'1'HE

EDWARD G. MINER

LIBRARY

SCHOOL of MEDICINE

and DENTISTRY

The Universily of Rochester

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AN ESSAY

THE

ANALOGY

OF THE

ASIATIC AND AFRICAN PLAGUEAND THE

AMERICAN

YELLOW FEVER,

WITH A VIEW- TO PROVE THAT THEY ARE THEE SAME DISEASEVARIED BY CLIMATE AND OTHER CIRCUMSTANCES.

BY PHINEAS JENKS, OF PENNSYLVANIA;l t

ZONORARY MEMBER OF THE PHILADELPHIA MEDICAL AND CHEMICALSOCIETIES.

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And though the putrid southBe shut ; though no convulsîve agul;F'.*If· 'Shake, ,£rom the deep foundations of the wrld,Th' imprisoned plagues ; a secret ve#om oftCorrupts the air, the water, and the land.

Armêtrong.

PHILADELPHIA :

PRINTED FOR THE AUTHOR BY HUGH MAXWELL, NO. 23, NORTHSECOND-STREET, OPPOSITE CHRIST-CUL'nCLI.

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AN INAUGURAL DISSERTATIONroa

THE DEGREE

OF

DOCTOR OF MEDICINE:

SUBMITTED

TO THE EXAMINATION

OF Tliiá

REVEREND JOHN ANDREWS, D. D. Provost,

(PRO TEMPORE),

AND OF THE

TRUSTEES, AND MEDICAL PROFESSORS

OF THE

UNWERSITY OF PENNSYLVANIA,

GN THE FIFTH DAY oF JUNE, ONE THOUSAND ZIGHT

HUNDRED AND POUR,

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TO BENJAMIN RUSH, M. D.

PROFESSOR OF THE INSTITUTES, AND PRACTICE OF MEDICINE,IN THE UNIVERSITY OF PENNSYLVANIA.

I feel peculiar pleasure in dedicating this essayto you, not from a belief that its faults can beshielded by the patronage of your distinguishedname; but as a mark of my gratitude for the know-ledge I have obtained from your publíc lectures andprivate instructions; and for the many acts of friend-ship I received from y011 lf-hile I had the pleasure

of being your domestic pupil. Accept, sir, of thebest wishes for your health and happiness of yourobliged and affectionate friend,

THE AUTHOR.

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TO DOCTOR ISAAC CHAPMAN,

OF BUCKS COUNTY.

It affords me the greatest satisfaction to havean opportunity of thus publickly acknowledging my

gratitude to you for the numerous services you haverendered me both in your medical and private capa-

city. It was under your guidance that I com-menced my medical studies, which to me has beenthe happiest period of my life. It was then that I

f had an opportunity of witnessing the correctness of

your judgment, and medical knowledge, which

have so frequently been exercised in the alleviationof human misery. That you may long live to enjoythat health you have in so distinguished a mannerrestored to others, is the fervent wish of your

friend and former pupil,

THE AUTHOR.

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PREFACE.

AN implicit adoption of the opinions of mencelebrated for talents and learning, appears to bethe principal cause of the slow advancement of me-dical science. The systems of Hippocrates andGalen, were alone taught in the schools of medicinefor many.ages, until fatal experience shewed thefallacy of many of their positions, and the folly ofadhering to theories unattended with success inpractice. Unfortunately, however, for science andfor man, the systems of many of their successorswere not formed by rational induction from esta-blished facts; but existing in the imaginations onlyof their authors, were equally fallacíous, and are de-servedly consigned to oblivion. Such was theLentor of Boerhaave : such the Spasm of Hoffman.

Sydenham, although he erected an ever-dur-ing monument to his own memory, by his doctrine

2

of epidemics, effectually trammelled the progress ofmedical science by suggesting the idea of nosology·This arrangement, which afterwards became thefavourite nursling of Savage, añd of Cullen, hasbeen justly and emphatically styled, the handmaidof Empiricism. The Brunonian system contri-buted to loosen this shackle, and the late improve-ments and discoveries which have taken place inthe United States, have fully shewn the improprie-ty of such classification. A new era is commencingin the annals of medicine, when physicians will nolonger prescribe for the name of a disease, but willhave their attention directed to the pulse, the sen-

sible qualities of the atmosphere, the grade of mor-bid action, present in the system, and the peculiarlaws by which epidemics are governed. Whenthis change takes place, and I trust it shortly Will,we shall unanimously view our autumnal fevers, asthe efïect of natural causes which are iii our powerto controu] ; and not a particular judgment fromHeaven. We shall no longer hesitate to acknow-ledge them the ofrspring of our own climate, foster-ed ìn filth, and propagated by noxious exhalations.St. Domingo Packets will no more be the peculiarsubjects of execration, nor shall we see contagionthrough the microscope of terror, Auttering in thesails of foreign vessels. An attention to cleatiliness

10

in our cities will be the consequence, and putrifyingmasses will no longer be left to assail the senses of

our citizens. Quarantines will be abolished, and

our energies guided 1)y reason, and philosophy willbe properly directed. Then shall we clearly per-ceive, that our past aíñictìons were the consequence

of physical lethargy; and the united voice of Ame-

rica, and of the world will hail the philosopherswho, by their labours awakened our citizens fromit, and led them to search for the origin of thefever in domestic causes.

In the following pages it may be presumed thatI have too hastily decided upon the non-contagiousnature of the plague; and it is but doing myselfjustice to declare, that when I commenced this in.quiry, I was rather inclined to favour an oppositedoctrine ; but my researches, and the mass of facts

I have collected have convinced me that my opi-

nions were erroneous, and that I had fallen into a

popular mistake.I feel considerable diffidence in appearing before

the public at this early period of li fe; and were it notan indispensable task, imposed by an institute ofthe university, upon every candidate for medical

honors, I should not now have obtruded my opini.ons upon the world. No person can be more sensi-

blc than I am, of the imperfections of the following

11

12

essay ; but I trust that my youth, the short timeallowed to prepare an inaugural thesis, and moreespecially the unfavourable circumstance of all ill

state of health, will be a suiñcient apology to the

candid and scientific who honour this first fi Uit of

my studies with a perusaI.

1

AN ESSAY, &c.

