­tagion to that substance, whatever it is, which is ge­nerated in an unhealthy body, and by application to a sound body, excites in it a similar unhealthiness. They may mean to describe, or designate, by it, that structure, constitution, or vice, of the atmosphere, which disposes to, or excites disease. If so, they are in fault—for they employ the same term to desig­nate two different facts.—But let us not dispute [Page 111] about words. Perhaps, the following statement of my opinions, will lead us to the formation or attain­ment of some more accurate notions on this point.

Owing to a variety of causes, which have been enumerated in the course of these letters, I suppose the atmosphere of New-York to have become vi­tiated, in 1795, to an uncommon degree: that there was either an unusual absence of that principle neces­sary to support healthy life, or an extraordinary con­centration, diffusion, or quantity, of some other, un­friendly to healthy life. From the operation of one, or other, of these states of the atmosphere, and of the causes above-mentioned, on the bodies of the residents in this city, I suppose a predisposition, greater or less, according to the situation and other circumstances of individuals, was formed, in the citi­zens, generally, to the Fever which prevailed here that year. With some persons, this condition of the atmosphere, of itself, might be sufficient to produce in them disease. But, ordinarily, I believe, the aid of some cause, which should disturb the regularity of the distributions, or functions, of the body, was re­quired to bring the system into a state of febrile ac­tion. Such, for instance, as intemperance in eating or drinking, sudden fright, fatigue, or indeed, any considerable irregularity in what Systematics call the Non-Naturals.

This condition of the atmosphere, I suppose, ac­quired strength, daily, as the season advanced; or, in other words, the power of the atmosphere, &c. to predispose to the Fever, was increased, as the season progressed. I say to predispose,—for I suspect it sel­dom, of itself, produced the disease, after that had at­tained its height, in those who remained here con­stantly. [Page] Though, on persons coming into the city, from abroad, it doubtless operated with much greater force, in many cases, than on the citizens, at any time. This is easily accounted for, from the known effects of custom. For

The systems of those who continued here became habituated to the atmosphere; and while those who came here from the country, with ruddy faces, sunk down in death, the pale and yellow beings who stalked through our streets, derided disease, and pursued their customary occupations.—But, to return from this di­gression.

Not only am I convinced of the accuracy of the preceding ideas, but I have no doubt that this vice of the atmosphere was rendered still greater by exhala­tions from the bodies of the sick—It is a point well-established in medicine, that the air of a room is rendered unsuitable for respiration, if a num­ber of healthy persons are obliged to breathe it over several times, without the admission of fresh air from abroad. So injurious is such a confinement, in re­spect to air, to the human body, that it has, in nume­rous instances, produced terrible febrile diseases. And if such effects arise from the repeated breathing over the same, or nearly the same, air, by healthy persons, we should naturally conclude, as is the fact, that such repeated respiration (especially when united with the constant exhalation from their bodies) by the sick, must be still more pernicious to health.—You will pardon me for the introduction of remarks so trite and familiar, for the sake of the use I wish to make of them; which is no other than this—I have mention­ed [Page 113] it as my belief that the state of the atmosphere was such, in this city, the last year, as, in conjunction with the general influence of the causes producing that state, to predispose to, and, in some instances, pro­duce, the Fever; and that this ill-conditioned atmos­phere was rendered still more noxious by means of the numbers who became sick, in the course of the season; and to this I would add, for the reasons con­tained in the remarks above, that I think it not im­probable that some were affected with the Fever, in consequence of the further vitiation of the atmosphere by the sick, who, without that circumstance, would have remained free from disease. So, likewise, there may be persons, the balance of whose health is so tre­mulously sensible to every external influence, as to preponderate to the side of disease, on the slightest impulse of its causes. With such, the mere contact of a sick person, or a transitory exposure to the efflu­via arising from a sick body, may be sufficient to pro­duce Fever; and instances of this kind may have hap­pened, in the course of the Fever in question. Such cases, however, must have been extremely rare, if there were any; and no one has ever come to my knowledge.—But, with regard to Fevers produced by such a state of the air, as above-described, even when aided by the mixture of human effluvia, arising from sick bodies,—if these are to be called Contagious di­seases, and the cause which excited them Contagion, so, likewise, may all other Fevers on the same principle, continued, remitting, intermitting, Fevers,—be called Contagious, and their causes, as marsh miasmata, &c, Contagion.—Now, to such a use of terms I have not the least objection, provided the person who employs them, be uniform and explicit in his application of them.

[Page 114]To conclude,—If, in speaking of the Fever of 1795, the epithet Contagious is meant to express that it was communicated by contact, &c. like the Small­pox, Meazles and Plague, I must repeat it, I find no good reason for admitting this to have been the fact; but, for the reasons before alledged, I think there is just ground for a belief that the Fever was never ex­cited in this way. But if, on the other hand, the term Contagion be meant to convey an idea of the in­fluence of the atmosphere to predispose to, or pro­duce, disease,—whether that influence arise from the abstraction, or addition, of a principle, or be distinct from human effluvia, or combined with them—there appears no reason for denying the Fever of 1795 to have been Contagious.—Still, as the term Contagion is not generally used in a sense to restricted, as in this second instance, but is often employed by the same writer, to express both the cause of the disease com­municated by contact, &c. and of that produced by the influence of the atmosphere, there seems to be a pro­priety in rejecting it altogether, in the present instance, or at least in confining the use of it, to designate a single mode of producing disease; and, according as it is applied in the former or latter instance, the Fe­ver of 1795 may be denominated Contagious, or the reverse.

