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If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: A Treatise on the Plague and Yellow Fever - With an Appendix, containing histories of the plague at Athens in - the time of the Peloponnesian War; at Constantinople in the time - of Justinian; at London in 1665; at Marseilles in 1720 - -Author: James Tytler - -Release Date: February 20, 2022 [eBook #67453] - -Language: English - -Produced by: Thiers Halliwell, Turgut Dincer and the Online Distributed - Proofreading Team at https://www.pgdp.net (This file was - produced from images generously made available by The - Internet Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK A TREATISE ON THE PLAGUE AND -YELLOW FEVER *** - -Transcriber’s notes: - -The text of this e-book has been preserved as in the original, -including archaic and inconsistent spellings (although the archaic 'long -s' has been replaced with an ordinary 's'), but numerous presumed -typographic errors have been corrected silently. They are listed at the -end of this transcription. Footnotes have been numbered consecutively -and repositioned below the relevant paragraph. As many of them are -exceptionally long they have been indented to differentiate them from -the body text. Italic text is denoted by _underscores_, and a caret -(^) indicates that the following character is superscripted in the -original, e.g. N^o. - - - - - A - - TREATISE - - ON THE - - PLAGUE - - AND - - YELLOW FEVER. - - _With an APPENDIX, containing_ - - HISTORIES OF THE PLAGUE AT ATHENS IN THE TIME OF - THE PELOPONNESIAN WAR; AT CONSTANTINOPLE IN - THE TIME OF JUSTINIAN; AT LONDON IN 1665; - AT MARSEILLES IN 1720; &c. - - By JAMES TYTLER, - Compiler of the Medical Part of the Encyclopædia Britannica. - - Let every one, Physician or not, freely declare his own sentiments - about it; let him assign any credible account of its rise, or the - causes strong enough, in his opinion, to introduce so terrible a scene. - - THUCYDIDES. - - ‘Twas all the business then - To tend the sick, and in their turns to die, - In heaps they fell. - - ARMSTRONG. - - _Published according to Act of Congress._ - - _SALEM_: - - PRINTED BY JOSHUA CUSHING, FOR - B. B. MACANULTY. - - 1799. - - - - -CONTENTS. - - - PART FIRST. - - _Of the_ Asiatic _or_ True _Plague_. - - - SECTION I. Page - - _Of the Plague in general.--Inquiry into the Antiquity of the - Distemper.--Of the Plagues mentioned in the Old Testament.-- - History of several remarkable Plagues which, at various times, - have desolated the world._ 1 - - - SECTION II. - - _Of the Countries where the Plague is supposed to originate.-- - The Influence of Climate in producing Diseases.--And of the Moral - Conduct of the Human Race in producing and influencing the same._ 21 - - - SECTION III. - - _Of Disease in general.--The nature of the Plague as a Disease - considered.--Of Contagion.--Whether the Plague is Contagious or - not.--Medical History of the Distemper.--Inquiry into its - Immediate Causes, and whether an approaching Plague is indicated - by any visible Signs._ 74 - - - SECTION IV. - - _Of the best Methods of Preventing the Plague._ 302 - - - SECTION V. - - _Of the Cure of the Plague._ 347 - - - PART SECOND. - - _Of the Yellow Fever._ - - - SECTION I. - - _History of the Yellow Fever._ 371 - - - SECTION II. - - _Symptoms of the Yellow Fever, as described by various authors. - --Comparison between them and those of the Plague, with an - inquiry into the Causes.--History of the Distemper as it has - appeared in various parts of the United States since the year - 1793.--A discussion of the question Whether the Yellow Fever - is Contagious or not._ 382 - - - SECTION III. - - _Methods of Prevention and Cure._ 507 - - - SECTION IV. - - _Remarkable Cases._ 534 - - - _APPENDIX._ - - N^o I. - - _Account of the Plague at Athens, in the time of the - Peloponnesian War:--From_ THUCYDIDES,--SMITH_’s Translation_. 545 - - - N^o II. - - _Account of the Great Plague in the time of_ JUSTINIAN:--_By_ - PROCOPIUS. 547 - - - N^o III. - - _Account of the Plague at London in 1665:--From Dr._HODGES _and - others_. 548 - - - N^o IV. - - _Account of the Plague at Marseilles in 1720:--From the - Periodical Publications of the time._ 554 - - - N^o V. - - _Account of the Plague in Syria, Cyprus &c.--From Dr._PATRICK - RUSSEL_’s Treatise_. ibid. - - - N^o VI. - - _Remarkable case of a Remitting Fever at Bassorah in 1780._ 556 - - - N^o VII. - - _Set of Queries furnished by Doctors_ AIKIN _and_ JEBB; _and by - Mr._ HOWARD _put to several foreign Physicians, during his tour; - with their Opinions concerning the Plague_. 563 - - - - -A - -TREATISE - -ON THE - -Plague and Yellow Fever. - - - - -PART FIRST. - -_Of the_ Asiatic _or_ True _Plague_. - - - - -SECTION I. - - _Of the Plague in general.--Inquiry into the Antiquity of the - Distemper.--Of the Plagues mentioned in the Old Testament.--History - of several remarkable Plagues which, at various times, have desolated - the world._ - - -Among the many diseases which afflict the human race, we find ONE, -upon record, so irresistible in its progress, so fatal in its attacks, -and so entirely beyond the powers of medicine; that, like the serpent -_Python_, the _Leviathan_, or the _Mammoth_, among animals, it has -generally been distinguished by names expressive of its destroying -nature; not, like other diseases, by any particular appellation derived -from its symptoms. In the Hebrew language this distemper is expressed -by the word which signifies _perdition_;[1] in Greek it is called -_loimos_, from _luo_, to destroy; in Latin, _pestis_, from _pessundo_, -to overthrow; and in English, the _plague_, from the Latin _plaga_, -a stroke with a whip; alluding to the common opinion, that it is a -scourge from heaven, taking vengeance on mankind for their sins. - - [1] Thus Dr. Hodges; but Calmet informs us, that the Hebrews call - by the name of plagues all diseases sent by way of punishment or - correction from God; as the pestilence, infection, the leprosy, - sudden deaths, famines, tempests: in a word, all calamities, whether - public or private. _Calmet’s Dict._ vol. ii. fol. 412. _Plaga._ - - Parkhurst derives the Greek term _loimos_, either from _luo_, as - above, or from another Greek word signifying _to faint_; the same - from which the English word _eclipse_ has its origin; or it may be - from the Hebrew _lehem_, to consume. - - A friend observes, that “we no where find the word _perdition_ - in our version of the Old Testament. We have, however, the word - _destruction_, which is of a similar import; as, for instance, in - Prov. xv. 11. where the Hebrew is _abdun_. In Rev. xvii. 8 & 11, we - find the English word _perdition_; but as we have no Hebrew version - of the New Testament, we may advert to the ancient Syriac version. - The Syriac being a sister dialect of the Hebrew, differs, radically, - but little from it. The Syriac of the two places referred to above is - _abdna_; hence the word _abaddon_, whole root is _abd_, and is the - same with that of the Hebrew word above. - - “As to the word _plague_, we often find it in the Old Testament, but - perhaps never in that specific sense in which the moderns use it. The - original word, rendered plague, is pretty generally _ngp_, or its - derivations; as Exod. xii. 13., ii. Sam. xxiv. 21, &c.” On this last - occasion, however, as the word _pestilence_ had been used before, in - the same chapter, we can scarce doubt its having been really some - kind of disease: and we know that modern plagues will sometimes - destroy as quickly as this is said to have done. - -Other distempers, called by the general name of _Epidemics_, have at -different times infected whole cities, and even overspread extensive -regions; but these, though sometimes very fatal, have always been -found so much inferior to the distemper of which we treat, that, on -a comparison, we may justly say, though epidemics have slain their -_thousands_, the true plague has slain its _ten thousands_. In speaking -of the destructive ravages of epidemics, we may count the dead by -tens, by hundreds, or by thousands; but in the true plague, always by -thousands, by myriads,[2] or by millions. Procopius, when speaking of -a plague which desolated the world in his time, compares the number -of the dead to the sand of the sea; and Mr. Gibbon, who attempts to -specify, thinks they might amount to an hundred millions;[3] and I -cannot help being of opinion, that the destruction generally occasioned -by violent plagues, amounts to about one half of the population; the -reasons for which opinion will be given in the course of this work. In -all violent plagues, we hear of the dead being left unburied; of their -being cast into pits, &c. But if we wish to make any gross comparison -between the destructive power of the true plague, and that of any other -violent epidemic, we cannot, perhaps, have a better instance than -that which took place at Bassorah (a city on the confines of Persia) -in the years 1773 and 1780.[4] In the former of these years that city -was visited by the true plague; and in the latter, by an epidemic -remittent fever. The fever was most violent in its kind, and destroyed -twenty-five thousand in the city and neighbourhood; but the true -plague, no fewer than two hundred and seventy-five thousand in the same -place. Supposing the two computations therefore to be equally exact, we -must calculate this plague to have been eleven times more deadly than -the epidemic. If therefore the ingenious classifiers, in modern times, -have brought into alliance the plague with other epidemic diseases, -and characterised the former from the latter; we may justly say, that -they have fallen into the same error with other naturalists, who -characterise the superior from the inferior; the lion from the cat, not -the cat from the lion. As to the remedies applied in these diseases, -doubtful in epidemics, they so universally fail in the true plague, -that, notwithstanding the improved state of medicine, we may yet say, -it stands among diseases, in a great measure, like a giant without any -champion to oppose; like a poison without any antidote. - - [2] A myriad is generally supposed to contain ten thousand. - - [3] Gibbon’s History, vol. iv. - - [4] Transact. of Society for improving Medical Knowledge. - -In this unhappy predicament, the breaking out of a plague, in any city -or country, proves a most distressing calamity, not only on account of -the numbers destroyed by the disease itself, but by reason of the bonds -of society being loosed; so that humanity gives way to terror; children -are abandoned by their parents, and parents by their children; every -thing wears the appearance of ruin and desolation; while, in too many -instances, avarice urges on the unprincipled to rapine, or even to -murder. Nor are the cruel modes of prevention, sometimes practiced even -by the authority of the magistrate, less abhorrent to humanity, then -the lawless outrages of the thief or murderer. Instances of all this -will appear in the course of the work; the following are so remarkable, -that I cannot help inserting them in this place. In the great plague at -Marseilles, in 1720, the town being almost deserted, and few choosing -to venture into it, “three sea-captains, and some hundreds of sailors, -having the courage to enter the city, from the sea-side, found therein -a gang of murderers, who made it their business to destroy people -seized with the plague, and to plunder their houses. The ringleader of -them, named _Rouanne_, a gunsmith, was broken alive upon the wheel, and -forty others were hanged. Rouanne owned that he had killed a thousand -persons. There were found, upon one of the murderers, jewels to the -value of more than thirty thousand livres.”[5] During the time of -this public calamity, four men, who came from Marseilles to Aix, were -shot by order of the parliament, lest they should have brought the -infection along with them.[6] Even this is not equal to what Mr. Howard -informs us was practiced in a hamlet of Dalmatia, where, the plague -having raged with such violence, that only two or three remained; the -neighbouring magistrates ordered these miserable survivors to be shot. -At such prices will people buy a precarious, nay, an imaginary, safety. -In short, what Mr. Gibbon says of the situation of people in the time -of violent earthquakes, will also, in a great measure, hold good in -the time of pestilence, or any great public calamity. “Instead of the -mutual sympathy which might comfort and assist the distressed, they -dreadfully experience the vices and passions which are released from -a fear of punishment; the houses are pillaged by intrepid avarice, -revenge embraces the moment and selects the victim: while [7]vengeance -frequently overtakes the assassin or ravisher in the consummation of -his crimes.” - - [5] Political State for 1720. - - [6] Political state, ibid. - - [7] Mr. Gibbon, agreeably to the subject on which he writes, - particularises the mode of vengeance; saying, “the _earth frequently - swallows up_ the assassin,” &c. It is hoped the substitution of - the word _vengeance_, in general, will not be deemed a material - alteration. - -Whether the world hath been in the same predicament ever since the -human race began to multiply, or whether plagues have originated at -some remote period, is a question not easily determined. It is certain -that, as far as histories go, they give us accounts of plagues; -much less frequent indeed in very ancient times than in those which -followed; but the compass of historical knowledge is narrow. There are -no authentic histories of any nation previous to the termination of -those of the Old Testament. Where sacred history ends, profane history -begins. The fabulous period affords many accounts of wars, heroes, -giants, and monsters, but scarce any of plagues. Diodorus Siculus -indeed makes mention of a plague which happened in Greece, after the -flood of Deucalion; and which, he says, was occasioned by the general -corruption of vegetables, &c. consequent on the flood. Deucalion’s -flood is supposed to have been nearly cotemporary with the departure -of the Israelites from Egypt; so that, if there is any truth in the -relation of Diodorus, it is not improbable that some of the Egyptian -plagues might have spread into Greece. We are likewise told of a -pestilence at Athens in the time of Theseus;[8] but all the accounts -of these times are so uncertain, and so much involved in fable, that -little or no dependence can be placed on any of them. - - [8] Univ. Hist. vol. vi. - -The first distinct account we have of plagues of any kind, then, is in -the book of Exodus, where we are told of many heavy judgments sent upon -the Egyptians because of their disobedience. Before this, indeed, we -read of plagues sent on the king of Egypt, for having taken Abraham’s -wife; but as these fell only upon the king and his household, we cannot -suppose any thing like a general pestilence to have taken place among -the people. In like manner did it happen to Abimelech, king of Gerar, -on the same account. All the women belonging to the king’s household -were rendered barren for a time; but we hear of nothing happening -to the nation at large. Again, when Moses and Aaron went in before -Pharaoh, they said to him, “Let us go and sacrifice to the Lord our -God; lest he fall upon us with the sword, or with _pestilence_.” This -shews indeed that both Moses and Pharaoh knew that such a thing as -_pestilence_ existed, or might exist; but it cannot prove that the -disease we now call the plague or pestilence commonly took place among -nations in those days as it has done since. Even among the plagues -inflicted upon the Egyptians by the hand of Moses and Aaron, we find -only two that can be supposed to have any similarity to the disease we -now call the _plague_; viz. the _boil_, and the destruction of their -first born. The former _may_ have been pestilential buboes; the latter -also _may_ have been the effect of a most malignant pestilence; such -as, in the beginning of it, is said frequently to kill suddenly, as by -lightning; but whether it was so or not, we cannot now determine. - -In the history of Job, who is supposed to have been cotemporary with -Moses, we have a case more in point. The boils, with which he was -covered, are by Dr. Mead supposed to have been the small pox; though in -the true plague the body is sometimes covered with gangrenous pustules, -constituting a disease still more dangerous and painful than the small -pox; but whatever the disease of Job was, we may reasonably conclude, -that in his time there was none similar to it commonly existing among -mankind. - -After the departure of the Israelites from Egypt, we find frequent -mention of a plague as a disease commonly to be met with; but it was -always that of leprosy; those destructive plagues, which might be -supposed to resemble the disease we now call by that name, being all -miraculous. Concerning the prevalence of the leprosy among the Jews, -Diodorus says that they “were driven out of Egypt as impious, and -hateful to the gods; for their bodies being overspread and infected -with the itch and leprosy, (by way of expiation) they got them -together, and, as profane and wicked wretches, expelled them out -of their coasts.” This he tells us was a reason given to one of the -kings of Syria why he should exterminate the Jews. In another place -our author gives the following account of the origin of the Jewish -nation. “In ancient times there happened a great plague in Egypt, and -many ascribed the cause of it to God, who was offended with them. For -there being multitudes of strangers of several nations who inhabited -there, who used foreign ceremonies, the ancient manner of worship was -quite lost and forgotten. Hence the natural inhabitants concluded, -that unless the strangers were driven out, they should never be freed -from their miseries. Upon which they were all expelled,” &c. He then -tells us that some of them came into Greece under the conduct of Danaus -and Cadmus; but the greater part entered Judea, then quite desert and -uninhabited. Their leader “was one _Moses_, a very wise and valiant -man,” &c.[9] - - [9] Diodor. Sic. Frag. - -The allusion, in this last passage of Diodorus, to the plagues of -Egypt, mentioned in Exodus, is manifest; and it is equally manifest, -that the Egyptians themselves, as well as the sacred historian, owned -them to be miraculous. Here, however, let it be remarked, that, though -these, and others inflicted on the Israelites, were miraculous, we -are not from thence to conclude that they took place without the -intervention of natural causes. On the contrary, in speaking of the -plagues of Egypt, we are told, that when the locusts came, “the Lord -sent a strong _east wind_, all that day and all that night; and when -it was morning, the _east wind_ brought the locusts.” In like manner -“the Lord turned a mighty strong _west wind_, which took away the -locusts, and cast them into the Red sea.” Again, when the sea itself -was divided, “the Lord caused it to go back by a strong _east wind_ all -that night.” The Egyptians were witnesses to this; but, as they did not -believe that the powers of nature had any superior, they could never be -induced to think that any of the elements would take part in a dispute -between two nations, or favour the one more than the other. - -In diseases inflicted on the human body, we are assured that the powers -of nature were as much employed as in the miracles already mentioned. -When it was told David that the child born to him by Bathsheba should -die, the infant was seized with a natural distemper, probably a fever, -and died the seventh day. When Hezekiah was informed that he should -die, he did not, any more than David had done, give himself up to -despair; but used, for his recovery, such means as were in his power, -viz. prayers to God; from whom, by the constitution of things under the -Old Testament, he would receive a direct answer. And it is remarkable, -that though the answer was favourable, yet the disease was not removed -by any invisible power operating like a charm, but by the use of a -remedy. It is plain therefore that this disease was occasioned by one -natural power, and removed by another. The boil (for that was the -distemper) was brought to maturity by a poultice of figs, and the king -recovered.[10] If then the scripture informs us, that even where the -Deity himself speaks, he has directed the use of a remedy, much more -ought we to be diligent in the use of such as our feeble skill can -suggest, in those cases where he leaves us entirely to the exercise -of our own judgments. To sit down supinely, in case of a dangerous -distemper, with a notion, that if God wills us to die we certainly -shall die, _in any use of natural means_; and if he wills the contrary, -that we shall as certainly recover, _in any neglect of them_; is a -conduct equally unscriptural and absurd. - - [10] Mead. - -In the books of Moses we find the Israelites, in case of disobedience, -threatened with the _botch_ of Egypt; with terror, consumption, and the -_burning ague_. From the name of this last we may reasonably suppose -it to have been the same with the remitting fever of the East, which -is attended with the most intolerable sensation of burning in the -bowels; but whatever the nature of these diseases might have been, -they certainly were not very common in the world at that time, or they -would not have been threatened as extraordinary judgments. They were -not the same with the pestilence; because we find, that after they -had been threatened with fever, consumption, and extreme burning, it -is added, “I will make the _pestilence_ cleave unto thee:” as if it -had been said, that the pestilence, which hitherto had appeared only -on extraordinary occasions, should then become _endemic_, and never -leave them. But, on the whole, the first account we have of any general -plague, seems to be that which was inflicted on the Jews on account -of the sin of their king in numbering the people. David was nearly -cotemporary with the Trojan war; and Homer, in the first book of his -Iliad, informs us, that a plague likewise took place in the camp of -the Greeks; and that too for the sin of their king in carrying off the -daughter of the priest of Apollo, and refusing to restore her at the -entreaty of her father. - -In comparing the account of the sacred historian with that given by -Homer, we cannot help observing a striking similarity between them. -Both plagues were inflicted on the people for the sin of their kings; -both were miraculous; the one continued three days, the other nine. -In both the Deity himself appeared: an angel brandished a drawn sword -over Jerusalem; and Homer says, that, from the top of Olympus, Apollo -shot his arrows into the Grecian camp. Lastly, both were stopped in a -similar manner: David offered sacrifices to the true God; and Agamemnon -returned Chryseis, his captive, to her father, the priest of Apollo, -by whose prayers and sacrifices the plague was stopped. Hence it seems -not impossible, that the story told by Homer, is only that of David, -altered as he thought most proper for embellishing his poem; and that -this was the first remarkable plague in the world. - -In the year 767 B. C. we hear of a universal pestilence; but the -imperfect state of history in those early periods affords few accounts -that can be depended upon, either concerning that or any thing -else.[11] Till after the foundation of Rome, indeed, authentic history -scarce commences; and it is not till the 279th year of that city, -that we hear of its being in any remarkable degree infected with a -pestilential disorder.[12] The plague we speak of is said to have taken -place about the year 469 B. C. which comes within 38 years of that of -Athens in the time of the Peloponnesian war. The near coincidence of -these dates, in times so remote, and when chronology was so little -settled, tends to excite a suspicion that both arose from the same -infection. Of its ravages at Athens we have an excellent account -by the historian Thucydides,[13] who was an eye witness of what he -writes. He says, that according to report it began in Ethiopia, from -whence it came down into Egypt, and thence into other countries. It is -possible, therefore, that it might reach Italy some time before it came -into Greece; for it seems scarce probable, that such a very violent -infection could have taken place in Italy without being communicated to -the neighbouring countries; whence we may reasonably conclude, that the -first plague at Rome, and that of Thucydides, were the same. At Rome, -we are informed, it swept away almost all the flower of the youth who -were able to bear arms, the greatest part of the tribunes, and both the -consuls. The mortality was so great, that no place of sepulture could -be found for the dead bodies, but they were thrown promiscuously into -the Tiber. In short, so low were the Romans at this time reduced, that -the Æqui and Volsci, two Italian nations with whom they were almost -always at war, made an immediate attack, in hopes of being easily able -to carry the city; but in this they were disappointed. The situation -of Athens was truly deplorable; being not only engaged in a foreign -war, but crowded with people from the country; numbers dying daily in -the streets, and the survivors giving themselves up to all manner of -licentiousness.[14] - - [11] In the subsequent section this plague will be more fully treated - of. - - [12] A plague is spoken of in the time of Romulus; but the accounts - of this, and some others, are extremely obscure and indistinct. - - [13] See Appendix No. I. - - [14] See Thucydides’s account at large, Appendix No. I. - -As it seems probable that the same infection desolated both Rome and -Athens, so it seems not unlikely that it was a continuance of the same -which destroyed the Carthaginian army in Sicily, while carrying on a -successful war against Dionysius, tyrant of Syracuse. The plague, as we -are informed by the Universal History, was common in the Carthaginian -territories, especially those on the continent of Africa; and this -pestilence broke out soon after the conclusion of the Peloponnesian -war. As it originally came from Africa, it is probable that it had -never been quite extinguished there; and the compilers of the Universal -History think it probable that the army might have brought the seeds -of it along with them into Sicily. But, whatever was the origin, the -distemper soon became so malignant, that the living were not sufficient -to bury the dead; and those who attended the sick perished in such a -manner, that, after some time, few dared to come near them. At first -they gave the dead a kind of burial; but in time the number became -so great, and the survivors so few and weak, that an hundred and -fifty thousand are said to have rotted above ground. “Justin seems -to intimate that almost the whole Carthaginian army perished by the -plague; and that in a manner all at once, as it were in an instant. -Diodorus, however, informs us, that a considerable body of Africans -and Iberians survived the dreadful calamity. It is worth observation, -that not a single person of those who attended the sick survived.” The -miserable remains of this army, consisting at first of more than three -hundred thousand, were now attacked by their enemies, whom they were no -longer able to resist. Their land forces were entirely defeated, and -their fleet was burnt: “the Gods themselves, (says Diodorus) when the -ships were all in a blaze, and the flames ascending above the masts, -seeming to destroy the Carthaginians with lightning from heaven.” Forty -gallies still remained, and the unfortunate general was now obliged to -purchase liberty to return with the few men he had left. But even these -were treacherously attacked by the tyrant’s fleet, and several of them -sunk. On his arrival at Carthage, he found the whole city not only in -mourning, but in despair: “the wretched inhabitants giving full vent to -their grief, made the shore ring with their groans and lamentations. -In short, a greater scene of horror, except the spot of ground where -the Carthaginian army encamped before Syracuse, than Carthage now was, -cannot well be conceived.” This reception completed the despair of -the unhappy general. Clothing himself in mean and sordid attire, he -joined with the rest in bewailing their common calamities. After some -desperate exclamations against the gods, whom he accused of partiality, -“The enemy, said he, may rejoice at our misery, but have no reason to -glory in it. The troops we have lost did not fall by their valour, nor -did they now oblige those that arrived here to leave Sicily by force. -We return victorious over the Syracusians, and are only defeated by -the plague. As for the baggage found in our camp, this ought not to be -looked upon as the spoils of a conquered enemy, but as moveables which -the casual death of their owners has left the Syracusians in possession -of.” Having then gone on to express his grief for the loss of his army, -and declared his intention not to outlive them, he shut himself up in -his house, refusing admittance even to his own children, and put an end -to his life.[15] - - [15] Univ. Hist. vol. xvii. - -Whether the unfortunate remains of this army brought with them the -infection to Carthage, and there produced a new scene of desolation, we -are not informed; but there seems to have been a very great tendency -to pestilential disorders in the Carthaginian armies; for, in the time -of the siege of Syracuse by Marcellus, a plague broke out in the camp -of the Carthaginians who had come to assist the Syracusians. From them -it passed into the city itself, with so much malignity, that nothing -was to be seen but heaps of dead and dying. None durst receive or -assist the sick, for fear of being infected by them; and the bodies -of the dead were, for the same reason, left unburied, to infect and -poison the air with their putridity and corruption. Nothing was heard, -night and day, but groans of dying men; and the heaps of dead bodies -continually presented mournful objects to the living, who expected -every moment the same fate.[16] The infection reached the Roman camp; -but we do not hear of its being conveyed, at this time, either to -Rome or Carthage. In the time of the contest with Jugurtha, however, -a very terrible calamity took place in Africa. “According to Orosius, -a great part of Africa was covered with locusts, which destroyed all -the produce of the earth, and even devoured dry wood. But, at last, -they were all carried by the wind into the sea, out of which being -thrown in vast heaps upon the shore, a plague ensued, which swept -away an infinite number of animals of all kinds. In Numidia only, -perished eight hundred thousand men; and in Africa Propria, two hundred -thousand; among the rest, thirty thousand Roman soldiers, quartered -in and about Utica for the defence of the last mentioned province. At -Utica, in particular, the plague raged with such violence, that fifteen -hundred dead bodies were carried out of one gate in a day.”[17] - - [16] Univ. Hist. vol. viii. - - [17] Id. vol. xviii. - -From the time that the Romans finished their African wars, till they -had accomplished most of their conquests in Asia, their empire seems -to have continued free from this dreadful scourge; but soon after the -destruction of Jerusalem by Titus, such a violent infection seized on -the city, that for some time upwards of twenty thousand are said to -have died in it daily. - -As the Roman arms were carried still farther to the eastward, and all -the countries reduced, to the confines of Persia, the plague seems to -have become more common among them. In the time of Marcus Aurelius, a -war was undertaken against the Parthians, which was carried on by the -Romans with great success, and with no less cruelty; for, though the -city of Seleucia opened its gates to the Roman general, he caused the -inhabitants, to the number of four hundred thousand, to be massacred. -But they soon paid dear for this cruelty, by a dreadful pestilence, -which broke out, according to the historian Ammianus Marcellinus, in -the very city which they had desolated, and was brought by their army -into Italy, from whence it spread throughout the whole empire. Other -historians say, that it originated in Ethiopia, from whence it spread -into Egypt, and thence into the country of the Parthians. We know not -how long the infection continued; only that, some years afterwards, -when the emperor was defeated by the Germans, the pestilence still -raged to such a degree, that slaves, gladiators, and even the banditti -of Dalmatia and Dardania, were enlisted for the defence of the empire. -It is certain that great havock must have been made by it, as we find -that the barbarians were encouraged to invade the empire on all sides, -and could scarcely be repulsed; insomuch that historians compare this -with the most destructive wars the Romans had ever waged.[18] - - [18] Univ. Hist. vol. xv. - -During the time that the empire was overrun by the northern barbarians, -the plague frequently made its appearance; which we shall have occasion -to notice more particularly in the following section; but in those -times the destruction by the sword was so extraordinary, that less -mention is made by history of any pestilential disorder. In the time of -Justinian, however, about sixty-five years after the final destruction -of the western empire, the most violent plague recorded in history took -place. Of this we have a particular account by Procopius.[19] “The -distemper (says Mr. Gibbon) arose in the neighbourhood of Pelusium, -on the confines of Egypt, between the Sarbonian bog and the eastern -channel of the Nile. From thence, tracing, as it were, a double -path, it spread to the east, over Syria, Persia, and the Indies, -and penetrated to the west, along the coast of Africa, and over the -continent of Europe. In the spring of the second year, Constantinople, -during three or four months, was visited by this pestilence. Such was -the corruption of the air, that the pestilence was not checked, nor -alleviated, by any difference of seasons. The numbers that perished -in this extraordinary mortality have not been recorded; only we find -that, during three months, there died at Constantinople five, and at -last ten thousand a day. Many cities of the east were left vacant, and, -in several districts of Italy, the harvest and vintage withered on the -ground. The triple scourge of war, pestilence and famine afflicted the -subjects of Justinian; and his reign is disgraced by a visible decrease -of the human species, which has never been repaired, in some of the -fairest countries of the globe.”[20] - - [19] See Appendix, No. II. - - [20] Gibbon’s Hist. vol. iv. Procopius, in speaking of the numbers - who died in this extraordinary plague, compares them to the sand of - the sea; and afterwards expresses them by a phrase which has been - translated _two hundred millions_. The phrase is _myriadas myriadon - myrias_. Mr. Gibbon, by dropping the first word, restricts the sense - to _one hundred millions_; which he thinks not wholly inadmissible; - but the probability seems to be, that Procopius did not mean to - specify the number, but to represent it as incalculable. This is done - by putting a comma, or semicolon, after the first word; and we may - then read, that there perished _myriads; a myriad of myriads_. The - grammar is rectified by reading _myriades_ instead of _myriadae_. - -This plague broke out in the time of Justinian, in the year 541 or 542 -of the christian era; and not only ravaged Constantinople in the time -of Justinian, but returned with increased violence during the reigns of -many of his successors. In the time of Mauritius we find the Avari, a -barbarous nation to the north of the Danube, driven back by the plague -after they had crossed that river to invade the Roman territories. The -reign of Phocas, successor to Mauritius, was still more unfortunate. -“Great numbers were swept off, either by famine or pestilence; the -earth refused her fruits in season; the winters were so severe, that -the seas were frozen, and the fish destroyed.” Phocas ascended the -imperial throne in 603; but in the midst of such confusion as then -filled the world, we can scarce expect an accurate account of the time -when this most malignant pestilence ceased. We can scarcely suppose -it to have lasted two centuries; but, in the reign of Constantine -Copronymus, which began in 742, we find the distemper still raging, and -the same dreadful phenomena of nature still continuing. The plague, we -are now told, broke out in Calabria in Italy; whence it soon spread -over Greece, Sicily, the islands in the Ægean sea; and at last reached -Constantinople; where it raged for three years together, with such -fury, that the living were scarce sufficient to bury the dead. The -earthquakes, which accompanied or preceded this pestilence, were such -as had never been known in any age. In Syria and Palestine several -cities were swallowed up; others, entirely ruined; and some, if we may -give credit to Nicephorus, removed without any considerable damage, six -miles and upwards from their former seats. At the same time happened an -extraordinary darkness, which lasted from the fourth of August to the -first of October, there being little or no distinction, during all that -time, between day and night.[21] During the reign of the same prince, -there happened such an extraordinary frost, that, at Constantinople, -both seas were frozen for an hundred miles from the shore; the ice -being covered with snow twenty cubits deep, and sufficiently strong -to bear the heaviest carriages. When the frost broke, mountains of -ice and frozen snow, being driven by the wind through the straits, -did a great deal of damage to the walls of Constantinople. The month -following, several prodigies appeared, or were thought to appear, in -the air. At the same time a comet, which the Greeks called _Docites_, -because it resembled a beam, was seen for ten days in the east, from -whence it moved into the west, and shone there for one and twenty days -more. The people were struck with terror and amazement at the sight -of the prodigies, and apprehended the last day to be at hand.