THE origin of the Plague has long been a con-tested point- The ancient Egyptians ascribed itto infection brought by flying serpents, and theyworshípped the bird Ibis for destroying them, and,as they supposed, thereby avertiñg the disease. *More modern nations have attributed it to an ob-

scure, and stìll more distant origin, and sanguìnelypresumed to say, that it has had an existence eversince, being constantly kept up by contagionBut, at this enlightened era, when science per-vades every philosophie inquiry, and when in-duction from facts and ocular demonstration arealone admissible, it is no ways astonishing that suchvague and unmeaning conjectures should be over.thrown and superseded by theories which have atleast a probability to recommend them to the world.To ascribe the Plague to a supernatural origin,

* See Webster, vol. 2. p. 197.

would be to cast a reflection upon one of the attri-butes of the Deity. We shall therefore content our-sèlves in humbly attempting to make it appear, thatit is the natural eirect of physical causes; or, in otherwords, the effect of the decomposition of vegetableand animal matters.

We infer that miasma, and those noxiousgasses eliminated in the process of putrefaction, arethe rauses of the plague, from its appearing onlywhere they exist. At Rosetta, which is one of thefìlthiest cities in the world, the plague prevails withuncommon violence. The streets are extremely

narrow and dirty, and there are large quantities ofswampy, boggy ground, with numerous ditches,and canals, which contain stagnant water, aroundthe town. That these are the causes of the Plague

is proved by its sudden and almost instantaneousdisappearance in hot weather. The theory of theaction of heat in destroying the plague, shall begiven in the sequel : suffice it here to suggest, theimprobability of heat destroying a contagious dis-ease so immediately, An assertion of this kindought to be cautiously made, more especially whenthere are neither facts nor anajogy to support it: forwho ever heard of small pox, or measles, or anyother disease that is generally admitted to te Coil-tagìous disappearing so shddenly ?

14

The Plague always 'makes its appearance inEgypt about the time the Nile begins to fall. Forwhen it recedes, the large quantities of slime and

vegetable matter left behind, quickly undergo the

putrefactive fermentation from the excessive heatof the climate. And although this may, of itself,

be sultìcient to generate the Plague, yet, unfortu-

nately for the Egyptians, the large quantities of fishwhich are likewise deposited on the surface of the

earth are an additional source of pestilence. Tothese two ·obviolls sources, a third may be addedwhich contributes its share in the work of destruc-

tion. The waters of the Nile, notwithstanding theyare said to be incapable of putrefaction when left

behind stagnating in ditches and ponds, yet we

presume the observation. is not correct, as their

component parts are the same as all other waters,

and the climate particularly favourable for that pro-cess.

That these are the causes of the plague, therecan be no doubt: first, from its always commencingin the neighbourhood of the Nile when its waters

begin to recede ; and secondly, from its alwaysdisappeariIig when the sources of exhalation aredestroyed by the heat of the sun.

Near Jaffa there is a lake, the stagnant watersof which, in the opinion of Assalini, are the cause of

15

the Plague: as a proof of this opinion, he observes," that those divisions bf the French army, whichwere eIlcamped near it, ñrst suffered bythedisease-"

That miasma is the remote cause of the Plague

is further proved bÿ the following fact : that when-ever the English army in Egypt was on its march,tile Plague did· not prevail amongst them; but ifthey encamped for any length of time, exposed to

morass exhalations, it invariably made its appear-anee.

The canal that passes through Grand Cairo,from the fìlth thrown into it from adjoining houses,

and from the number of privies that enter into it,emits so great a stench for several months in theyear, that the gold and silver in the neighbouringhouses are tarnished by it.* I wish it to be remenl-bered, that în the vicinity of this canal, the Plaguesometimes rages with violence.

I could recite many more facts to prove that

the causes of the Plague are miasma, and other

gasses eliminated in the process of putrefaction; butas it is my intention to be as concise as the nature

of the subject will adInit, I shall be excused foremitting them.

I shall now take a cursory view of the origin Ofthe Yellow Fever, and must hère observe, that, like

the Plague, it is unknown in cleanly situations.' See Antes, Observations on Egypt, p. 38.

16

..

He who views with attention the progress ofour autumnal fevers, must soon be convinced thatthey are nearly allied to each other, and have onecommon origin. The miasmata, and poisonsvapours that generate them, will produce anintermittent, a bilious remittent, or a bilious yellowfever, agreeably to the degree of predìsposingdebility, and the force of the miasma elìminatek].Hence we observe, that lIl situations where inter-mittents were once prevalent, they are now un-known, and remittents are the autumnal epidemic.This change would appear to depend upon thegreater surface of ground exposed to the action .ofthe sun, by the clearing ofland, and upon the cuttingdown groves of trees which arrested the progressof miasmata: for it is a fact, now well established,that swamps, or bogs, defended from the actionof the sun by our forests, are perfectly inoffensiwe.From these causes, and from the particular consti-tution of the atmosphere, it is that our mild autum.nal remittentp, which has been so long familiar toour citizens, has yielded up its reign to the YellowFever.

I need hardly add in this place, that the sourcesof autumnal diseases are far more copious thaliheretofore. Those forests which once surroundedour cities and prevented the sun's action upon the

17

3

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earth, are now hewn down; and as our poprïlationhas increased, the vegetable and animal matters an-nually brought to our cities far exceeds what tookp*ce formerly. The offals of those matters, not-Withstanding it has been believed to the contrary,are too frequently left in the more obscure parts ofour cities to putrify : add to this, the numerous pondsof stagnant water in our environs.* Even our com-mon sewers, eliminate emuvip, which are a source ofdisease to those who are unaccustomed to them.And we have high authority for declaring, that bilgewater has frequently been the remote cause of Yellow Fever, whilst numerous melancholy instances haveshewn that the confined air in the holds of ships hasalso produced the same disease. Our wharves fromthe decay of the timbers of which they are construct..ed, and our docks and privies are all copious sourcesof autumnal fevers. The limits of this essay will ndtadmit of my reciting further proofs of the origin ofthose diseases: nor have I an inclination to pursue thesubject further than will answer my prçsent purpose ;I must therefore beg leave to refer the reader to theworks of Doctors Rush and Caldwell, where he willobtain ample informations

0 This, agreeably to Doctor Seaman, was one of the sources ofthe Yellow Fever of Rventeen hundred and ninety-five, in New.