I have now gone through with the consideration of all the subjects, preliminary to an account of the dis­ease itself. In my next letter, I shall lay before you, the result of those scanty observations which I had opportunity to make.—Knowing the causes of their imperfections, you will not fail of extending your charitable indulgence to their author.

LETTER EIGHTH. Some Account of the Symptoms of the Fever of 1795.

AFTER the frequent confessions, which occur in the preceding letters, of the circumscribed sphere of my observation, it were presumptuous in me to pre­tend to deliver a regular history of the symptoms of the Fever of 1795. You will observe, from the ac­count which I shall transmit to you, that the appear­ances it exhibited were too various to authorize such an attempt in any one who had not opportunity to ex­amine them, in relation to numbers of the sick. It is proper, therefore, that I warn you, once more, to consider what is here delivered as the result of my own observation only—except where it is expressly mentioned to be otherwise.

The Fever of 1795 was, generally, sudden in its access; so much so, in some instances, as to resemble convulsions. In a less number of cases, it came on gradually, and after a slowly-increasing illness of several days. It began with great pain of the head, heat and redness of the face, and fullness and redness of the eyes, accompanied by a strong, full, tense, pulse, and an almost universal costiveness. Pains in the back and limbs were common; but not as much so as of the head. A great inquietude, or anxiety, of the stomach and breast, was common; approaching, sometimes, to syncope, and sometimes a vomiting, which soon ceased, or continued, at in­tervals, through the disorder.—The Fever which now commenced was rarely ushered in by a chill, and con­tinued [Page] for a greater or lesser period, according to circumstances, with so many varieties and combina­tions of symptoms, as to render it impossible to pursue a regular description. I shall, therefore, dispose my remarks under several heads; preserving as much connection as circumstances will permit.

I. Though the pulse was generally full, strong, and tense, in the beginning of the Fever, it was not always so. It was sometimes weak and low, but still tense—if it be proper to use this term, to point out a condition of the pulse, as it appears to me, wholly peculiar to this Fever. I well remember that, in a youth of 12, or 13, years of age, the pulse became much fuller after a plentiful bleeding; though he was of a feeble constitution, and had been slightly affected with the Fever once before.—In two gentlemen, who were considerably affected by the Fever, for several weeks, but not to such a degree as to be confined to their beds, this peculiar pulse was very distinguishable; as much so, I think, as in any other persons whose pulse I examined.

Hemorrhages, from various parts of the body, were frequent, especially in the advanced stage of the disease, and where it had been violent from the first. These were from the nose, fauces, especially the gums, from punctures made in bloodletting, and from the stomach: I saw no other. Bleeding from the nose and fauces often occurred in the beginning of the disease, and was removable by the general reme­dies. Bleedings from the punctures made in blood­letting, were seen in the close of the disease, and were restrained with the greatest difficulty. I recollect to have been constantly engaged in an attempt to re­strain such a hemorrhage, in company with another physician, two of the most melancholy hours I ever [Page] experienced. Hemorrhagy from the stomach I shall mention more particularly hereafter.

II. Symptoms of pulmonic affection were not un­common; though I do not recollect to have observed them till the last of September, or beginning of Oc­tober. They sometimes rose nearly to the height of pneumonia.

Hiccough was a troublesome symptom, and often accompanied vomiting; and there was sometimes, as it appeared to me, a mingled hiccoughing and belch­ing.

III. The marks of congestion in the brain were too numerous and unequivocal to be mistaken.—A vio­lent pain in the head was one of the earliest, most constant, and most distressing, symptoms of this dis­ease—Coma was a very frequent symptom; and, as I thought, in proportion to the severity of the disor­der. Towards the close, it amounted almost to total stupefaction; it being scarcely possible to rouse the patient. Some degree of delirium was common; par­ticularly at the commencement of an exacerbation of the Fever; manifesting itself in the hurried manner in which the patient performed any action, and in the rambling manner in which he conversed. That kind of delirium which some have called light-headedness, was remarkably present, in one person, at the close of his disorder. He often started up, wildly, without any apparent object, then lay down, and commenced singing, in an interrupted, incoherent manner; but without any violence. And the day before his death, he continued to sing, with slight intervals, more than an hour.—At other times, he would fix on some par­ticular words, and repeat them over and over; some­times, with no appearance of emotion; at others, [Page] with some glimmering of consciousness.—In another person, a patient of a physician of my acquaintance, the affection of the brain was like that in Phrenitis. A blistering-plaster applied, if I remember accurately, for 24 hours, to the head, which had been shaven, excited no vessication, and scarcely any redness, though twice the usual quantity of cantharides was incorporated, and the patient was of a delicate ha­bit. In this case the affection of the brain took place on the third day, and the patient died on the fifth or sixth.—On examination and dissection of the contents of the cranium, all the membranes, and the very sub­stance of the brain, were discovered to be in a remark­able and uncommon state of inflammation.—I have been the more particular in relating this case, as it seems to contradict, in a degree, the ideas of Dr. Rush, p. 50, of his History of the Philadelphia Fever: our season having been unusually wet.

As connected with the state of the brain, it may be proper to mention here, that the eyes were often suf­fused, the whites of them tinged with yellow, and the small vessels turgid with blood. In some patients they had an expression of singular wildness; while, in others, there was a remarkable vacuity, or absence of expression.—I saw no instance of squinting; nor ob­served any uncommon state of the pupil: but I ought to acknowledge that my attention was not particularly directed to the condition of the eyes, in this respect.