[22] -Dreadful earthquakes, strange phenomena in the heavens, inundations, -&c. occurred in the year 812, during the reign of Michael Balbus; but -no remarkable plague is mentioned by the Greek historians, till the -year 1025, when a new train of calamities took place. The plague broke -out in Cappadocia, raging with such violence there, as well as in -Paphlagonia and Armenia, that the people were forced to abandon their -dwellings. A terrible famine followed; after which the earthquakes -again commenced with redoubled fury: at Constantinople they continued -forty days together; while people were terrified by a _comet_ (probably -a large meteor) which passed with a dreadful noise from north to south; -the whole horizon appearing to be in a flame. - - [21] Univ. Hist. vol. xvii. - - [22] Ibid. - -From these calamities the world, at least that part of it known to -the Greek historians, appears to have enjoyed some respite till the -year 1346. Indeed we may now say, as in the time of the invasion by -the northern barbarians, that the sword, and not the pestilence, was -the plague of those times. A most violent and universal pestilence, -however, now took place; though, for want of such historians as -Thucydides and Procopius, we cannot here give a particular account of -it. In general we are told, that it began in the kingdom of Cathay (the -northern part of China) from whence it gradually overspread all the -countries between that and the western extremity of Asia. Invading, -at last, Constantinople, it proceeded from thence to Greece, Italy, -France, Africa, Germany, Hungary, Denmark, Britain and Ireland. Thus, -it seems to have been as extensive a contagion as ever appeared in the -world. It is even probable, that, from the remains of this contagion, -Europe hath been but very lately set at liberty; as we hear, not long -after, of plagues being very frequent in different parts of that -continent. In England it assumed somewhat of a new form towards the end -of the fifteenth century; being then known by the name of the English -Sweating Sickness. But, except in the greater propensity to sweat, -the disease appears not to have differed from the true plague. The -sweating sickness first made its appearance in the army of Henry VII, -when he landed at Milford in 1483; and that year invaded London, where -it continued only from the 21st of September to the end of October. -It returned in 1485, 1506, 1517, 1528 and 1551; since which time it -has not been known in Britain. In 1517 it was extremely violent and -mortal; sometimes killing the sick in three hours; and so general was -the infection, that, in some places, one half of the inhabitants -died. In 1528 it also raged with great violence; the sick sometimes -dying in four hours. The last attack, in 1551, was also very violent. -In 1529 it appeared in Holland and Germany, destroying great numbers -of people; but it hath not been observed, at least in any remarkable -degree, in those countries since that time. In the course of the 17th -century, various parts of Europe have suffered very much from the -plague in its usual form. Indeed (for reasons given in the subsequent -section) we can scarce suppose the pestilential contagion ever to -have ceased entirely. In 1603, London was visited with the plague; -and on this occasion the practice of shutting up infected houses was -first introduced.[23] In 1656 another plague took place in the same -metropolis, but does not appear to have made any violent attack. In -Naples it raged that year with great fury; destroying, according to -some accounts, fifteen thousand, according to others, twenty thousand, -a day. But these accounts the author of the Journal just quoted, with -great probability, supposes to have been exaggerated. Others say, that -four hundred thousand Neapolitans were destroyed by this infection; -so that we must at any rate believe it to have been very violent. In -the plague of London in 1665, immense numbers perished; and particular -accounts were published of this calamity; of which an abridgment is -given in the Appendix to this work, No. III. Since that time it has not -been known in Britain; but other parts of Europe have not been equally -fortunate. In the beginning of the eighteenth century it appeared in -several parts of the continent; particularly in Copenhagen in the year -1711; where it committed great ravages, as it had done at Dantzic two -years before; but in 1720 it appeared at Marseilles in France, where it -raged with such fury as to destroy sixty out of the hundred thousand -supposed to be the whole population of the place.[24] Since that time -France hath been free from the distemper; but in Sicily, the dominions -of the Ottoman Porte, and places adjacent, it hath been felt very -severely. In 1743 it was supposed to have destroyed two thirds of the -inhabitants of Messina. A particular account of its ravages was read -before the Royal Society of London by Dr. Mead. The following is taken -from Dr. Lobb’s Treatise on the Plague. “From the beginning of June to -the end of July, of forty thousand inhabitants, two thirds perished. -The disorders in the city were incredible. All the bakers died, and no -bread was baked for many days. The streets were full of dead bodies; -at one time from twelve to fifteen thousand remaining in the open air: -men, women and children, rich and poor, all together dragged to the -church doors. The vaults being full, and the living not sufficient -to carry the dead out of the city, they were obliged to put them on -funeral piles, and burn them promiscuously. Nothing was more shocking -than to see people, far above the common stations, go about begging for -a loaf of bread, when they could hardly walk, with their tumours upon -them; and few were in a state to help them. All these calamities did -not hinder the most execrable villanies, which were committed every -moment; and, though so few survived, the governor was obliged to make -several public examples.” - - [23] Journal of the Plague Year. - - [24] See Appendix, No. IV. - -In the Turkish dominions, though we have not read of such extraordinary -devastations as formerly took place, yet we are assured that the -pestilence rages there very frequently. From 1756 to 1762 we have -histories of it by Dr. Russel and others, the substance of which -accounts is given in the Appendix, No. V. In the time of the great war -between the Turks and Russians, it found its way to Moscow, which city -it invaded in 1771. M. Savary says, it was brought thither by infected -merchandise from the store houses of the Jews; and that it carried -off two hundred thousand people. In the sixth volume of the Medical -Commentaries, however, we are told that it was brought from the army -by two soldiers; both of whom were carried into the military hospital, -and both died. The anatomist who dissected their bodies died also. The -infection quickly seized the hospital, and thence the whole city. -This happening in the beginning of the year, its progress was for some -time checked by the cold; but its ravages became greater as the summer -advanced. It raged most violently during the months of July, August -and September; in which time there were instances of its destroying -twelve hundred persons in a day. Twenty-five thousand died in the month -of September; in the course of which month scarce one in an hundred -of the infected recovered. Only seventy thousand, according to this -account, perished by the disease. The year 1773 proved very fatal to -Bassorah; where, as formerly mentioned, two hundred and seventy-five -thousand perished in the summer season, through the violence of the -distemper.[25] But in countries where the plague rages so frequently, -and where there are few that make observations with any accuracy, we -cannot expect complete histories of every attack made by it; neither -would the limits of this Treatise admit of a detail of them, though -there were. We know, however, that since the year we speak of, the -plague has ravaged Dalmatia, particularly in the year 1784, when -it almost desolated the town of Spalatro, destroying three or four -thousand of its inhabitants. Though some countries therefore have for a -number of years remained free from the attacks of this terrible enemy, -yet there are others where it is as it were stored up, and from whence -it may, on a proper occasion, break forth as formerly, and once more -spread ruin and desolation through the world. - - [25] An English gentleman, who resided in Bassorah at that time, - preserved himself from the infection by retiring to a mud-house, - where he had no communication with the inhabitants. Having a large - quantity of Bengal cotton, he sold it to the people to wrap their - dead in. The price was put in a basket, which he hauled up by a rope - to his ware-room; lowering it again with the proportionate quantity - of cloth. In the course of the summer he had an account of _seventy - thousand_ winding sheets thus disposed of! - - (Transact. of a Society for improving Medical Knowledge.) - - - - -SECTION II. - - _Of the Countries where the Plague is supposed to originate.--The - Influence of Climate in producing Diseases--And of the Moral Conduct - of the Human Race in producing and influencing the same._ - - -In considering the origin of a calamity so dreadful and so universal, -we might reasonably suppose that the fatal spots which gave rise to -it would long ago have been marked out and abandoned by the human -race altogether. But this is far from being the case. In the accounts -already given of various plagues, they are always said to have been -imported from country to country, but never to have originated in that -of the person who wrote of them. If a plague arose in Greece, we are -told it came from Egypt; if in Egypt, it came from Ethiopia; and had we -any Ethiopic historians, they would no doubt have told us that it came -from the land of the Hottentots, from Terra Australis Incognita, or -some other country as far distant as possible from their own. In short, -though it has been a most generally received opinion, that plagues -are the immediate effects of the displeasure of the Deity on account -of the sins of men; yet, except David and Homer (already quoted) we -find not one who has had the candour to acknowledge that a plague -originated among his countrymen on account of their sins in particular. -In former times Egypt and Ethiopia were marked out as the two great -sources of the plague; and even as late as the writings of Dr. Mead -we find that the same opinion prevailed. The Doctor, who attempts to -explain the causes of the plague, derives it entirely from the filth -of the city of Cairo, particularly of the canal that runs through it. -But later writers, who have visited and resided in Egypt, assure us -that the country is extremely healthy, and that the plague is always -brought there from Constantinople. It is true that Dr. Timone, in the -Philosophical Transactions, No. 364, tells us, that it appears from -daily observation, as well as from history, that the plague comes -to Constantinople from Egypt; but the united testimonies of Savary, -Volney, Mariti and Russel, who all agree that Egypt receives the -infection from Constantinople, must undoubtedly preponderate. - -“The pestilence (says M. Savary) is not a native of Egypt. I have -collected information from the Egyptians, and foreign physicians who -have lived there twenty or thirty years; which all tended to prove the -contrary. They have assured me that this epidemic disease was brought -thither by the Turks, though it has committed great ravages. I myself -saw the caravelles of the Grand Signior, in 1778, unlade, according to -custom, the silks of Syria at Damietta. The plague is almost always -on board; and they landed, without opposition, their merchandise, and -their people who had the plague. It was the month of August; and, as -the disease was then over in Egypt, it did not communicate that season. -The vessels set sail, and went to poison other places. The summer -following, the ships of Constantinople, alike infected, came to the -port of Alexandria, where they landed their diseased without injury -to the inhabitants. It is an observation of ages, that if, during the -months of June, July and August, infected merchandise be brought into -Egypt, the plague expires of itself, and the people have no fears; and -if brought at other seasons, and communicated, it then ceases. A proof -that it is not a native of Egypt is, that, except in times of great -famine, it never breaks out in Grand Cairo, nor the inland towns, but -always begins at the seaports on the arrival of Turkish vessels, and -travels to the capital; whence it proceeds as far as Syria. Having come -to a period in Cairo, and being again introduced by the people of Upper -Egypt, it renews with greater fury, and sometimes sweeps off two or -three hundred thousand souls; but always stops in the month of June, or -those who catch it then are easily cured. Smyrna and Constantinople are -now the residence of this most dreadful affliction.” - -M. Volney informs us, that the European merchants residing at -Alexandria agree in declaring that the disease never proceeds from the -internal parts of the country, but always makes its first appearance on -the sea-coasts at Alexandria; from thence it passes to Rosetta, from -Rosetta to Cairo, and from Cairo to Damietta, and through the rest of -the Delta. It is invariably preceded by the arrival of some vessel -from Smyrna or Constantinople; and it is observed, that if the plague -has been violent during the summer, the danger is greater for the -Alexandrians during the following winter. - -To the same purpose, the Abbe Mariti says, “The plague does not usually -reside in Syria, nor is this the place where it usually begins. It -receives this fatal present from Egypt, where its usual seat is -Alexandria, Cairo or Damietta. The plague of 1760 came at once from -Cairo and Alexandria; to the latter of which it had been brought from -Constantinople. When it comes from that capital, as well as from the -cities of Smyrna and Salonica, it acquires a peculiar malignity; and -its activity never expands itself with more fury than in the plains of -Egypt, which it overspreads with incredible rapidity. It is observed, -that this plague, so destructive to Egypt, seldom attacks Syria; but -that the latter has every thing to dread from a plague hatched in the -bosom of Egypt.” - -The testimony of these three authors, who have all been lately on -the spot, must certainly have very great weight, especially when -corroborated by that of Dr. Russel; for which see Appendix, No. V. But -still there is some difficulty. M. Savary informs us, that, _except -in cases of great famine_, the disease never breaks out in Cairo; -which certainly implies that in cases of famine it does originate in -the city itself; and Mariti, by saying that the Syrians have much -reason to dread a plague _hatched in the bosom_ of Egypt, undoubtedly -intimates that plagues sometimes do originate in Egypt. Smyrna and -Salonica likewise seem to come in for their share of the blame; and -Dr. McBride, in his Practice of Physic, informs us, that some parts -of Turky are visited by the plague once in six or seven years; and M. -Savary says, that Egypt is visited with it once in four or five years; -but if Egypt never receives it but from Turky, it would seem that the -plague could at least be no more frequent than in that country; or, -if the fact be otherwise, that the disease must either originate in -Egypt itself, or be brought to it from some other country than Turky. -Dr. Timone, in the paper already quoted,[26] tells us, that the plague -has taken up its residence in Constantinople; but that, though the -seeds of the old plague are scarce ever wanting, yet a new infection -is likewise imported from time to time. Thus, in attempting to find -out the countries where the plague originates, we are led in a circle. -Constantinople accuses Egypt, and Egypt recriminates on Constantinople. -Ethiopia, the most distant and least known of those countries which -in former times had any connexion with the more civilized parts of -the world, for a long time bore the blame of all; but the Jesuit -missionaries who resided long in Abyssinia (the ancient Ethiopia) do -not mention the plague as more common in that country than some others; -neither does Mr. Bruce, in the accounts he has published, take notice -of any such thing. Ethiopia could not speak for itself, by reason of -the ignorance and barbarity of its inhabitants; and Constantinople -is now very much in the same predicament. The investigation of this -subject therefore would require an accurate account of the climates -of those countries where the plague is found to commit the greatest -ravages, and a comparison of them with those which are now accounted -the most unhealthy in other respects, and likewise a comparison of the -diseases produced in the latter, with the true plague. - - [26] Philosoph. Transact. No. 364. - -The most unhealthy climates now existing (those where the plague -commonly rages excepted) are to be met with in the hottest parts of the -world; the East and West Indies, the wastes of Africa, and some parts -of America. In all these, Dr. Lind, who has written a treatise on the -diseases incident to Europeans in hot climates, seems to lay the whole -blame upon the heat and moisture accompanying it. In the East Indies -Bencoolen, in the island of Sumatra, is the most unhealthy of all the -English settlements; but he informs us, that by building their fort -on a dry, elevated place, about three miles from the town, it became -sufficiently healthy. Next to this, Bengal is most subject to sickness; -for which he assigns the following reason: “The rainy season commences -at Bengal in June, and continues till October; the remainder of the -year is healthy and pleasant. During the rains, this rich and fertile -country is covered by the Ganges, and converted as it were into a -large pool of water. In the month of October, when the stagnated water -begins to be exhaled by the heat of the sun, the air is then greatly -polluted by the vapours from the slime and mud left by the Ganges, and -by the corruption of dead fish and other animals. Diseases then rage, -attacking chiefly such as are lately arrived. The distempers are fevers -of the remitting or intermitting kind; for, though sometimes they may -continue several days without sensible remission, yet they have in -general a great tendency to it. If the season be very sickly, some -are seized with a malignant fever, of which they soon die. The body -is covered with blotches of a livid colour, and the corpse, in a few -hours, turns quite livid and corrupted. At this time fluxes prevail, -which may be called bilious or putrid, the better to distinguish them -from others which are accompanied with inflammation of the bowels. The -island of Bombay has of late been rendered much more healthy than it -formerly was, by a wall built to prevent the encroachments of the sea, -where it formed a salt marsh; and by an order that none of the natives -should manure their cocoa-trees with putrid fish. - -“Batavia, the capital of the Dutch East India dominions, is annually -subject to a fatal and consuming sickness. Here the Dutch, in -attempting to make this, their capital in India, resemble their cities -in Europe, have adorned it with canals or ditches, intersecting -each other, running through every part of it. Notwithstanding the -utmost care to keep these clean, during the rainy season, and after -it, they become extremely noxious to the inhabitants, but especially -to strangers. It has been remarked, that the sickness rages with -the greatest violence when the rains have abated, and the sun has -evaporated the water in the ditches, so that the mud begins to appear. -This happened in 1764, when some British ships of war had occasion -to stay for a little time at Batavia. The stench from the mud was -intolerable; the fever was of the remitting kind; some were suddenly -seized with a delirium, and died in the first fit; but none survived -the attack of a third. Nor was the sickness at that time confined -to the ships; the whole city afforded a scene of disease and death; -streets covered with funerals, bells tolling from morning to night, and -horses jaded with dragging the dead in herses to their graves. At that -time a slight cut of the skin, the least scratch of a nail, or the most -inconsiderable wound, turned quickly into a putrid, spreading ulcer, -which, in twenty-four hours, consumed the flesh, even to the bone. -Besides these malignant and remitting fevers, which rage during the wet -season in the unhealthy parts of the East Indies, Europeans, especially -such as live intemperately, are also subject to fluxes, and to an -inflammation, or disease of the liver; which last is almost peculiar to -India, and particularly to the Coromandel coast.” - -In the same work we have an extract from Mr. Ives’s journal of a -journey from India to Europe by land. “Gambroon in Persia, says he, -is very unhealthful. Few Europeans escape being seized with putrid -intermitting fevers, which rage from May to September, and are often -followed with obstructions of the liver. Various authors who have -treated of Gambroon, do, as well as the present English factory, impute -its unhealthfulness, during the summer months, to the noxious effluvia -with which the air is contaminated, from the great quantities of -blubber fish left by the sea upon the shore, and which very soon become -highly offensive. In the rainy seasons, at the island of Karee, in the -Persian Gulf, intermitting fevers and fluxes are the usual distempers. -On our arrival at Bagdad (supposed to contain 500,000 souls) we found -a purple fever raging in the city; but though it was computed that an -eighth part of the inhabitants were ill, yet the distemper was far from -being mortal. Here we were informed that the Arabs had broken down the -banks of the river near Bassorah, with a design to cover with water -the deserts in its neighbourhood. This, it seems, is the usual method -of revenge taken by the Arabs for any injury done them by the Turks -at Bassorah; and was represented to us as an act of the most shocking -barbarity, since a general consuming sickness would undoubtedly be -the consequence. This was the case fifteen years before, when the -Arabs, by demolishing the banks of this river, laid the environs of -Bassorah under water. The stagnating and putrefying water in the -adjacent country, and the great quantity of dead and corrupted fish -at that time lying upon the shore, polluted the whole atmosphere, and -produced a putrid and most mortal fever, of which between twelve and -fourteen thousand of the inhabitants perished; and, at the same time, -not above two or three of the Europeans who were settled there escaped. -The effects of the violent heats we endured were, an entire loss of -appetite, a faintness and gripes, with frequent and bilious stools; -which greatly exhausted our strength. My stomach was often so weak, -that it could receive only a little milk. Several of us became feverish -through the excessive heat, and were obliged to have recourse to gentle -vomits, &c. Though we were furnished with the most ample conveniencies -for travelling, which money, or the strongest recommendations to the -principal christians, as well as mahometan chiefs, could procure, -and had laid in a quantity of excellent madeira, claret, and other -provisions, &c. yet most of us suffered in our constitutions by this -long and fatiguing journey.” - -On these climates in general Dr. Lind observes, that in well cultivated -countries, such as China, the air is temperate and wholesome; while -the woody and uncultivated parts prove fatal to multitudes accustomed -to breathe a purer air. In all places also, near the muddy and impure -banks of rivers, or the foul shores of the sea, mortal diseases are -produced from the exhalations, especially during the rainy season. -“There is a place near Indrapour, in Sumatra, where no European can -venture to remain, or sleep one night on shore, during the rainy -season, without running the hazard of his life, or at least of a -dangerous fit of sickness; and at Podang, a Dutch settlement on -Sumatra, the air has been found so bad, that it is commonly called the -Plague-Coast. Here a thick, pestilential vapour or fog arises, after -the rains, from the marshes, which destroys all the white inhabitants.” - -In treating of the diseases of Africa, the same author takes notice of -those of Egypt; which country, he says, is rendered unwholesome by the -annual inundation of the Nile, and being surrounded on three sides by -large and extensive deserts of sand, by which means it is exposed to -the effects of that noisome vapour, which, during the summer months, -arises from sultry, hot sand. He doth not, however, say, that the true -plague originates in this country, either from the inundation of the -Nile or any other cause. On the climate of Egypt I shall once more -quote M. Savary, who is a strenuous advocate for its healthiness, and -is at pains to confute the opinion of Mr. Pauw, and others, who assert -the contrary. “Mr. Pauw (says he) pretends, that at present Egypt is -become, by the negligence of the Turks and Arabs, the cradle of the -pestilence; that another epidemical disease, equally dreadful, appears -here, by the caravans of Nubia; that the culture of rice engenders -numerous maladies; that the want of rain and thunder occasions the -air of the Thebais to acquire a violence that ferments the humours -of the human body, &c.” “These assertions (M. Savary observes) have -an air of probability, which might impose on people who have not -lived in Egypt; but Mr. Pauw has ventured opinions in his closet, -without the guidance of experience. In vallies, indeed, enclosed by -high mountains, where the atmosphere is not continually renewed by -a current of air, the culture of rice is unwholesome, but not so, -near Damietta and Rosetta. The plains are nearly on a level with the -sea; neither hill nor height impedes the refreshing breath of the -north, which drives the clouds and exhalations off the flooded fields -southwards, continually purifies the atmosphere, and preserves the -health of the people; so that the husbandmen who cultivate the rice are -not more subject to diseases than those who do not. The heats of the -Thebais certainly surpass those of many countries under the equator. -Reaumer’s thermometer, when the burning breath of the south is felt, -sometimes rises to thirty-eight degrees above the freezing point,[27] -often to thirty-six. Were heat the principle of diseases, the _Said_ -(Upper Egypt) would not be habitable; but it only seems to occasion a -burning fever, to which the inhabitants are subject; and which they -cure by regimen, drinking much water, and bathing in the river: in -other respects they are strong and healthy. Old men are numerous, and -many ride on horseback at eighty. The food they eat in the hot season -contributes much to the preservation of their health; it is chiefly -vegetables, pulse and milk. In Lower Egypt, the neighbourhood of the -sea, the large lakes, and the abundance of the waters, moderate the -sun’s heat, and preserve a delightful temperature. Strabo and Diodorus -Siculus, who long lived here, did not think the country unhealthy. -There is, indeed, an unwholesome season in Egypt. From February till -the end of May, the south winds blow at intervals, and load the -atmosphere with a subtile dust, which makes breathing difficult, and -drive before them pernicious exhalations. Sometimes the heat becomes -insupportable, and the thermometer suddenly rises twelve degrees. The -inhabitants call this season _Khamsin, fifty_; because these winds are -most felt between Easter and Whitsuntide; during which season they eat -rice, vegetables, fresh fish and fruit; bathing frequently, and using -plenty of perfumes and lemon juice; with which regimen they prevent the -dangerous effects of the Khamsin. But it must not be supposed that this -wind, which corrupts meat in a few hours, blows fifty days. Egypt would -become a desert. It seldom blows three days together; and sometimes is -only an impetuous whirlwind, which rapidly passes, and injures only -the traveller overtaken in the deserts. When at Alexandria a tempest -of this kind suddenly arose, driving before it torrents of burning -sand, the serenity of the sky disappeared, a thick veil obscured the -heavens, and the sun became blood-coloured. The dust penetrated even -the chambers, and burnt the face and eyes. In four hours the tempest -ceased, and the clearness of the day appeared. Some wretches in the -deserts were suffocated, and several I saw brought to appearance dead; -some of whom, by bathing in cold water, were restored to life.” - - [27] Water boils at eighty degrees of this thermometer. - -The internal parts of the continent of Africa are but little known. -The northern parts, containing the States of Barbary, are sufficiently -healthy; the middle parts of the western coast, known by the names -of Negro-land, Guinea, &c. are extremely unhealthy and pernicious to -strangers. Dr. Lind informs us, that, at a distance, this country -appears in most places flat, covered with low, suspended clouds; and -on a nearer approach heavy dews fall in the night time; the land being -every morning and evening wrapped up in a fog. The ground is clothed -with a pleasant and perpetual verdure, but altogether uncultivated, -excepting a few spots, which are generally surrounded with forests or -thickets of trees, impenetrable to refreshing breezes, and fit only for -the resort of wild beasts. The banks of the rivers and rivulets are -overgrown with bushes and weeds, continually covered with slime, which -sends forth an intolerable stench. All places however are not equally -unhealthy; nor is any place equally unwholesome at all times of the -year. It is only with the rainy season that the sickness commences. -But as it would be tedious, and not answer our present purpose, to -enumerate those places which are healthy, and those which are not, -I shall only extract from Dr. Lind’s work an account of one which -seems to be as bad as can well be imagined. It is called _Catchou_, a -town belonging to the Portuguese, and situated in 12 degrees N. lat. -“I believe (says the author of this account) there is scarce to be -found on the whole face of the earth a more unhealthy country than -this during the rainy season. We were thirty miles distant from the -sea, in a country altogether uncultivated, overflowed with water, -surrounded with thick, impenetrable woods, and overrun with slime. The -air was vitiated, noisome and thick, insomuch that the lighted torches -or candles burnt dim, and seemed ready to be extinguished; even the -human voice lost its natural tone. The smell of the ground, and of -the houses, was raw and offensive; but the vapour arising from the -putrid water in the ditches was much worse. All this, however, seemed -tolerable, in respect of the infinite numbers of insects swarming every -where, both on the ground and in the air; which, as they seemed to -be produced and cherished by the putrefaction of the atmosphere, so -they contributed greatly to increase its impurity. The wild bees from -the woods, together with millions of ants, overran and destroyed the -furniture; while swarms of cock-roaches often darkened the air, and -extinguished even the candles in their flight; but the greatest plague -was the musquetoes and sand-flies, whose incessant buzz and painful -stings were more insupportable than any symptom of the fever. Besides -all these, an incredible number of frogs, on the banks of the river, -made such a constant and disagreeable croaking, that nothing but being -accustomed to such an hideous noise, could permit the enjoyment of -natural sleep. In the beginning of October, as the rains abated, the -weather became very hot, the woods were covered with abundance of dead -frogs, and other vermin, left by the recess of the river; all the -mangroves and shrubs were likewise overspread with stinking slime.” - -No doubt these accounts are calculated to inspire us with dreadful -ideas of the countries mentioned in them. What could be done by the -putrefaction of dead animals and vegetables, certainly would be done -here; the produce, however, was not the true plague; not even in -_Catchou_; but “a sickness which could not well be characterised by -any denomination commonly applied to fevers; it however approached -neared to what is called a nervous fever, as the pulse was always -low, and the brain and nerves principally affected,” &c. Certainly -if in any country heat, moisture and putrefaction could produce a -plague, it would be in this. Yet, in all the places we have mentioned, -whether India, Arabia, Egypt, or Guinea, (and we might go through the -whole world in the same manner) we have not been able to find either -moist heat or dry heat, even when aided by putrefaction, insects, and -nastiness of all kinds (not justly chargeable upon any climate;) I -say, we have not found the united powers of all these able to produce -a plague. Nay, it is even doubtful whether climates can produce those -inferior diseases above mentioned. Even Dr. Lind, who appears to be -so willing to ascribe every thing to climate, seems embarrassed in -this respect. “There are many difficulties (says he) which occur in -assigning a satisfactory reason, why in some countries, as in those -between the tropics, heavy and continual rains should produce sickness; -while in other places, especially in the southern parts of Europe, -a want of rain for two or three months in summer brings on diseases -almost similar. Upon this occasion (adds the Doctor) I cannot help -observing, that there is hardly a physical cause which can be assigned -for the produce of any disease, that will not admit of some exceptions: -thus, not only the woods and morasses in Guinea are tolerably healthy, -with some exceptions, in the dry season; but a few instances might be -produced of towns surrounded with marshes and a foggy air, where the -inhabitants suffer no inconvenience from their situation, even during -the rainy season. Do the impetuous torrents of water poured from the -clouds during the rainy seasons, in tropical countries, contain what -is unfriendly to health? Thus much is certain, that the natives of -such countries, especially the mulattoes, avoid being exposed to these -rains as much as possible, and when wet with them immediately plunge -themselves into salt water, if near it. They generally bathe once a -day, but never in the fresh water rivers, when overflown with rains, -preferring at such times the water of springs. Is the sickness of these -seasons to be ascribed to the intense heat of the then almost vertical -sun; which frequently, for an hour or two at noon, dispels the clouds, -and with its direct beams instantly changes the refreshing coolness of -the air into a heat almost insupportable? - -“Further: As the season of those sudden and terrible storms, called -the hurricanes, in the East and West Indies, and tornadoes on the -coast of Guinea, partly coincides with that of the rains, do these -dreadful tempests in any measure contribute to produce the prevailing -sickness at those times? It was remarkable one year at Senegal, that, -in the beginning of the rainy season, in the night succeeding one of -these tornadoes, a great number of the soldiers, and two thirds of -the English women, were taken ill, this garrison before having been -uncommonly healthy. - -“Lastly: Is it not more probable, as in those countries the earth for -six or eight months in the year receives no moisture from the heavens -but what falls in dews, which every night renew the vegetation, and -reinstate the delightful verdure of the grass, that the surface of the -ground in many places becomes hard and incrustated with a dry scurf, -which pens up the vapours below, until, by the continuance of the -rains for some time, this crust is softened, and the vapours set free? -That these dews do not penetrate deep into the surface of the earth, -is evident from the constant dryness and hardness of such spots of -ground, in those countries, as are not covered with grass and other -vegetables. Thus the large rivers, in the dry season, being confined -within narrow bounds, leave a great part of their channel uncovered, -which, having its moisture totally exhaled, becomes a hard, dry crust; -but, no sooner the rains fall, than, by degrees, this long parched up -crust of earth and clay gradually softens, and the ground, which before -had not the least smell, begins to emit a stench, which in four or five -weeks becomes exceeding noisome; at which time the season of sickness -commences.” - -From these quotations it must certainly appear, that the author himself -is dissatisfied with his theory; and that, though in the outset he -thought heat and moisture, assisted by the exhalations from putrid -animal and vegetable substances, sufficient to produce the disorders -of which he treats, yet, on a more minute investigation, he is obliged -to acknowledge, that something inexplicable still remains. This he -now wishes to solve by unknown properties in the water, by confined -exhalations, &c. But as the consideration of these things belongs -properly to the next section, I shall here only remark, that there hath -not yet been given any satisfactory account of the origin of epidemic -diseases of what I call the _inferior_ kind, much less of the true -plague, which stands above them all, as I have already said, like the -serpent Python above other serpents. - -To what has been quoted from Dr. Lind, I shall here subjoin the -testimony of Dr. Clark, who had an opportunity of observing the -epidemic diseases which raged at Bengal in 1768 and 1769. These were, -“the remittent fever and dysentery, which begin in August, and continue -till November. During the beginning of the epidemic, the fever is -attended with extreme malignity and danger; frequently carrying off -the patient in twelve hours; and, if not stopped, generally proves -fatal on the third or fourth day. In August the remissions are very -imperceptible; in October they become more distinct; and, as the cold -weather comes on, the fever becomes a regular intermittent. At that -time, too, the putrid dysentery begins to rage with the fever. These -diseases were very fatal to many Europeans, particularly new comers, -in 1768. But in the year 1770, when there was a scarcity of rice, it -was computed, that about eighty thousand natives, and one thousand -five hundred Europeans, died at Bengal. The streets were covered -with funerals; the river floated with dead carcases; and every place -exhibited the most melancholy scenes of disease and death. During -the sickly seasons at Bengal, the uncertainty of life is so great, -that it frequently happens that one may leave a friend at night in -perfect health, who shall not survive next day. There have been several -instances of persons who have returned home in a state of perfect -health from performing the last duties to a deceased friend, and have -next day been numbered with the dead. But the cool, agreeable season, -from December to March, is productive of no prevailing diseases. -The complaints to be met with are in general the consequences, or -remains, of the diseases of the former period. The complaints which -the Europeans are subject to in the dry months are, the cholera and -diarrhœa. Fluxes and fevers are then seldom epidemic; and, when they do -happen, are not attended with much danger. - -“At Batavia the rainy season is from November to May, during which time -malignant, remitting and continued fevers and the dysentery rage with -great fatality. Captain Cook, in his first voyage, arrived