York,

We find that an analogy exists in the excitingcauses of those diseases. These are fatigue of body,or mind, excess in eating or drinking, heat, immode-

rate evacuations, cold, grief, fear, &c. All those

oflìcers, attached to the British army in Egypt,who laboúred under great apprehensions for their

own safety, fell victims to the Plague. This,and the other sedative passions, are exciting causesonly as they abstract stimuli, thereby accumulating theexcitability, which is acted upon by other stimuli withgreater force : for I hold it to be a fact that all direct.exciting causes are of a stimulating nature. Thatthese are the exciting causes, is evident, since thosewho evade them escape the disease. The Europeans

in Egypt know, from experience, that by confiningthemselves in their houses, they are secured from theraïages of the Plague; but upon what principle theyare ignòrant: they are not aware that it is by evading

the exciting causes : this, however, shall be explained

more fully hereafter.I shall now proceed to shew, that the symptoms

of those diseases are generally analogous, and explain

the reason0 why they sometimes vary.

First ....The Plague frequegtly comes on sud-denly mid without a chill : so does the Yellow

19

ljever. The force of the causes that induce them

suddenly prostrates the system below the point ofreaction, and hence those instances of sudden deathwhich sometimes occur in both diseases.

Secondly....We sometimes see both PIague andYellow Fever come oñ with chills, and all the ordi-Ilary symptoms of mild autumnal fevers, where theremote' cause, and the predisposing debility has notbeen great : for it is a fact, I presume that will notbe denied, that the force of a disease is always in theratio of the force of the causes that induce it. Hence,

the judicious physician, by ascertaining the strengthof those causes, and the space of time they were ap-plied, can, with some certainty, predict the durationof the disease, and its íìnal issue.

crìúrdly ....Are sickness at stomach, and vomittingìarge quantities of bile, attendant symptoms ofthe Plague ? So are they of the Yellow Fever:and the stomach is frequently so irritable that one ofthe chances of saving the lives of our patients is lostby their thrgwing up the medicines they had taken.

Fourt/16....1\*ier the 'similarity of these diseasesfrom hiemorrhages, particularly from the nose andUterus. These occurred in the Plague at Aleppo,

20

0---

but they are a more common symptom in the Yellow

Feven

Fij'thty ....From abortions. Russel observes

that these were universal in the Plague ; which it '

is presumable were owing to preternatural deter.mination to the uterus induced by a local debility

of the parti but they are not so common in the Yel-low fever, and their less frequent occurrenco may,

perhaps, be attributed to the liberal use of the lancet. '

Sixthly....A great prostration of strength fromthe force of the remote causes is observable Sn both

diseases. . -.

Seventhè....The pulse frequently intermits, in

some instances it is preternaturally quick, in others,

preternaturally slow, according to the force of sti-muli acting upon the heart and·arteries.

Eighthly....Á natural tongue is sometimes met

with i also a white and furred tongue, which is af.

terwards changed to a yellow or black colour in

both diseases.

Ninthly....We sometimes see an absence of

thirst altogether; at other times the patient is exces-

21

sively thìrsty, and drinks with avidity every thingthat is offered him in both diseases.

Tenthly ....We observe their analogy in their being attended with diarrhœa, or obstinate costive-

ness ; also

Eleventhly····In syncope or fainting. Doctor -P. Rússel expresses his surprise at seeing patientsfaint in the first attacks of the Pla*ue, for he hadbeen accustomed to that symptom only in the laststages of disease.from direct dèbility. It, how.ever, takes place in the first stage of Plague andYellow Fever, from the pressure of excitement, orindirect debility, as is proved by its being curedby blood-letting. • .

Tweifthly Loss ofspeech, faultering, tremorsof the tongue, deafness, a muddy or red eye, . aresymptoms common both to the Plague and YellowFever.

The Plague ends generally on the third day;but it is sometimes protracted to the eleventh day,and even longer in some instances. The crisis ismostly brought on by a sweat, such as was observ-

22

ed in the Yellow Fever of 1803. This is one of

* natures indications„ and shews a tendency in thedisease to go off by the enunctories of the skin.

In accounting for the greater fatality, . andshorter duration of the Plague than Yellow FeverI am riecessitated to call in the effects of climate,and some other circumstances. The Turks are an

indolent, and enervated people, depressed both inbody and mind by the tyranny of their rulers.-Although they are inhabitants of one of the mostfertile portions of the globe, yet this fertility de-

pends upon casual circumstances,- and when thoseoccur, they are, in a physical light, the banc öf

thousands: subject to the nod of their pachas, their

lives are in perpetual jeopardy : they are strangersto those noble and energetic sensations which cha.racterise the inhabitants of enlightened govern-

ments, and that contributes so largely to health by

giving tone to the body and mind. Add to this,the effect of an Asiatic sun acting upon accumulat-

ed excitability, and our surprise at the greater mor-tality of the Plague will cease; more especially whenwe consider the abundance of filth, the quantity ofmiasmata daily eliminated, and the force of all thosecauses which produce it.

23 .

Buboes and carbuncles, although they some-times appear in the Yellow Fever are not so fre-

quent as in the Plague. This difference wouldseem to arise from the excessive heat of an Asiatic

or African climate, which induces a cutaneous 4

debility that determines the disease to- thoseparts in the form of buboes and carbuncles. In

proof of this I may observe, that in the year 1760, .When the Plague raged at Aleppo, they did notappear as symptoms until the hot months of Apriland May, after which time they were common.

" But the symptoms of the Plague," says

Doctor Russel, " are scarcely in all respects alike0 any tivo persons ; and vary extremely . in thecourse of an hour in tliç same subject. The dis-ease attended in the beginning with symptoms nothighly alarming, often ends fatally within a few

hours, while the most formidable attacks, by asudden and unexpected alteration, sometimes termi-nate happily."*

In like manner patients walk about in theYellow Fever, and sometimes even transact busi-ness but a few hours before their death ; whilst in

other cases, where the patients are seized violently,they frequently recover.

' Russel's Nat. Hist. of Aleppo, p. 350.