The state of the mind was very variable. Some were exceedingly impatient and irascible; others, astonishingly obstinate; and this particularly, when, as was often the case, there was a loss of memory, or some degree of mania. A strong appeal to their good-sense, calling them by name, seemed to effect a tem­porary restoration of their docility and recollection,— [Page] which were soon lost.—Many were very confident, at first, supposing their illness not be the Fever; but gave themselves up to despair, immediately on being convinced that it was the Fever. Many were full of dreadful apprehensions, from the first; and often­times, exceedingly aggravated what would have been, otherwise, a slight disease. A few, were calm, col­lected, undaunted, throughout their sickness. And here it may not be unseasonable to remark, that these same varieties were, in a degree, observable in those who continued well. Some physicians thought they could discern a tendency, among the citizens, gene­rally, to mania. It is certain that fear was a terrible evil, and frequently proved the exciting cause of the Fever.

IV. I have remarked that a great anxiety at the sto­mach was sometimes felt, on the patient's being first seiz­ed with the Fever. This anxiety, it may now be added, in some cases, extended through the complaint; but was most distressing when the Fever was most violent. A great sense of soreness was often complained of, when any thing was taken into the stomach, as if it were raw;—to use the words of one in whom it was ob­served. In some, the sensibility of this organ was so excessive as to make it almost impossible to administer, either food or medicine, by the mouth.

Patients were often afflicted with extreme pain in the bowels; but more resembling that in dysentery, than in cholic. A discharge, generally, afforded a present relief.

Flatulency, both of the stomach and bowels, was almost universal, and to an extraordinary degree.— The abdomen was sometimes distended with wind; [Page 119] but the distension subsided after a conderable dis­charge of wind, downwards. This was often the case in one of my patients.

Several dissections, as I am informed by the gen­tleman principally concerned in them, shew the sto­mach to have been in a remarkable state of inflamma­tion and excoriation. It appears to me that this dis­ease of the stomach, or inflammation—(if it be pro­per to call it so) extended through the whole length of the Alimentary Canal; as it is known to do in Apthae and some other disorders; for one case of excoriation and partial mortification of the Rectum came within my knowlege, and I have heard of several others.

I have mentioned, above, that Costiveness was al­most universal at the commencement of the Fever; but it was not always present. For though it was observable in the greater number of patients, so much so as to deserve to be ranked among the cha­racteristic signs of the disease; and though a constant tendency to a costive state, was general in those sick with the disorder; yet, in some, the Fever was at­tended from the first, or for a while, by a Diarrhea; and in one instance, the whole of the Disease ap­peared to me to be turned upon the bowels, and to be converted into, or assume the form of a Diar­rhea.

Some were seized with vomiting at the first, which was soon stopped, or ceased spontaneously, and ne­ver returned. One case of this kind, proved favora­ble—the patient recovering; another unfavorable, the patient dying.—In others, vomiting commenced the disease, and continued through it: while in others, again, it came on in the course, or at the [Page] close of the disorder; and this both in successful and unsuccessful cases.

V. The matters vomited up varied in colour and consistence, in different persons, and in different pe­riods of the disease. The most common was of a yellowish, greenish, or a muddy green and yellow, appearance, and very fluid. Vomitings of this kind, were seen both in those who recovered, and who died; and were both temporary and continued.— Next, in frequency, was that of a blackish appearance, commonly described as resembling coffee-grounds, but bearing a nearer resemblance to blood partly burnt, and diluted with muddy water. Several who had this vomiting recovered.—I never saw an instance of that tar-like vomit, which has been noticed by some writers. But, of all others, that which struck me as evidential of the greatest derangement of the stomach, was the vomiting up of, what appeared to be, thin blood, in which floated a flaky, filmy sub­stance, which I suppose to have been the villous coat of the stomach.—This I saw but in a single instance, a few hours before death. This discharge was fre­quent, though small; and accompanied by a large worm.

I cannot help thinking that the matters vomited up, except it be those of the yellowish or greenish cast, have all a portion of blood mingled with them; and that their various appearances depend—aside from their mixture with the contents of the sto­mach—in great measure, on the quantity of blood mingled with them. It appears to me that, in this disease, the secretion of the Bile is greatly affected; and that, in many instances, the blood itself passes into the biliary vessels, charged with the Bile, de­signed to have been separated, and being poured in­to [Page] the duodenum, and discharged by stool or vomit­ing, communicates the blackness observed in those evacuations. Beside this, as appears from dissection, and from the case just mentioned, the coats of the stomach itself are destroyed; and the numerous little vessels, which, in a healthy state, distill into it a limpid and colourless fluid, now are preternaturally distended, receive the blood, instead of lymph, and pour it, by their numerous orifices, into this organ. This effusion of blood may be supposed to increase, as the disease increases in violence, till, at length, the tender coats of the stomach are separated, and thrown up, mingled with pure blood.—If these ideas be just, it is clear that no vomiting can be more evidential of a fatal termination of the disease, than this; none can afford a more unequivocal sign to the physician, that his attention is no longer useful^*.

The discharges from the bowels were very dark, in general, even where no preparation of mercury was used. They were, likewise, in most cases, re­markably fluid, where the bowels had been once. [...] [Page 122] thoroughly, opened; and, where the purgatives were brisk, and in all severe cases, excessively offensive.— They were, sometimes, of a dark, shining appearance, somewhat like molasses, melted pitch, or black-lead. But I have seen stools of this colour, in other dis­eases—particularly once in the Croup—where calo­mel was frequently used as a purge.—I mention this, as it may sometimes happen, that physicians deceive themselves, in such cases, ascribing that to the disor­der, which depends on medicines.

Some were troubled, with a retention of urine; but, more generally, with an unusual flow; and this in one instance, I distinctly recollect, where the quan­tity of fluids taken into the body, was very small.

In respect to sweating, I discovered nothing uni­form. In one case, the patient always had a profuse, clammy, sweat, when he fell into a restless sleep, with a rise of fever. This was often observable, likewise, in that state of remarkable anxiety which frequently preceded an evacuation by stool.