here in -October 1779; the whole crew, excepting Tupia, a native of Otaheite, -being in the most perfect health. But, in the course of nine days, they -experienced the fatal effects of the climate, and buried seven people -at Batavia. On the 3d of December, the ship left the harbour. At that -time the number of sick amounted to forty; and the rest of the ship’s -company were in a very feeble condition. When the ship anchored at -Prince’s Island, in the Straits of Sunda, the sickness increased, and -they buried twenty-three persons more in the course of about six weeks. -The Grenville Indiaman, which touched at this island in 1771, suffered -equally from the malignity of the air. A few were taken on board, when -the ship sailed from Batavia, ill of a malignant fever; which spread -by contagion at sea, and carried off great numbers. I visited several -in this ship, when she arrived at China, who were reduced to mere -skeletons, by the duration of the fever and dysentery; both of which -were most certainly propagated by contagion. - -“Those parts of Sumatra lying immediately under the line are -continually subject to rain, and the ground near the shore is low, and -covered with thick trees and underwood. The heat being intense, noisome -fogs arise, which corrupt the air, and render the country fatal to -foreigners. The land of North Island, which lies on this coast, near -the beginning of the Straits of Sunda, appears at a distance finely -variegated; but at the place where the wood and water are to be got it -is low, and covered with impenetrable mangroves, and infested with a -variety of insects. It is here that most of the East India ships take -in wood for their homeward voyage. A Danish ship, in 1768, anchored -in this island, and sent twelve of her hands on shore to fill water; -where they only remained two nights. Every one of them was seized with -a fever, whereof none recovered: but although the ship went out to -sea, none, except the twelve who went on shore, were attacked with the -complaint.” - -With regard to China, this author says, that the “port of Canton is -by no means so healthy as is generally represented. The comparative -degree of health which Europeans enjoy here has been ascertained from -the instances of the supercargoes, which is, however, a very erroneous -standard. The generous and regular way in which these gentlemen live, -for the most part, exempts them from diseases; and, being but few in -number, no great mortality can take place among them. But seamen, who -never observe much regularity in their way of living, who work hard in -the day time, are but badly clothed, and not provided against the damps -and cold north-easterly winds at night, seldom fail to be afflicted -with the diseases already mentioned (fevers and fluxes.) Even the -factors of different nations, who reside here for any considerable -time, experience all the inconveniences peculiar to any sultry climate: -florid health is a stranger to their countenances; their constitutions -are soon weakened and enfeebled; and they become subject to habitual -fluxes and other complaints, the usual consequences of too great -relaxation.” - -The climate of the southern part of China, according to the same -author, is excessively hot during the summer months. Even in September -and October, when the nights are cold, the days continue to be sultry. -The cold months are, December, January and February; “and during this -time the vicissitudes of the weather are more quick than in any other -part of the world. When the wind is northerly, and the thermometer -at 46, upon a change of the wind to the south, it is next day up to -60 or 70. People who reside here are always at a loss with regard to -their clothing; one day finding a silk coat sufficient; and the next, -upon a sudden change of wind, finding it necessary to wear a flannel -waistcoat.” - -On the subject of climate, therefore, I must conclude with the -following observations:--First: That, as the diseases above mentioned -are produced both in moist and dry countries, in those in the torrid -and those in the temperate zone, they can neither be the offspring of -moisture or drought, of heat or cold, of septics or antiseptics, but of -something not yet discovered. Second: That, upon fair investigation, it -does not appear, that ancient historians have been able to ascertain -the origin of any plague whatever: they have universally ascribed it -to the anger of the Deity, while their own pride would never allow -it to have originated in any country with which they were connected. -Third: It doth not by any means appear, that the climates of those -countries, where the plague is known to be most common, are at all -inferior to those already described, excepting the very circumstance -of having the plague frequently in them: nay, indeed, that they -are equally bad. Nobody will pretend to argue, that the climate of -Asia Minor, of Greece, of the Morea, or of any of the countries most -infected with the plague, was, or is, worse than that of _Catchou_ in -Africa, already described; yet it is certain, that we have a number -of testimonies that the plague has ravaged Asia Minor, while we have -not one of its visiting _Catchou_. Ancient Greece, the Peloponnesus -(Morea) and Asia Minor, were accounted healthy and fine countries; and -modern travellers assure us, that they have not degenerated in this -respect; yet these countries are desolated by the plague, while the -unwholesome regions above described are entirely free from it, unless -imported from some other quarter. To give this matter, however, as -fair a discussion as possible, I shall here consider the account we -have of the climate of Bassorah, given by the gentleman residing there -in 1780; whose case, in the remitting fever, is given, Appendix, No. -VI. “The overflowing of the Euphrates, and its waters stagnating in -the desert, have always been accounted primary causes of epidemical -diseases at Bassorah. The great floods from the melting of the snow -on the mountains of Diarbekir, the ancient Assyria, happened in the -year 1780, early in the month of May, when the heats in Persia and -Arabia begin to be excessive. The desert, which reaches to the gates of -Bassorah, is, for many miles, incrusted with a surface of salt; which, -when mixed with the stagnated waters, and exposed to the sun, produces -the most noxious effluvia. As early as the 25th of May, the town was -surrounded by a salt marsh, the heated steam arising from which was, at -times, almost intolerable; but the canal that runs through a great part -of the city being filled with the bodies of animals, and all kinds of -putrid matter; and, at low tides, all these substances exposed to the -sun, made the air in the town scarce supportable; and, being totally -destitute of police, the streets were in many places covered with human -ordure, the bodies of dead dogs and cats, &c. which emitted a stench -more disagreeable and putrid than any thing I ever experienced in my -life. As to the degree of solar heat, it far exceeded what I conceived -the human frame to be capable of bearing. The sensation under this heat -was totally different from what I had ever experienced; it resembled -the approach of an heated substance to the body. The quicksilver, in -Fahrenheit’s thermometer, rose to between 156 and 162 degrees.[28] From -the 30th of May I never saw it so low as 156, but generally between 158 -and 160. After I left Bassorah I was told that it rose still higher. -In the coolest part of the house, with the aid of every invention to -decrease the heat, the quicksilver rose to 115; but after I came away, -I was informed that it rose still higher, even at seven in the morning, -the hour which we accounted the coolest in the day. Once the heat was -said to be so intolerable, that no one could expose himself to it -long enough to observe the thermometer in the sun. Some of the oldest -inhabitants of Bassorah said that they never remembered to have heard -of such a heat in any part of Persia or Arabia. The natives of the -country appeared more alarmed at the heat than the Europeans: nothing -could induce them to expose themselves to the sun after ten o’clock. I -left Bassorah for Aleppo on the 30th of May. On our arrival at Zabira, -the heat was so intense, that even the Arabs sunk under it.” - - [28] Spirit of wine boils at 175. - -From this account it was natural to expect that violent sickness would -ensue. This was the opinion of the inhabitants, and they were not -deceived. The sickness, however, was not the true plague, but a violent -remitting fever; and even this did not originate in the city itself, -but was observed to approach from Asia Minor, ravaging Diarbekir, and -keeping the course of the Tigris, to Bagdad, where many died. From -thence it followed the course of the Euphrates to Bassorah, and for -about twenty miles lower. The opposite, or Persian shore, though within -a few miles, was exempted, and it did not spread more than twenty -miles into the desert.[29] - - [29] Transactions of Society for improving Medical Knowledge. - -I might now proceed to give an abstract of what has been said of the -power of climate in producing diseases on the Western Continent, and -West India islands; but as this belongs more especially to the second -part of this Treatise, I shall here pass it over, as well as what Dr. -Smith has said of the climate of Greece, in the Medical Repository, -and which he endeavours to prove to be similar to the climate of -North America. But, before we proceed to consider what diseases may -be produced by _climate_ alone, it is proper to discuss the question, -how far man is naturally subject to diseases of any kind? Many, no -doubt, will be apt to suppose this a very absurd question; for as man -is now, by nature, subject to death, it seems to follow, that he is -also naturally subject to disease, as the means of bringing on death. -But, however plausible this may appear, experience shows, that disease -and death are not always connected. Many people die of mere old age; -the powers of life being exhausted, and the system so far decayed, -that the various parts of it can no longer perform their offices. On -the other hand, a disease destroys by attacking some particular organ, -and either totally consuming or altering it in such a manner, that -it disturbs the vital operations, while yet strong and vigorous. We -may therefore compare the death of a person from mere old age to the -natural extinction of a candle when the tallow is totally consumed; -and death from disease, to the blowing out of a candle while a part -of it remains, and might have burned for a considerably longer time. -Thus I am inclined to consider all diseases as merely accidental; and -this with the greater certainty, because, though, in common with other -believers in revealed religion, I think that death is the consequence -of Adam’s transgression, yet I do not find that disease of any kind was -threatened except in cases of positive transgression, long after the -days of Adam. - -Every one allows, that, though some diseases are natural, some are -likewise artificial; but nobody hath attempted to draw the line of -demarcation between them. Every thing is charged upon climate, heat, -moisture, drought, vapour, &c. and yet, upon examination, we shall find -the utmost difficulty in deriving a single disease from the causes we -assign. No person in his senses will say that Adam, in consequence of -eating the forbidden fruit, became liable to the venereal disease. As -little can we say for the gout, the stone, or the dropsy; and if we -cannot particularize the diseases to which he became naturally liable, -we have no right to say that any kind of disease became natural to -him in consequence of his transgression. If, therefore, death itself, -originally not natural to man, did yet take place in consequence of -his moral conduct; and if diseases, without number, have arisen among -his posterity, though not natural to him in consequence of his first -transgression, we have equal reason to believe that these diseases -have taken place among them in consequence of their moral or rather -_immoral_ conduct, in totally deviating from the line prescribed them -by their Maker, and following others of their own invention; and this -will appear the more probable, when we consider, that, long after -mankind became subject to death, we find diseases, particularly the -pestilence, threatened as the consequence of subsequent transgressions. - -If, without taking scripture into consideration, we attend only to -what may be gathered from profane history, we find the testimony of -all the ancients concurring in one general point, viz. that in times -of great antiquity men were more healthy, and even stronger, than in -the times when those authors lived. This is taken notice of by Homer, -when comparing the strength of men in the time of the Trojan war with -those in his days, about two centuries later.[30] Virgil, who lived in -much more modern times than Homer, carries his ideas of the degeneracy -of man much farther; and informs us, that Turnus, when fighting with -Æneas, took up and threw a stone which twelve men of that time could -not have lifted. Now, though we know that both these accounts are -fabulous, yet they perfectly coincide with the voice of historians of -all nations; for we are universally told, that the first inhabitants -of countries were a brave, hardy people, living according to the -simplicity of nature, free from diseases, and attaining to a good old -age. - - [30] - - A pond’rous stone bold Hector heav’d to throw, - Pointed above, and rough and gross below; - Not _two_ strong men th’ enormous weight could raise, - Such men as live in these degenerate days. - - Iliad, B. xii. - - -This is so conformable to what is generally said at present, probably -very often by rote, without regard to rational evidence, that, were -we so inclined, ample room might be found for declamation against -modern luxuries, particularly the practice of drinking ardent spirits, -as pernicious to health, and destructive to the human body. On this -subject, however, we may once for all observe, that, although we find -ample evidence of the baleful influence of these liquors in producing -other diseases, yet we find none of their ever having had any share -in the production of an epidemic or general disease among mankind. -In ancient times the art of distillation seems to have been unknown; -so that whatever mischief was done in those days must have been done -by wine, or other fermented liquors. In modern times, though the use -both of fermented liquors and ardent spirits is undoubtedly carried -to excess, yet there is no evidence of their producing an epidemic, -or even making it more violent or general than it would otherwise -have been. Dr. Cleghorn, having spoken largely of the manner of -living of the natives in Minorca, proceeds thus: “I should next give -a circumstantial account of the diet and way of life of the British -soldiers in this island; but as this would be a disagreeable task, -I shall only observe, that the excess of drinking is among them -an universal vice, confirmed into habit. But, however different -the Spaniards be from the English, in their meat, drink, exercise, -affections of the mind, and habit of body; yet the health of both -nations is equally influenced by the seasons. An epidemical distemper -seldom or never attacks the one class of inhabitants without attacking -the other also; and, surprising as it may appear, it is nevertheless -true, that the peasants, remarkable for temperance and regularity, and -the soldiers, who, without meat and clothes, frequently lie abroad -drunk, exposed to all weathers, have diseases almost similar, both as -to their violence and duration.” - -There can be no doubt that excess in drinking hath put an end to the -lives of many individuals; and it hath been observed, that such as -attempt to preserve themselves from the plague by the use of strong -liquors, have generally fallen sacrifices to it;[31] but this cannot -prove that such excess would have brought on the distemper without some -other cause. It hath been certainly found, that excess in drinking or -eating, excess in venery, excessive fatigue by labour, watching, study, -&c. will all make an epidemic disease more violent when it attacks a -particular person; but no experience hath yet shown that the _first_ -person seized with an epidemic always fell under this description. All -that can be said on the subject is, that, by such excesses as have -already been described, the body is prepared for receiving the disease, -by an exhaustion, or evaporation (if we please to call it so) of the -vital principle; as wood is prepared for burning by the evaporation -of its moisture; but as wood, however dry, will not burn without the -contact or application of fire, so neither will the body, though ever -so well prepared, be attacked by any epidemic, unless the true cause of -that epidemic be also applied. - - [31] See Sec. IV. Preventives of the Plague. - -Thus we are still disappointed in our attempts to discover the origin -of the plague. We have seen that the most unhealthy climates in the -world do not produce it of themselves; neither can the conduct of any -individual bring it upon himself, without an unknown _something_, which -nobody has yet found out. It was this difficulty of finding out the -natural cause, which certainly induced by far the greatest number of -writers on the subject to ascribe it to Divine Power; and even as late -a writer as Dr. Hodges tells us, that he believes in the _to Theion_, -the “finger of God,” in the plague, as much as any body. As for those -who have endeavoured to account for the origin of this distemper -from an inquiry into natural causes, and conclusions drawn from the -late experiments on air, they have totally failed; as will be fully -elucidated in the following section. - -If then we are to believe that diseases, especially those called -epidemics, among which the plague holds the first place, have arisen -in consequence of a certain line of conduct adopted by the human race, -or have been inflicted by the Deity as punishments on that account, we -are to look for their origin among those to whom the Deity principally -manifested himself; that is, the Jews, and nations who interfered with -them. Among the Jews we hear of the first general plague distinctly -mentioned; viz. the three days pestilence of David, and to which it is -possible that Homer alludes in his Iliad. Next to this is the great -plague of 767 B. C. said to have spread all over the world. This -coincides with the time of Pul, king of Assyria; who, having overthrown -the ancient kingdom of Syria, turned his arms against that of Israel, -and no doubt extended his conquests among the eastern nations, as we -know very well the Assyrian monarchs did. As the ten tribes, ever after -their separation from the house of David, had in a manner totally given -themselves up to idolatry, we are not to wonder if the pestilence, so -frequently threatened by Moses, was very common, or, as physicians -term it, _endemic_, among them. Thus, whatever enemy invaded the -country, would almost certainly carry the disease along with them, and -spread it among the other nations with whom they afterwards had any -connexion. At this time, or even before this, during the wars of Syria -with Israel and Judah, this dreadful pestilence might begin; but, as -to its being all over the world in any particular year, I do not see -how it can be ascertained; because there are no general histories of -the world in those early times. It appears more probable that this -general pestilence took place at the time that Sennacherib’s army was -destroyed. I have no doubt, indeed, for the reasons already given, -that the plague had infected Sennacherib’s army before he went into -Ethiopia. In that country, in all probability, he would leave it; and, -after his return to Judea, when the dreadful catastrophe befel him -of an hundred and eighty-five thousand of his men being destroyed in -one night, there can be no doubt that the remains of his army would -carry with them the seeds of a most malignant pestilence, capable of -spreading destruction far and wide. It is true, we are not directly -told, in Scripture, that the Assyrian army was destroyed by a plague, -but that the angel of the Lord destroyed them; but, as this expression -is quite similar to what we read of the pestilence in David’s time, -there can be but little doubt that the means of destruction made -use of in both cases were the same. Josephus expressly says, that -Sennacherib’s army was destroyed by a pestilence. Neither are we to -conclude, because this pestilence was miraculous, that it therefore -certainly killed every one on whom it fell; or that it would not infect -those who came near the sick, as any other disease of the kind would do. - -From the same source may we derive the propensity in the Carthaginian -armies to pestilential disorders. Carthage was a colony of Tyre; and -the Tyrians were in close alliance with the Jews, during the reigns -of David and Solomon, and very probably afterwards; so that from -them the distemper might be communicated in such a manner as to be -almost endemic; and thus hardly an army could be sent out but what -would have the infection with it, breaking out with violence now and -then, as occasional causes tended to give life to the contagion. It -is impossible, however, from the source just mentioned to trace the -plague of Athens, or the first plague in Rome; but it is very natural -to suppose that the violent one which raged in Rome, during the reign -of Titus, came from Jerusalem. That city had sustained a most dreadful -siege, and the obstinate and wretched inhabitants had endured such -calamities as have scarcely been recorded in the history of nations. -Among these calamities was a pestilence, which, in all probability, -would be conveyed to Rome, and there occasion the destruction already -mentioned. - -But what seems to render this account of the origin of the plague more -probable is, that the Jews are to this day accused of propagating the -disease in those countries where it is most frequent. Baron de Tott -is of opinion that the plague in Constantinople originates among the -Jewish dealers in old clothes; for these avaricious dealers, purchasing -the infected goods, sell them indiscriminately to every one who will -buy, and that without the least care taken to remove the infection -from them; by which means it is no wonder to find the plague, as well -as other diseases, disseminated among them in great plenty. Dr. Russel -informs us, that the Jews are most liable to the plague, the most -fearful of it, and the most ready to fly from the infection. The Abbe -Mariti agrees in the same accusation against this unfortunate people. -“The Jews (says he) purchase at a low price the goods and wares which -remain when most of the family are deceased, and then store them up; -which, when the plague is over, they sell at a dear rate to those will -buy, and thus propagate the pestilential poison: again it kindles, -and presently causes new destruction. Thus this opprobrious nation, -preferring gold to life, sell the plague to mussulmen, who purchase it -without fear, and sleep with it, till, renewed of itself, it hurries -them to the grave.” M. Volney, though he does not mention the Jews in -such express terms as Mariti and Russel, yet agrees as to the mode of -its propagation in Constantinople, and the reason of its continuance -in that city. “It is certain (says he) that the plague originates in -Constantinople, where it is perpetuated by the absurd negligence of -the Turks, which is so great, that they publicly sell the effects of -persons dead of the distemper. The ships which go to Alexandria never -fail to carry furs and woolen clothes, purchased on these occasions, -which they expose to sale in the bazar of the city, and thereby spread -the contagion. The Greeks who deal in these goods are almost always the -first victims.” - -Thus the account we have of the origin of the plague at present is, -that the city of Constantinople, having been long and deeply infected, -the infection is stored up through the avarice of the Jewish merchants, -who buy the goods and clothes of the infected. The stupidity of the -Turks allows these goods to be sold in Constantinople, or exported -freely to all parts to which their vessels sail, particularly to -Alexandria; where the avarice of the Greeks prompts them to buy without -examination or precaution, to the destruction of their own lives, and -of multitudes of others. Egypt being the principal place of traffick, -the plague is more frequent there than in other parts of the empire. -Syria is comparatively free from it; which M. Volney supposes to be -owing to the small number of vessels which come there directly from -Constantinople. - -In this way we may, in a pretty plausible manner, account for the -origin of this distemper; viz. that it originally fell upon the Jews -as a punishment for their iniquities; that from the Jews it has been -at different times conveyed to other nations; and, by a mixture of -those nations, has, at times, become general all over the world. At -last it has, by the avarice of that people who first had been the -occasion of its being introduced into the world, become permanent in -Constantinople, whence it is still diffused among different nations in -proportion to their dealings with that capital. - -But it may now be said, ‘Allowing the positions contended for to be -true in their utmost extent, how comes it to pass that the plague -hath not been general in every age and in every country? Since the -destruction of Jerusalem, the Jews have been dispersed over all -nations: if nothing then were wanting to produce a pestilence but -Jews and old clothes, no age or country ought to have been free from -it; nevertheless it is certain that violent plagues take place only -at particular times, with long intervals between; and of late the -pestilential disposition seems to have become much less frequent than -formerly; the western parts of Europe, particularly Britain, having -been free from it for a great number of years. There must therefore be -some cause, different from what has yet been mentioned, by which the -infection is occasionally roused from inactivity, and excited to spread -desolation all around.’ - -That there are predisposing causes to epidemic disorders, especially to -the plague, the most fatal of them all, is not denied. These prepare -the body for receiving the infection, but they will not, without that -infection, produce the disorder. Of these causes so many are to be -found in the conduct of mankind themselves, that we scarcely need to -look for them any where else. In looking over the histories of plagues, -we find them in an especial manner connected with famines and wars. -The former sometimes take place in consequence of the failure of crops -through natural causes; but, considering the general fertility of the -earth, we must certainly account it owing to bad management, in some -respect or other, that every country hath not as much laid up within -itself as would guard against the consequences of at least one or two -bad crops. Yet we believe there is not, at present, a country upon -earth in this predicament. If a crop fails any where, the inhabitants -must import largely, or they must starve. This is the case even in the -fertile regions of the East, where the earth produces in excessive -abundance,[32] and there is little or nothing of any kind of provision -exported to other countries. A remarkable instance of this occurred in -the plague at Aleppo, a history of which is given by Dr. Russel. He -tells us, that the winter of 1756 proved excessively cold, which was -followed by a famine next year. This account is confirmed by Mr. Dawes, -in a letter to the bishop of Carlisle.[33] He tells us, that in the -course of the winter many perished through cold; that the inhabitants -were reduced to such extremities, by the single failure of the crop in -1757, that women were known to eat their own children as soon as they -expired in their arms with hunger; and that human creatures might be -seen contending with dogs, and scratching for the same bone with them -in a dunghill. A dreadful plague followed; which, the two succeeding -years, swept off not fewer than sixty thousand in the city of Aleppo. - - [32] Herodotus says, that in his time the province of Babylonia - produced commonly two hundred, and in plentiful years three hundred - fold. - - [33] Philos. Transact. vol. liv. - -It is probable that in this case the famine either produced the -plague, or made it worse than it would have otherwise been; and it is -not denied that the cold and bad season was the direct cause of the -famine. But as little can it be denied, that had the people, or their -governors, been so provident as to have laid up stores sufficient to -supply the country for one year, this famine would not have been felt. -As far, therefore, as the plague was connected with the famine, we must -own that it was chargeable on the human race themselves; not the sins -of this or that particular person, but a general deviation from the -task assigned them by their Maker, viz. that of cultivating the ground; -and, instead of this, spending their time in folly and trifling, to say -no worse. - -But famines are occasioned not only by natural causes, but by wars; -in which mankind, acting in direct opposition to the laws of God and -nature, destroy and lay waste the earth, taking every opportunity of -reducing to extremity both those whom they call innocent and those whom -they call guilty. Thus vast multitudes are reduced to want, to despair, -and rendered a prey to grief, terror, and every depressing passion of -the human mind; they are exposed to every inclemency of the weather; to -the scorching heats of the day, and the chilling damps of the night; in -short, to every thing that we can conceive capable of predisposing the -body for the reception of diseases of the very worst kind. No wonder -therefore that war and pestilence go hand in hand; and, by taking a -review of the history of mankind, we shall see, that, always at those -times when the nations have been most actively employed in the trade -of butchering one another, then, or very soon after, they have been -afflicted with pestilence. To begin with the great plague of 767 B. C. -which coincides with the rise of the Assyrian empire: Till this time, -though there had been numberless wars, yet they were carried on upon a -much smaller scale than now, when great empires were to be set up, and -when the most distant nations were to be assembled in order to gratify -the pride and ambition of an individual. The Assyrians, we know, -penetrated into Ethiopia; but how far east or how far west they went, -we are not certainly informed. To their wars, however, we may with -reason ascribe the desolations occasioned by this first plague. From -Thucydides’s account of the plague at Athens, it seems plain that it -was occasioned, or at least rendered more violent, by the wars of the -Greeks with one another at that time. Had the Carthaginian army staid -at home when they went to war with Dionysius, tyrant of Syracuse,[34] -it is very probable that the pestilence would not have broke out among -them. The like may be said of the plague which broke out among them in -the time of Marcellus.[35] That in the time of Jugurtha, indeed, is -said to have been occasioned by locusts; but, had not vast bodies of -men been collected together for the purposes of war, the plague could -never have committed such ravages. The plague in the time of Titus -could not have been brought from Jerusalem, nor perhaps would it have -existed there, had not Titus made war against that city; and so of -others. - - [34] See Sec. i. p. 10. - - [35] Ibid. p. 12. - -The plague which began in the reign of Justinian, as it was more -violent than any recorded in history, so it was preceded by wars -equally unexampled. The Romans had indeed for ages employed themselves -in war; but, by their constant superiority to every adversary, their -empire had become so amazingly extensive, that, whatever wars were -carried on in the remote provinces, the great body of the empire always -remained at peace; and this was the case even in their most violent -civil wars. On the accession of Alexander Severus, about the year 232, -they began to encounter enemies so numerous and formidable, that all -their power proved insufficient to repel them. In the tenth year of -Alexander’s reign, the Persians, having overthrown the ancient empire -of the Parthians, turned their arms against the Romans, and, though -frequently defeated at that time with great slaughter, renewed their -incursions in the reign of Gordian, about the year 242, when they -were in like manner defeated and obliged to retire. As these defeats, -however, did not at all affect the strength of the Persian empire, -the Romans still found them as formidable enemies as ever; while the -Goths, Sarmatians, Franks, and other northern nations, harassed them in -other parts. In the reign of Decius, who ascended the throne in 249, -they became extremely formidable, insomuch that the emperor himself, -with his whole army, was at last cut off by them. The consequence of -this was, that the empire was instantly invaded in many different -parts, and, though the barbarians were at times defeated, we never -find that the empire regained its former tranquillity. The Persians -and Scythians, taking advantage of the general confusion, invaded the -provinces next them, while the finishing stroke seemed to be given -to the Roman affairs by the defeat and captivity of Valerian by the -Persians. - -This disaster, as may well be imagined, produced an immediate invasion -by numberless barbarians, while such multitudes of pretenders to the -imperial crown were set up, each asserting his claim by force of -arms, that the whole Roman territories were filled with bloodshed -and slaughter. At this time Gallienus, the son of Valerian, was the -_lawful_ emperor, if indeed we may apply the word to the domination -of such a monster. His mode of government may be imagined from the -following letter written to one of his officers in consequence of -a victory gained over an usurper named _Ingenuus_. “I shall not be -satisfied with your putting to death only such as have borne arms -against me, and might have fallen in the field: you must in every city -destroy all the males, old and young; spare none who have _wished_ ill -to me, none who have spoken ill of me, the son of Valerian, the father -and brother of princes. _Ingenuus_ emperor! Tear, kill, cut in pieces, -without mercy: you understand me; do then as you know I would do, who -have written to you with my own hand.” In consequence of this horrible -order, not a single male child was left alive in some of the cities of -Mœsia, where this inhuman tragedy was acted. - -In the midst of this dreadful commotion, we find the pestilence -contributing its share to the common work of desolation. In Alexandria -in Egypt, says Dionysius, bishop of that place, “fury and discord raged -to such a degree, that it was more easy to pass from the east to the -remotest provinces of the west, than from one place of Alexandria to -another. The inhabitants had no intercourse but by letters, which were -with the utmost difficulty conveyed from one friend to another. The -port resembled the shores of the Red Sea strewed with the carcases -of the drowned Egyptians: the sea was dyed with blood, and the Nile -choked up with dead bodies. The war was attended with a general famine, -and the famine with a dreadful plague, which daily swept off great -numbers of people, insomuch that there were then in Alexandria fewer -inhabitants, from the age of fourteen to that of eighty, than there -used to be from forty to seventy.” It was not in Egypt alone that this -calamity prevailed. It raged with great violence in Greece, and at Rome -itself; where, for some time, it carried off five thousand persons a -day. Many terrible phenomena of nature took place at the same time. -The sun was overcast with thick clouds, and great darkness took place -for several days, attended with a violent earthquake, and loud claps -of thunder, not in the air, but in the bowels of the earth, which -opened in several places and swallowed up great numbers of people in -their habitations. The sea, swelling beyond measure, broke in upon the -continent, and drowned whole cities.[36] - - [36] Univ. Hist. vol. xvi. pp. 433, 435. - -At last the civil commotions were settled by the accession of Claudius -to the empire in 268. He found the Roman force so exhausted, that, when -marching against the Goths, he wrote to the senate in the following -terms: “If I should not be attended with success, you will remember -that I fight after the reign of Gallienus. The whole empire is quite -spent and exhausted, partly by him, and partly by the many tyrants -who, during his reign, usurped the sovereignty, and laid waste our -provinces. We want even shields, swords and spears.” In this miserable -plight, however, he gained a most extraordinary victory; three hundred -thousand of the enemy being killed or taken. But, while Claudius thus -carried on the work of death successfully against the barbarians, -he was attacked from a quarter where he could make no resistance: a -violent plague broke out in his army, and carried off himself and a -vast number of his men. - -The dreadful defeat given to the Goths did not long preserve the -tranquillity of the empire. New invasions took place, and new massacres -ensued. At last, on the accession of Dioclesian to the empire, it was -thought proper, on account of the present emergences, to divide such -wide-extended territories into four parts, to be governed by four -emperors of equal authority. By the activity and valour of these, -particularly of one of them, named Galerius, the northern barbarians -were repressed, and the Persians reduced so low, that they were obliged -to yield up a great part of their territories; and it is said that -their country might even have been reduced to a Roman province, had the -emperor so inclined. We know not whether, in his eastern expedition, -the Roman army received any infection, nor do we hear of any plague -breaking out in it; but we are told that Galerius himself died of an -uncommon distemper; an ulcer, attended with mortifications, violent -pains, and the production of an infinite number of vermin, which -devoured and tormented him day and night. This distemper, however, -seems rather to have been a cancer than a pestilential disorder, as -he laboured under it for more than a year. After his death, dreadful -wars continued, both by reason of the incursions of barbarians, and -the contests of those who enjoyed, or wished to enjoy, the empire. The -eastern parts, however, had for some time kept free from pestilential -contagion; of which the christian writers say, that Maximin, who -reigned there, had made his boast; and, being a heathen, ascribed it -to the care he took of preserving the worship of the gods. But, if -this was really the case, he soon found his gods unable to protect -him; for, soon after the accession of Constantine the great, and his -embracing christianity, the dominions of Maximin were afflicted with -famine accompanied with pestilence, and that attended by symptoms of a -most extraordinary nature; particularly ulcers about the eyes, which -rendered multitudes of those who were infected with the distemper -totally blind. The christians did not fail to ascribe this plague to -the sins of Maximin; but it must be observed, that to his other sins -he had added that of involving himself in a violent war, during which -the pestilence broke out, and which probably was one of the causes of -it. We may likewise observe, that if the sins of Maximin brought on the -plague, the piety of Constantine could not keep it off; since we find -that in the year 332, a considerable time after the death of Maximin, -the territories of Constantine were ravaged by a dreadful plague, and -the famine was so severe, that, at Antioch, wheat was sold at four -hundred pieces of silver per bushel. The distemper which put an end to -the life of Maximin himself was indeed so extraordinary, that we may -reasonably excuse those who called it a judgment sent directly from -heaven. His eyes and tongue are said to have putrefied; “an invisible -fire was kindled in his bowels, which, being attended with unrelenting -torments, reduced him in a few days to a perfect skeleton; his whole -body was covered over with a kind of leprosy, and devoured by swarms -of vermin; he could not be prevailed upon to take any nourishment, but -greedily swallowed handfuls of earth, as if he had hoped by that means -to assuage his pains, and allay the hunger with which he was tormented -without intermission.”