1 --

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. ií

I furthefinfer,the similàrityofthosedíseasesfrom

their passing by, and attacking persons of the sameoccupations in life. Dr. Whìtman observes, thathe was informedbythe merchants of Cairo, that theoil-sellers, water-carriers, and tanners were not sub.

ject to thedisease. The tanners,in Philadelphia, andthose persons who were in the practice of using oliveoil, and the warm.bath, escaped the Yellow Fever.;but tradesmen who are alternately· exposed to the ac-tion of heat añd cold, are the most susceptible ofthosediseases. I iñfer their similarity further from

the great mortality that attends them in theircommencement; this fatalìty is owing ·to .theirattacking persons who have been much debilitated

by hard labour, by.dissipation, or by sedentary oc-cupations.

The Plague and Yellow Fever appear in dif-

ferent grades; from a mild.intermittent, or remittent

where the patients are not confìned to their beds, 111)

to the most malignant form of disease. They

likewise assume different symptoms in difïereIlt

years. The Plague, sometimes appears witha determination te the skin ; in which case it is

called sudor anglicanus. It originated in Eng-land, and for a long time was entirely confined

to Englishmen. This is not the only instance in

ivhich persons allied to each other by consan-

,,25

4

guinity, or by habit, have appeared to have agreater susceptibility to disease than others. Dei-merbroeck observes, in the Plague atNimeguen thatwhole families were attacked by it when they lived

in different parts of the same city, and even wherethey lived in different towns. The Plague occasion-

ally appears in the form of an epidemic eolie, asin Spain in the year 1600, where it carried off thepatients in three or four daysi and in London it wascalled by the less harsh sounding name of spottedfever. Tile Yellow Fever of our city, in like man-ner, is well known to assulne a variety of symp-

toms. It is not uncommon to see it appear with

profuse sweats, and in the forms of eolie and pe.tichiàl fever, and the Dysentery is among its mostfrequent forms.

Those diseases resemble each other in the sub-

jects they attack. Persons who are seventy yearsof age, says Antes, seldom take the Plague, andvery old persons never have it. As life is the effectof stimuli, acting upon the excitability of the sys-tem, those miasmata which produce disease in otherinstances, support and increase life in old people·Hence the propriety oftheirremainingin the eveningof life in marshy or unhealthy situations. Persons oftense fibres and sanguinous temperaments are saidto be the most subject to those diseases, and stran-gers are generally the íìrst victims to their ravages.

2Ô

This fact can be accounted for only on the

principle of one of the laws of stimuli, which is,when stimuli has been applied for a long time, the

system loses its susceptibility to be acted upon,and their effects cease unless theirforce is increased.

Iii some years the Plague attacks one class of

men only, as in the year 1361, wilen it raged prin-cipally among the nobility of England, and in otheryears those in the humbler walks of life only areaffected. It not unfrequently singles out per-sons from one nation, while others escape, as didthe Dutch and Italians when it raged in Swisser-

. land. In like manner the French emigrants univer-sally escaped the Yellow Fever, in Philadelphia, in1793.

The small.pox and measles, which are truly

contagious diseases, cannot be taken a second time;

but unfortunately for mankind, the diseases whichare the subjects of this essay, may be repeatedlytaken. The most violent attack preserves not the

sufrerer from their future assaults, but renders him

still more susceptible ofthem, by inducing debility.A person in Constantinople died of the twelfthattack of the Plague.* And many of the citizens

of Philadelphia can attest the repeated attacks ofthe Yellow Fever upon themselves.

• See Webster, p, 139.

27

We find a resemblance in those diseases-;

from their not occurring every year under, thesame circumstances of lìIth. This may depend, in

sonne degree, upon the heat of the sun in cool sum.

mers· being ins,mcient to cause putrefaction andexhalation, but principally upon a coinciding ma-

lignant state of the atmosphere.This malignant constitution of the atmosphere

is now *enerally admitted. The idea was stronglyvindicated by Doctor Sydenham. It appears

First....From those diseases never becoming·epidemic beyond its confines or limits.

Secondly ....It appears from the universality of

epidemics in particular years, as the influenza,which not long since spread over every quarter ofthe globe.

Thirdó....From epidemicsnotoccurring, whentheir causes obviously exist, and sporadic casesonly appear, as in our Yellow Fevers.

Fourthly ....From great epidemics, disappear-ing after having prevailed for a long tillie, rlsthe· Plague which ravaged England, Germany,

28

1. #t -

1--L- -

29

Frañce, and Holland, I must hère éoncur with Mr.

Webster, in believing those countries are not secur-

ed from its future attacks, by their attention to·

quarantines. TVhen this constitution Of the at-mosphere again occurs, this disease will· renewits acquaintance with them. What this cplìstitu.

tion of the atmosphere is, or how * such a changehas been effected, I am unable to say ; but oursenses inform us of the fact, although philosophershave been puzzled to account for it. We must

admit as truths what our senses recognise as such,or thc *orkl would be deprived of some of themost valuable of them that are notv known.

Fìfthly ....The existence of such a state of at-

mosphere, as above described, is further evinced bya fact taken notice of by Diemerbroeck, and Mr.:

Webster, viz. that flesh and vegetables putrifymuch sooner during the pievalence of great epide-mies than at any other time. I am aware that this.

may be ascribed,to miasmata, and the other causes;ofdisease ; but I am rather disposed to attribute it to.

a certain malignant change in.the atmosphere.

Sixthly .... I infer it also from the appearance ofnew and uncommon insects, and such as live in or

are fond of a contaminated atmosphere. The appear-

anee of such insects has often been observed before;

or during the prevalence of great epidemics, whilstother species delighting in a different atmosphere,perish during those periods of disease.