Blood drawn in this Fever, was remarkably want­ing in floridity; and this was especially true of that which was evacuated in the close of the disease— whether by art, or spontaneous effusion. In one in­stance it seemed endowed with a caustic quality, and affected a lancet so as to leave a permanent inequality and discolouration of its surface.

VI. Sleep, for the most part, appeared unnatural and unrefreshing; attended by great restlessness; and sometimes by great mobility of the muscles, twitch­ing of the tendons, and frequent starting up. One of my patients often raised himself up, suddenly, out of bed, with every appearance of extraordinary ter­ror; [Page 123] but with no evident or clear consciousness of the act. In one person, I saw remarkable subsultus tendi­num.

There was great variety in muscular power, in dif­ferent persons. A man who died with the very worst symptoms of the Fever, the evening before his death, rose from his bed, ran down two flights of stairs, re­turned, and was only prevented from going down a second time by his nurse's having locked him in his chamber.—In another case, where the disease was mild, the patient felt perfectly easy and composed, and in full possession of mental and corporeal strength, while he lay on his bed; but, when he rose, and at­tempted to walk, a sense of universal anxiety was felt, his ideas became confused, his strength seemed to de­sert him, a sudden faintness came over him, and twice he sunk down, unable to proceed.

An evacuation, by stool, often suddenly restored the patient, who was lifted from bed, to such a degree of strength, that he continued for some time after, to walk about the room, or sit up.

VII. I noticed no uncommon sensibility to light but in a single case; and that was not of long dura­tion.

Hearing, in one instance, I observed to be unusually acute; but generally, it was much impaired; and, sometimes, seemed to be entirely lost. Perhaps this may account for the apparent loss of memory in some persons.

The taste was either exceedingly impaired, or very fickle. The same may be said of the appetite. When the appetite began to return, and food to be relished, [Page] the sick were very voracious, but not easily suited. They discovered no partiality for animal food. Thirst was moderate, in a few instances; but oftener exces­sive. I have seen Porter desired; but it was not often relished, when allowed. The same is true of coffee. Water was, universally, the most agreeable drink; and I allowed its free use. One of my patients fre­quently drank, in one night, when very feverish and restless, three quarts of water. The appearance of the tongue varied, according to the violence and du­ration of the disease, from white, to yellow, darkish, and black, like burnt blood; and the gums often as­sumed this last appearance, when there had been bleeding from them.

An astonishing insensibility to cold was nearly universal.—I remember, in one of those cold turns which we had in September, a remark [...]le instance of this. One of my patients occupied a chamber in the second story: the room was very large, extending the whole width of the house, and having a chimney, a large door, and two windows at either end. The bed was hard, in the middle of the room, the door and all the windows open, and he covered with a single sheet, frequently thrown off in his restlessness, yet he complained of no cold, while I was chilled through, though sheltered from the draught of air, with my usual cloaths on, and the addition of a sur­tout and double cloak.

VIII. Yellowness of the skin was not constantly present in this disease; at least, not in any remarkable degree. A tinge of it was common in the eyes and on the skin; but not stronger, in numerous instances, than in ordinary Fevers. Some were exceedingly yellow, even to being tawny—so that the bed and body linen were stained, both by the sweat and urine.

[Page]I saw eruptions but in a single instance. They re­sembled musketo bites so nearly, that, had I not been forewarned of this similarity by Dr. Rush, in his ac­count of the Philadelphia Fever, I should have mista­ken them, especially considering the numbers of these animals.—In this instance, the eruptions were on every part of the body; which had not been exposed to their ravages.

I have sometimes observed a coldness of the skin, on the body, generally, but especially of the feet, of which the patient was unconscious, while the face and breast were red and communicated a burning sensation to the touch.

IX. I have, hitherto, said nothing of the type of the Fever of 1795; and, in truth, it is a point on which I [...] wish to be silent, as, of all others, con­nected with the Fever, it is the one where my observa­tion is the least satisfactory. In its mildest form, the Fe­ver or pyrexia, appeared to me to be moderate and constant; without any evident or strongly-marked exacerbation: when severe, it fell in with Dr. Cul­len's idea of a Continued Fever, as stated in his First Lines § 27, more than with any other: but, in both cases, I could not determine that there was any regu­larity in the rise, or diminution of pyrexia; on the contrary, the remission (if it be proper to term it so) was more or less protracted, and the exacerbation sooner or later, moderate or severe, in proportion as the patient preserved a regular state of body and mind, or was irregular in these respects. For exam­ple—any sudden agitation of mind, as anger, pertur­bation, &c. and any irregularity of body, such as eat­ [...]ng improper food or too much food, drinking any stimulating drink, restlessness, too long detention of the faeces, &c. appeared to hurry on a return of all [Page 127] the violent symptoms; while, on the other hand, the sick never failed to get through the day with more ease to themselves, when no such excess, or irregula­rity, happened.

In one case which came under my care, and which various causes contributed to render the most inte­resting of any I attended, there were complete inter­missions, during a part of the disorder; but there was no kind of regularity, either in their commencement, or duration; and a slight excess, in any of the parti­culars mentioned in the preceeding paragraph, was sufficient to bring on a speedy and violent turn of Fever.