[37] All this, we are told, was the effect of -poison, which he had swallowed in despair, after being defeated in -battle; but the symptoms are unaccountable. - - [37] Univ. Hist. vol. xvi. - -After the death of Constantine, the empire being again parted, civil -dissensions took place; the northern barbarians and Persians renewed -their incursions, and at length the battle of Mursa, between the -emperor Constantius and an usurper named Magnentius, destroyed such -numbers that the empire no more recovered its former strength. From -this time therefore the wars with the barbarians became more and more -violent; and, though frequently overcome, the advantage was ultimately -on their side. In 361, the first year of the emperor Julian, the -pestilence again made its appearance. It was accompanied by many -other grievous calamities: Dreadful earthquakes were felt in every -province; most of the cities in Palestine, Libya, Sicily and Greece, -were overturned. Libanius writes, that not one city in Libya was left -standing, and but one in Greece; that Nice was utterly ruined, and -Constantinople greatly damaged. The sea, in several places, broke in -upon the land, and destroyed whole cities with their inhabitants. At -Alexandria, the sea, retiring during an earthquake, returned again -with such violence, that it drowned several towns and villages in the -neighbourhood. The earthquakes were followed by a famine, and the -famine by a pestilence. It was observed by the christian writers, that -the famine seemed to follow Julian from place to place: and no wonder -that it did so; for he not only had always a large army along with -him, which consumed great quantities of provision, but, attempting to -remedy the evil by fixing the prices of provisions, he rendered it much -worse, as the dealers in corn were thereby tempted to convey it to -other places.[38] Indeed this emperor seems to have been inclined to -produce famines wherever he went; for, on his entering the territories -of the Persians, with whom he was at war, he wasted the country to such -a degree, that he could neither subsist nor return; while the enemy, -imitating his example, destroyed all before him. The consequence was, -that, by the time Julian was killed, the famine raged in the Roman camp -to such a degree, that not a single person could have escaped, had not -the enemy mercifully granted them peace. - - [38] Univ. Hist. vol. xvi. - -Notwithstanding this dismal situation, we hear of no plague invading -the camp of the Romans at that time. The wars, however, continued with -great violence; and, in the time of Valentinian, Valens and Gratian, -became worse than ever. The dreadful state of the empire in the time -of Gratian is thus described by St. Jerom: “The whole country, from -Constantinople to the Julian Alps, has been swimming these twenty years -in Roman blood. Scythia, Thrace, Macedon, Dardania, Dacia, Thessaly, -Achaia, both Epiruses, Dalmatia, both Pannonias, are filled with Goths, -Sarmatians, Quadians, Alans, Huns, Vandals, Marcomans, &c. whose -avarice nothing has escaped, whose cruelty has been felt by persons of -all ranks, ages and conditions.” “What evils, (says Gregory Nazianzen) -have we not seen or heard of! Whole countries have been destroyed with -fire and sword; many thousand persons of all ranks and ages have been -inhumanly massacred; the rivers are still dyed with blood, and the -ground covered with heaps of dead bodies.” - -In the midst of so great calamities, the pestilence, as an evil of -inferior nature, might in many cases pass unnoticed by the historians -of the times; nevertheless, even during that distracted period, we -find some accounts of it. In 384 we are told of a famine and plague -at Antioch; and, in 407, of one in Palestine, said to be occasioned -by multitudes of grasshoppers, which even obscured the sun, and -turned day into night. After having done incredible mischief, they -were thrown by the wind partly into the Red Sea, and partly into the -Mediterranean; whence being again cast ashore by the waves, they -putrefied, and occasioned a pestilence. Two years after, when Rome -had been first besieged by Alaric the Goth, the city was reduced to -such straits, that human flesh was publicly sold, and some mothers -are said to have devoured their children. This terrible famine was -occasioned by the uncultivated state of the country, which had lain -waste for several years, by reason of the wars, and the ports of Africa -being blocked up by Heraclianus lest an usurper should become emperor; -and thus this loyal admiral, for fear that the people should have a -bad governor, determined rather that there should be no people to be -governed. Notwithstanding this terrible famine, however, we hear of no -pestilential disorder taking place; not even after the taking of the -city by Alaric, when bloodshed and massacre were added to the other -calamities. - -All this time the empire, by the incursions of barbarians, by -usurpations, civil wars, and the general licentiousness of the people, -had been in a situation not to be described. The invasion of the Hunns, -a new and more formidable enemy than they had ever experienced, now -completed the ruin of the Romans. The whole western part of the empire -became one continued scene of carnage and desolation. The common -epithet bestowed upon Attila, the king of these barbarians, was, “The -_Scourge_ of GOD, the _Destroyer_ of _Armies_.” As a specimen of his -behaviour, we shall select the account of his taking of Aquileia in -452. That city, “being well fortified, and defended by the flower of -the Roman troops, held out, in spite of his utmost efforts, for three -months; at the end of which it was taken by assault, pillaged for -several days together, and laid in ashes; not a single house being -left standing, nor one person alive that fell into the enemy’s hands. -The cities of Trevigio, Verona, Mantua, Cremona, Brescia and Bergamo, -underwent the same fate; the barbarians raging every where with such -fury as can hardly be expressed or conceived, and putting all to the -sword, without distinction of sex, age, or condition.”[39] - - [39] Univ. Hist. vol. xvi. - -Every one must own that this was a very effectual method of preventing -the plague in those cities. It did not, however, prevent that, or some -other diseases, from destroying such numbers of the tyrant’s troops, -that he was for that time prevented from taking Rome itself. From this -time, to the total extinction of the western empire, we do not hear of -any remarkable infection taking place. The barbarians still continued -their wars with one another, while the emperors of Constantinople were -likewise at continual variance with the Persians. At last, in the -year 532, they concluded what they called a _perpetual_ or _eternal_ -peace, which lasted _eight years_! Other treaties and truces were -concluded; notwithstanding which, the war was almost continual in the -east; while, by the second conquest of Italy, and the invasion of the -Gothic territories, new desolations overspread the west. Thus, for a -great number of ages, mankind had been preparing themselves for the -dreadful pestilence which was about to ensue. Whatever infection could -be communicated to the air by multitudes of carcases rotting above -ground had been done in an ample manner. Whatever debility could be -communicated to the human frame by famine, exposure to the inclemency -of weather, by fatigue, terror, grief, and every thing that can render -life miserable, had also been communicated by the most powerful -means. There only wanted _something_ to begin the calamity; and this, -whatever it was, took place in the fifteenth year of Justinian. Mr. -Gibbon ascribes the origin of it to locusts; and its universality, to -the general mixture of all nations, and the unrestrained intercourse -they had with one another. “No restraints (says he) were imposed on -the frequent intercourse of the Roman provinces. From Persia to France -the nations were mingled by wars and emigrations; and the pestilential -odour, which lurks for years in a bale of cotton, was imported, by the -abuse of trade, into the most distant regions. Procopius relates, that -it spread always from the sea-coast to the inland countries: the most -sequestered islands and mountains were successively visited; the places -which had escaped the fury of its first passage, were alone exposed to -the contagion of the ensuing year. In time, its malignity was abated -and dispersed; the disease alternately languished and revived; but -it was not till the end of a calamitous period of fifty-two years, -that mankind recovered their health, or the air resumed its pure and -salubrious qualities.” - -Thus Mr. Gibbon endeavours to explain the causes of this plague from -an alteration in the salubrity of the atmosphere, without taking into -consideration the dreadful commotions among mankind, above related. -But, now that we have noticed two very general infections, one in -767 B. C. the other 1300 years after, we find them both preceded and -accompanied by wars uncommonly violent and destructive. The great -plague in the time of Justinian is said by Mr. Gibbon to have continued -only fifty-two years; but this we must understand of its first and most -violent attack; for it appears, from the testimonies produced in the -former section, that pestilential disorders, even very violent ones, -continued at intervals for several centuries. Thus, from the year 541 -to 593, the space of fifty-two years is included; nevertheless, in the -time of Phocas, who began to reign ten years after, the same calamity -continued; as did also violent wars with the Persians and other -barbarians. - -The year 622 is remarkable for the flight of Mahomet from Mecca to -Medina, from which time we may date the rise of the empire of the -Saracens; a people who, for desolation and destruction, were perhaps -never equalled except by the Hunns and Moguls. In 630 the impostor -himself died, after having just united the Arabs or Saracens, and -fitted them for the work in which they were to be employed. Their first -exploit was, to fall upon the empire of Persia, now weakened by its -endless wars with the Romans. This was conquered in two years; after -which they broke into Palestine, and conquered the provinces bordering -upon Syria. In 634 they reduced Syria itself and Egypt. In 636 they -took and plundered Jerusalem. In 642 they conquered the African -provinces, and reduced some of the islands in the Levant. With unabated -fury they proceeded to the east and west; laying siege, in 668, to -Constantinople itself, where they received their first check by the -shipwreck of their fleet, and the defeat of their army. Thus, in the -space of 38 years, the immense tract of country from the eastern part -of Persia to the confines of the Mediterranean Sea, with the northern -coasts of Africa, the whole including a space scarce inferior to the -empire of Alexander the Great, was reduced under subjection to a race -of savage barbarians, who knew only how to plunder, destroy, and reduce -other nations to slavery. - -In this manner were the eastern parts of the world prepared for a new -infection, supposing the old one to have been entirely gone off. The -Saracens pursued their good fortune, ravaged and conquered from India -to Spain, and from Spain were proceeding northward through France, to -extend their conquests to the other countries of Europe. But here, in -728, their fury was stopped by Charles Martel, the father of Pepin, and -grandfather of Charles the Great. After a most obstinate and bloody -battle, which lasted seven days, and in which the barbarians lost three -hundred and seventy-five thousand men,[40] they were driven beyond the -Pyrennean mountains, and never after durst enter France. Thus was one -fury stopped, only to give place to another. Charles, as ambitious and -as cruel as the Saracens, having in vain attempted the conquest of -Spain, reduced Italy and Germany; and, having dreadfully massacred the -Saxons, and almost exterminated the Hunns, set up the German Empire, -and was crowned emperor of the West in 800. - - [40] M. Millot places this account among the “exaggerations which - ought not to have a place in history;” but, as we have no evidence - for or against the fact, it was thought proper to let it remain as - related by the historians of those times. It is certain that in those - days mankind assembled for the purposes of bloodshed and slaughter in - prodigious numbers; the destruction was commonly in proportion to the - numbers assembled. The account is not more incredible than that of - Tamerlane’s filling up the harbour of Smyrna by causing each of his - soldiers to throw a stone into it. Such an army could have spared the - number in question. - -While the nations were thus deluging the earth with blood, the -pestilence made its appearance in the east, attended with extraordinary -phenomena.[41] Some of these are taken notice of by the Arabian -historians, and others are mentioned by them, concerning which -the Greek histories are silent. In 636, particularly, we hear of -violent storms of hail throughout the Arabian Peninsula, and of Syria -being ravaged by epidemic distempers. It would seem, indeed, that -the plague, during the whole of these horrible periods, had never -been extinguished; for in 671 they tell us that a celebrated Arab, -named _Ziyad_, died of the plague; though neither Greek nor Arabian -historians take notice of any remarkable pestilence as raging at that -time. We are told that this man was attended by no fewer than _an -hundred and fifty_ physicians.[42] “But, _as the decree was sealed_, -and _the thing determined_, they found it impossible to save him.” This -distemper was attended with such an excruciating pain in his right -hand, that the unhappy patient had recourse to a _cadi_, or judge, to -inform him whether he might lawfully cut it off. The judge determined -that it was absolutely unlawful to do so; notwithstanding which, -Ziyad resolved to proceed: but his heart failed him when he saw the -instruments and cauterising irons to be employed in the operation; for -in those times of barbarity and ignorance they knew no other method of -stopping blood but by a hot iron; and therefore some of the physicians -in ancient times, when a limb was to be cut off, ordered the incision -to be made down to the bone with a red hot razor. But, to return to our -subject: In Syria and Mesopotamia swarms of locusts infected the earth -about the year 679; but, as it seems extremely probable that the plague -was never out of the eastern regions, we cannot expect to hear much -of it, unless when extremely violent. That in the time of Constantine -Copronymus seems to have extended over Arabia, as we are told that -the Khalif Yezid, who was cotemporary with Copronymus, died of the -plague. We are also told, that the earthquakes which afflicted the -territories of the Greek emperors extended themselves to the countries -about the Caspian Sea. In those ages indeed the phenomena of nature -appear to have been so extraordinary, that we can scarcely account -them any other than miraculous. Some of these have been described in -the former section, on the authority of the Greek historians: the -Arabians make mention of others similar. They tell us, also, that -once or twice it rained black stones, and that some of these were so -inflammable, that an Arab having attempted to make a fire with one of -them in his tent, it burst out into such a violent flame as consumed -the tent altogether.[43] This rain may be accounted for from the -explosion of a volcano; but how shall we account for the sun himself -losing his light? a phenomenon acknowledged even by Mr. Gibbon; though -that author huddles things together in such a manner as seems totally -inconsistent with the regular chain of events. He tells us, that the -dreadful plague, which broke out in the time of Justinian, was preceded -by comets, and most violent earthquakes; and that these comets were -attended with an extraordinary paleness of the sun. This may be; but -the word _paleness_ cannot apply to the _darkness_ which lasted from -the fourth of August to the first of October, and to which he seems to -allude, though it happened long after the time of Justinian; neither -can it be applied to what I am now about to relate, viz. that in the -year 782, a little after sunrise, the solar light was lost without an -eclipse, and the darkness continued till noon. It is impossible to -read the histories of those times without remembering the words of -our Saviour, that there should be signs in the sun and in the moon, -distress and perplexity of nations, the sea and waves roaring, men’s -hearts failing them for fear, &c. But, however the God of nature might -thus intimate to mankind his displeasure with their proceedings, it -is certain they made no alteration in their conduct. The Saracens, -having conquered immense tracts of country, engaged in civil wars -among themselves; the western nations, after having tried in vain to -destroy each other, at last united in a romantic design of conquering -Palestine from the Infidels; while the Turks, leaving their habitations -about Mount Caucasus, where, like the vultures of Prometheus, they -had for ages remained unseen and unknown, precipitated themselves -upon the Greeks and Saracens, and lastly, as if all hell had broke -loose at once, the Moguls, from the most easterly part of Asia, poured -destruction upon the countries to the west, even as far as Russia and -Poland. - - [41] See Sec. i. - - [42] Modern Univ. Hist. Arabia. - - [43] That such accounts are not to be looked upon as entirely - fabulous, may be gathered from what is related by Mr. Thomson in - his travels through Palestine, viz. that on the brink of the lake - Asphaltites he found numbers of “small _black pebbles_, which are - soon set on fire by being held in the flame of a candle, and yield a - smoke intolerably stinking and offensive; but have this remarkable - property, that by burning they lose nothing of their weight, nor - suffer any diminution in their bulk. They are capable of taking as - fine a polish as black marble, and are likewise said to be met with - of considerable size in the neighbouring mountains.” - -All these events took place in a few centuries. In 844 the Turks -quitted Mount Caucasus, and settled in Armenia Major. In 1030 they -fell upon the Saracen empire, now divided among innumerable chieftains -continually at war with each other. Among these was one called the -Sultan of Persia, and another of Babylon. The former being worsted, -called in the Turks to his assistance. They sent him an auxiliary -army of only _three thousand_ men; and from this slender beginning -has arisen the vast empire of the Ottoman Porte. The three thousand -men were commanded by a general called by the Greeks _Tangrolipix_, -and by the Asiatics _Togrul Beg_. Being a man of ability, the Sultan -of Persia, by his assistance, got the better of his adversary; but, -refusing to let the Turks depart, Tangrolipix with his army withdrew -to the desert of Carbonitis, where, being joined by numbers of -discontented Persians, he began to invade the territories of the -Saracens. The Sultan of Persia sent against him an army of twenty -thousand men, whom Tangrolipix surprised and defeated, acquiring at the -same time an immense booty. The fame of his victory, and his wealth, -procured him bands of robbers, thieves, and blackguards, from all the -neighbouring countries; so that he soon found himself at the head of -fifty thousand. Against such a formidable force the Sultan of Persia -marched in person; but happening to lose his life in the engagement by -a fall from his horse, his men threw down their arms and acknowledged -Tangrolipix to be Sultan of Persia. - -The new sultan instantly thought of destroying other sultans and -potentates; for which purpose he opened a passage for his countrymen -from Armenia to Persia. The Sultan of Babylon was the first victim; -after which Tangrolipix turned his arms unsuccessfully against the -Arabians, but afterwards more successfully against the Greek emperors. -The first invasion by the Turks took place in 1041; and in four hundred -and twelve years they became absolute masters of the empire. Though -unsuccessful at first against the Saracens, they prevailed greatly -afterwards, and, by the time of the crusades, we find them masters of -Palestine, as well as several other countries formerly conquered by -the Arabs. From the time of their first invasion, in 1041, we may say, -the war never ceased; and there is the greatest reason to suppose that -the Greek empire would have been overthrown in a very short time, had -not the crusaders checked their progress. The immense numbers with -whom the barbarians had now to contend (amounting to no fewer than -seven hundred thousand) threatened with destruction the newly erected -empire of the Turks; and had it not been for the want of unanimity -among the crusaders themselves, and the jealousy of the emperors of -Constantinople, they certainly would have overthrown it. But, as -matters went, all their labour was lost; and they only increased the -general carnage and desolation to an extreme degree. The first crusade -was planned in 1093, published in 1095, and in March 1096 the first -army set out. In 1097 they began their conquests, but soon found it -very difficult to keep them. The Turks being at home, and united, had -many advantages over foreign invaders; which the latter endeavoured -to counteract by drawing continual supplies of fresh men from Europe. -Thus, for several centuries, the western part of Asia was rendered -a scene of bloodshed and desolation. When they had contended for -something more than _two hundred_ years, Jenghiz Khan, the Mogul, seems -to have formed the _noble_ design of destroying the whole human race -at once, excepting only his own immediate followers. His plan was, to -_exterminate_ man, woman and child wherever he went, and to plant the -countries with his own people. It is impossible to do justice to his -exploits. Voltaire, speaking of the irruption of the Moguls, says, -that the people fled every where before them, like wild beasts roused -from their dens by other beasts more savage than themselves. In the -Universal History we are told, that he is supposed to have destroyed -_fourteen millions and an half_ of his fellow creatures. He died in -1227, and left successors worthy of himself. Some of these proceeded -eastward, and some westward. The latter, under the conduct of a -_monster_ named _Hula-ku_, overthrew, in the year 1256, the remains -of the Saracen empire, by the taking of Bagdad. The miserable Khalif, -coming forth to meet his conqueror, was trampled under his horse’s -feet, then sewed up in a sack, dragged through the streets, and thrown -into the river. The Moguls who proceeded eastward invaded China. The -Chinese resisted with innumerable multitudes, and battles were fought -to which those of the present age are mere skirmishes. The soldiers, -overcome with thirst, drank blood instead of water; hundreds of -thousands fell on both sides, while human blood ran in streams for five -or six miles. At last the fury of the Moguls was stopped by the ocean; -for, having attempted the conquest of Japan, their fleet was wrecked, -and an hundred thousand perished. Like other great empires, also, -pretenders to the sovereignty started up, and the whole was parcelled -out into a number of little states, which, of course, ceased to be -formidable. - -The decline of the Mogul empire did not restore peace to the world. -The Turks continued their ravages; the western nations continued their -crusades. England, which became a kingdom in 800, had been ravaged -and conquered by the Danes and Normans, and likewise distressed by -civil wars. At last, having emerged from its own difficulties, it -began to inflict upon other nations the miseries itself had endured. -Wales and Scotland became objects of the ambition of Edward I, who had -already signalized his valour in the crusade. The Welsh were totally -subjugated, and the Scots overthrown in the very bloody battle of -Falkirk, where almost the whole force of the country was destroyed. The -Scots, however, were never totally subdued. Robert Bruce retaliated on -the English in the battle of Bannock-burn, where two hundred thousand -English were defeated by thirty thousand Scots. But Robert was not -contented with asserting the liberty of his country. Jealous of his -brother Edward, he sent him with an army to conquer Ireland. We shall -not doubt of his valour, or of the miseries he inflicted, or was -willing to inflict, upon the people among whom he came. In destroying -them he destroyed his own army. They were reduced to the most dreadful -straits by famine, insomuch that they were obliged to feed upon the -most loathsome matters, their own excrements not excepted. - -Being now arrived at the beginning of the fourteenth century, we see -that, from Ireland to China, mankind had involved themselves in one -general work of destruction. Besides the wars, famines had been so -frequent, that the eating of one another seemed to be but a common -affair. Indeed the history of mankind would tempt one to believe that -they thought themselves brought into the world for no other purpose but -to destroy each other. As far back as the year 409, in the time of the -wars of the Vandals in Spain, a dreadful famine took place, which, in -410, reduced many to the necessity of feeding upon human flesh; parents -devoured their children, and the wild beasts, being deprived of the -dead bodies which they used to feed upon, but which were at this time -devoured by the living, fell upon the latter, and thus increased the -general destruction. Such of the Romans as fled into strong holds and -fortresses, were in the end obliged to feed upon one another. To these -calamities the pestilence was added, which did not fail to rage in its -usual manner. Famine and pestilence had also ravaged the city of Rome -when besieged by the Goths under Vitiges, and under Totila. In this -last siege the unhappy citizens were reduced to such straits, that they -consumed even the grass which grew near the walls, and were at last -obliged to feed on their own excrements. We do not indeed hear, at this -time, of any particular instances of people feeding upon one another; -though, in such dreadful emergences, it is scarcely to be doubted that -some would have recourse to this terrible expedient in order to allay -their hunger. But in the famines which took place during the ravages of -the Saracens, Turks and Moguls, nothing seems to have been more common. -In 1066 a most grievous famine took place at Alexandria in Egypt, and -throughout the whole country. Three bushels and a half of flour were -sold at eighty dinars, a dog at five, and a cat at three. The Visir, -having waited on the Khalif, left his horse at the palace gate; but, -before he returned, the animal had been carried off and eaten. Three -men were hanged for this theft, and their bodies ordered to be exposed -upon gibbets; but next day they were found picked to the bones, their -flesh having been all cut off and devoured the preceding night. Bodies -of men and women were boiled, and their flesh publicly sold. A violent -plague followed, which swept away the greatest part of the inhabitants. -As the hellish Moguls spread desolation wherever they advanced, so -their retreats were equally formidable. In 1243, having advanced as far -as Aleppo in Syria, they found themselves obliged to retreat, and that -for a very odd reason, viz. that their horses were not well shod. This, -however, did not hinder them from destroying every thing the earth -produced, and stripping every man, nay, every woman, they met, even of -their clothes. The consequence was, a terrible famine, so that people -were fain to sell their children for small pieces of bread. - -Such was the conduct of men, from one end of the earth to the other, -during the interval, if any interval there was, between the plague -in the time of Justinian and that of 1346. The pestilence, which had -continually raged in one place or other, now overspread the whole -world. At what time it began to decline we know not; and, indeed, as -the same desolations and massacres continued, if these had any share in -its production, it ought scarcely to have declined at all. That there -was all this time little or no interval, appears from what Dr. Rush -says, vol. iii. p. 165, that between the years 1006 and 1680, that is, -in a period of 674 years, the plague was _fifty-two_ times epidemic all -over Europe. Supposing the intervals between every general infection -then to have been equal, and the plague to have lasted only one year at -a time, it must have recurred once in twelve years. But the intervals -were not equal; for the Doctor tells us that it prevailed _fourteen_ -times in the fourteenth century; which gives an interval of less than -seven years; and if the pestilence so frequently overspread the whole -continent, we may be very sure that it never was out of particular -places of it. The Doctor adds, “The state of Europe in this long period -is well known.” We shall also consider that of Asia. - -The empire of the Moguls, which had fallen into decay, revived under -Tamerlane; who, following the example of Jenghiz Khan, had the epithet -of the _destroying prince_ bestowed upon him by the Indians, on account -of his behaviour in their country. Building his captives into walls -with stones and lime, pounding them by thousands in large mortars, was -his common practice; while the Turks, proceeding westward, wasted every -thing with fire and sword; the christians all the while continuing -their mad crusades, and when driven from one place endeavouring to -establish themselves in another. At last the Turks and Tartars, or -Moguls, or rather their emperors, happening to quarrel, the battle of -Angora, in Galatia, decided (at the expense of some hundred thousand -lives) the dispute in favour of Tamerlane; but, as his empire ended -with his life, the Turks soon recovered from the blow they had -received; and, by the taking of Constantinople in 1453, put an end to -the terrible commotions which had prevailed in the east for so many -ages. The crusades had also for some time been discontinued, and the -world hath since that time been comparatively in a state of peace. - -But, by so much intercourse with the Asiatics, especially with the -countries particularly subject to the plague, all Europe had been so -deeply infected, that the distemper could not but prevail for a long -time, even though it had not been kept up by the almost continual -wars of the Europeans with one another, which was too much the case. -Dr. Sydenham informs us that before his time the plague commonly -visited England once in forty years; but by this we must understand a -very violent infection; for Dr. Rush tells us that plagues prevailed -in London _every year_ from 1593 to 1611, and from 1636 to 1649. The -author of the Journal of the Plague Year (1665) mentions a visitation -in 1656; and Mr. Carey, in the beginning of his account of the plague -of London in 1665, says, that the plague was _almost continually_ -among the diseases enumerated in their bills of mortality; so that we -may fairly conclude it to have been _endemic_ in that city. Now let -us see how England had employed itself. Its kings, as well as many of -their subjects, had gone to the holy wars, as they called them, and, by -continuing in that devoted country where most probably the pestilence -first originated, it is impossible to suppose that some of them did not -receive the contagion. Having caught the pestilence in the _holy war_, -they came home to diffuse it among their countrymen, and to keep it up -by _profane wars_, I suppose, both foreign and domestic. Henry VII put -an end to a very long and bloody contest between the houses of York and -Lancaster; but he brought the pestilence along with him, which raged -violently during the fifteenth and sixteenth centuries. A most violent -war, for half a century, on the continent of Europe, and civil wars in -England, would still continue to keep the infection alive from 1600 -to 1648, when a general peace was concluded; and from the subsequent -state of tranquillity, probably, after the violent attack in 1665, it -seems to have languished and died in England, as a plant in a soil not -natural to it. - -But, though England has since remained in peace, on the continent it -has been otherwise. In the beginning of the eighteenth century, the -heroic madness of Charles XII seemed ready to confound the north, while -the glorious exploits of prince Eugene and the duke of Marlborough -appeared equally confounding to France. In the midst of these grand -atchievments, the pestilence silently claimed its share in the common -work of destruction; carrying off upwards of two thousand in a week for -some time, in 1709, in the city of Dantzick, and, in 1711, twenty-five -out of sixty thousand inhabitants in Copenhagen. - -The infection, however, seemed now to be retiring to the place from -whence it originally came. In 1666, or soon after, it seems to have -totally abandoned the island of Britain; with the attack in 1711 it -left the western countries of the continent next to that island; in -1713, 1714 and 1715 we are informed by baron Van Swieten that it -ravaged Austria; in 1721, or soon after, it abandoned France; in 1743 -it made its last attack on Messina; and in 1784 we find it confined -to Dalmatia and the eastern territories, where it has so long reigned -without interruption. - -From the view then which we have taken of the conduct of the human -race, and the consequences of that conduct, we may reasonably conclude, -that war will produce famine and pestilence, and that after all -violent wars a violent pestilence may be expected, especially if the -contending parties interfere with those nations where it is most -frequent. Another piece of conduct by which mankind expose themselves -to pestilential contagions is, the practice of cooping themselves up -in great cities. Mr. Gibbon, speaking of earthquakes, says, that men, -though always complaining, frequently bring mischief upon themselves. -“The institution of great cities (adds he) which enclose a nation -within the limits of a wall, almost realises the wish of Caligula, that -the Roman people had but one neck. In these disasters (earthquakes) the -architect becomes the enemy of mankind. The hut of a savage, or the -tent of an Arab, is thrown down without injury to the inhabitant; and -the Peruvians had reason to deride the folly of the Spanish conquerors, -who with so much cost and care erected their own sepulchres. The rich -marbles of a palace are dashed on its owner’s head, a whole people -is buried under the ruins of public or private edifices, and the -conflagration is kindled and propagated by innumerable fires necessary -for the subsistence and manufactures of a great city.” In plagues, -great cities are unquestionably as pernicious as in earthquakes; not -indeed by reason of the weight and bulk of the materials, but the -confinement of the people within the sphere of infection, and their -continual exposure to the causes which prepare the body for receiving -it. In fact, it has always been found that plagues begin in cities; -and were it not for the multitudes that continually fly out of them -there can be no doubt that the mortality would be much greater than -it is. The intercourse of many nations with one another, the carrying -from one end of the earth to the other of goods capable of bringing -with them the infection, must also be supposed a very principal cause -of pestilence; but this last will be more fully considered in the next -section. At present we may conclude, that, the pestilential contagion -having originally fallen upon mankind for their sins, it is still kept -alive by the same causes; and, as far as we can conjecture, these sins -are, the propensity to murder and destroy which breaks forth in war; -the vanity, pride and luxury which produces great cities; and the same -vanity, &c. joined with avarice, which gives life to commerce. Add to -all this the neglect of the cultivation of the earth, which ought to be -the principal business of man. In consequence of this neglect, immense -tracts of it are still overrun with woods, covered with stagnant and -noxious waters, or lying in waste and now uninhabitable deserts, fit -only for serpents and the most destructive animals. Thus the very -climate is changed from what it ought to be; the elements become -hostile to man in an extreme degree, and the whole system of nature, -originally designed to give life and happiness to the human race, is, -through their own misconduct, changed into a system of misery, disease -and death. - -The account just now given of the ways in which mankind bring upon -themselves the plague, and other diseases almost equally terrible, is -so conformable to the opinions of the learned Dr. Mead, that I shall -conclude this section with a few extracts from his works. Of the -small pox he says, that he supposes this “to be a plague of its own -kind, originally bred in Africa, and more especially in Ethiopia, as -the heat is excessive there; and thence, like the true plague, was -brought into Arabia and Egypt, after the manner above mentioned” (i. -e. by war and merchandise.) “Now (adds he) if any one should wonder -why this contagion was so long confined to its native soil, without -spreading into distant countries, I pray him to consider, that foreign -commerce was much more sparingly carried on in ancient times than -in our days, especially between Mediterranean nations; and likewise -that the ancients seldom or never undertook long voyages by sea, as -we do. And Ludolfus observes, that the Ethiopians in particular were -ignorant of mercantile affairs. Therefore when in process of time the -mutual intercourse of different nations became more frequent by wars, -trade and other causes, this contagious disease was spread far and -wide. But, towards the end of the eleventh century, and beginning of -the twelfth, it gained vast ground by means of the wars waged by a -confederacy of christian powers against the Saracens, for the recovery -of the Holy Land; this being the only visible recompense of their -religious expeditions, which they brought back to their respective -countries.” Of the true plague he says, “It appears, I think, very -plainly, that the plague is a real poison, which, being bred in the -southern parts of the world, is carried by commerce into other parts -of the world, particularly into Turky, where it maintains itself by -a kind of circulation from persons to goods; which is chiefly owing -to the negligence of the people there, who are stupidly careless in -the affair: that, when the constitution of the air happens to favour -infection, it rages there with great violence; that at that time, -more especially, diseased persons give it to one another, and from -them contagious matter is lodged in goods of a soft, loose texture, -which, being packed up and carried into other countries, let out, when -opened, the imprisoned seeds of the contagion, and produce the disease -whenever the air is disposed to give them force; otherwise they may be -dissipated without any considerable ill effects. The air of our climate -is so far from being ever the original of the true plague, that most -probably it never produces those milder infectious distempers, the -small pox and measles. For these diseases were not heard of in Europe -before the Moors had entered Spain; and, as already observed, they were -afterwards propagated and spread through all nations, chiefly by means -of the wars with the Saracens. The sweating sickness was most probably -of foreign original. It began in the army with which king Henry VII -came from France, and landed in Wales; and it has been supposed by some -to have been brought from the famous siege of Rhodes, three or four -years before, as may be collected from one place of what Dr. Keyes says -in his treatise on the disease. We had here the same kind of fever -in 1713, about the month of September, which was called the _Dunkirk -fever_, is being brought by our soldiers from that place. This, -probably, had its original from the plague which broke out at Dantzick -a few years before, and continued some time among the cities of the -north.” - -I now take leave, for the present, of this subject, which exhibits -the conduct of mankind in such a disagreeable view. Some, like M. -Millot above quoted, may be apt to suppose that many of the accounts -are exaggerated. But it is evident, that in our days it is impossible -to determine any thing to be a falsehood, said to have happened in -former ages, which is not absolutely contradictory to reason. Every -one of the accounts inserted in this section has found a place in the -works of historians reckoned authentic, particularly in the Universal -History. All who believe the New Testament must certainly believe, -from the words of our Saviour, that extraordinary things were to -happen in the ages subsequent to his appearance. Can we then discredit -the relations of those historians who inform us that extraordinary -things have happened? Modern historians, making their own judgments -the infallible measure of wisdom, and the strength of nations now -existing the ultimate measure of human power, have endeavoured to turn -into ridicule every thing which does not precisely accord with these -two. In this the French are particularly culpable; accounting every -thing to be incredible which exceeds the power of modern France to -accomplish, though they certainly do not know even the extent of this -power. Of such scandalous vanity we have a notable instance in the -works of president Goguet, who positively determines that the walls of -ancient Babylon, the pyramids of Egypt, and all the wonderful works of -Semiramis, Nebuchadnezzar, &c. were not equal to the canal of Languedoc -made by Louis XIV! - - - - -SECTION III. - - _Of Disease in general.