I shall now take a view of the diseases that

precede, and succeed the Plague and Yellow Fever,

and it is presumable, I shall still find the analogy

to hold good. It is observable that before the ap-pearance of great epidemics, those diseases thatprecede them increase in violence; and it is neces.sary to make use of more powerful remedies to cure

them. The physician who is ignorant of this fact,and has. not his attention directed to it, will find

that his limitted knowledge will be obvious to the

world by his want of success.The severity and mortality of those diseases

which are the forcrunners of great epidemics, have

been taken notice of by Dr. Sydenham as preceding

the Plague of 1665, " Pleurisies, quinsies, and

other inflammatory diseases," says he, " usuallybecome epidemic. and I Ilever knew them morecommon than they were for some weeks precedingthe beginning of the late Plague in London."-*Such was the violence of the symptoms, that thisgreat man tells us, he could with díiñculty distin-guìsh them from the Plague. A malignant pleu-

ä0

0 Vcl. I. p. 122.

risÿ was the signal of the approach of the Plague inHungary, Austria, and Turkey. So certainly domalignant.;diseases precede it, that Ballonius haslaid it down as a general rule that spotted fevers,

malignant small pox, and measles, become epide-

mic before the Plague makes its appearance.If we turn our attention towards the Yellow

Fever of our own country, we shall find, that it too

is preceded by diseases of high excitement; andthis change is not confined to those cities-where it

prevails, but extends all over our country. Ourwinter diseases are much more inñammatory thaiíformerly, and the scarlatina anginosa, thè meásleà,and many other diseases, have been ··observed :tò

prevail with unusual Violence. If then bur ordinarydiseases have become so much more malignant

than they formerly were previous to the appeal'àñceof our great epidemic, is it not shíñcient to toll-vince us, that it is not of foreign origin ; but 'gene-rated by the filth of our cities, and nurtùrech'by a

malignant state of our atmosphere. I may hereobserve, that the diseases which succeed those

epidemics, are equally violent with those thatprecede them. After the Plague begins to declinein Egypt, ophtlialmia makes its appearance. This

disease, in all probability, depends upon the samecauses as the Plague, and although it does not

9 G8350

31

S2

deprive those who are the subjects of its attack, óflife, yet it reduces them to a state more deplorable

than death itsel£ " Nearly every fìfth inhabitant,"

says Sir Robert Wilson, " has lost one eye, andmány both." The circumstance of the total blind-

ness of many of the English, and French troops isWell, known. After the decline of ophthalmia, thedyseñtery commences its career,' Which, after con-tinuing sometime, is succeeded by intermittentsand remîttents.

Soalsothe diseases, that succeedtheyellow fever

partake in some degree of its violence. Patients la.

bouring under pneumonies, we are informed by Dr.Rush, frequently puked bile, and some Of them had

a yellowness of the skin, and both níeasles, andsmall pox, have been observed to be, uncommonlymortal, when they succeed epidemics. More bilious

pleurisies have occurred in Philadelphia, since the

appearance of the Yellow Fever in 1793, than tliereever had been,, in the sáme number of years before.This violence, in the diseases, that suceed epidemicshas been observed bÿ Dr, Cleghorn, in the Island ofMinorca.

Have those two diseases any other precursorsin which thejr sameness appears ? 18 answer, theyhave. Great swarms of locusts, as well as flies andworms of different species, are said to precede the

plague. The inhabitants of Aleppo believe theappearance of uncommon insects, the desertion ofbirds, and frogs ceasing to croak, the precursors of

an approaching pestilence.Great numbers of spiders were the precursors

of the Plague that raged in Ppland, Hungary, and

Russia, from the year 1703, to the year 1709. It

is a curious fact, that crows, sparrows, and other

birds did not appear during this pestilentialseason.

In the United States it is well known, that in-sects appear in abundance as the precursors of ourYellow Fever; and within these few yehrs we haveseveral species that are uncommon and new, suchas the Méloe Chapmani, or potatoe fly, called byFabricíus the lytta vittata, with more propriety, as

it is not a species of Meloe, and the Tipula trìticœ,or common wheat Íty.*

To these may be added the canker worm,which existed in such quantities in the New.Eng.land states, as to devour the orchards in 1791, con.

tinuing their ravages until just before the appear-

* The credulity of the people had lcd them to suppose, that thi,

Ry was brought here during the revolutionary war, by the IIessìans; but

naturalists have ascertained that no such fly híd ever existed in Europe,

nor in any other part of the world that has been yet dii;corel-Kd.

SS

5

anee of the Yellow Fever at New Haven in 1794,

at which time they disappeared.*Musquitoes, cockroaches, and ants were ob-

served to be uncommonly numerous previous to

the appearance of the Yellow Fever in 1797.It is observable, that animals of different kinds

.

become very sickly before the appearance of greatepidemics. This fact has been taken notice of byDoctor Russel, as being observed by thé inhabit-

ants of Aleppo, and from the high authority of thisauthor, and the coincidence of others equally re.

spectable, we place full confidence in the observa-

tion. Thus we are told, that in the year 1664,

previous to the appearance of the Plague in Eng- .land, there was a great sickness among cattle,and numbers died. And in the year 1682, therewas a mortal disease among cattle in Italy, Swis-serland, and Germany, called the angina maligna,

of which thçy died in twenty-four hours. At this

period the Plague was raging irl some parts of Eu-rope.

Doctor Whitman informs us, that at the timethe Plague raged at Jaffa, in 1800, a great mortalityprevailed amongst cattle and dogs,t

.

0 See Webster, vci. I. p. 302·t See page 531.

34

i

Previóusly to the appearance of the Yellow

Fever in 1797, there was a disease prevailingamong the cats in Philadelphia, which destroyedhumbers ; and· I well recollect to have heard the

citizens express their apprehensions of what rnightensue ; and it appeared their tìmidity was not ill-founded, for their much dreaded dangers were rea.lized.

The farmers through the United States willlong recollect the fatality there was among horses,from the losses they incurred by a .disease' calledyellow- waters, which appears to be a true bilious

remitting fever. *Since America has been visited by the Yellow

Fever, even the inhabitants of the waters have feltthe effects of disease. The fish in many of ourrivers, are known to be sickly; and have sometimesbeen seen floating, in numbers, dead, upon the sur-face of the water. Vegetation, itself, feels a

change. The peach and the plumb tree are nowwithering under the effects of a contaminated atmos.phere;-t the privy has ceased to Hourish throughout

.

' Dissections of horses that have died with this disease, warrantsuch a conclusion, as their livers, I believe are invariably found to bemuch affected.

t The plumb tree, in the eastern states, is diseased by warty ex.Grescences, which were generally supposed to be the consequence of

S5

the United States. And the trees in Philadelphia.have been observed in sickly autumns to eliminatea disagreeable effluvia.