X. The period of convalescence, as well as of Fe­ver, was variable. In the former part of the time, and before the weather began to grow cool, patients sel­dom died after the tenth day—as far as I can learn; but their deaths took place on the 3d, 4th, 5th, 6th, 7th, rarely on the 8th, and still more rarely on the 9th day. After the cold weather appeared, they sometimes dropped off suddenly, and after having ex­hibited all the marks of convalescence, three weeks from the time of their seizure.—So, of those who re­covered, some regained their health with an elastic quickness; while others, were very slow in the ac­quisition of strength; were a long time troubled with great weakness in some of their joints, and oftenest the knees; and were afflicted by oedematous swellings of the feet, ancles, and legs.

You have now before you the result of my obser­vations, on the appearances of the Fever of 1795; and I shall conclude this letter by the simple men­tion [Page] of two facts, which will serve to confirm the doctrine of the great Sydenham, concerning the despotic nature of the reigning sickness.

The Meazles had begun to appear, when the Fe­wer came, and they disappeared; but no sooner was the Fever vanquished, than they returned more generally than ever, and have continued in this city ever since.^*

I cannot learn that any febrile disease was observ­ed in the city, while the Yellow-Fever was present. I saw only one instance of Intermitting-Fever in a lady, who contracted it in the country. It was slight, and was soon cured on her coming to town, by the usual remedies. Her residence in town, like­wise, was in a part to which the Yellow Fever never came. Beside this, I heard of one other instance, of a gentleman coming hither, from some other place, with the Fever and Ague; which was, also, cured by the usual means.

I shall proceed, in my next letter, to bring you ac­quainted with those means which were most success­ful in the removal of that disease which I have just described.

LETTER NINTH. Method of Cure, in the Fever of 1795.

IT was obvious, to the slightest observation, that the mildness, or severity, of the Fever of 1795, de­pended, in no small degree, on the situation of the [Page] patient. That those who lived in the higher, drier, cleaner, and more airy parts of the town, were more lightly affected; and that a removal, from the other quarters, into such as were so circumstanced, was al­ways followed by beneficial effects to the person re­moved. In consequence, a milder treatment, in every respect, especially a more sparing use of evacuations, was warrantable in some cases, than in others; and as some practitioners were chiefly employed among those whose favorable situations protected them from the most malignant attacks of the disease, you will readily conceive why there should prevail, in the minds of some, an opinion that very active remedies were unnecessary, and a recurrence to the lancet in­expedient, at least, if not pernicious. It is true that I did not always use it myself; but it is also true, that I never failed to regret the omission. And though I lost no patient by the neglect, yet I am convinced that, in every such case, however slight the disease might appear, the cure was protracted. But, if the remedies were not always the same, the principle on which they were administered, was uniform; and their operation the same in kind, if not in degree.— And, after the Fever became more general, and the season considerably advanced, there was but little choice left in the use of means. Positive and speedy relief was required; for to temporize, was to kill.— You will sufficiently comprehend, from these re­marks, how far the practice recommended below admitted of variety in the application; and I shall de­tain you no longer from the consideration of the par­ticular remedies, which are meant to be arranged nearly in the order of their comparative importance.

I. BLOOD-LETTING.—This was indicated by the severe pain, heat, and redness, of the head and countenance; by the redness, turgescence, [Page] and heaviness, of the eyes; by the oppression, pain, and anxiety, often observable at the breast; by the fullness, hardness, tensity, or oppressedness of the pulse—and equally by that slender, wiry, vermicular feeling which it sometimes had—commu­nicating an idea of approaching numbness to the finger which felt it.^*

The effects of bleeding were, in every instance where I had an opportunity of observing them, most salutary. The sick seldom failed of finding immedi­ate relief from it, and of perceiving that relief in­creased as the blood continued to flow. It diminished the pains in the head, breast, and stomach: oppres­sion, anxiety, faintness, and heat, were moderated: the eyes rarely failed to assume a clearer and more natural appearance: and it seemed to communicate a new energy to the system.—I remember an instance where a patient was so unable to assist himself, on the second day of the disease, that, when I wanted to bleed him, it required two persons to support him, in passing a few steps from his bed, into the open air.— There, he was seated and supported in a chair. He grew easier, in every respect, as the blood flowed.— After taking away about twenty ounces, and tying up his arm, he rose without assistance; walked seve­ral rods, to a Necessary; took care of himself; had a profuse evacuation, by which he seemed to gain addi­tional strength; and returned to his bed, without any aid, and with a firm step.

Such were the immediate effects of bleeding early in the disease. The importance of this remedy was not diminished by the duration of the disorder, nor [Page] the necessity for it lessened, while the symptoms con­tinued which made it useful in the commencement.— On the contrary, it was oftentimes as requisite, and as beneficial, the fifth and the sixth days, as on the first. But this necessity for its use, at so late a period, did not often occur, where it had been vigorously em­ployed, in connection with other remedies, at the first.

The following case, which I state briefly, is one among numbers, in evidence of the advantage of early, free, and repeated bleeding.

A physician was called to a young man, with all the symptoms of the disease—as it generally appeared at the first—in the evening. He bled him 16 or 18 ounces; directed purges, &c. in the manner hereaf­ter to be mentioned; and though the weather was then cool, ordered the windows to be removed, both day and night. The symptoms were relieved; but the next morning it was thought necessary to repeat the bleeding; which was done, to an equal quantity. The purges, &c. were also continued. In the even­ing, a third bleeding was performed, and a like quan­tity of blood was taken away; and the other reme­dies were continued. On the ninth day, from the seizure, the man was well, and able to pursue his bu­siness; though his strength was not perfectly res­tored.

In one instance which came to my knowledge, bleeding removed an obstinate vomiting, of many days continuance, which threatened the life of the pa­tient, and which had resisted all other remedies.

It seems hardly necessary to add any thing more, in favor of this remedy, after its beneficial effects have [Page] been stated, with so much eloquence and perspicuity, by Dr. Rush, in his various publications, respecting the Yellow Fever.