--The nature of the Plague as a Disease - considered.--Of Contagion.--Whether the Plague is really Contagious - or not.--Medical History of the Distemper.--Inquiry into its - Immediate Causes, and whether an approaching Plague is indicated by - any visible Signs._ - - -Hitherto we have considered the origin of the plague entirely in -a moral point of view. We have seen, that, in conformity to the -general opinion of mankind, it may reasonably be supposed to have -been inflicted upon mankind, the Jews particularly, for their -transgressions; that, having been once introduced, it has been -perpetuated, and spread from nation to nation, and that in proportion -to the degree of immorality of a certain kind prevailing through the -world. From this it is naturally to be inferred, that, were the human -race to live at peace with one another, to disperse themselves over -the face of the earth for the purpose of improving it by cultivation, -and were they to be contented with what the produce of each country -affords, there would be no plague among them. But we know that such -a reformation is not to be expected, and we must take the world as we -find it. The question then is, By what means shall individuals secure -themselves from being destroyed by a plague which shall happen to -invade any country; or how shall a person, already infected with it, be -restored to health? For this purpose let us begin with considering the -nature of disease in general, and of the plague particularly. - -As to disease in general, physicians have differed very considerably -in their definitions; and, though many have been given, few seem to be -unexceptionable. That of Dr. Fordyce seems to be among the clearest -and most expressive. “Disease (says he) is such an alteration in the -chemical properties of the fluids or solids, or of their organization, -or of the action of the moving powers, as produces an inability or -difficulty of performing the functions of the whole or any part of the -system, or pain, or preternatural evacuation.” But as this definition, -however just, cannot be easily understood by such as are unaccustomed -to medical language, I shall attempt the following explanation of the -animal economy, and the diseases to which it is subject. - -1. By nature our bodies are formed of certain solid and fluid parts, -operating upon one another in a manner of which we know but little. -Anatomists have described the structure of the human body and its -parts in a certain degree, but have always found themselves lost in an -inconceivable minuteness of texture. The whole structure of the human -body, visible and invisible, is called its ORGANIZATION. - -2. This organized body is acted upon by certain powers residing in the -atmosphere, by which it becomes endowed with LIFE. - -3. The operation of those powers upon a well organized body constitutes -that agreeable and vigorous state which we call HEALTH. - -4. The operation of any other power, substituted in place of the -natural one, even upon a body perfectly organized, produces a state -very different from health; commonly attended with some uneasy -sensations, and which is called DISEASE. I say it is _commonly_ -attended with uneasiness, but not always; for many persons within a few -hours, nay, a few minutes, of their death, have imagined themselves -quite recovered and well. To illustrate the meaning of what is said -of the substitution of any power instead of the natural one: It is -natural for man to breathe air of a certain quality; and while he does -so he continues in health; but let him breathe the vapour of burning -charcoal, or of fermenting liquor, mixed in considerable quantity with -the air to which he has been accustomed, and he will very soon find -himself diseased. Many other kinds of elastic fluids may be substituted -instead of the vapour just mentioned, all of which will in a short time -produce a disease in the most healthy man. The state of a diseased body -being very different from that of a sound one, the appearances are -consequently very different. The various appearances of disease in the -human body are called _symptoms_ of that disease, from a Greek word -signifying _appearance_.[44] - - [44] “_Symptom_ (says Dr. Fordyce) is the Greek name for - _appearance_:” but, from the strict etymology of the word, it - ought rather to be translated _accident_. The universal consent of - physicians, however, has applied it to every appearance produced in - the human body by any distemper whatever. - -5. A disease proves mortal only by the DISORGANIZATION of the body. By -disorganization I mean any considerable alteration in the structure of -the body, visible or invisible. The truth of this will appear from a -consideration of the method by which animals may be recovered, after -being to appearance dead by breathing the vapour of charcoal, or fixed -air in any other form, viz. by plunging them in cold water. In a cave -in Italy a continual stream of this kind of air issues from the ground. -It rises but a small way, so that a man may safely enter, because his -head is above the vapour; but, if he brings a small dog with him, the -animal, in consequence of breathing the pernicious fluid, falls down -as if dead, and would very soon die if left there. By throwing it into -a lake in the neighbourhood, (cold water of any kind would answer as -well) it recovers. In the dissection of some unfortunate people, -who have been killed by breathing this pernicious fume, a manifest -disorganization has been observed, viz. a rarefaction of the blood, and -too great dilation, or even rupture, of the small vessels. - -6. A disease cannot always be cured by removing the cause which -brought it on: it is necessary also to repair the injury done to -the organization. This is exemplified in the case of the dog just -mentioned. Taking him out of the vapour is not sufficient for his -recovery, because the organization of the body is injured; the cold -water by contracting the vessels repairs the injury, and the cure -is completed. To the entire preservation of this organization it is -probably owing, that people have frequently recovered after being -thought dead for a long time.[45] - - [45] Dr. Anthony Fothergill, in his prize dissertation upon the - suspension of vital action, quotes some experiments of Dr. Kite, - in which he was able to restore to life animals that had been - immersed in water for eight, ten or twelve minutes, though he - acknowledges that this operation, though performed with great - attention, often failed; while other animals, that had been longer - immersed, recovered spontaneously. He further adds, that if it be - not attempted before the convulsions of the animal cease, which - on an average of many experiments happens in about eleven minutes - and a half, it will not be sufficient to renew the vital motions. - But, “among the human species (says Dr. Fothergill) there are not - wanting well authenticated instances of spontaneous recovery at - an incomparably longer interval, and after every external mark of - life had disappeared. Such is the latent energy of the heart, that - it sometimes, after remaining several hours quiescent, renews on - a sudden the secret springs of life, surmounts the barriers of - the resisting blood, and restores circulation with all the other - functions. Hence the unexpected recoveries from death-like syncope - brought on by sudden terror, or great effusions of blood, even after - the funeral obsequies have been prepared. Hence some persons have - accidentally been brought to life, even after interment, by the rude - motion produced in sacrilegious attempts to wrest rings or bracelets - from the apparently dead body.” - - Several surprising instances of the recovery of persons supposed to - be dead, even of the plague, are given by Fabricius Hildanus; to - one of which Dr. Fothergill seems to allude in the above quotation. - Hildanus relates, that in the year 1357, when the plague raged - violently at Cologne, a certain noble lady, by name _Reichmuth - Adoleh_, being seized with the disease, was thought to have died, - and was buried accordingly. Her husband, out of affection, would not - take off her wedding ring, which she happened to have on her finger. - The undertakers being acquainted with this circumstance, next night - came to the church where she was buried, opened the sepulchre, and - prepared to take off the ring; when to their utter astonishment she - began to raise herself up in the coffin. Struck with consternation - they fled in the utmost haste, leaving to the fortunate lady the - lantern with which they lighted themselves to the church, and by - means of which she now found out where she was, and after being - come to herself, returned to her own house. Here being known by her - voice, and the ring she wore, she found admittance, and by means of - a generous diet gradually regained her health; bringing her husband - afterwards three children, and surviving the accident many years. - - A second instance no less remarkable is of a woman of the name of - _Nicolle Lentille_, who, being supposed dead of the plague, had been - thrown into a pit with a great number of the bodies of others, dead - of the same distemper. After lying there a whole night, she came to - herself in the morning, but neither knew at first where she was, nor, - when she did, could she find any means of escaping, or extricating - herself from the heap of dead bodies with which she was oppressed. - Being at a distance from any house, her cries were of no avail, and, - in the mean time, having taken no nourishment for four days, she was - so tormented with hunger that she eat part of the cloth which covered - her face. At last, after remaining twenty-four hours in this dreadful - situation, the pit being opened to bury some other person, she - exerted her utmost endeavours in calling for assistance, and at last - was heard by those who stood round. Being taken up and brought home, - she presently recovered, and lived several years after. - - A third example is given by our author of one who, being carried to - a church to be buried, had his face previously sprinkled with holy - water by a priest. But this was no sooner done than he shuddered and - opened his eyes in a fright; on which he was carried home, recovered, - and lived eight years after. Other examples might be brought, but - these are sufficient to show what dreadful accidents may ensue from - early burials, and how cautious people ought to be in consigning - their friends and relations to the dust from whence they were taken. - -7. When the organization of the body is injured, the action of the -natural powers themselves occasions uneasiness, and increases the -disease. The cure then is, to substitute instead of the natural -power, as far as possible, the action of some other power till the -organization is restored; after which the natural power must be again -allowed to act, or a disease of another kind will take place. This -may be exemplified in a consumption of the lungs; where, that part -being very much disorganized, pure air renders the disease worse; and -the sick are relieved by mixing with the common atmosphere such kinds -of air or vapour as would prove pernicious to people in health. But, -supposing this method to be successful, and the consumption to be -entirely removed, it is plain that the use of the pure atmosphere must -be resumed, or the impure air would bring on a disease in the same -manner as on a healthy person. - -8. The body is wasted in the natural operations of life; part of -it passing off with the vapour of the breath, part by insensible -perspiration, &c. Hence it naturally tends to disorganization and -death, unless the waste be repaired. - -9. This natural waste of the body is repaired, and health kept up, by -the food and drink taken into the stomach. - -10. Hence arises another set of diseases; for as the reparation of the -waste, just mentioned, depends on the proper action of the stomach upon -the food, and the assimilation of the latter with the substance of -the body, it is plain that this operation depends both on the proper -quality of the food, and the sound state of the stomach itself. - -11. The body is composed of solids and fluids of different kinds, -every one of which is subject to diseases peculiar to itself; but, by -reason of the connexion of the parts of the body with one another, -it is impossible that any one can be very much disordered without -affecting all the rest. As the bond of connexion, however, is in many -cases totally invisible to us, surprising instances frequently occur -of one part being affected in consequence of an injury done to another -very distant from it. This connexion between all parts of the body is -called SYMPATHY. Dr. Gardiner of Edinburgh, in his observations on -the animal economy, &c. says, that “the stomach is the principal seat -of many of the most remarkable sympathetic affections which happen in -valetudinary states of the body. Every disorder accompanied with severe -pain affects the stomach, whilst this viscus affects not only in its -diseased state every part of the system, but at other times the effects -of healthful stimuli applied to it are instantly communicated to the -rest of the body, as when we take food, wine, or medicine.” Dr. Darwin -in his Zoonomia informs us that the stomach is said to sympathize with -almost every part of the body; but Dr. Moore, in his medical sketches, -tells us that the _heart_ possesses a greater share of sympathy than -any other part in the body, and next to it the stomach.[46] - - [46] Dr. Gardiner, in his observations above quoted, gives the - following curious anecdote. “An unmarried lady, of a healthy - constitution, has such a peculiarity in the structure of her nerves, - that, though she can, in general, bear strong odours as well as - most people, yet she cannot suffer a rose to be in her bosom, or - to hold it in her hand a few minutes, without becoming faint, and - having an inclination to vomit. Conserve of roses, rose-water, and - similar articles made from roses, have more powerful effects upon - her, and usually excite vomiting. Going into a room where any of her - companions are washing with rose-water, never fails to produce this - effect; nor does she recover of her indisposition in less than two - hours.” - -12. The solid parts of the body are the bones, the muscles, brain -and nerves; the fluids are, the blood, and others produced from it. -The bones are known to every one; the muscles are the fleshy parts -throughout the whole body; and the nerves are a kind of cords seemingly -originating from the brain, and from thence accompanying the blood -vessels through all parts of the body. - -13. Much has been disputed about what is to be accounted the primary -part of the body, on which all the rest depend; and one class of -disputants have arranged themselves on the side of the _blood_, and -the other on that of the _nerves_. The dispute is like one about -the beginning of a circle. It cannot be decided, because the blood -cannot act without nerves, nor the nerves without blood. I speak of -the human body, being aware that in some animals the position may be -controverted. The following is a concise state of the matter. - -14. All the blood in the body passes through the heart; which has four -cavities; two called _ventricles_, and two _auricles_. These, from -their position in the body, are called the _right_ and _left_. The -right ventricle communicates with the right auricle, as does also the -left ventricle with the left auricle; but there is no communication -between the right ventricle and the left, nor between the right -auricle and the left. Through these cavities all the blood passes to -every part of the body, and returns from every part; but, as in the -former case, we are here at a great loss where to begin its motion; -for this is precisely to find the beginning of a circle. As we must -begin somewhere, however, we shall do so with the right ventricle of -the heart. This receives the blood returning from all parts of the -body, and propels it into the right ventricle; not the whole quantity -at once, for it cannot contain one half of it; but by degrees. The -auricle contracts as soon as it is full; and in the time that the -auricle fills, the ventricle contracts, so that it may be empty, and -ready to receive the blood from the auricle. By the contraction of -the right ventricle the blood is driven into the pulmonary artery, -and passes into the lungs. Here the artery branches into an infinite -number of small vessels much finer than hairs; and these again, -uniting into larger trunks, form at last the pulmonary vein, which -brings back the blood to the heart. The pulmonary vein is inserted -into the left auricle of the heart, which, as soon as it is filled -with blood, contracts, and expels the blood from it into the left -ventricle. From the left ventricle issues a large artery called the -_aorta_, which by its branches supplies the whole body with the vital -fluid. In all parts of the body the arteries divide themselves into -innumerable small branches, which terminate in veins equally small -as in the lungs; but it has been disputed whether the arteries and -veins actually join each other in the form of vessels, or whether the -arteries deposit the blood in small cells, from which the veins suck -it up. The dispute is of no consequence, nor can it be absolutely -decided, on account of the exceeding smallness of the vessels; though -the microscopical observations are rather favourable to the opinion -of a continuation of vessels. The veins from all parts of the body -unite into larger vessels, and these again uniting with one another, -form at last one very large vein called the vena cava, which opens -into the right auricle of the heart, from which the circulation goes -on as already described. The two ventricles of the heart, and all the -veins throughout the body, are furnished with a kind of valves, which -allow the blood to proceed in the way of circulation, but prevent its -returning in a contrary direction. - -15. The lungs, through which all the blood in the body passes, receive -likewise the air which we draw in every time we breathe. They consist -of two large bodies called _lobes_; from their situation called the -right and left. The air is conveyed into them by the wind-pipe, called -also the _trachea_, and the _aspera arteria_. On entering the cavity of -the breast, the wind-pipe divides into two large branches called the -_bronchiæ_; one of which goes to the right and the other to the left -lobe of the lungs. By the further division and subdivision of these -vessels the lungs are filled with an innumerable multitude of little -tubes, terminating in exceedingly minute bladders or cells, which -are the final receptacles of the air sucked in when we breathe. Each -of these cells is surrounded with a kind of network of blood-vessels -exceedingly small, and consisting of very thin membranes; so that, in -passing through the lungs, the blood is exposed as much as possible to -the action of the air. - -16. It is a matter of great importance to find out what is the use -of this exposure of the blood; and great disputes have taken place -concerning it. In former times it was supposed that the blood received -from the air a _vital spirit_, without which it would have been totally -incapable of performing its offices in the body. Later physiologists -endeavoured to explode this notion. Dr. Hales particularly, by shewing -that the circulation of the blood through the lungs might be continued -by inflating and contracting them alternately by the fumes of burning -brimstone, endeavoured to prove that the use of the air was only to -give the lungs an opportunity of dilating and contracting alternately, -by which means principally he thought the circulation might be carried -on. This continued to be the most common hypothesis as late as the time -of Dr. Huxham. It was however thought also that by the compression of -the air the blood was altered in its texture, its bulk, &c. Accordingly -Dr. Huxham tells us in the preface to his treatise on air and epidemic -diseases, that “air fit for respiration ought neither to be too hot, -nor very cold; for the use of the inspired air is to temperate the -blood, which would otherwise grow too hot, and putrefy, as is evident -from the experiment of the most excellent Boerhaave made in a hot -house; for, if the air is more hot, or even equally hot, as the blood -of any animal, it certainly soon dies.”[47] - - [47] This certainly does not hold good if we suppose the heat of the - atmosphere to be indicated by a thermometer; for we are assured that - animals can live in a heat much superior to that which raises the - mercury to 97. - -17. The modern discoveries in the composition of air, have tended -greatly to elucidate the use of this fluid in the lungs, and its action -on the blood in respiration. Dr. Priestly first determined it to be -what he terms a _phlogistic process_, i. e. a process by which the -parts of the blood no longer proper to be retained among the rest, or -at least some of them, are carried off. That _something_ is carried off -either from the lungs themselves, or from the blood circulating through -them, is evident; for the air which is taken into the lungs in a dry -state, comes out of them extremely moist, and loaded with vapour. An -essential change is also made in the nature of the air itself; for it -now assumes in a great measure the nature of what has been called fixed -air, or the fume of charcoal, or fermenting liquor, and thus becomes -unfit for being breathed a second time. This change is made by the -addition of some terrestrial substance to the pure atmosphere, which -the latter volatilizes and carries along with it.[48] - - [48] The discoveries of modern chemists have determined that the - aerial fluid, termed _fixed air_ or _carbonic acid_, and which is - nearly the same with the vapour arising from fermenting liquor, and - is also largely contained in the fume of burning charcoal, is not - a simple but a compound substance; one part consisting of the pure - part of the atmosphere, or _oxygene_, the other of real charcoal. The - proportions, according to M. Chaptal, are 12,0288 parts of charcoal - to 56,687 of oxygen. - -18. But, whatever may be _carried off_ from the blood, during its -passage through the lungs, something is certainly _added_ to it, -for the blood in the pulmonary artery is of a dark red, but when it -has undergone the action of the air in the lungs, and returns by -the pulmonary vein, it is then of a bright scarlet, which colour it -retains through all the arteries of the body, but loses it on its -return through the veins. This scarlet colour is communicated to blood -in all cases when exposed to the air; and Dr. Priestley has observed -that it is acted upon by the air even through a bladder; much more -then must it be so through those very thin membranes which form the -coats of the fine pulmonary vessels. What this subtile matter is which -the blood receives, shall be afterwards inquired into; at present it -is sufficient to take notice that it is absolutely necessary, for the -purposes of life, that the blood should pass through the lungs: for, -as Dr. Huxham observes, “we see neither nutrition, nor the motion of -the muscles, performed by any blood that hath not passed through -the lungs; this is observable from the coronary arteries[49] to the -ultimate ramifications of the aorta.” As the previous circulation -of the blood through the lungs therefore is absolutely necessary to -the growth and life of the body, and as the blood certainly receives -_something_ from the air, we must account this a proof, and no -inconsiderable one, that the air contains a _vital spirit_, which it -imparts to the blood in the lungs. But, before we proceed farther on -this subject, it is proper to take some notice of - - [49] The name of the vessels by which the heart itself is supplied - with blood. These come from the aorta by the circuitous way of the - lungs. - -19. _The nerves._ These, which constitute such a remarkable and -important part of the human body, are white cords, of a soft pulpy -substance, defended by a tough skin which goes along with them as far -as they can be traced. All the nerves either originate from the brain, -or terminate in it. The former doctrine hath been generally adopted, -and in conformity to that doctrine the following account of the nerves -is laid down. The brain is enclosed in the cavity of the scull, but not -without the intervention of two membranes, called the _dura_ and _pia -mater_, to prevent injury from the hard bones, as well as for other -purposes. The brain is divided into two lobes, the right and left. It -is composed of two different kinds of substance, the outermost called -the cortical, the innermost the medullary substance; the latter seems -composed of fine fibres. The whole of the medullary part of the brain -terminates in a substance called the _cerebellum_, very much resembling -the brain, but smaller. The cerebellum terminates in another substance -resembling the medullary part of the brain, called the _medulla -oblongata_. The cerebellum lies in the back part of the head, and -the medulla oblongata under it. The latter terminates in the spinal -marrow, extending from the lower and back part of the head to the lower -extremity of the back bone, and is enclosed in the hollow of that bone. -The nerves proceed from these four substances, viz. the brain, the -cerebellum, the medulla oblongata, and spinal marrow. As they pass to -all parts of the body they accompany the arteries, dividing with them -into innumerable small branches; but they do not return with the veins; -so that they seem not to contain any fluid which goes and comes, or -which circulates like the blood. The nervous fluid, if any such there -be, seems to move constantly one way, either to the brain or from it. - -20. Hitherto we have noticed only things which are evident to our -senses, and which the industry of anatomists has abundantly evinced; -but now our subject renders it necessary to step aside a little into -the obscure regions of theory and conjecture. The muscles, as we have -formerly said, are the fleshy parts of the body; and by them all the -motions of the body are performed. The flesh is distributed into -distinct portions, each of which is enclosed in a membrane belonging -to itself. Each of these portions is a muscle, and each muscle has -a branch of an artery and the branch of a nerve belonging to it. On -both these the action of the muscle depends; for, if we cut the nerve -belonging to a muscle, it immediately loses all power of action; and -if we cut the artery which accompanies the nerve, it does the same. As -therefore the blood is found to receive _something_ from the air, and -as it loses this when passing through the arteries, and as the nerves -lose their power when the communication with the blood is cut off, it -seems extremely probable, that what is imbibed by the blood in the -lungs is taken up by the fine ramifications of the nerves, and is no -other than the immediate principle of life and sensation. Thus we will -establish a doctrine directly opposite to that commonly received; for, -instead of supposing that the nerves originate from the brain, we are -now led to suppose that they terminate in it. Instead of supposing that -the sensations originate in the brain, we will be led to suppose that -every sensation originates in the organ appointed for that sensation. -Thus we are conscious that our _eyes_, not our _brain_, are the parts -of our body which immediately perceive the light; our fingers, or -any other parts of the body, _feel_ what is applied to them; and of -consequence we have reason to believe that the _animal spirits_, -_nervous fluid_, or whatever we please to call it, proceed from the -surface of the body inwards to the brain, not outwards from the brain -to the surface of the body. The brain itself seems to resemble a large -collection or reservoir of water, in which the sensations, like so many -small streams from every part of the body, unite, and in which our -intellectual faculties reside in a manner totally inexplicable by us. -Thus far it seemed necessary to theorise, in order to form some idea, -however obscured, of the connexion between the nerves and our sensitive -and intellectual, or, if we please to call them so, our _spiritual_ -faculties. - -21. In consequence of this very intimate connexion between the blood -and nerves, it is easy to see that any injury done to the one may -very greatly affect the other; and that a very slight, nay, to us -imperceptible, change in the organization of either, may produce the -most grievous, and even incurable disorders throughout the whole body, -or in any particular organ. Let us now consider a little farther the -blood-vessels. - -22. It hath been a question, whether in the structure of these vessels -nature hath observed an exact proportion. For instance, if the blood -passes by a kind of starts through four cavities, as we are assured -that it does, it seems natural to suppose that these four should be -exactly equal. This, however, hath been denied; and some, from its -accommodating the human frame to their theory, have fancied that -they saw the use of such disproportionate work. Dr. Huxham expresses -himself in the following words: “Nor doth the air only refrigerate the -blood, but, by preventing its too great ebullition, and condensing -it, hinders it from bursting the vessels. This indeed is of exceeding -great importance, if, with the very learned _Helvetius_, we suppose -the capacity of the right ventricle of the heart to be greater than -that of the left, and that the pulmonary arteries are larger than the -correspondent veins; for it thence follows, that the blood ought to -be considerably condensed by the inspired air, that an equal quantity -of blood may be received, in one and the same time, by the pulmonary -veins and left ventricle of the heart, that is thrown off from the -right ventricle, and through the more capacious pulmonary arteries. -This indeed many deny, asserting quite the contrary. It is necessary, -however, that the aorta should receive as much blood from the left -ventricle of the heart, as is thrown off from the right ventricle -through the pulmonary artery; and that in the very same and equal -time, or a fatal deluge would soon overwhelm the lungs, because the -contraction of each ventricle is made at one and the same time; we -always find therefore the aorta and pulmonary artery, in a natural -state, equal on this account; also the capacity of the ventricles ought -to be equal, that they may receive, in one and the same space of time, -equal quantities of blood,” &c. - -If any thing farther is necessary upon this subject, we may still -observe, that if the blood were at all condensed by the air, it would -be so unequally, because the air is at some times much colder than at -others; and thus the disproportion of the cavities of the heart to -one another could not fail of producing the most disagreeable if not -fatal effects. We often see what terrible consequences ensue upon the -enlargement of any part of an artery near the heart; and these would, -sometimes at least, be felt by every individual.