But why, it may be asked, should we descendto enquíre into the diseases of animals, and vege-tábles, and how will mankind be benefited by su,chan enquiry ? To this I answer, that by ascertainingtile precursors of those diseases we shall be warnedof their approach, and may not only consult means

to prevent their appearance and evade their effects

by an early desertion of our cities; but by recording

snch facts, we further establish the sameness of thetwo diseases.

In pursuance of my plan, I shall next examinethe analogy of thè Plague and Yellow Fever in as-sumìng an empire over all other diseases whenthey are cpidemic, and here I am supported by the

respectable authorities of Sydenham, Huxham, and

Diemerbrocck, each of whom has repeatedly ob-served the ascendency great epidemics have, after

worms ; but Mr. Webster, by the assistance of a microscope has disco-vered, that .the worm is rather the efrect of the excrescence which

aíïords to it a nidus, to deposit it£ on. 0The peach tree, if not immediately, is indirectly affected by the

present state of the atmosphere ; for. as well as I have been able to ill-form myself, the worm that has been so destructive to that valùable

tree, 15 of modern datei and may be the 'ofFspring of, or at least delighb

m a contaminated atmosphere, which is favourable to its procrcation-

56

.- - -1,-,r--f-- ....9;--i

they make their appearance, over all preceding dis-eases, and either force them to retire entirely, orblend themselves with them, so that the last epide-mic increases as the preceding one decreases. Butin illustration of this, I will give an example :suppose that the scarletina has prevailed for sometime, and that the measles make their appearanceduring this period, the scarletina, if it be a diseaseof less force, will yield to the measles, and as it

declines; will put on many symptoms in commonwith them. It is an axiom in medicine, that notwo epidemics of unequal force, can ever prevail atthe same time. Hence it is, that the Plague, whichis a disease of the highest degree of excitement,drives away all other diseases during. its reign,as Doctors Sydenham and Hodges observes was thecase in Londen, in the year 1665.

. It is a curious fact, that those vanquished dis-eases will revive again, after the decline of the epi-demie with many of its symptòms. It would fur-ther appear, that a weaker disease will chase awayone of much greater' force that has prevailed forsometime, as tile small pox, which has been knownto assume an ascendency over the Plague. Froma knowledge of this fact, we would naturally infer,that a disease which has continued for some time,expends itself, or loses part of its force.

..... 37

58

Many of the American physicians have learn,ed, from experience, that our Yellow Fever whenit prevails, is the solitary epidemic. All other dis-eases receding as it approaches, and yield to itssuperior force. It would then appear, that thisdoctrine of epidemics is not the mere creature offancy ; but firmly established by the experienceof ages, and in a practical point of view, of·the ut-most consequence, in as much as.it will alone directus to a successful practice.

Those diseases yield . to the same remedieswhen they exist under the same circumstances.Thus the Plague, iii certain years, in some parts ofEgÿpt, will not admit of blood-letting, on accountof the great prostration of the systeïh from the forceof the causes that induce it. Thus too bleedingis sometimes prejudicial in the Yellow Fever of theWest Indics from similar causes ; but where theheat of the climate is not so excessive, nor exhala-tion so great as to prostrate the system below thepoint of reaction, the symptoms do not onlyadmit of bleeding, but call loudly for it. Hencein the Plague at London in the year 1665, the mostsuccessful practitioners of that day bled freely, asalso did Bottalus, in France. And the singularsuccess of Doctor Dover's practice completelyestablishes the propriety of blood.letting in this

diseasè, under certain circumstances. The reader

<vill pardon me for a quotation, of some length, fromthis author, as the work is ilot now to be obtained.

" When I took by storm the two cities of Guaiaquil,under the line in the South seas, it happened that not

long before, the Plague had raged amongst them.For our better security, therefore, and keeping ourpeople together, wc lay in their churches, and like.wise brought thither the plunder of the cities. 1/Vewere very much annoyed with the smell of deadbodies. These bodies could hardly be said to beburied, for the Spaniards abroad use no coffins, but

throw several dead bodies, one upon another, with

only a draw board over them, so that it is no wonderwe received the infection.

" In a very few days after we gót on board, oneof the surgeons came to me, to acquaint me, thatseveral of my men were taken after a violent manner,with thatianguor of spirits that they were not able

to move. I immediately went among them, and, to

Illy great surprise, soon discerned what was the mat.ter. In less then forty-eight hours we had in oúrseveral ships one hundred and eighty men in thismiserable condition.

" I ordered the surgeons to bleed them in both

arms, and to go round to them all, with a.cominand toleave them bleeding till all were blooded, and then

S9

--

40

come and tie them up in their turns. Thus they laybleeding alld fainting so long that I could not con-ceive they could lose less than one hundred ounces

each man; they afterwards took spirit of vitriol;"and Doctor Dover informs us, that " out of the one

hundred and eighty, but seven or eight died, andthese owed their deaths to strong liquors which their

mess-mates procured for them."* But those ·men

still retained their European constitutions, and wouldbear more depletion than the inhabitants of the coun.

try. It is somewhat remarkable, that there should

be such a contrariety of opinion with respect to the

propriety of blo,od-letting in the Plague; when a refer-cnce to climate and season, and to local situation

would at once reconcile these different opinions, andconvince their álvocates of the justness of those twoopposite modes of practice.

But in the Yellow Fever of the United States,

where the temperature of our climate approaches

nearly to that of England, in 1665, the lancet is hailed

asthe"MagnumDei Donum,"and willbelooked upon

A such until European refinement, and its concomit-ant dissipation are more generally admitted amongstus. Then, and not till then, will tonic medicinessupersede its use.

' 0 See the Physician's Legacy, p. 10Q·

I shall next inquire into the contagíous natureof those diseases, and attempt to ascertain from a massof facts whether they can be communicated from

one person to another; and here I have to oppose Rus-sel, and many others of high respectability : but as

truth is my object I hope to be pal'doned for this op-position.

I shall not, because one or two individuals have

been exposed to the Plague, and not taken it, inferthat the disease is not contagious ; because even the

small pox itself cannot be taken, unless there is a pre-

disposition, or susceptibility in the system to be actedupon by the variolus pOiSOn ; and I have seen severalsuch instances, not only in the small pox, but in the

measles and kille pox, and have heard of well at.

tested cases in Syphilis ; one in particular, which isrelated by Dr. Barton 2 his lectures on MateriaMedica.