II. PURGING. No case occurred, in my particular practice, where, notwithstanding the vomiting, ca­thartics could not be administered. When this symp­tom was very troublesome, they were required to be given in a solid form, at more considerable intervals, and of as small a size as possible. The activity of the purge was always to be proportioned to the vio­lence of the symptoms; and it was important that all medicines of this kind should be given in divided doses—so as to promote a gradual and continued dis­charge.—The operation was often very much assisted by clysters; for which water alone was necessary.

The good effects of cathartics were not less obvi­ous than those of venaesection. They were indicated by the constipation, so generally present; by pain in the bowels, flatulency, and tumefaction of the abdo­men; by pains of the head, heat and flushings of the face, and of the whole body; and finally, by the vo­mitings: and all these symptoms they rarely failed to obviate, or relieve. This relief, too, was oftentimes so sudden, as to seem like enchantment.—Frequently have I seen a patient, after an hour or more of severe pain, restlessness, heat, thirst, and inquietude of every kind—feeble, exhausted, and as it were, ready to ex­pire—rise with the greatest difficulty, and with the aid of others, to the chair, and after his evacuation, feel his pains removed, his heat and restlessness va­nished, his strength renewed, and himself able to fit up, or walk about, and breathe the air with freedom: and sometimes, the discharge was followed by a re­freshing sleep, and gentle perspiration.

[Page]These benefits were neither so certainly, nor so fre­quently, obtained, where the evacuations were violent and sudden. Indeed, it appears questionable to me, whether it be ever proper to excite such discharges, in Fevers. Patients, when much reduced, are apt to sink under such immediate and abundant evacua­tions.

III. COOL AIR.—It was of the utmost importance to procure a constant application of cool air to the body of the patient, from the commencement of the Fever. The advantages which resulted, were univer­sal and wonderful.—To this end, the sick were or­dered to be placed on a hard bed, with very little covering, in the middle of the room; and the doors and windows were, as much as possible, kept open day and night.—The good effects of this practice were exceedingly increased, where the application of the cool air could be made to the patient in an erect posture. For, not only was it more equable, but the head was also relieved, thereby, from that sense of fullness and oppression which was invariably experi­enced in a recumbent posture. The sick, therefore, were directed to sit up, in the course of the day, with the assistance of their attendants, as long as their strength would permit, without their becoming ex­hausted. While in this situation, their feet and legs were covered more warmly than any other part of the body: and if cloths, dipped in cold water, or vinegar, were often applied to the temples, the relief obtained was still greater.

IV. COOL DRINKS.—The great thirst, which was nearly universal in this Fever, from the first, made the drinks, of necessity, an article of early attention. It was observable that they never could be too cold. Pa­tients [Page 134] complained of the warmth of water which had been standing but a short time; and seemed to languish for a supply of fresh water, with an anxiety which became truly painful, when the usual hour of its distribution approached.^*

The good effects of a plentiful use of cool, dilut­ing drinks, were obvious. They tempered the pre­ternatural heat and anxiety of the stomach; often re­strained vomiting, and the faucial hemorrhage; serv­ed to dilute, and carry off, the offensive contents of the intestines; and disposed to a more equable and aqueous sweat.—Of all other drinks, Water was most relished—and on many accounts, was the most pro­per. A pleasant and suitable drink was made, by pouring warm water on fresh apples, and suffering it to cool; and likewise, by the addition of a piece of toasted bread to water. Milk, much diluted with water, was relished by some; some were fond of but­ter-milk; and as all these possessed bland and nutriti­ous, qualities, they were advantageously used, where a variety of drinks was required by the capricious taste of the patient.

I had no opportunity of trying the effiacy of ICE, but the testimony of a Physician, in whole judgement and veracity I place great confidence, is strongly in its favor, and inclines me to believe that it may be used with high expectations of advantage. Under his direction, it answered, better than any thing else, in relieving heat and fever; restraining hemorrhagy; [Page 135] and obviating, partially, or entirely, the vomiting— even the black vomiting.

V. CLEANLINESS.—This is of the utmost impor­tance, and, in a measure, indispensable.—The bed and body linen should be often changed; the cloaths necessary about the bed, well aired, several times a day: there should be two beds, one of which may be aired, while the other is in use: all unne­cessary furniture—particularly woollen, silk and cot­ton—every thing which may absorb and retain efflu­via and moisture—should be removed: all utensils employed about the patient, frequently changed and rinsed: the room should be often sprinkled and dusted: the face, mouth, eyes whole head, hands— and, where it can be done, body of the patient, washed with cool water, several times in the day. The more exactly—other circumstances being regarded—these directions can be put in execution, the better for the patient; and, as my own experience convinces me, the more certain and speedy will be his recovery.— You will observe that I say cool water; for I cannot believe that the shock which would follow from the application of cold water to the body, would be be­neficial.—It is not here, as in the use of air; for water is so much more perfect a conductor of heat, that the abstraction would be universal and sudden, were it applied cold. And, beside, as much is effected per­haps, by the ablution, as by the coldness, consequent upon bathing.

It was not in my power, in any case, to carry this practice to the extent I wished; but, caeteris paribus, the relief of the patient was proportioned to the de­gree in which it was pursued.

[Page 136]VI. BLISTERS.—The advantages usually derived from the use of blisters, were not evident. It was sometimes doubtful whether they were any way serviceable. Yet there were instances in which they afforded relief; though mostly temporarily.— I have seen them, applied to the breast, relieve the oppression at the lungs; and applied to the back of the neck, relieve the head: in both cases, when the disease had been of some days continuance. A physician, to whom I mentioned these remarks, in­formed me that his experience justified them, except when, as was often observed by him, a hemorrhage ensued from the vesication, and continued for some days. Perhaps it was necessary to the efficacy of blis­ters, that they should have been, always, preceded by copious blood-letting.