[50] - - [50] But there is a still more egregious blunder, and this the more - surprising as it has been very general among physiologists, viz. - that when an artery branches into two the capacity of the branches - taken together is greater than that of the trunk. This would make the - whole arterial system one continued _aneurism_,[51] and, instead of - promoting the circulation of the blood, would in the most effectual - manner prevent it. In what manner an error so extraordinary in its - nature could pass the mathematical physicians of the last century, - I cannot imagine; but certain it is, that, in the year 1780 or - 1781, the Edinburgh College were schooled on this subject by one of - their own students named _John Theodore Vander Kemp_, a Dutchman. - This gentleman found, by accurate mensuration, that when an artery - divides, if the diameters of the two branches are made the two - shorter sides of a right-angled triangle, the diameter of the trunk - will be the hypothenuse; and thus, as the areas of circles are to one - another in proportion to the squares of their diameters, the sum of - the areas of the two branches will be equal to the area of the trunk. - On looking into Blumenbach’s physiology, I find the same remark. - - [51] An aneurism is a preternatural enlargement of an artery. The - blood stagnates in that place, and at length eats through the flesh - and skin. - -It is true, indeed, that this objection will in some degree hold, even -though we suppose all the cavities of the heart to be equal, and the -capacities of the blood vessels to be perfectly uniform throughout the -whole body. For, if we suppose the blood to be at all condensed in the -lungs by the coldness of the atmosphere, it must undoubtedly follow, -that while passing from them it occupies less space than before it -arrives at them. Hence the pulmonary vein, the left auricle of the -heart, the left ventricle, the aorta, and all the rest of the arteries -for a considerable way, must be comparatively empty, even though -they receive as much fluid as fills the vena cava, right auricle and -ventricle of the heart, and pulmonary artery. The equality which ought -to prevail in the system, and which indeed cannot be dispensed with, -can only take place in those remoter branches of the arteries in which -the blood has reassumed its former state of dilation or rarefaction. - -23. If we consider this matter attentively, we shall find it not a -little mysterious. Every time we breathe out the air we have sucked -into our lungs, a considerable quantity of moist vapour is breathed -out along with it; but it has been proved by undeniable experiments -that the emission of aqueous vapour from any substance cools it in -proportion to the quantity of vapour emitted. Every breath we draw, -then, cools the lungs, and consequently the blood, to a certain degree, -and, as the number of times that we breathe in a day is exceedingly -great, the cold produced by the evaporation ought to be in proportion. -But we see that, notwithstanding all this cooling, whether we breathe -cold air or hot air, the temperature of the body remains still the -same. The air then, though constantly carrying off the heat of the -body, does not cool it in the least by its action on the lungs. The -only possible way of solving this apparent contradiction is, by -supposing that the air, when acting upon the blood in the lungs, leaves -precisely as much heat as it carries off, and therefore, though we -breathe ever so long, we cannot by this means become either hotter or -colder. - -24. To illustrate this subject, we might now enter into an inquiry -concerning the origin and cause of animal heat; but this will be -touched upon hereafter. We shall here only take notice that the heat of -the body is almost universally allowed to proceed from the lungs. It -has likewise been demonstrated, that the air does in fact contain an -incredible quantity of heat, even when it appears to us to be extremely -cold. A certain proportion of this heat is separated from it every time -we breathe; and if, either by the mixture of other fluids with the air -we breathe, or by any change in the organization of the body itself, -a greater or smaller proportion of heat should be communicated to the -blood, disease must ensue. - -25. To sum up then what has been said concerning the blood and nerves: -The whole mass of fluid passes from the right side of the heart to the -lungs. In the lungs it receives from the air something[52] necessary -to the functions of life and sensation, and purifies itself from -those matters which might prove pernicious. From the lungs it passes -to the left side of the heart, and thence through the whole body. In -its passage through the body, it is accompanied with nerves, which, -taking up from the arterial blood that _vital spirit_ received from -the air, convey it to all the organs of motion, of sensation, and to -the brain, where the whole powers of perception being united form our -_intellectual faculties_, and, as far as our senses can perceive, -the human spirit itself. The blood, thus deprived of its spirit, is -collected from all parts of the body by the veins, and returned to the -right side of the heart, from whence it is again sent to the lungs, -and the process carried on as before. This hypothesis concerning the -peculiar function of the nerves I first inserted in the Encyclopædia -Britannica, second edition, under the article BLOOD, in the year 1778. -It has been since continued in the third Scots edition, and from thence -into the Irish and American editions. - - [52] It seems now to be proved beyond a doubt that this - _something_ so long unknown is that fluid called by Dr. Priestley - _dephlogisticated air_, and by Lavoisier _oxygen_. - -26. It has already been observed, that the body is subjected to a -continual waste. One source of this waste is the breath, by which a -considerable part passes off in vapour. A great quantity also passes -off by the pores of the skin; frequently in a perceptible liquid called -_sweat_, but oftener in an invisible vapour from all parts of the body, -called _insensible perspiration_. The latter has been thought to be the -great source of waste to the human body; and it is certain, that if any -person in health be weighed when he rises in the morning, he will be -found considerably lighter than when he went to bed. The loss of weight -in this case proceeds not only from the pores of the skin, but from the -lungs; but though physicians have made a general allowance for both -these, I have not heard of any experiment by which we can determine -how much passes off by the one, and how much by the other, nor indeed -does it appear easy to make such an experiment. Galen plainly overlooks -the perspiration from the lungs entirely. “This excrementitious vapour -(says he) is expelled through small orifices, which the Greeks call -pores, dispersed all over the body, and especially over the skin, -partly by sweat, and partly by insensible perspiration, which escapes -the sight, and is known to few.” Sanctorius, and the succeeding -writers, have classed both together indiscriminately; allowing the -discharge to be so great, that if eight pounds of aliment be taken in, -five of them pass off in this manner. In a system of anatomy, published -at Edinburgh in 1791, the author says, that the discharge by the skin -“is even much larger than this (the discharge from the lungs we may -suppose) since it not only throws off a quantity of the aliment, but -likewise what is added to the blood by inhalation, which, entering -often in a very considerable quantity, is thus again expelled.” The -same author likewise says, that the “perspirable matter from the skin -is principally water,” and that it issues in such quantity as to be -seen in subterraneous caverns evidently flying off from the surface of -the body like a dense vapour. But other physiologists, particularly Dr. -Blumenbach, inform us, that the matter of insensible perspiration is -quite similar to the discharge from the lungs, particularly containing -a great quantity of fixed air. The same account is given in Chaptal’s -chemistry, on the authority of Messrs. Milly and Fouquet. This may -be looked upon as a valuable discovery, especially in conjunction -with that related by Drs. Beddoes and Girtanner, viz. that the flesh -of animals contains a quantity of oxygen. Dr. Girtanner obtained a -quantity of this air from the raw flesh of animals, and says that it -may be repeatedly obtained by exposing the flesh to the atmosphere, and -distilling with a heat of 60 or 70 degrees of Reaumur’s thermometer -(something below that of boiling water.) Hence it is natural to -conclude, that, as the discharge from the lungs purifies the blood -from its useless parts, so does the insensible discharge from the skin -purify the solid parts from those particles which are no longer useful. -The probability of this also becomes greater by considering, that in -diseases, when the quantity of matter to be thrown off is very great, -the skin becomes foul, the teeth furred with black sordes, &c. all -which disappear as soon as the quantity of the offensive particles is -reduced to its natural standard. As to any considerable quantity of -aqueous vapour being discharged this way, unless in case of sweat, it -does not seem probable; for in such a case our clothes would always -be moist; and in the night time the accumulation of moisture would -certainly be perceptible. The sweat is entirely of a different nature -from the insensible perspiration, and blood and even _sand_ has been -known to issue through the skin along with it. (_See the Anatomical -System above quoted._) - -27. This very considerable waste of the body is repaired by the aliment -taken into the stomach. In the mouth it is mixed with a considerable -quantity of the liquid called _saliva_, and in the stomach with another -called the _gastric juice_, with which that organ always abounds. From -the stomach it passes into the intestines, where it is mixed with other -two fluids; one called the _pancreatic juice_, the other the _bile_. -This last is of a yellow colour, and is sometimes produced in enormous -quantities, insomuch that Dr. Wade, in his account of the fevers in -Bengal, mentions some patients who have voided by stool half a gallon -of bilious matter in one day. - -28. In the stomach principally the aliment undergoes a certain change -called _digestion_, by which it becomes capable of being converted into -the substance of the body. Much has been inquired and disputed, to no -purpose, about the nature of this change, and how it is effected. One -party has declared for _attrition_; a second for _putrefaction_; a -third for _heat_; a fourth have supposed that our meat was digested by -_chewing_; as if, like the lobster, people had teeth in their stomach! -and, lastly, some learned moderns, after much pains and trouble, have -found out that it is digested by _solution_. Dr. Moore has summed up -the discoveries concerning digestion in the following words: “The -food, being previously divided and blended with the saliva and air by -mastication, (chewing) is swallowed, and meets in the stomach with -the gastric juice, whose dissolving power, assisted by the natural -heat of the place, is the principal agent in digestion. The process is -completed by the pancreatic juice and bile, the nutritious parts of the -food being by this process converted into chyle for the support of the -body, and the grosser parts thrown out.”[53] - - [53] Moore’s Medical Sketches. - -29. The inside of the stomach and intestines are full of the mouths of -innumerable small vessels, which continually suck up from the aliment, -as it passes downwards, the finer parts, in form of a white liquid, -called _chyle_; and from the whiteness of their colour the vessels have -the name of _lacteals_, from the Latin word _lac_, milk. After passing -through the substance of the stomach and intestines, and running along -the membrane called the _mesentery_, to which the intestines are -attached, the lacteals unite in a large reservoir called the _thoracic -duct_; and this again opens into a large vein on the left side, called -the _subclavian_, which conveys the blood from half the upper part of -the body; soon after terminating in the vena cava, by which the chyle -is conveyed to the heart, thence to the lungs, and so on in the common -course of circulation. The conversion of the chyle into blood is called -the process of _sanguification_. - -30. The blood, thus formed out of the aliment we swallow, is not one -uniform fluid like water, but composed of three distinct substances; -one, which gives it the red colour, and seems to be composed of little -round globules; another, quite colourless, but of a viscid nature, -and which very soon coagulates, called the _lymph_; and a third, of a -yellowish colour, and retaining its fluidity much longer, called the -_serum_. A remarkable property of this last fluid is, that air can act -through it upon the blood; for Dr. Priestly found that a portion of -black blood assumed a bright, florid colour from the air, even though -covered with serum an inch deep. When blood is drawn, the red globules -are detained by the lymph which coagulates, and both together form -the red mass called _crassamentum_; the serum remaining fluid, and -retaining its name. - -31. Besides these fluids, the blood either invisibly contains, or -is capable of being converted into, a great many others; for all -the fluids in the body are separated from it, and all of them, the -bile only excepted, from the arterial blood, before it has lost that -portion of its spirit which it imbibes from the air. When a fluid is -to be secreted, sometimes it is done only by an infinity of small -vessels branching off from the arteries, and depositing the liquids -which pass through them in particular places; and such are the fluids -which moisten the inside of the body, and which are carried off by the -breath, or by sweat. But this separation does not by any means hinder -the artery from terminating in its usual way in a vein, for in no case -is the whole substance of the blood converted into any other liquid; -all of them appear to be contained in it. But the greatest number of -fluids are separated by means of certain substances called _glands_. -These are small round or oval shaped bodies; each of them enclosed in -a membrane or skin which separates it from the other parts, and each -furnished with a small tube called the _excretory duct_, through which -the liquor separated in the gland passes to its place of destination. -Each gland has also an artery and nerve, and a vein to bring back the -blood after it has parted with the fluid intended to be separated. The -bile is separated in the liver from the blood of a large vein called -the _vena portarum_, formed by the union of some of the veins of the -intestines and mesentery. This vein branches out through the liver like -an artery, terminating in other veins, which at last bring back the -blood to the heart. - -32. As the human body is thus furnished with an apparatus for -separating and carrying off, it is also furnished with one for -absorbing or taking in. All the inward parts of the body are moist; -and the moisture is furnished by the small vessels above described, -and which separate part of the lymph from the blood. By such continual -separation the cavities of the belly, breast, brain, &c. would soon -be filled with liquid, were not some means provided for carrying it -off as fast as it is formed. The means in question are a set of small -vessels called _lymphatics_. These “arise from the internal surface of -the breast, belly, and every cavity of the body; they also overspread -the whole external surface of the body, and large lymphatic vessels -are usually found close to the large blood vessels of the extremities, -besides those small superficial ones which lie above the muscles in the -cellular membrane (the fat or rather the membrane containing it.) The -large viscera generally have two sets of lymphatics, one lying on the -surface of the viscus, and the other accompanying the blood vessels -belonging to it. The faculty of absorption, though refused to the -lymphatics, was ascribed by many anatomists to common veins, and this -opinion continued to prevail in some degree, until Hunter and Monro -totally overturned it, exploding at the same time the notion that any -of the lymphatics are continuations of arteries, and establishing, -beyond a doubt, that all are absorbent vessels.”[54] All the lymphatics -terminate in the thoracic duct; so that the liquid separated by the -_exhalant arteries_ (so the vessels are termed by which that fluid is -separated) is again mixed with the blood, and again performs the same -offices. - - [54] Moore’s Medical Sketches. - -We have now taken a review of the several parts of the human body, -slight and superficial indeed, but such as the limits of this work -would allow, and sufficient to furnish to those entirely unacquainted -with medical matters some general ideas on the subject. We have seen -that the body, in general, consists principally of four great parts, -the blood-vessels, the lymphatic vessels, the nerves, and the muscles. -Besides these we enumerate the glands and membranes; the former being -nearly allied to the blood-vessels, the latter _apparently_ to the -nerves. The bones, having no concern with our present inquiry, are not -taken notice of. The stomach and intestines, being principally composed -of muscular fibres, nerves, and blood-vessels, must be considered -as belonging to these departments. Each of these large divisions -has obtained the name of _system_; and even the subdivision of the -blood-vessels into arteries and veins. Thus the arteries of the body, -taken collectively, are called the _arterial system_; the veins the -_venous system_; the brain and nerves the _nervous system_; the muscles -the _muscular system_; the lymphatics the _lymphatic system_; and the -glands the _glandular system_; &c. These appellations have been given -for the sake of distinctness and perspicuity, but they have had a bad -tendency. Insignificant disputes have arisen concerning the superiority -of one system to the other, and which is to be accounted the _primum -mobile_ of the body. By observing also the _general_ structure of the -body in a more full and ample manner than that of the parts which -compose it, physicians have been apt to generalize too much in their -theories, and to fancy that from a few obvious laws they might be able -to explain the phenomena of disease in almost every possible variety. -To illustrate this, let us take the blood for an example. This to sight -appears an homogeneous fluid; and Boerhaave and others have ascribed -diseases to some defect or bad quality of the blood. But this fluid -consists of three parts, each, as far as we can perceive, essentially -distinct from the other; viz. the lymph, serum, and red globules. -As each of these happens to be diseased, the cure must be different; -or if two happen to be diseased, the medicines must still be varied. -But, besides these general diseases arising from what, like the blood, -is common to the whole body, each component part of the body has an -arterial system, a venous system, a nervous and lymphatic system, &c. -belonging to itself; all of which, though dependent on the body at -large, have yet laws of their own, in consequence of which any one of -them may be considerably diseased without much affecting the general -system; and this constitutes what is called _local_ disease. Again: -The parts of the body are so connected with one another, that the -disease of one may show itself in another; or it may affect the whole -body in such a manner as to produce a general disease; though Dr. -Rush considers this last, at least from injuries of the viscera, as a -rare occurrence;[55] but we certainly know that general diseases are -very often followed by evident diseases of particular organs; and in -these cases it is impossible to say whether the general disease did -not begin, though imperceptible to us, in that very organ in which -we suppose it to terminate when the local disease was come to such -an height as to be evident to our senses. In some cases it is plain -that local injuries will bring on most violent diseases of the whole -system. Thus a local inflammation of the end of one of the fingers, -by physicians called a _paronychia_, has been known to induce a most -violent fever, nay, even to occasion death. These violent symptoms -end as soon as the suppuration is completed; so that, were it not for -the excessive pain of the inflammation, we might be apt to suppose -that the fever terminated in the suppuration, whereas it evidently -was occasioned by the local disease, or the tendency of the part to -suppurate; the pain and inflammation being necessary preliminaries. -Again: When an intermittent fever is said to terminate, or to be -followed, by a hardness of the liver, we do not certainly know whether -an original disease of the liver might not have been the cause of -the intermittent. From a consideration of all these things, viz. the -extreme diversity of parts which compose the human body, the ultimate -invisibility of the structure of each, the incomprehensible manner -in which they are united, the equally incomprehensible dependence -they have upon one another in some cases, and independence in others, -the numerous laws by which they are governed, and which must be very -much unknown to us, the invisible and incomprehensible nature of the -powers which act upon them, &c. &c. I say, when we consider all these -things, the boldest theorist must be humbled when he attempts to -account for the phenomena of disease in any one instance. The excessive -difficulty in which we are involved is beautifully described by Dr. -Ferriar when speaking of hysterics; and obstacles equally insuperable -by our theories will undoubtedly be met with in any other distemper. -“We are ignorant (says he) by what laws the body possesses a power of -representing the most hazardous disorders, without incurring danger; -of counterfeiting the greatest derangement in the circulating system, -without materially altering its movements; of producing madness, -conscious of its extravagances; and of increasing the acuteness of -sensation by oppressing the common sensorium. In hysterical affections -all these appearances are excited, which are incompatible with the -reasonings of every system-maker who has yet endeavoured to explain the -inexplicable. Nature, as if in ridicule of the attempts to unmask her, -has, in this class of diseases, reconciled contradictions, and realized -improbabilities, with a mysterious versatility, which inspires the true -philosopher with diffidence, and reduces the systematic to despair.” - - [55] Medical Inquiries and Observations, vol. iv, p. 133. - -Notwithstanding all these difficulties, however, physicians have -theorised, and that with such animosity, as if all the arcana of nature -had been laid open to every professor who thought proper to invent or -new-model a system; though the constant succession of theories might -certainly have shown them the vanity of such attempts. Some of these we -must now consider. - -Medical theorists have exerted their greatest abilities in explaining -the nature of those general diseases affecting the whole body, -denominated _fevers_; and which are likewise called _acute_ diseases, -from the violence with which they sometimes attack, and the rapidity -with which they run through their course. Dr. Fordyce says, that -fever will sometimes kill in _five minutes_ from the first sensation -of uneasiness. Ancient physicians have described a number of fevers, -which they supposed to be of different species, and accordingly have -distinguished by different names. Modern system-makers have added -to the number; so that a bare detail of the names which they have -given to their divisions and subdivisions, would constitute a very -formidable catalogue; but the latest practitioners are decidedly of -opinion that there is but one kind of fever, varying itself according -to circumstances. Dr. Rush declares himself of this opinion in -the most express and positive terms. “There is (says he) but one -fever. However different the predisposing, remote or exciting causes -may be, ... still, I repeat, there can be but one fever.... Thus -fire is an unit, whether it be produced by friction, percussion, -electricity, fermentation, or by a piece of wood or coal in a state of -inflammation.”[56] - - [56] Vol. iv, p. 133. - -“I have said that there is but one fever. Of course I do not admit -of its artificial division into genera and species; a disease which -so frequently changes its form and place, should never have been -designated, like plants and animals, by unchangeable characters.... -Much mischief has been done by nosological arrangements of diseases. -They erect imaginary boundaries between things which are of an -homogeneous nature.... They gratify indolence in a physician, by fixing -his attention upon the name of a disease, and thereby leading him to -neglect the varying state of the system, &c.”[57] - - [57] Ibid. p. 149. - -So much then having been said and written upon the disease in question, -one might be apt to suppose that the nature of fever would have -been thoroughly investigated, and its causes explained in the most -satisfactory manner, long before this time. Instead of this, however, -we find it still like a word which every body uses, and nobody -understands. Dr. Fordyce, who has lately written a treatise on the -subject, endeavours to prove that there is not any single symptom from -the existence of which we can certainly determine the presence of this -disease. “Fever (says he) has obtained its name in Greek, Latin, Arabic -and Persian, principally from the idea of heat: _pur_, in Greek fire; -_febris_ in Latin, from _fervere_, to burn,” &c. This idea, he goes -on to demonstrate, is erroneous; as the body of a feverish patient -frequently sinks the thermometer below the natural standard; while the -patient sometimes finds himself cold when the thermometer shows him -to be really hot, and hot while the same instrument shows him to be -cold. Neither is cold, followed by heat, a certain indication of the -presence of fever, as many fevers begin without any previous sensation -of cold. Frequency of the pulse also is no certain sign; and having -discussed this last symptom he concludes thus. “If we examine the -restlessness, anxiety, state of the tongue, head-ach, or any other of -the symptoms which often take place in fever, we shall find that they -also may be present when there is no fever, and absent in a patient -afflicted with this disease; and therefore we cannot allow that there -is any pathognomic symptom of fever.”[58] Dr. Rush declines giving -any definition of fever;[59] but, with all due deference to these two -very experienced physicians, we must account such extreme scepticism -altogether erroneous. If fever cannot be defined, it cannot be -described; for a _definition_ is no other than a short _description_. -If again there be no single symptom by which the presence of fever -can be known, it is impossible that there can be any _combination_ -by which it can be known, any more than we can form an unit by any -combination of cyphers. In fact Dr. Fordyce himself is at last obliged -to acknowledge that there is a certain symptom with which fever -_generally_ begins; and, by his insisting upon it in various parts of -the work, we must certainly be induced to suppose that it was by this -sign principally that he determined whether his patients had a fever -or not. “The first appearance (says he) which generally takes place is -uneasiness and restlessness; a general uneasiness, the patient feeling -himself ill, but incapable of fixing on any particular part of the -body. This uneasiness affects the mind at the same time. Perhaps in -this case it is the mind that is first affected.... Along with this -uneasiness there is a restlessness, the patient wishing to change his -place or posture frequently; the mind cannot likewise rest upon one -object; it often wanders from one to another subject. At the same time -there is a feel of weariness which resists the disposition in the -patient to change his place and posture, and resists the disposition -of the mind to alter the object of its attention, rendering the wish -for such changes ineffectual. With these arises an actual inability of -exerting the muscular powers, or performing any of the functions of the -body; and also an actual inability of exercising the great faculties of -the mind, the powers of perception, memory, arrangement of ideas, and -of the judgment, in the same degree that they existed in health. The -degree in which these take place is extremely different in the attacks -of different fevers; but these appearances are _very rarely_ absent, -although indeed they may also happen in other diseases.” - - [58] A _Pathognomic_ symptom is one which being present _certainly_ - indicates the presence of a disease, and being absent, the contrary. - - [59] Vol. iv, p. 123. - -Dr. Rush accounts the lassitude with which fever begins, one of the -transient phenomena of it; and this with other phenomena he calls -_symptoms_. Such as are more permanent and fixed, and which by other -writers have been reckoned different species, he calls _states_; and of -these he enumerates forty. Such as have any relation to the plague are -as follow. - -I. The MALIGNANT state, known by attacking frequently without a -chilly fit, is attended with coma, a depressed, slow or intermitting -pulse, and sometimes by a natural temperature or coldness of the -skin.... This depressed state of fever more frequently when left -to itself terminates in petechiæ, buboes, carbuncles, abscesses and -mortifications, according as the serum, lymph, or red blood, is effused -in the viscera or external parts of the body. - -2. The SYNOCHA, or common inflammatory state; attacking suddenly with -chills, succeeded by a quick, frequent and tense pulse, great heat, -thirst, and pains in the bones, joints, breast or sides. - -3. The BILIOUS state of fever; known by a full, quick and tense pulse, -or by a quick, full and round pulse without tension, and by a discharge -of green, dark coloured or black bile from the stomach and bowels. This -state sometimes assumes the form of an hectic; the patient feels no -pain in his head, has a tolerable appetite, and is even able to sit up -and do business. - -4. The TYPHUS state; known by a weak and frequent pulse, a disposition -to sleep, a torpor of the alimentary canal, tremors of the hands, a -dry tongue, and, in some instances, a diarrhœa. Sometimes it assumes -symptoms of synocha on the eleventh, fourteenth, and even twentieth -days. The common name of this state is the _nervous_ fever. - -5. Intermissions, or the INTERMITTING and REMITTING states, occur -most distinctly and universally in those which partake of the bilious -diathesis. - -6. The SWEATING state occurs not only in the plague, but in the yellow -fever, small pox, pleurisy, rheumatism, hectic and intermitting states. - -7. The FAINTING state; occurring in the plague, yellow fever, small -pox, and some states of pleurisy. - -8. The BURNING state. This is attended not only with an intolerable -sensation of heat in the bowels, but with a burning sensation excited -in those who touch the patient’s skin. It occurs mostly in the -remitting fevers of Asia. - -9. The CHILLY state differs from a common chilly fit by continuing four -or five days, and to such a degree that the patient frequently cannot -bear his arms out of bed. The coldness is most obstinate in the hands -and feet. A coolness only of the skin attends in some cases, which is -frequently mistaken for an absence of fever. - -10. The INTESTINAL state; including the cholera morbus, diarrhœa, and -cholic. - -11, 12, 13, 14, 15. The APOPLECTIC, PHRENETIC, PARALYTIC, LETHARGIC and -VERTIGINOUS states. - -16. The ERUPTIVE state; including the small pox, measles, and other -exanthemata of Dr. Cullen. - -17. The HÆMORRHAGIC state; known by fluxes of blood from various parts -of the body. - -18. The CONVULSIVE or SPASMODIC state. Convulsions are frequently -attendant on the malignant state of fever. - -19. The CUTANEOUS state; attended with various eruptions on the skin, -particularly _petechiæ_. - -These include the most remarkable varieties described by physicians -as different species. From the subsequent account of the symptoms of -the plague, it will appear that this single distemper monopolises, -as it were, the symptoms, at least the most dangerous and terrible, -belonging to them all. Those nosologists therefore who suppose the -states of fever above described to be different species, instead of -saying that the plague belongs to one kind of fever, ought to say -that it is a complication of a great many different kinds. But here a -question arises: Do all the varieties of fever just now described, or -do all the other fevers described by different authors, include all the -different modes by which the plague makes its attack? If so, then we -know that the plague really partakes of the nature of fever, or may be -accounted the highest degree of it. This is the opinion of Dr. Rush; -for in his 4th vol. p. 153, he considers the different inflammatory -states of fever, according to their strength, in the following order. -1. The plague. 2. The yellow fever. 3. The natural small pox. 4. The -malignant sore throat, &c. To this I can have but one objection, -and to me it appears insuperable; viz. that the plague frequently -destroys without any symptom of fever; and, if so, we must certainly -account it a distemper of another kind. To decide this matter, let -us compare the symptoms of the most violent fever with what happens -in times of violent pestilence. We can scarce imagine a fever more -powerful than that which destroys in five minutes, and the following -is the description of it from Dr. Fordyce. “When the first attack of -fever has been fatal, it has been classed among sudden deaths, and -all of these have been very erroneously called apoplexy, or syncopy -(_fainting_.).... When the attack is fatal, it sometimes kills in five -minutes, sometimes it requires half an hour, seldom longer than that -time. While the patient is yet sensible, violent head-ach with a great -sense of a chilliness takes place, the extremities become very cold, -and perfectly insensible; there is great prostration of strength, -so that the patient is incapable of supporting himself in an erect -posture; he becomes pale, his skin is of a dirty brown, and he is soon -insensible to external objects; the eyes are half-open, and the cornea -somewhat contracted. If the patient goes off very soon, the pulse is -diminished, and at last lost, without any frequency taking place, but -if it be longer before he dies, the pulse becomes excessively small -and frequent; all the appearances of life gradually subside, and -the patient is carried off. Of this the author has seen instances, -sometimes at the first attack, oftener in the returns of the disease, -although very few.” - -This no doubt is very terrible, and no plague whatever can exceed it. -Indeed, when _death_ is the termination, it signifies little what the -_disease_ is called. But the question is not whether fever or plague is -the most dreadful, but whether they are the same. Now, from the above -description, it is plain that fever never kills without some warning. -In the present instance, head-ach and chilliness give a certain, though -short, warning of the ensuing catastrophe; but, in violent plagues, Dr. -Sydenham informs us, that people have been suddenly destroyed as if by -lightning. Dr. Guthrie assures us that in the last plague at Moscow -he has seen soldiers drop down suddenly as if they had been struck -by lightning, or by a musket ball; yet some of these recovered by -bleeding and proper management; but it is certainly not unreasonable -to suppose that many, who were not thus taken care of, perished. Dr. -Hodges speaks of the contagion of the plague in the most energetic -terms. He says, “it is so rare, subtile, volatile and fine, that it -insinuates into, and resides in, the very pores and interstices of -the aerial particles. It is said to be of a poisonous nature also, -from its similitude to the nature of a poison, so that they seem to -differ in degree only; for the deadly quality of a pestilence vastly -exceeds either the arsenical minerals, the most poisonous animals or -insects, or the killing vegetables; nay, the pestilence seems to be -a composition of all the other poisons together, as well as in its -fatal efficacies to excel them.... The contagion of the plague is -more active than lightning, and in the twinkling of an eye carries to -a distance putrefaction, mortification and death. As for the manner -whereby it kills, its approaches are generally so secret, that persons -seized with it seem to be fallen into an ambuscade or a snare, of which -there seems to be no suspicion.... In the plague of 1665, as in many -others, people frequently died without any symptoms of horror, thirst, -or concomitant fever. A woman, who was the only one left alive of a -family, and in her own opinion in perfect health, perceived upon her -breast the pestilential spots, which she looked upon to be the fatal -_tokens_; and in a very short space died, without feeling any other -disorder, or forerunner of death.... A youth of a good constitution, -after he had found himself suddenly marked with the tokens, believed at -first that they were not the genuine marks, because he found himself -so well; yet he was dead in less than four hours, as his physician had -prognosticated. A fever, however, did for the most part show itself, -and was always of the worst kind. Sometimes it seemed to resemble a -quoridian, sometimes a tertian; there never was a total cessation, but -every exacerbation was worse than before.” In like manner the author -of the Journal of the Plague Year informs us that many, supposing -themselves, and supposed by others, to be in good health, would -suddenly find themselves seized with great sickness, crawl to a bench, -and instantly expire. “Many (says Dr. Hodges) in the middle of their -employ, with their friends and other engagements, would suddenly fall -into profound, and often deadly sleeps.” - -It is needless to multiply examples: the above are sufficient to -show that the plague, when in its most violent state, kills suddenly -and imperceptibly, and that like the bite of a vampire,[60] without -producing any sensible disorder. In a state somewhat inferior, it -excites the most malignant fevers; in one still inferior it produces -fevers of a milder nature, and so on until we find it so mild, that -those infected with it are not even confined to their bed. In all -this inquiry, however, we find the secrecy and invisibility of the -pestilence, so often mentioned in scripture, still confirmed. Other -distempers may “waste openly at noon-day,” but this always “walks in -darkness.” - - [60] The vampire is a kind of bat, of a very large size, met with - in some parts of South America and in the East Indies. This vile - creature delights in human blood, and often attacks people in the - night time in the most insidious manner. A late traveller relates - that at Surinam he was bit by one of them, which sucked so much of - his blood that in the morning he found himself exceedingly weak and - faint. He felt no pain, nor was sensible of the injury in any other - way. The vampire commonly attacks the great toe, making a wound - so exceedingly small that the person is not awaked by it; it then - sucks till gorged with blood, and, lest the patient should awake, it - keeps fanning him all the while with its large wings, the coolness - of which, in that hot climate, promotes sleep. In this manner some - are said to have been destroyed. Captain Cook relates an humourous - anecdote of one of his sailors, who being ashore at New Holland, and - having wandered a little way into the woods, returned in a fright, - crying out that he had seen _the devil_! Being asked in what shape - Satan had appeared, he answered, “He was about the size of a _one - gallon keg_, and very like it; and if I had not been _afear’d_, I - might have touched him.” It was a vampire. The man, notwithstanding - his fright, had not exaggerated its magnitude. People, though - mistaken and terrified, are not to be disbelieved in every part of - their relation. - -In one of the inferior stages of this distemper the body is affected -with those eruptions named buboes and carbuncles. Dr. Patrick Russel, -in his treatise on the plague at Aleppo, divides the symptoms of the -distemper into six classes. In the first there were no eruptions, -and all the patients of this class died. In the second, and all the -rest, there were buboes and carbuncles. But, in the latter of these -especially, it is worthy of remark, that they appear neither as -a suppuration, nor as a common mortification, but like the eschar -formed by a caustic, which can scarcely be cut by a knife. This -appearance is not to be met with in any other disease. In many there -are mortifications of various parts of the body, but all these are -soft, and seemingly corruptions of the flesh. When a person dies of any -ordinary distemper, the flesh soon corrupts and dissolves, but there -is no example of its turning to a hard eschar like that made by a hot -iron, or the caustic with which issues are made. This shews not merely -a cessation of life, but the operation of some very active power in the -body, like fire, tending to destroy the texture of it entirely, and to -reduce it to a cinder. This power seems also to operate internally in -the fleshy parts; for when the bodies of those were opened who died -with the _tokens_, as they are called by Dr. Hodges, upon them, the -mortification was always found much larger inwardly than it appeared -to be on the outside. The tokens themselves are by Dr. Hodges called -“minute distinct _biasts_, which had their origin from within, and -rose up in little pyramidal protuberances, sometimes as small as pins’ -heads, at others as large as a silver penny; having the pestilential -poison chiefly collected at their bases,” &c. - -That the plague was by the ancients reckoned a disease of a nature -different from all others, appears from Galen, as quoted by Deusingius. -“What is called the _pestilence_ is most properly remarked by Galen -not to be a _genus_ of any known disease. For whatever diseases and -symptoms are associated with the plague, truly and properly so called, -the same are wont to be called _pestilential_ diseases; of which indeed -there are an innumerable multitude, and these not always nor every -where the same.”