But if I can recite proofs of armies marchingthrough towns, where hundreds ofthe inhabitants aredaily swept off by the Plague, and the disease notbeing in a single instance communicated to the

soldiery, provided they do not halt in those toWns,but for a few days ; a space of time insuítìcient totake the disease from exhalation or míasmatat

Or it I can record, from undeniable authorities,numerous instances of the removal of the sick from

41

6

á pestilential to a healthy village, with their beds andbedding and yet the disease not be communicatedin the latter.

If from thè perusal of the most respectableauthors, I am enabled to transcribe the fact, shew-ing that the Plague has been known to prevail, in thefìlthy half of a populous city, sweeping off two thirdsof the inhabitants, and yet not communicated to thecleanlier parts, notwithstanding there has been a con-stant intercourse with the infected, I shall be excus-ed, for not implicitly adopting the opinions of mypredecessors, and for declaring my dìsbelief, in theDoctrine of the contagious nature of that disease-

I wish it here to be understood, that it is not

my intention to aver, that those diseases are nevercummunicated from one pprson to another; for undercertain circumstances, I conceive they may, fromwhat has been happily called the contagion of excre-tion.* But the dysentery, and the autumnal biliousremittent, may be communicated in the same mánn(zr-And are we to esteem a disease contagious, that iscreated by the filth around the patient, from the indo-lence, or inattention of the attendants, in not remov-ing the excretions of the sick, or not affording them aproper change of linen, and sufficiently ventilatingtheir rooms ? 0 f each of those errors are the Turks

3 By Dr. Rush.

42

guilty, and it is more than probable, that the Doctrineofcontagion, has received its chief support, from thosecircumstances, and from limited observation, ,

But there is nothing specific in those excretions;and a disease arising from them, would be as apt tobecome a Yellow Fever, or a Typhus Fever, as thePlague.

When the Plague raged at Aleppo, in the year1761, many of the inhabitants, who were labouringunder thedisease, came to Tripoli, with their bedding,&c. yet there was no instance of its being communi-cated to any person in that city.* Facts like thesesare esteemed curious, by those who favour the Doc.trine of contagion, and they are unable to account forthem; but with my ideas of the disease, I find it byno means difficult; for I could as easily conceive,that ñre could be generated by compressing water,as that the Plague or Yellow Fever, could spread inan atmosphere, incapable of originating them. Ifthose diseases are contagious, surely it is a contagion,sui generis, for who ever heard of the small, pox, ormeasles, not spreading under such circumstances ?

When the Plague was at Lîmsol, in theyear 1751,many of the inhabitants fled to Lal'nica, a Town notfar distant, with the disease, and the pestilential soresupon them, some of whom died; yet there was not

0 See Russel on the Plague, Page 12.

43

a single instance of its being communicated from ongtg another ; is it then possible, that a disease as con-tagious, as the Plague is said to be, should be importedinto a city like Larnica, under the above circumstan-ces, without being propagated among the citizens ?The disease however appears to have raged there, thevery next season with considerable violence.*

Assalini asserts that, " he found by observationin the French army, that if a battalion infected, leftits cantonement for another, the distemper not onlyceased in that corps, but that no one having commu-nication was exposed to the smallest danger: nor didthe phenomena terminate here, for even if the battalion

quitted the piace in ten days, the slighest symptom ofthe disease never appeared amongst them."

If my ideas, of this quotation be correct, it wouldappear, that Assalini supposed the causes of thePlague, existed in the neighbourhood of those can-tonements ; and that by removing the troops, thosecauses were evaded; and indeed, from this author

supporting the doctrine of non-contagion as he has ,clone, I am certain this is his meaning, but his lan-guage is not sufficiently explicit.

The British army, in their march to Cairo, saysSir Robert Wilson, passed through numerousvillages,,vhere the Plague raged, withóut taking any precau.

0 Russel, Page 4.

44

tions; and the Turkish soldiers, even took up the

dead with impunity; the disease not being com-municated to any of the army, whilst it made terri-ble havock with those troops that were stationed at

Aboukir.

The villages in Egypt, are within a quarter, orhalf a mile of each other; and it is no uncommon

thing to see the Plague raging violently in some, andnotin others; the inhabitants of the healthy, havingfree communication with. the pestilential villages,

without taking the disease, or being under any appre-hension of it : nor were the English army more cau-

tious; they were not biased by preconceived opinions;and observation had taught them, that the Doctrine

of contagion was not well founded. Thus how fre-quently do we see error perpetuated by great authori-ties, and how falacious are popular opinions !

The Plague, sometimes spreads desolation over

one half of grand Cairo, while the other half escapes

its ravages. That part of the city, where the disease

prevails, is extremely íìlthy; and the Turks.have con.stai·t intercourse with the infected, without beingunder apprehensions for their own safety-for theyhave an idea, that if they are to have the disease, theywill have it, whether they avoid the sick or not. Yet

notwithstanding this intercourse, the disease, is not

carried to the healthy parts of that city.

45

The Plague raged at Maraash, in 1765, andthere was a constant intercourse kept up between that

city, and Aleppo; yet the disease was not introduc-- €d into the latter place. Evagrius describes a Plague,

which raged about the year 594, in Antioch, which. never could be carried from one city to another.

We have upon record, numerous accounts ofnurses, who have attended the sick, for whole seasons,without experiencing the least indisposition; and ofchildren sucking the breast of their dying motherswith impunity.

It would be no difficult matter, to multiplyproofsof the non.contagious nature of the Plaguè; but as itis my wish to be as concise as Dossible, and myobject, to support the doctrine no further than is re-quisite to establish the analogy between the Plagueand Yellow Fever, I shall proceed to make a fewobservations, on the non-contagious nature of thelatter disease.

In the year 1793, when the disease first made itsappearance, it was universally believed to be conta-gious ; but later experience has taught many of ourphysicians, that their observations were too hastily ·made, and their opinions prematurely formed; thereis yet however, a respectable number, who still ad-here to this doctrine; and their liberality will leadthem to pardon me for this feeble, though honest op-

46

.-

position to their opinions, when they reflect upon themagnitude of the subject, and the diíñculty of proper-ly investigating it.