VII. The Tinctura Sacra, given in small quantities, at intervals, in water, was found by one Physician, to have the happiest effects, in relieving nausea, and obviating the tendency to vomit, in all cases where a destruction of the coats of the stomach had not taken place. The same gentleman derived much advantage over the disease, where, from long-continued vo­miting and effort to vomit, the stomach appeared to have sustained considerable injury, or abrasion, from the use of Ol. Oliv. vel amygdal. dulc.—The oil co­vered the inflamed, or abraded, part, and protected it from mechanical stimulus, while it allayed the soreness and irritation produced by the action of the diseased fluids it contained.

VIII. FOOD.—I have before remarked that the sick shewed no preference for animal food; on the con­trary, they very generally refused it. Some, who requested it to be prepared for them, found themselves [Page] unable to eat it, when presented to them.—Fruits, milk, biscuit boiled in milk or water, sago, salep, hasty-pudding, and vegetable food, generally, were most relished by them, both during their illness and their convalescence.—This was peculiarly fortunate, as any indulgence in a contrary course, was sure to be followed by distressing effects. The more rigidly attentive patients were to preserving a simplicity of diet, the more certain and pleasant was their recovery. And, in all cases that I had opportunity to observe, their convalescence was always extended or shortened, tedious or satisfactory, in proportion as they returned suddenly to the use of meats and stimulating drinks, or adhered to vegetable food and water.

I have now, my dear friend, made you acquainted with that course which I generally pursued, in regard to those who came under my care. The number was not great, nor the success always complete—for I had not always the liberty of employing the means I wished to, as fully and freely as was necessary to com­plete success. But, I can truly say, that I never saw them do injury; and that they appeared to me to do good, in every case, where they were employed, and in the proportion of their trial and application.— More than this no man can truly declare; more than this ought never to be expected from any remedies. The most able practitioners are destined to see their patients frequently expire, in spite of all their care, through the obstinacy of the patients themselves, and the prejudices of their friends, the carelessness of at­tendants, or the intervention of unforeseen and una­voidable accidents. The consciosuness of having done their duty, of having acquitted themselves, under cir­cumstances [Page] so distressful and embarassing, to the best of their knowledge, and with purity of intention, will prove a never-failing consolation, though the execra­tions of ignorance, and the calumnies of hatred, may pursue and persecute them.—Happy,—at least in this respect,—are those, "the peaceful tenor of whose way," while it excites neither opposition nor malice, and neither elevates to opulence nor fame, secures them from misrepresentation and injustice.

LETTER TENTH. Miscellaneous remarks on Medicines used as Remedies in the Fever, and general conclusions.

YOU wish to obtain every possible information, respecting the Fever of 1795; you are not satisfied with knowing what remedies I employed, nor which were most successful; but you would learn all that were used; the success, or failure of each. I ap­plaud your curiosity, my friend, for I am not ignorant of the benevolent motives which excite it; but I fear that there is little with which it is in my power fur­ther to gratify it. The practice which I saw, was that which I have recommended: other remedies I know were used; but, not having had opportunity, but in few instances, to mark their effects, I ought not, from my own convictions, how well-founded soever they may appear to me, precipitately to con­demn either the prescriptions, or their authors. In the variety of cases, constitutions, and circumstances, it might happen that some of those very things, which [Page] appeared pernicious when I saw them used, were sometimes proper and salutary. It would be pre­sumptuous, therefore, in me, to decide without more information; but I may be allowed an opinion; and that opinion need not be with-held from a friend.—I confess, then, that from the success which attended the antiphlogistic plan of cure, I am persuaded that no other can be salutary, or safe; and the few in­stances in which the effects of a different mode of treating the Fever were observed by me, strengthened my previous convictions of its inutility and dan­ger.

The medicines chiefly trusted to, by those who pursued a different course from that laid down in the preceding letter, were, as I am informed, Calomel, to promote, or effect a Salivation,—Bark—Lauda­num—Wine, and other stimulating drinks—with an Animal diet.

Of the effects of Salivation, not having seen it take place, by nature nor art, in the Fever of 1795, I can say nothing. Dr. Rush countenances the practice, in his Treatise on the Fever of Philadelphia, and adds the testimony of many respectable authorities to his own.—As a Cathartic, Calomel, combined with other purgative substances, was unquestionably use­ful. Some, I know, thought otherwise; and that other purgatives might be more safely and efficacious­ly employed; and, I confess, I saw some cases in which it appeared to affect the stomach very painful­ly. But a Physician on whose judgment I have great reliance, informs me, that he saw reason to re­ject a similar opinion, which he had hastily adopted; repeated observation having convinced him, that all the symptoms of gastric affection were worse in those [Page] who had not been purged with Calomel, than in those who had been evacuated by its assistance.

I gave Bark, in no form, but in three cases. Two were in the early part of the reign of the Fever, the two first patients that I had; and I am convinced it retarded the cure in both. In the other instance, it was administered after the Fever had left the Patient, and he was convalescent. Here it was given as any other Bitter, and as much in compliance with his opinions, as from any expectation of its doing good; and, as far as I can judge, with very little effect of any kind.—In the following case, its exhibition was not so harmless.