[61] - - [61] Non esse certi morbi genus, id quod _pestilens_ vocatur, - rectissime notatum a Galeno est (3 Epid. comm. 3. t. 20.) quicunque - enim morbi ac symptomata consociantur pesti veræ proprieque diclæ, - ijdem _morbi pestilentes_ apellari consuevere, quorum equidem - innumerabilis existit cohors, ac non semper et ubivis eadem. - (_Deusing. de Peste_, _Sect._ iii.) - -In like manner Diemerbroeck, as quoted by Allen, gives his opinion, -that “The plague is something different from a fever, and a fever is -only a symptom of it, as I have _very often_ observed; and therefore -some very ill define the plague by a fever, since a fever does not -essentially belong to it.... A pestilential fever, the _companion -of the plague_, is not occasioned by a pestilential venom, but by -the mediation of putrefaction; that is, it is not produced because -the humours are infected with the pestilent venom, but because the -heart, being irritated, overwhelmed and much weakened by the pestilent -venom, can neither duly digest and rarefy, nor govern and sufficiently -discharge the infected humours; which for this reason putrefy and -acquire a preternatural heat, and so excite a fever; which by reason -of the foresaid secondary cause, is different and distinct from the -plague, and a symptom of it. This is confirmed both by the maxims and -authority of the ancients and moderns, as well as by practice, and -evident examples.” - -Thus it appears, both by fair reasoning by induction from facts, and -from the authority of the greatest physicians, that the plague is -certainly a disease by itself, and entirely distinct from all others. -Hence it follows, that, though we could investigate the causes of -fever in their utmost extent, we might still be ignorant of the true -plague. That nothing, however, may be omitted, let us now consider what -physicians have advanced on this subject, and what progress they have -made in ascertaining the sources from whence so many direful calamities -are derived. - -In an inquiry of this kind, or indeed concerning any cause whatever, -it is plain that the nature of the effect must be first understood. -Fever then being an _effect_, we must begin with investigating its -_nature_. But fever itself is only manifest by certain changes in the -human body. Before we can investigate the nature of fever, therefore, -we must investigate the human body, and that in a manner very different -from what we did before. We must now consider the sources of life; in -what manner the vital principle acts upon the body, and by what means -its motions can be disturbed, or how they may be rectified when once -disordered, &c. &c. - -The systems of medicine before the time of Boerhaave are now so -generally exploded, that it is needless to take any notice of them; -and the reputation of Boerhaave himself in this way seems to be almost -expiring. His doctrines, nevertheless, merit some attention, because -he takes into account a principle overlooked by succeeding theorists, -viz. the _cohesion_ of the parts of the body. That he did so is -evident, from his having written upon the diseases of a _weak and -lax_ fibre, and the diseases of a _strong and rigid_ fibre. In other -respects he followed in a great measure the mechanical physicians of -the former century. He therefore took but little notice of the nervous -system, as being less subject, or indeed to appearance not at all -subject, to the known laws of mechanics. The blood was more manageable. -The microscopical discoveries of Lewenhoeck furnished an excellent -foundation for his system. This celebrated observer had discovered, or -fancied he had discovered, that the red part of the blood is composed -of globules. Inaccurate indeed these globules must have been, since -each of them was composed of six; four touching one another in the -middle, with one above, and one below, thus [Inline illustration]. -The serum was said to be composed of single globules, and by this -attenuation it was supposed that the fluid, instead of red, appeared -of a _yellow_ colour. Still, however, this was insufficient. Each of -the yellow globules was _discovered_ (either by fancied observations -or by conjecture, it matters not which) to be composed of six others, -which, singly taken, might constitute the lymph or some other fluid; -and thus, like the number of the Beast, we might go on by sixes to the -end of the chapter, and solve all the phenomena of nature. In justice -to the microscopists, however, it must be observed, that some of -them have given a much less fanciful account of the structure of the -blood than Lewenhoeck. Mr. Hewson found it composed of vesicles, or -small bladder-like substances, with a black spot in the middle. These -vesicles dissolved in pure water, but kept their original form, which -he says was as flat as a shilling, when a small portion of neutral salt -was added to the fluid. The solid particles he supposed to be produced -by the lymphatic system; the black particles by the spleen. - -The supposed observations of Lewenhoeck were of considerable use to -Boerhaave in the forming of his system of medicine, though they seem -not to have accorded very well with his doctrine of lentor or viscidity -in the blood. But, let this be as it will, having laid it down as the -foundation of his theory, that the diseases of the body proceeded from -too great a laxity of the fibres, or from too great a rigidity of them, -and a great many from this _lentor_, his practice was accordingly -directed to such medicines as he imagined would remove these supposed -causes of disease. As the lentor of the blood was one of his favourite -suppositions, he was therefore perpetually at war with this imaginary -enemy, and dealt very much in saponaceous medicines with a view to -break it down. But here it is evident that this great man was mistaken, -even though we should allow the existence of lentor as much as he -pleased. The viscidity, _lentor_, or any other state of the blood, is -an _effect_ of something. It is part of that state into which the body -is brought by the disease. The efforts of the physician therefore ought -to be against that which produces the lentor; for, unless this be done, -the cause of the disease must perpetually counteract the medicines by -producing new lentor as fast as they destroy it; and besides, must have -greatly the advantage of the physician, by being already in possession -of the whole mass of blood, while the medicines can only enter it very -gradually, and that by the stomach and lacteals, instead of being -instantly mixed with it, and exerting their power immediately upon the -fluid itself. - -But besides this mistake, which is common to other systems, Boerhaave’s -lentor has been denied, and that upon such strong grounds that it is -now universally exploded. Another system quickly succeeded, in which -every thing was managed by the nerves. This was introduced by Hoffman, -adopted, and perhaps improved, by Dr. Cullen, under whose auspices -it acquired such a degree of celebrity, that for a long time it was -dangerous to write or speak against it; and the person who had the -audacity to do so underwent a kind of medical proscription from the -Edinburgh College and all its students. According to this celebrated -theorist, the brain is that part of the body first formed in the -embryo; it may be seen with nerves proceeding; from it long before the -heart or any blood-vessel belonging to it is visible. Hence we are to -conclude that this part is necessary to the existence of every other -part of the body, though it doth not appear that they are essentially -necessary to its existence. The superiority of the nerves to all other -parts being thus established, the Doctor undertook to prove that -all other parts of the body were formed from them; that the body is -nourished immediately from them, and in short that the whole body is -in such subjection to the nervous system, that, except for the mere -purpose of distending the vessels, we can scarcely know for what end -the blood exists; since the nerves can alter its consistence, or that -of any of the fluids secreted from it, by a mere affection of that -system, without any thing either added to or taken from the vital fluid. - -Thus we were compelled to believe that all diseases at their first -origin are affections of the nervous system, from whence they are -propagated through the whole body. The Cullenian practice in acute -diseases, of which the plague is the most violent, was built upon a -maxim of Hoffman: “Atonia gigoit spasmos:” _Atony produces spasms_. In -explaining the nature of typhus fever, therefore, with which he classes -the plague, the Doctor supposed that the contagion acted first upon -the nervous system, by producing therein a debility. The immediate -effect of this debility is a _spasm_, or preternatural contraction of -the capillary vessels, or extremely small arteries. Hence the blood -finds some difficulty in circulating, and the patient is seized with -shivering, and has a sense of cold. When this has continued for some -time the system begins to _re-act_ against its enemy; the spasm is -resolved, and, the reaction of the system continuing, the action of the -heart and arteries is augmented, and the body becomes warmer. - -Thus the coldness, shivering, and consequent heat, which constitute -the first attack of fever, are very plausibly explained; but in the -mode of cure this learned physician fell into the same mistake with Dr. -Boerhaave; for though spasm is undoubtedly, even according to himself, -an _effect_, he directs his medicines entirely against it, as if it -were a _cause_. Thus, forgetting what he had just before advanced, -that the spasm is occasioned by debility, he recommended the most -debilitating medicines and regimen to cure people already too much -debilitated; and to such practice his enemies alledged that many fell -victims. The theory and practice, however, still kept its ground; and -as great numbers of students were every year bred up in the belief of -it at Edinburgh College, who carried the principles of their teacher to -all parts of the world, it bade fair for becoming universal. But, in -the midst of this eclat, the whole system received such a rude shock -from the doctrines of _John Brown_, though at that time not even M. D. -as it hath not yet recovered. - -Though the author of the new system contended, as much as Dr. Cullen, -for the supremacy of the nerves, he did not upon that foundation -attempt to establish his practice. He considered the living body as one -machine, the _whole_ of which might be acted upon, and always was acted -upon by certain powers. It possesses a certain inexplicable property -called _excitability_, capable of being augmented or diminished. Every -power which augments the _excitability_ he called a _stimulus_; the -opposite would have been a _sedative_; but according to this system -there is not any sedative, nor can there be one in nature. The reason -is, that excitability itself has no existence but in consequence of -the action of certain powers called _stimulants_. The total subduction -of these reduces the excitability to nothing; of consequence no power -can act against it in a state of non-existence. What other physicians -call _sedatives_, therefore, according to the new system, are only weak -_stimulants_. The fallacy of such reasoning is obvious; but as it does -not affect the practice, we shall not spend any time in considering it -further. - -On the principles just now laid down, the Brunonian system divides all -diseases to which the human body is liable into two great classes; -the one produced by too much excitement, the other by too little. The -former contains those diseases by other physicians called inflammatory; -the latter such as are called nervous, putrid, or all in which the -powers of life are too weak, and require to be supported. This last -is supposed to be much more numerous than the former; and in the cure -of these it was that the founder of the system appeared to greatest -advantage. A most violent altercation took place between Dr. Brown and -the Edinburgh College; yet, notwithstanding all the influence of the -professors, and their unanimous opposition to the new doctrines, they -found themselves ultimately unable to resist a single man unsupported -either by wealth or reputation. The plausibility of his system, and -its being obvious to every capacity, overcame every obstacle; so that -even the practice of the Cullenians themselves underwent considerable -alterations. It is not, however, to be denied that the system hath -been considerably improved, or at least altered, by some of Dr. -Brown’s pupils, who have had the advantage of extensive practice, -and of visiting many different countries; which the Doctor himself -never had. His materia medica was besides exceedingly confined; the -only medicines he had any great opinion of, being laudanum and ardent -spirits. The Peruvian bark he held in very little estimation, as being -a weak stimulus. He seems to have been unacquainted with the virtues -of mercury, except in the venereal disease, and most probably would -have given laudanum in those cases of fever where mercury is found by -others to be so efficacious. But this deficiency hath been abundantly -supplied by some of his followers. In a work entitled “The Science -of Life,” published by Dr. Yates and Mr. McLean, practitioners in -the East Indies, we find mercury exhibited in prodigious doses. As a -specimen we shall select their third case, which was a dysentery. On -the first of September the patient took two grains of calomel and as -much opium every two hours. This was continued for two days. On the -third, the dose was given every hour; besides which, he had half an -ounce of mercurial ointment with a drachm of calomel rubbed into his -body. Next day the pills were continued, and the quantity of ointment -tripled by thrice rubbing in. This was continued for three days, at -which time, an eruption on the skin appearing, it was feared he could -not be salivated; this eruption being a sign that no salivation could -be produced. The same mode of treatment, however, was persisted in. -September 7th the calomel in the pills was augmented to four grains; -the warm bath was used, and the ointment continued; but at night twenty -grains of calomel and six of opium were given every two hours. At the -same time two ounces of ointment, with four of calomel, were ordered -to be rubbed in. Next day, though his pulse was almost imperceptible, -and his extremities cold, “the medicines were continued as far as -circumstances would admit;” with what view it is not said, nor indeed -is it easy to be discovered. At one in the morning, however, the -patient died; an event not at all surprising. Our authors excuse -themselves for this failure by saying that the viscera of the patient -were diseased, as was evinced by the impossibility of exciting a -salivation; and “that when a patient is evidently incurable by the -common practice, it becomes the duty of the practitioner to depart from -it.” - -No doubt we may readily assent to both these assertions; but though -a patient be evidently incurable by the common practice, or by any -other, there is no necessity for killing him, or for persevering in -a course of violent medicines that evidently make him worse. The -whole of this case indeed strongly militates against the doctrine of -excitement; for if mercury be such a powerful stimulus to the powers -of life in general, how comes it to pass that in the present case the -unhappy patient, instead of being in the smallest degree excited, was -prodigiously debilitated, and that from the very first time of taking -the medicines. This will appear from the following table, exhibiting -the symptoms of the disease as they kept pace with the medicines taken. - -DAYS OF THE MEDICINES TAKEN. SYMPTOMS. -MONTH. - -_August 29 Ordinary doses of Pain of bowels, -& preceding._ mercury and opium. and frequent stools, - growing worse. - -_Sept. 1 & 2._ Opium and mercury, Still increasing. - two grains - each, every two - hours; besides opiate - draughts. - -3d The opium and Stools very frequent, - mercury as before, with violent - but now given every pain in the bowels; - hour; half an extreme thirst, - ounce of mercurial tongue furred, and - ointment, with 60 no sleep. - grains calomel. - -4th Pills as usual. Vomiting during - Ointmt. thrice rubbed the night. Tongue - in, once with brown and furred. - 120 grains of mercury. - -5th Medicines as before. Violent pain in bowels. - -6th Medicines as before. Extreme pain on - pressing the arch - of the colon; frequent - stools, profuse - sweats, great dejection - of spirits. - - -7th Pills as before, As yesterday. An - with four grains of eruption on the skin. - calomel. Mercury At night incessant - in the ointment increased stools, with violent - to half an pain in the belly; - ounce. Warm bath. profuse sweat. - At night an ounce - of mercurial ointment, - with two ounces - calomel. - -8th Pills, ointment & Incessant stools - calomel as before. with violent pain; - Warm bath thrice. at night with blood. - At night two ounces Extreme debility. - ointment, with four - of calomel. - -9th Medicines of the Stools innumerable; - same kind, as many extremities - as could be taken. cold, pulse scarce to - be felt. - -10th Death at one in - the morning. - -From a consideration of this patient’s symptoms, in comparison with the -quantity of mercury taken, it most evidently appears, that it acted -in no other way than as an irritating poison; affecting, with extreme -violence, the already diseased intestines, and, instead of exciting -the vital powers of the whole system, manifestly destroying them. Let -it not be imagined, however, that this case is selected from the rest -merely because it was fatal, or because it affords an opportunity of -finding fault with the practice recommended in the book. It is the only -one in which the mercury had a fair trial; and even here it was not -very fair, as being conjoined with a great quantity of opium. In the -other cases, which terminated favourably, the mercury was overpowered -by such horrible doses of opium, that we cannot tell which medicine -had the greatest share in the cure; besides, that in other cases the -patients were allowed the free use of wine, which we all know to be a -powerful stimulant and cordial; but it is not said that the poor man, -whose case is above related, had a single drop of wine, or any thing -else, except opium, to support him against the action of such a violent -medicine. - -On this case it is of importance still to remark, that it affords, -in the strongest manner, an argument against what our authors say, -p. 86, that “mercury acts by supporting the excitement of the whole -body, it invigorates each particular part; and thus occasions, to a -certain extent, the regeneration of those organs which may have been -injured by disease.” In the instance adduced, there is no evidence of a -stimulus upon any other part of the system than the bowels, which were -already debilitated or diseased in such a manner that they could not -bear it. The system in general, instead of being excited, was sunk and -debilitated from the very first moment, until at last the excitement -terminated entirely by the patient’s death. But further: There is very -little probability that mercury or any other medicine whatever can -prove a general stimulus, and that for the following reasons. - -1. No medicine can assimilate with the substance of the body. Medicines -properly so called are here alluded to. Food or drink of any kind taken -for the support of the body while in health, however they may act -medicinally upon occasions, are excepted. - -2. The body is composed of many various substances, each differing in -its nature from the other. The nature of the medicine, whatever it may -be, is uniform, and cannot act upon substances of different kinds in -an uniform manner; and without this there can neither be an universal -stimulant, nor an universal debilitant. - -3. All medicines, being incapable of assimilation with the body, -must be considered, when taken into it, as foreign matter; and the -introduction of them at any rate is in fact the creating of a disease. -This is evident from multitudes of instances where people by quacking -with themselves, and taking medicines unnecessarily, have destroyed -their health. - -4. As every medicine has one peculiar nature, and one mode of action -in consequence of that nature, it must, when introduced into the body, -where there are fluids of various natures, act upon one of them more -than the rest; and this may be called the _chemical_ action of that -medicine upon the body. - -5. In consequence of the chemical action of the medicine, the mode -by which it is expelled out of the body will be different; for, as -all medicines are extraneous substances, they must be sent out of the -body as fast as possible; and it is their action upon one particular -part which promotes their expulsion. Thus, if from the nature of the -medicine it acts in a certain way upon the stomach and bowels, it will -vomit or purge, or perhaps both; and by this action it is expelled -from the body, along with whatever other matters happen to be in the -stomach or intestines; and thus medicines do good only accidentally; -for mere vomiting or purging are most certainly diseases; but where -noxious matters exist in the bowels, and do not naturally excite -these operations, an emetic or purgative is unquestionably useful. -Here the authors of the Science of Life reason differently; and it is -worth while to refute their argument, as being the foundation of such -_tremendous_ practice as nobody of common sense would choose to be the -subject of. Of tartar emetic they speak in the following terms. “That -tartar emetic is a stimulant of very high power, is evident from the -small quantity of it which produces the state of indirect debility that -occasions vomiting. It should be given in such a manner as to increase -and to support the excitement. But this will be found difficult, as the -duration of its action seems to be even shorter than that of opium. -If its action does not continue more than a quarter of an hour, might -it not be repeated at such short intervals, and the doses so reduced -as to allow the establishment of the indirect debility?” This is -arguing in a circle. They first suppose that vomiting is occasioned -by indirect debility, that is, the weakness produced by an excessive -stimulus to the whole system, as in cases of drunkenness; and then, -from the existence of vomiting, they prove that a general stimulus -had pre-existed. The cases, however, are widely different. In cases -of drunkenness, the person feels himself at first exhilarated, alert -and active, which shows the existence of a general stimulus. But -who has ever found himself exhilarated by taking a dose of tartar -emetic? Yet in a general excitement it is absolutely necessary that -this exhilaration should take place, because it is an inseparable -consequence of an addition of vital power, let it come in what way -it will. Thus we know that if a person happens to be much exhausted -by fatigue and abstinence, he will be exhilarated and his strength -augmented by a single mouthful of meat, as well as by a glass of wine. -This shows that both these are general stimulants to the system; but -what medicine have we that will produce similar effects? Perhaps opium -comes the nearest in the whole materia medica; but the uneasiness -it occasions in the stomach manifests a greater action upon it than -the other parts; for if the whole body were equally excited, the -withdrawing of the stimulus, or its naturally losing its force, could -only have the same effect with fasting or fatigue; but the debility of -the stomach, the confusion of the head, and other effects which attend -a dose of opium, demonstrate that it acts partially, and not equally -over the whole body. The Science of Life indeed says that these effects -are owing to the improper omission of the medicine, or not repeating -the doses in due time. This may be; but no improper exhibition of -food, or want of due repetition, will produce such symptoms; which -undoubtedly is a proof that food stimulates the system in one way, and -opium in another. - -6. If any medicine could be found that acted as an universal stimulus -or exciter of the whole system, it could not like others be expelled, -by any particular evacuation; but, by destroying the balance between -the force of the acting powers and the subject on which they act, -would most certainly kill, unless very powerful means were used to -counteract its effect. The only stimulant we are acquainted with which -acts equally on the whole system, and which can be readily exhibited -as a medicine, is that pure kind of air called by Dr. Priestley -_dephlogisticated_, by Scheele _empyrean_, and by the French chemists -and their followers _oxygen_. The exciting powers of this air, when -breathed instead of the ordinary atmosphere, are astonishing. It not -only augments the appetite, but the power of the muscles, and the -inclination to use them; so that without any intoxication or delirium -the person cannot refrain from action; and it not only exhilarates -the spirits in an extraordinary manner, but beautifies the face. Did -the cure of diseases therefore, or any set of them, depend on mere -excitation, no other medicine but _oxygen_ would be necessary. What -effects it may have in diseases of debility is not yet ascertained; but -to persons in health it certainly proves fatal: their bodies are unable -to bear its powerful action, and of consequence they waste, and would -die of consumptions, if its effects were not counteracted. Nor is this -at all an easy matter; for Dr. Beddoes informs us that, by breathing -this air for a short time each day, only for three weeks, he found -himself in great danger of a consumption, and was obliged to use much -butter and fat meat in his diet, besides giving up the use of the air -altogether, in order to get clear of its mischievous effects. - -Another mode of stimulating or exciting the whole system is, by -putting into it a larger quantity of blood than it naturally contains. -This is entirely similar to the breathing of _oxygen_; especially if -arterial blood be used, which has already imbibed its spiritous part -from the atmosphere. In the last century the transfusion of blood was -proposed not only as a mode of curing diseases, but of restoring old -people to youth; and Dr. McKenzie, in his Treatise on Health, quotes -from the memoirs of the Academy of Sciences several instances of the -blood of brute animals being infused into human veins, without any -inconvenience. It seems, however, not only a bold but an unnatural -attempt to use the blood of beasts for such a purpose; and, however -lavish mankind may be of their blood upon certain occasions, it is -to be feared that there are few who would be willing to spare any to -relieve another from sickness; but indeed little can be said about the -practice; as, on account of some bad consequences, or failures, it was -forbidden by the king of France, and by the pope’s mandate in Italy, -and has now fallen into disuse. In a paragraph at the end of Heister’s -surgery (4to edition) it is asserted that the transfusion of blood was -productive of madness. Dr. Darwin, however, in his Zoonomia, still -proposes the transfusion of blood as a remedy, and even describes a -convenient apparatus for performing the operation. In one part of his -work he says, “Might not the transfusion of blood, suppose of four -ounces daily, from a strong man, or other healthful animal, as a sheep -or an ass, be used in the early state of nervous or putrid fevers?” -In another place he mentions his having proposed it to a gentleman -whose throat was entirely closed up by an incurable swelling, so that -he could swallow nothing. This is a disease not very rare, and which -always must be fatal; because the patients, though not affected by -any sickness, die of hunger; and, to relieve them from this miserable -situation, extraordinary attempts are not only allowable but laudable. -The Doctor proposed to his patient, “to supply him daily with a few -ounces of blood taken from an ass, or from the _human animal_, who is -_still more patient and tractable_, in the following manner: To fix a -silver pipe, about an inch long, to each extremity of a chicken’s gut, -the part between the two silver ends to be measured by filling it with -warm water; to put one end into the person hired for that purpose, so -as to receive the blood returning from the extremity; and when the gut -was quite full, and the blood running through the other silver end, -to introduce that end into the vein of the patient, upwards towards -the heart, so as to admit no air along with the blood. And, lastly, to -support the gut and silver ends on a water plate filled with water of -98 degrees of heat; and, to measure how many ounces of blood were taken -away, to compress the gut from the receiving pipe to the delivering -pipe.” The gentleman desired a day to consider of this proposal, and -then another; after which he totally refused it, saying that he was now -too old to have much enjoyment of life, and that, being so far advanced -in a journey which he must certainly accomplish sooner or later, he -thought it better to proceed than return. The Doctor informs us that -he died a few days afterwards, seemingly very easy, and careless about -the matter. One experiment of this kind I have been witness to; not -indeed on a human creature, but on a calf. This creature received into -one of its jugular veins a considerable quantity of blood from the -carotid artery of another, nearly of the same age (about a month, or -little more.) It was impossible to say any thing about how much was -transfused; only the bleeding was continued till the animal which lost -the blood began to shew signs of faintness. The artery was then tied -up, and the orifice in the jugular vein closed. The calf which had -lost the blood appeared very languid and faint, but lived a few days -in a drooping state; when it either died of itself, or was killed, -as being supposed past recovery. The other, which had received the -blood, appeared to be in every respect highly excited. It became -playful, even in the room where the operation was performed, its eyes -assumed a bright and shining appearance, and its appetite was greatly -increased. Thus it continued for about a fortnight; appearing all the -time to be in high health, and eating much more than usual; but at last -died suddenly in the night. From these effects on healthy subjects, -however, we cannot infer what would happen in such as are diseased; -but it is plain that if the cure of diseases were to depend upon mere -_excitation_, the means are in our power, without any local irritation, -which always must take place in some degree by the use of ordinary -medicines. This path is not absolutely untrodden: the pneumatic -practitioners of the present day have tried oxygen in consumptions, and -found it pernicious; and Dr. McKenzie informs us that the transfusion -of blood was tried ineffectually in the same. - -7. As all the medicines usually prescribed at present are only to be -accounted partially stimulant, or as acting upon particular parts of -the system, we see that some may promote one evacuation, and some -another; while all produce some change in the organization, which may -prove useful or detrimental, may increase the disease or cure it, -or may produce another, according to the judicious or injudicious -application. But for a knowledge of all this we must be indebted to -experience: there is not a theory on earth that can lead us a single -step. - -Before we dismiss the consideration of medical theories, however, -it will still be necessary to give some account of the new system -as it hath branched out in various ways: for though the fundamental -principle is now received by a great number of physicians, yet the -superstructure is exceedingly different from what Dr. Brown himself -erected and, indeed, from the very same principles we find conclusions -made as directly opposite to one another as can be expressed in words. -Drs. Yates and McLean, for instance, at Calcutta in the East Indies, -have concluded that the plague “is a disease of a very high degree of -exhaustion;” which Dr. Brown would have called debility. Dr. Rush at -Philadelphia, proceeding also upon the Brunonian principles, determines -it to be the most inflammatory of all diseases,[62] and which Dr. Brown -would have called a disease of excitement. These two doctrines are, in -every sense of the word, as distant from one another as east from west. -Let us then consider both, if any consideration can avail us on the -subject. - - [62] See above, p. 102. - -By the ancients it was supposed that diseases were occasioned by -something either bred in the body or received into it, and that the -power of nature produced, during the course of the disease, a certain -change in this matter, called _coction_, or _concoction_; which, if we -please, we may express by the English word _cooking_. The matter of the -disease, called also _morbific_ matter, thus _cooked_, was in a state -proper for expulsion, and was therefore thrown out by sweat, vomit, -stool, &c. or it might be expelled artificially, which could not have -been attempted with safety before. Modern systems deny the existence -of morbific matter, and resolve all into an affection of the nerves, -according to Dr. Cullen by certain sedative causes, but according -to Dr. Brown by an accumulation in some cases, and an exhaustion in -others, of the excitability or excitement of the body. The Science of -Life commences with stating what they suppose to be an improvement -of the Brunonian principles, and from which the following account of -the origin of diseases is extracted. “Upon the different states of -_excitability_ depend all the phenomena of health and disease. There -are three states of the excitability. 1. The state of accumulation; -when a portion of the usual stimuli is withheld.... When a portion -of the usual stimuli is withheld, the excitability accumulates, and -the body becomes susceptible of impression in the direct ratio of -the subduction. This state constitutes diseases of accumulation, -or of direct debility. 2. The middle state; when the excitability -is such that the application of the accustomed degree of exciting -powers produces _tone_ or _health_. 