There are few subjects, upon which there is not

a diñerence in sentimenti and it is no wonder there

should be upon this, which involves many difficulties·unfavourable to accurate investigation.

The contagious nature of the Yellow Fever has

been infered from the great number of physicians thatdied in 1793, but we do not think that this militates

in the least against our doctrine, for those physicianswére debilitated by their previous labours, and con-

sequently, were constantly predisposed to the dis-ease. They were also in the habits of frequently vi-siting parts of the city, where its causes obviously ex-isted in the most concentrated state. But there are

many physicians who have never had the disease, not-wíthstanding they were constantly exposed to it. And

indeed since 1797, a very few, in proportion to thenumber there are in the city, have had it.

But if we take a view of the city Hospital, estab-

lished for the reception of Yellow .Fever patients,we shall there find that the apothecaries, or nurses,were in no instance añècted, notwithstanding their constant, and laborious attendance upon the sick.If this disease had been marked by contagion, theHospital was a favourable place to propagate it; for

47

--

48

ust be admitted, that the daily fatigues of the at-tendance upon the sick, would render those personspeculiarIy susceptible of it.

It appears that the disease is not more contagi-ous when it is carried into ihe country. I never haveheard of but one well attested instance where the leastsuspicion could have been entertained of the diseasebeing taken from the sìck, and that doubtless arosefrom the contagion of excretion, as the room of thepatient was kept remarkably close.

But even those who are disposed to favour thedoctrine of contagion, now admit that the disease /When carried into the country will not spread, andthe reason assigned for it is, that the atmosphere istoo pure. If then it requires a foul atmosphere, or,in other ivords, a situation where putrefaction andexhalation exist, (for without something of the kindno atmosphere can be contaminated) why may notthose causes aloneproduce the disease ?

How many instances are there of nurses in pri-vate families who are constantly employed in attend-ing upon the sick, and who, notwithstanding, enjoyperfect health ? Chisholm himself, who appears uil-commonly Solicitous to support the doctrine of conta-gion, after wander·ing over the West-India islands insearch of matter, has been able to relate only a fewSolitary cases of it.

. It is a commón practice at Aleppo, Grand Cairn,and other places, for all the Europeans to shut them•

selves up in their houses, during the prevalence of

the Plagfç in those cities, under the idea that thedisease is contagious, and that they will thereby evadeit. They, at the same time, receive their food fromwithout, and will frequently stand within four or fivefeet of persons who have the Plague, and enter intoconversation with them, without being infected. Thepractice of shutting up, is laudable, and cannot be toohighly commended. When great epidemics prevail,eveJy person has the seeds of disease floating in hissystem, and wants only an exciting cause 'to bring jtinto action. If those same Europeans, instead ofshutting themselves up in their houses, had resortedto a healthy situation, exposed to the fatigues of ajourney, numbers of them, would, no doubt, havefallen victims to the Plague. The truth of this obser-vation is established by the citizens of Philadelphia,who during the prevalence of the Yellow Fever, after11aving been exposed to its remote. causes, íly from thecity in order to evade it; when they arrive in the coun.try, unconscious of danger, and attracted by its beau-ties, they resort, for amusement, to walking, riding,fishing, gunning, &c. and frequently pay for thisindulgence by the forfeit of their lives.

49

7

50

Those who shut themselves up in their housesduring our Yellow Fever, and never went out but to'procure provisions, also evaded the disease. *

We may here òbserve, that those diseases yieldtgthe same destructive causes which act by destroyingthe sources of exhalation. Extrerne heat invariablychecks them in as much as it deprives vegetable sub.Stances of their moisture and natural juices, therebypreventing fermentation and putrefaction.

Heavy rains have also the same effect for a limit.

ed time, but it is only while the waters are descending,and diluting the filth of our cities, so as to cut off the

agents in putrefaction, and thus to destroy that pro-

cess., This teìñporary respite from pestilence, tendaonly to lull into a security, which sometimes proves.fatal- to thousands.

I must here digress somewhat from my sub.. ject, and avail myself of this opportunityto enumer

rate some of the disadvantages that arise fromthe doctrine of contagion. Many diseases maybe cured in their forming.state, when at an advancedperiod, they bid defìance to our art. Such is thenature of those of which I have been treating ; and

the physician who is acquainted with the usefulnessof his profession, and knows what is in his power tcaccomplish, can vouch for the justness of this remalik.

' Sce Doctor Rush's Wotks, vol. 3. p. 101.

, , During the prevalence ofepidemics, physicians.

me 'in great demand, ·and those who believe in the

{1OCtrine Of contagion must COnstantly labour under

apprel-tensions for their own safety whenever theyenter the rooms of their patients. The cc,nsequencaof which must be, that they èan obtain but an imper-

· fect knowledge of the situation of the sick.This doctrine further supposes the neèessity +of

the continuance of qualfaùtines, which are calculatedonly to retard our efforts in preserving our cities fromdisease : they moreover divert our ettentien fromits proper focus, ahd direct them to lazarettoes : byplacing a confidence in which, they lead to the neclectof the filth which causes it ; and úntil this be remov.

ed, in vain will our citizens look for the return ofhealthy autumns; besides, if there be any truth in thedoctrine I liave supported, quarantines will be foundtotally insuíñcient to prevent the appearanée of•thqdisease.

Conclusion .... I have now traced the analogy of

the Plague and Yellow Fever through their causes,symptoms and duration, and cure; and it must appearvery obvious that they are one and the same disease,differing only in the degrees of force from the excessof their causes. To contend, therefore, that they aredifferent and specific diseases, would be as absurd as

+41

.

52

to declare, that a Yellow Fever could not exist with·out a black Voluit, or that an iníìarnmation of thelungs was not a peripneumony, because their was anabsence ofpain.*.

Having brought the subject of this essay to aclose, it remains now for me to return my thanks toyou, Illustrious Professors, for the friendly attention.and valuable instruction that I have received from

each of you, during my residence in this university.To merit a continuance of your friendship shall be

my endpavour. To Doctor Wister I am particular.

lÿ indebted, and I beg hinì to receive my sincerethanks, for the friendship he has evinced for me,which will always be held in grateful remembrance.

0 The black vomit is not an infallible pathognomonic symptom

of Yellow Fever, and the lungs are often prostated below the point of

pain.

THE END.

,

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