A medical friend was called to visit the patient of another Physician, who had quitted town, on account of his health. The sick man was opprest by the most alarming symptoms; of the number of which, were hemorrhagy and the black vomit. The stimu­lating system had been steadily pursued, and was con­tinued, under the direction of a pupil of the physician first employed. In particular, large quantities of Bark were exhibited, throughout the day.—On the entrance of the second physician, the Bark and all other medicines of the kind, were laid aside; cool air was freely admitted; and the antiphlogistic plan of cure strictly adhered to. The consequence was, that all the symptoms were relieved, and a prospect opened on the patient of a recovery. The vomiting and hemorrhagy had totally ceased. In this situa­tion, and while the Physician was attending to some persons whose condition was more alarming, the person who had the immediate charge of the sick man, began, again, to administer the Bark.—The next day —or the very same, at night—all the bad symptoms [Page] recurred; the Bark was, nevertheless, persisted in; and the man died.

Several similar cases have been reported to me; but none so minutely as to authorize an attempt to state them to you.

The extreme restlessness of a patient, in whom I had the strongest interest, and for whose fate the deepest anxiety, induced me, in violation of my more sober judgement, to administer Laudanum.— This I did not do, till he had spent three nearly sleep­less nights.—In every instance, it undoubtedly, in­creased the restlessness, clammy sweats, thirst and Fever. I was obliged to discontinue it.

Wine, brandy and water, and especially porter, when taken by any of my patients, had the most per­nicious effects. I had occasion to see an access of Fever, repeatedly brought on by the one, and a re­lapse by the other; where they were used without my knowlege, and contrary to my direction.

Of the effects of Animal Diet, I have already spoken, and have nothing new to add.

On the whole, it appears incontestible to me, that what is called the antiphlogistic treatment is to be adopted in Fevers like that which prevailed in New-York, in 1795, in all its strictness, and adhered to with pertinacious resolution. Both the symptoms of the disease, and the success attendant on the practice recommended, concur in establishing the propriety of employing it.—It is also to be remembered that, in this disease, not a moment is to be lost: a day, an hour, nay almost an instant of delay, may sometimes be fatal; and the means practised must be powerful in proportion to the violence of the symptoms. Nei­ther [Page] must we be deceived by the apparent mildness of the seizure—for a few hours may entirely change the face of things, and we may be left to lament that credulity which led us to temporize, and prevented the use of those remedies, which delay alone rendered ineffectual.

But, while the Physician strenuously directs his ef­forts to the removal of the symptoms of this disease, let him not overlook a passion which never fails to aggravate them. Fear, the exciting cause, in many in­stances, of the Fever; the fomenter of all its evils; and sometimes, as it were, the sole disease; is a fre­quent and dreadful calamity, and one of the direst adversaries with which medicine has to contend.—In numerous instances, during the continuance of the Fever of 1795, apprehension touched upon insanity; destroying all confidence in the Physician and in re­medies, or exciting an absurd and enthusiastic reliance on pretenders and madmen: and utterly disqualfying the patient for a proper attention to himself.—In the well, the evil was scarcely less. The name, alone, of Yellow Fever, seemed sufficient to induce disease, to banish discretion, to sever the bonds of social connec­tion, rend asunder the ties of parental, filial, and con­nubial affection, and put reason to flight.—It was in vain to point out the folly of this terror; to declare the disease not infectious, and easy of prevention; to offer mathematical demonstration that other disorders were often more mortal, without exciting any alarm; it was still the Yellow Fever, and that was an irresi­stable reply to every argument.—The city of New-Haven, summer before last, lost about 50 of its inha­bitants, with the Yellow Fever. Universal conster­nation prevailed throughout the place; all business was at an end; and most of the principal inhabitants fled.—Last summer, the Dysentery raged there: more [Page] than 70 persons died of it: but nobody fled; nobody was frightened; and the Magistrates, very gravely, put a stop to all communication with New-York, for fear of the Yellow Fever; made vessels ride qua­rantine, and confined stage-coach passengers, that no contagion might be diffused, through the city, from their trunks and their garments.—But, it is time to put an end to this series of letters; and seek, by no­velty, to give new interest to our correspondence. I shall take my leave of the present subject, with an enumeration of the inferences I have drawn from having viewed it, in the light here exhibited to you.

1. The Fever of 1795 was Endemic:—i. e. gene­rated by local causes, producing a Fever every year, in this city.

2. The peculiar ferocity of the Endemic of New-York, in 1795, is ascribable to the peculiarity of the season, together with a greater accumulation, than usual, of the ordinary causes.

3. It was not Contagious: i. e. communicated by contact of diseased persons, by cloaths, nor by visiting the sick, &c.

4. As it originated here, its prevention will depend on a change of the local and individual circumstances which promote it.

5. The Fever in 1795, exhibited such appearances as characterize what are customarily denominated In­flammatory Diseases.

6. It is cured by the remedies suited to remove In­flammatory Diseases.

[Page]7. The same causes which converted the ordinary Fever of New-York into the Yellow Fever, would change the Fever which prevails around our Wes­tern Lakes into the Yellow Fever; and, as certainly, the Intermitting Fever of Sheffield: while the esta­blishment of a free ventilation, the filling up of all pools, yards, &c. and a scrupulous attention to clean­liness and simple diet, would reduce our Fever to a simple Remittent or Intermittent, or remove it alto­gether; as the filling up and cultivation of your ponds and marshes, would forever banish all Fevers of the kind—as general diseases—from Sheffield.

I have now, my dear friend, performed the task demanded of me, in the best manner I am able con­sistent with my leisure, and my duty towards others. I cannot conclude without once more soliciting your indulgence, and requesting you to recollect with what expectations and confessions I entered on the compo­sition of these letters.—I have taken the words of Cicero for my motto— ‘Rationem, quò ea me cumque ducet sequar—’

And if I have erred in my conceptions of what is reason, and what was fact, let my intentions prove my apology.