3. The state of exhaustion. When -the application of stimuli has been greater than that which produces -healthy action, the excitability is exhausted, and the body becomes -less susceptible of impression in the direct ratio of the excess. This -state constitutes diseases of exhaustion, or of indirect debility. The -states of accumulation and exhaustion of the excitability, in their -different degrees, constitute all the diseases to which living bodies -are subject.” - -Here the chime runs on the word _excitability_, which is not defined. -If we call this property _life_, then we are only informed, that, as -life is more or less vigorous, the body enjoys a greater or smaller -degree of health; which we know without any medical instructor. If, -instead of the accumulation and exhaustion of excitability, we take the -original doctrine of excitement and debility laid down by Dr. Brown -himself, we are nothing better. The whole theory is lost for want of -the definition of a single word. As long as _excitability_ remains an -unknown property, we can explain nothing by it. We may indeed vary -our terms. We may call it _nervous influence_ with Dr. Cullen, or -_sensorial power_ with Dr. Darwin; but we shall still be as much in the -dark as ever; and all that can be made out of our theories, when our -language is _decyphered_, must be, that sometimes people are well, and -sometimes they are sick! - -Dr. Rush, in his Treatise on the Proximate Cause of Fever, adopts in -part Dr. Brown’s system pretty nearly as the author himself laid it -down. “Fevers of all kinds (says he) are preceded by general debility. -This debility is of two kinds, viz. direct and indirect. The former -depends upon an abstraction of usual and natural stimuli; the latter -upon an increase of natural, or upon the action of preternatural, -stimuli upon the body.... Debility is always succeeded by increased -excitability, or a greater aptitude to be acted upon by stimuli.... The -diminution or abstraction of one stimulus is always followed by the -increased action of others.” Here it is evident we are as much in want -of definitions as ever. We know neither what _excitability_ is, nor -what _debility_ is, and yet they are both held out as the _causes_, and -_proximate_ or _immediate_ causes, too, of symptoms produced by things -quite obvious to our senses. Thus cold and heat, with which we are -daily conversant, are only called the _predisposing_ causes of fever; -while _debility_ and _excitement_, words to which we have no meaning, -are said to be the _proximate_ cause. It would certainly be better to -throw away such words altogether, and say that cold, heat, &c. cause -fevers, without troubling ourselves farther about the matter. - -It remains now to take into consideration the pneumatic theories, -founded upon the discoveries made by Dr. Black, Dr. Priestley, -Lavoisier, and others, concerning various kinds of aerial fluids, or -_gases_,[63] as they are also called. Some of these, particularly -that afterwards called fixed air, were discovered by Van Helmont. -Considerable advances were made by a German chemist, named _Mayow_, in -the last century; but his book had fallen into such oblivion that his -name was scarce ever mentioned, until his discoveries were repeated, -and still greater advances made by others. Dr. Hales obtained air from -a great many different substances, but was unable to ascertain any -thing concerning its nature. Dr. Black of Edinburgh laid the foundation -of pneumatic chemistry, by discovering that a certain species of air is -capable of being absorbed by earths of different kinds, and that many -very heavy substances owe at least one half of their weight to this -condensed air. The discovery was accidental. Wishing to obtain a very -pure and white lime, he had recourse to the fine white earth called -_magnesia alba_. Some of this he distilled with a heat sufficient to -make the vessel red hot. Only a very small quantity of water came over, -but the magnesia had lost almost two thirds of its weight. This immense -loss was found to arise from an emission of air during the operation; -and by other experiments it was likewise found that the air might be -transferred from one portion of magnesia to another from which it had -been previously expelled; that the existence of this species of air in -certain bodies was the cause of that fermentation which takes place -when any acid is poured upon them, as vinegar upon chalk or potash. -Hence if any of these substances be deprived of its air, it will not -any longer ferment in this manner. It must not be forgot, however, -that when air thus unites itself with any terrestrial substance it no -longer has its former properties. It is reduced exceedingly in bulk, -and in proportion to this reduction only the body is increased in -weight; and therefore though we say that the _air_ is absorbed, we must -still remember that only _one part_ of it is so, and that by far the -least considerable in bulk. A violent fire will always expel the air -again, and restore it to its former bulk; and again the condensation -or absorption of the air is always attended with the production of -heat. This last property was not much attended to by Dr. Black, but -others have observed it; and the late Dr. Charles Webster of Edinburgh -published a theory in which he maintained that condensation was in -_all_ cases the cause of of heat. But, however true it may be that -condensation of any kind is followed or accompanied by heat, it is -evidently necessary to know the cause of the _condensation_ also, -otherwise we make no advance in solid theory. - - [63] _Gas_ is a German word, or derived from one, signifying - _spirit_. The word _ghost_ comes from the same original. - -The aerial fluid, discovered by Dr. Black, was one of those most -commonly met with. He called it _fixed air_, from its property of -adhering or fixing itself to different bodies. It was found to be the -same with that which had been discovered by Van Helmont, and by him -named _gas sylvestre_ (spirit of wood)[64] or the fume of charcoal; -it was found to be the same with the steam of fermenting liquor, and -with that very frequent and dangerous vapour, met with in coal mines, -called in Scotland the _choke-damp_. Like other discoveries, this was -quickly pushed beyond its proper bounds, and applied to the solution of -phenomena which it could not solve. Dr. MBride, particularly, supposed -it to be the bond of union between the particles of matter, or in other -words the principle of cohesion itself. It was also supposed to be -the substance of those scorching winds, called _samiel_, met with in -Asia and Africa, and which sometimes prove fatal to travellers. The -pernicious vapours called _mofetes_, which sometimes issue from the old -lavas of Vesuvius in Italy, were likewise supposed to be the same;[65] -but of this, particularly with regard to the samiel, there seems to be -no sufficient evidence. - - [64] This must be understood only of its general properties and - effects; for, though the fume of charcoal possesses many of the - apparent properties of pure fixed air, it contains also a very - considerable quantity of another kind of gas. - - [65] Many fabulous stories have been related concerning the samiel. - Even so late a traveller as Mr. Ives has adopted some of those - exaggerated accounts which have been discredited by those who have - long resided in the countries where this wind is commonly met with. - It is not peculiar to the deserts of Arabia, but is met with in all - hot countries which are destitute of water. In the African deserts - therefore it is common; and Mr. Bruce describes it by the name of - _simoom_. It was preceded by whirlwinds of a very extraordinary - kind. “In that vast expanse of desert (says he) from W. and to N. W. - of us, we saw a number of prodigious pillars of sand at different - distances, at times moving with great celerity, at others walking on - with a majestic slowness. At intervals we thought they were coming - in a very few minutes to overwhelm us; and small quantities of sand - did actually more than once reach us. Again they would retreat so as - to be almost out of sight; their tops reaching to the very clouds.* - There the tops often separated from the bodies; and these, once - disjoined, dispersed in the air, and did not appear more. Sometimes - they were broken near the middle, as if struck with a large cannon - shot. About noon they began to advance with considerable swiftness - upon us, the wind being very strong at north. Eleven of them ranged - along side of us at about the distance of three miles. The largest - of them appeared to me at that distance to be about ten feet - diameter.... It was in vain to think of flying; the swiftest horse or - the fasted sailing ship could be of no use to carry us out of this - danger; and the full persuasion of this rivetted me as if to the spot - where I stood.” At another time he saw them in much greater number, - but of smaller size. They began immediately after sunrise, like a - thick wood, and almost darkened the sun. His rays darting through - them gave them the appearance of pillars of fire. They now approached - to the distance of two miles from our travellers. At another time - they appeared beautifully spangled with stars. in Darwin’s Botanic - Garden we find a reason assigned for the appearance of these - whirlwinds; viz. the impulse of the wind on a long ledge of broken - rocks which bound the desert. By these the currents of air which - struck their sides were bent and were thus like eddies in a stream of - water which falls against oblique obstacles. In the same work we have - the following poetical description of them: - - * _N. B._ In these sandy deserts, where it never rains, - there are no clouds. - - “Now o’er their heads the whizzing whirlwinds breathe, - And the live desert pants and heaves beneath; - Ting’d by the crimson sun, vast columns rise - Of eddying sands, and war amid the skies, - In red arcades the billowy plains surround, - And whirling turrets stalk along the ground.” - - Whether the simoom is always preceded by these whirlwinds we know - not; but Mr. Bruce mentions an extreme redness of the air, pointed - out by his attendant Idris, as the sure presage. His advice was, that - all of them, upon the approach of the pernicious blast, should fall - upon their faces, with their mouths on the earth, and hold their - breath as long as possible, so that they might not inhale the deadly - vapour. They soon had occasion to follow this advice; for next day - Idris called out to them to fall upon their faces, for the simoom - was coming. “I saw (says Mr. Bruce) from the S. E. a haze coming, in - colour like the purple part of the rainbow, but not so compressed - or thick. It did not occupy twenty yards in breadth, and was about - twelve feet high from the ground. It was a kind of blush upon the - air, and it moved very rapidly; for I could scarce turn to fall upon - the ground, with my face to the northward, when I felt the heat of - its current plainly upon my face. We all lay flat on the ground, as - if dead, till Idris told us it was blown over. The meteor, or purple - haze, which I saw, was indeed passed; but the light air that still - blew was of heat sufficient to threaten suffocation. For my part, I - felt distinctly in my breast that I had imbibed a part of it; nor - was I free of an asthmatic sensation till I had been some months - in Italy, at the baths of Poretta, near two years afterwards.” It - continued to blow for some time, and in such a manner as entirely to - exhaust them, though scarcely sufficient to raise a leaf from the - ground. - - The account given by Mr. Ives is, that it blows over the desert (of - Syria) in the months of July and August, from the northwest quarter, - and sometimes continues with all its violence to the very gates of - Bagdad but never affects any body within its walls. Some years it - does not blow at all and in others it comes six, eight, or ten times, - but seldom continues more than a few minutes at a time. It often - passes with the apparent quickness of lightning. The sign of its - approach is a thick haze, which appears like a cloud of dust rising - out of the horizon, on which they throw themselves with their faces - on the ground, as already mentioned. Camels are said, instinctively, - to bury their noses in the sand. As for the stories of its dissolving - the cohesion of the body in such a manner that a leg or an arm may - be pulled away from those who are killed by it, or that their bodies - are reduced to a gelatinous substance, we cannot by any means give - credit to them. From its extreme quickness, and luminous appearance, - it would seem to be an electrical phenomenon immediately preceding - those vehement hot winds which all travellers agree in likening to - the vapour issuing from a large oven when the bread is newly taken - out. Its electrical nature will be more probable from the account - given by Mr. Ives, that the Arabians say it always leaves behind it a - very sulphureous smell. These particulars do not at all accord with - the supposition of its consisting of fixed air. I have indeed been - assured by a gentleman long in the service of the English East India - Company, that the samiel cannot pass over a river. Hence probably it - has been supposed to be a blast of fixed air, because this species - of gas is readily absorbed by water; but we know that the same thing - would also take place with any quantity of electric matter; for water - takes up this also much more completely than it does fixed air. - - The _mofetes_ are invisible, and kill in an instant. They rise from - old volcanic lavas, and, as it were, creep on the ground, and enter - into houses, so that they are very dangerous; but, though they may - probably consist of fixed air, we have not as yet any direct proof - of it. It is not indeed easy to imagine why any lava should suddenly - emit a great quantity of fixed air, and then as suddenly cease; nor - in what manner the air thus emitted should continue unmixed with - the atmosphere; for fixed air will very readily mix in this manner, - insomuch that a large quantity of it being let loose in a room has - been found to vanish entirely in less than half an hour. Sir William - Hamilton mentions a mofete having got into the palace of the king of - Naples. - -The industry of other experimenters did not long leave theorists -without abundance of materials upon which they might exercise their -talents. It is impossible in this place to assign to each his proper -rank in the way of discovery, or indeed to mention their names. Dr. -Priestley has distinguished himself far above the rest. He not only -repeated and improved Dr. Black’s experiments on _fixed air_, but -likewise found out a number of other kinds; particularly that from -animal substances in a state of putrefaction, which is so pernicious -to living creatures, insects excepted; for these last will thrive -amazingly in air that would prove certain death to a man. He also -discovered that this kind of air, and some others, were absorbed by -vegetables, and thence inferred the use of vegetables in purifying -the atmosphere. He even analysed the atmosphere itself, and found -that it consisted of two different kinds of fluids, one of which he -called _dephlogisticated_, the other _phlogisticated_ air. The former -was found to support animal life for a time, the latter to destroy it -instantly. Their effects upon fire were the same; the former exciting -the most vehement heat and bright flame, the latter extinguishing a -fire at once. - -The fame of Dr. Priestley’s discoveries quickly reached the continent -of Europe; the French chemists repeated his experiments with -improvements, as they thought; and indeed certainly made many curious -discoveries. Lavoisier was particularly remarkable for his numerous -and accurate experiments; but, by his changing entirely the language -of former chemists, and substituting a set of new terms of his own -invention, he certainly entailed the greatest curse upon the science -it ever met with. It belongs not to this treatise to give an account -of his system farther than to say, that, from the immense proportion -of condensed aerial matter found in most terrestrial substances, he -and his followers were led to conclude, that different species of -air constitute almost the _whole_ of the terraqueous globe. Water -particularly they have absolutely and most positively determined to -be a composition of two airs condensed, viz. the dephlogisticated and -inflammable, which they call _oxygen_ and _hydrogen_. However, this -doctrine is still opposed by Dr. Priestley and some others. - -In the midst of so much theory, and so many new and surprising -discoveries, it would have been wonderful indeed if the science of -medicine had kept free from innovation. It did not: the new chemistry, -with all its formidable apparatus of hard words, was introduced, -and thus the study of the science, already very difficult, was -rendered still more so. In passing this censure upon the modern -_nomenclature_, as it is called, I am sensible that I must rank with -the minority; nevertheless, I have the satisfaction of finding that I -am not altogether singular. Dr. Ferriar, in the preface to his second -volume, complains, “that, with every attempt towards the formation -of a system, new applications of words are introduced, which, though -desirable in the art of poetry, are very inconvenient in pathological -books, especially when this is done to give an air of novelty to old -theories and observations. For, between the ancient language, which -practitioners cannot entirely reject, and the new dialect, which they -cannot wholly adopt, the style of medical books is reduced to a kind -of jargon, that the author himself may possibly understand, but which -his readers find it very difficult to unriddle. Hence results a neglect -of medical literature, and hence the pernicious habit of regarding as -new whatever has not appeared in the publications of the last half -century.” To the same or a similar purpose, in the preface to his first -volume, he cites Quintilian. [66]“Some have such a multitude of vain -words, that, while they are afraid of speaking like other people, by a -kind of affected elegance, they confound every thing they have to say -with their immense loquacity.” - - [66] Est etiam in quibusdam turba inanium verborum, qui dum communem - loquendi morem reformidant, ducti specie nitoris, circumeunt omnia, - copiosa loquacitate, quæ dicere volunt. - -The pneumatic system naturally arose from a consideration of the -composition of the atmosphere we breathe. Finding this fluid to be -composed of two others, the one of which would preserve life for some -time at least, and the other instantly destroy it, it became natural to -think that diseases might be produced by any considerable variation in -the proportion of these ingredients. An instrument was soon invented by -which any considerable variation in this respect might be discovered; -but upon trial this was found to be of very little use. Dr. Priestley -himself tried, by means of this instrument, some very offensive air -which had been brought from a manufactory, and could find no remarkable -difference between it and that which was accounted pure. Still, -however, it was evident that by increasing very much the proportion -of one of the ingredients, some considerable alteration might be -produced, which could not but be perceptible in the human body; and -this led to the application of aerial chemistry to disorders of the -lungs. The mixture chosen for this purpose was pure dephlogisticated -(_oxygen_) with inflammable air (_hydrogen_;) and, though this has not -been known to effect a radical cure, it certainly has given relief in -many cases. In fevers also the application of fixed air (carbonic acid) -hath been found advantageous; but with regard to oxygen and some others -we have not yet a decided instance of their good effects in any case. -Dr. Beddoes indeed is of opinion that it would be of service in the -sea-scurvy; but in this (whether his conjecture be right or wrong) the -theory is certainly erroneous, as shall presently be evinced. - -In considering the pneumatic system it is evident that modern chemists -have fallen into the same error with their predecessors, viz. of -supposing that every thing which by the force of fire or otherwise they -could produce, from any substance, previously existed in it. Hence, as -from a piece of bone for instance, a chemist can produce water, salt, -oil and earth, it was supposed that these four were the principles or -elements of the bone. But this was false reasoning; for if these were -really the chemical principles, they ought to have been able to produce -some kind of bony substance by mixing them together after they had been -distilled. But no such thing could be done; and though we should add to -the mixture the whole quantity of air emitted during the distillation, -and which escaped the notice of ancient chemists, our success would -be no better. In like manner, because in certain circumstances oxygen -is obtained from the flesh of animals, it has been concluded that it -necessarily exists as an ingredient in their bodies while living; and -that, if this kind of air happens to predominate, the animal will be -affected in one way, or if hydrogen prevail, in another. But though -we have already quoted Dr. Girtanner with approbation as having -obtained oxygen gas from fresh meat, yet this does not by any means -prove to us that it exists in flesh as one of its component parts. -Even in the Doctor’s experiment it was necessary to expose the flesh -to the atmosphere in order to procure the gas by distillation; which -undoubtedly must excite a strong suspicion that the air in question -comes from the atmosphere itself; and, if this is the case, it is not -reasonable to suppose that a disease could be cured by any addition -of oxygen to the solid parts; because, though sound flesh may have an -inclination to absorb this kind of air, we do not know whether it would -have such a property of absorption in a diseased state. Indeed in the -scurvy, which Dr. Beddoes chooses as an example, experiment seems to -determine in favour of _fixed air_ rather than any other. But let us -hear Dr. Girtanner himself, who has at large discussed this subject -in two memoirs; one upon the laws of irritability, and another on the -principle of irritatibility. - -In these memoirs we find the Brunonian doctrine set forth with such -silence in regard to Dr. Brown himself, that some have not scrupled to -charge Dr. Girtanner with literary _theft_; but this is a matter which -belongs not to us to consider: the theory may be very good, whether -stolen or not. He changes the word _excitability_, used by Dr. Brown, -for _irritability_; but hath the misfortune of not being able to tell -us what he means by it. He goes on, however, to distinguish the three -states of _tone_ or health, _accumulation_, and _exhaustion_, as other -Brunonians do. Health, he says, in a fibre “consists in a certain -quantity of the irritable principle necessary for its preservation. To -maintain this state, the action of the stimulus must be strong enough -to carry off from the fibre the surplus of this irritable principle -which the lungs and the circulation of the fluids are continually -supplying. For this a certain equilibrium is necessary between the -stimuli applied and the irritability of the fibre, in fine that the sum -of all the stimuli acting upon it may be always nearly equal; powerful -enough to carry off from the fibre the excess of its irritability, and -not so strong as to carry off more than this excess.... When the sum -of the stimuli acting upon the fibre is not great enough to carry off -all its excess of irritability, the irritable principle accumulates in -the fibre, and then it is found in that state which I call the _state -of accumulation_; the irritable principle accumulates in the fibre, -its irritability is augmented, and the stimuli produce much stronger -contractions than when the fibre only retains its tone.... When the -sum of the stimuli acting upon the fibre is too great, the fibre is -deprived not only of the excess of its irritability, but also of some -portion of the irritable principle necessary for the tone of the fibre; -or, more properly speaking, the fibre loses more irritability than -it receives, and, of course, in a short time finds itself in a state -of _exhaustion_; and this exhaustion will be either _temporary_, or -_irreparable_.” - -Here it is evident that we have nothing but Dr. Brown’s system, without -the least explanation to render it more intelligible. A definition -is still wanting. This invisible and incomprehensible property of -_irritability_ ruins our whole fabric; nor can the deficiency be -supplied by human art or skill: of consequence we must abandon this -part of the system entirely, and come to something more cognizable -by our senses. It is impossible, however, to pass over in silence -the amazing inattention of the author, in imagining that on such -unintelligible principles he could explain other phenomena. “In the -state of _temporary exhaustion_ (says he) the fibre loses its tone, and -fails for want of irritability. The application of a stimulus while it -is in this state will not make it contract. Provided the stimulus be -not very strong, it will produce no effect at all, but in a short time -the irritable principle will accumulate afresh in the fibre, and then -it will again contract. It is only by little and little that the fibre -recovers its irritability. This truth, I dare venture to say, is as -new as it is striking. It unfolds a vast number of phenomena hitherto -inexplicable.” Here we have nothing but the pompous declaration of a -fact already well known; viz. that not only a _fibre_, but the whole -body, may be in a state of temporary insensibility, and yet recover -either of itself or by the use of external means. How many people have -fallen into a _syncope_, and yet recovered! How many limbs have become -paralytic, and in time recovered their sense and motion! Yet this is -all that we are informed of with so much parade and assumption of -novelty. We know that when a person is in a faint he is insensible to -ordinary stimuli, though very strong ones will rouse him; but what can -we infer from this? Nothing; only we see it is so. Does it avail us any -thing to be told that during the time of fainting the _irritability_ is -exhausted, and “in a short time the irritable principle will accumulate -afresh;” in which case the patient will no doubt recover, unless he -happens to be dead, which is the true meaning of an _irreparable -exhaustion_ of the irritability. - -In speaking of the principle of irritability he expresses himself in -the following manner. “I think that the oxygen is absorbed by the -blood, and that the venous blood is oxygenated in the lungs during -respiration. The most celebrated naturalists and chemists are of a -different opinion: they think that the oxygen does not combine with the -venous blood. According to them, this last loses carbon and hydrogen, -and recovers the bright colour natural to it, without absorbing any -thing from the atmosphere.... After having a long time attended the -phenomena of respiration, and made many experiments upon this subject, -I think it may be concluded that one part of the oxygen of the vital -air combines with the venous blood, of which it changes the black -colour, and makes it vermilion;[67] the second part of the oxygen -unites with the carbon contained in the carbonic-hydrogen gas, which -exhales from the venous blood, and forms carbonic acid air; a third -part unites with the carbon of the mucus, contained in great quantities -in the lungs, and which is continually decomposing; this part also -forms carbonic acid air; a fourth part of the oxygen combines with the -hydrogen of the blood to form water.” - - [67] Here Dr. Beddoes, from whose publication this account of - Girtanner’s memoir is taken, has the following note: “Dr. Goodwyn - had proved this before. Could Dr. Girtanner be ignorant of his - experiments?” In justice to myself, however, I must observe that this - very doctrine had been published in the Encyclopædia Britannica long - before either Dr. Goodwyn or Dr. Girtanner had made any experiments - on the subject. It may still be seen under the article BLOOD, and - reasons are there given for supposing that only one part of the - oxygen, viz, the elastic part, can be absorbed. - -On this theory I shall only observe, that though I lay claim to the -former part, I allow the Doctor all the latter part to himself; -particularly where he speaks of the _formation_ of water to be exhaled -during respiration. The air in question consists of two parts, like -_fixed air_ already mentioned. One of these is capable of being -attracted, condensed, or united with certain substances; the other -vanishes, leaving no other traces of its having ever existed, but heat, -greater or less according to circumstances. When the air is taken into -the blood, one part of it undoubtedly combines with something thrown -out by the lungs, and forms _fixed air_, of which our breath contains -a considerable quantity. We know certainly that the condensable part -of fixed air is formed out of the condensable part of the oxygen, -with certain additions. As therefore great part of this condensable -oxygen is thrown out in fixed air at every expiration, it is natural -to suppose that all of it is so: at least we cannot know the contrary -without a series of very difficult and tedious experiments, which have -never been made by Dr. Girtanner or any body else. But if the whole -of this condensable part be thrown out, none can enter the blood by -the breath; and consequently whatever true oxygen may afterwards be -expelled from that fluid, must be a factitious substance, formed either -during the artificial process, used for distilling it, or by a natural -process In the body itself. It is not therefore at all probable that -the oxygen which flesh emits in distillation can be derived from the -air by respiration. - -Another and more probable source is the food and drink we take; all -of which are more or less impregnated with air of different kinds, -particularly fixed air. This, we know, very readily condenses, and -certainly will do so when taken into the body. In this state it not -only may, but certainly will, pass into the blood, and through all the -different parts of the body, until, having accomplished its purpose, -whatever that may be, it is thrown out by insensible perspiration, as -has been already explained. - -The conclusions drawn by Dr. Girtanner from his experiments are, -1. That the change of colour which the blood undergoes during the -circulation is not owing to its combination with hydrogen air[68]. 2. -The deep colour of the blood in the veins is owing to the _carbon_ it -contains. 3. That the vermilion colour of the arterial blood proceeds -from the oxygen with which the blood is conjoined during its passage -through the lungs. 4. That respiration is a process exactly analogous -to the combustion and oxydation of metals; that these phenomena are -the same, and to be explained in the same manner. 5. That, during -circulation, the blood loses its oxygen, and charges itself with -_carbonic hydrogen_ air, by means of a double affinity. 6. That, during -the distribution of the oxygen through the system, the heat which was -united with this oxygen escapes; hence the animal heat. 7. That the -great capacity of arterial blood for heat is owing to the oxygen with -which it is united in the lungs. - - [68] Here it is necessary to observe, for the sake of accuracy and - perspicuity, that, in the new chemistry, the terms of which are - now very generally adopted, the words _oxygen_ and _hydrogen_ when - mentioned by themselves are not understood to signify any kind of - air, but what I have called the condensable part of the air. If - the word _air_ is added, then the whole substance of the fluid is - understood. But though this is the strict orthodox language of the - new chemistry, it is impossible to say whether every one who adopts - the terms be sufficiently careful in this respect. Indeed this is - one out of many inconveniences that might be pointed out which - have arisen from this nomenclature; for thus the mere omission of - a monosyllable, which may happen in numberless instances, totally - perverts the meaning of the author, and may of course subject him - to unmerited censure. Besides, it is not to be known, unless the - author tells us so, that he designs to observe this strictness, and - of consequence we must in multitudes of cases be uncertain of the - meaning of what we read. Thus, in the present instance, when Dr. - Girtanner speaks of _oxygen_, we know not certainly whether he means - the air in substance, or only one of its component parts. Probably - he means the condensable or solid part. If he does so, there must be - a very material difference between his theory and that laid down in - the Encyclopædia, and which is supported throughout this treatise. In - the latter it is maintained that the condensable part is thrown out - by the breath, being previously converted into fixed air, while the - elastic part enters the vital fluid, communicating to it not only the - red colour, but heat, and the principles of life and sensation, as - will be more fully explained in the sequel. - -On these propositions, which constitute in a great measure the -fundamental principles of the doctrine of _oxygenation_ of the human -body, we may remark, - -1. Nobody can reasonably suppose that hydrogen air is the cause of the -dark colour of the blood in the veins, because there is no source from -which it can be derived; and, besides, it is certain that no kind of -air can exist in its elastic state in the blood, without destroying -the life of the animal. Some experiments proving this are given by Dr. -Girtanner himself. It is true that an aerial vapour, of the nature of -_fixed air_, exhales from the body by insensible perspiration; but -there can be no doubt that this receives its elasticity only at the -surface of the body, and is expelled the moment it is formed. It has -indeed been proved, by undeniable experiment, that no air of any kind -exists in the larger veins; because a portion of a vein, included -between two ligatures, being cut out, and put under the receiver of an -air-pump, does not swell in the least when the air is exhausted, which -yet must be the case, did the smallest quantity of elastic air exist in -it.[69] - - [69] _Hydrogen_ air is the same with that by Dr. Priestley called - _inflammable_ air. He also discovered the true composition of it. - Having included a few grains of charcoal in the receiver of an - air-pump, and exhausted the air, he heated it in vacuo by means of - a large burning glass. The charcoal was entirely volatilized and - converted into this kind of air. He found, however, that without some - small portion of moisture this volatilization did not take place. - -2. When the Doctor asserts that the dark colour of the venous blood is -owing to the carbon it contains, he is in the first place chargeable -with the error of former chemists, who supposed that every thing which -could be extracted from any substance by fire, existed previously in -it, in that very form in which it is extracted by the fire; and in -the second place he speaks entirely at random, without even a shadow -of proof. Nay, he himself tells us, that he has repeated two of Dr. -Priestley’s experiments, which in the clearest manner demonstrate, -that neither the addition nor the abstraction of carbon, or any thing -else, give this dark colour to the venous blood. “A small glass tube -(says he) filled with arterial blood, of a bright vermilion, was sealed -hermetically,[70] and exposed to the light. The blood changed its -colour by degrees, and in six days became black as venous blood. The -same experiment was repeated, with this difference only, that the tube -was exposed to heat, and not to the light. The blood became black in -a shorter time.” In these experiments it is plain, that if the blood -contained oxygen at first, it did so at the last; the same with regard -to carbon. How came it then to pass, that without either evaporation of -the former, or addition of the latter, the change should be produced? -If the oxygen imbibed by the blood in the lungs was sufficient to -produce the red colour, why did it not preserve it? The case here is -precisely similar to what happens with the calx of silver. When that -metal is dissolved in aqua fortis, and again reduced to a solid form, -it appears as a white powder, and will preserve its colour if carefully -kept from the light; but if a vial be filled with it, and exposed to -the sun, that side on which the light falls will in a short time become -black, and this though the vial has been ever so carefully sealed.[71] -Formerly, chemists had a method of accounting for this appearance, as -well as that of the venous blood, by what they called the _evolution of -phlogiston_: but now that the very existence of phlogiston is denied, -we are deprived of this resource. But, whatever words we may use, it -is plain that in neither case have we any ideas affixed to them which -can make the matter at all more intelligible than it was before. But -with regard to the blood, we are at a considerable loss to understand -what the natural colour of it is; and indeed the question can only be -determined by examining the blood of a fœtus which has never breathed. -If the arterial blood of such a fœtus be of a dark colour, resembling -that in the veins of a grown person, we must look upon this to be -_natural_ to it, and we may as well inquire why a rose is red, or an -iris blue, as why the blood is of a dark, and not of a bright red. But, -if we find this dark red change to a bright scarlet in the arteries, -as soon as the child has breathed, we have as much reason to conclude -that the air occasions this superior redness, as that an acid is the -cause of a red colour in the syrup of violets, or an alkali of a green -colour in the same. Experiments are yet wanting to determine this -matter. Mr. Hunter has observed that “in such fœtuses as convert animal -matter into nourishment, they most probably have it (the colour of the -blood) influenced by the air, such as the chick in the egg, although -not by means of the lungs of the chick, we find the blood, in the veins -of their temporary lungs, of a florid colour, while it is dark in the -arteries.”--The probability therefore is, that the blood is naturally -dark; by the elastic principle of the oxygen that it is rendered -brighter; and that, this elastic principle being expended in the course -of circulation, the fluid reassumes its original colour. - - [70] A glass tube is sealed hermetically, by heating the open end or - ends, till they become soft, and then closing them with a pair of - pincers. - - [71] Thus letters, or other characters, may be curiously marked upon - the calx within the vial, by cutting them out in paper, and then - pasting them on the side to be exposed to the light. We may have them - in this manner either dark upon a white ground, or white upon a dark - ground. - -3. Though enough has already been said to evince that the superior -redness of the arterial blood is derived from oxygen gas, we shall -still quote two instances from Mr. Hunter’s Treatise on the Blood, -which set this forth in the clearest manner; and these instances are -the more remarkable, because they demonstrate the phenomena not of -the _dead_, but of the _living_ body. 1. A gentleman in an apoplexy, -who seemed to breathe with great difficulty, was bled in the temporal -artery. The blood flowed very slowly, and for a long time. It was as -dark as venous blood. He was relieved by the operation; but, on opening -the same orifice in two hours, the blood flowed of the usual florid -colour. 2. A lady in an apoplexy was treated in the same manner, and -Mr. Hunter observed, that when she breathed freely, the blood from the -temporal artery assumed a bright red colour; but when her breathing -was become difficult, or when she seemed scarce to breathe at all, it -resumed its dark colour, and this several times during the operation. - -4. Respiration is not, as Dr. Girtanner says, a process similar to the -combustion and oxydation (the calcination) of metals. Some of these -by calcination, and _all_ of them in the opinion of Dr. Girtanner, -unite with the condensable part of the oxygen contained in the air, -while the elastic part is dissipated in flame or heat. The reverse of -this takes place in breathing; for here the elastic part of the oxygen -unites with the blood, and makes it warm, while the condensable part, -uniting with certain particles to be thrown off from the body, passes -away in fixed air. Thus the process of respiraton does not resemble -the calcination of a metal (at least according to our author’s opinion -of that operation) but rather the inflammation of some combustible -substance; for in both cases a certain quantity of carbon is found -to be united with the basis of oxygen in the atmosphere, and thrown -off from the place of combustion; and thus a quantity of fixed air is -produced from every burning substance. Just so is it with respiration. -If the condensable part of the oxygen combined with the blood, then no -fixed air could be produced; or if any part of the oxygenous base was -absorbed, it must certainly be known by a proportional deficiency in -the quantity of fixed air produced. But there are no experiments made -with accuracy sufficient to determine this point. It is true that many -very able physiologists, as Borelli, Jurin, &c. have been of opinion, -that part of the air is absorbed in respiration; but when we come to -particulars nothing can be determined. Dr. Hales by experiment found -the quantity absorbed to be a _sixty-eighth_ part of the whole quantity -inspired; but, on account of supposed errors, he states it only at _an -hundred and thirty-sixth_ part. Between these two the difference is -so enormous, that we know not how to draw any conclusion from them. -The French chemists are more decisive, and agree pretty well with one -another. Chaptal calculates it at _three hundred and fifty-three_, and -La Metherie at _three hundred and sixty_, cubic inches in an hour. -Allowing these experiments to be just, the next question is, what -part of the air is absorbed. Lavoisier says, that it is the oxygenous -base, or the same with that which is absorbed in the calcination of -mercury. But how comes he to know this? Surely not in the same way -that he determines the absorption of it by mercury. In the latter case -he takes a certain quantity of mercury, includes it in another known -quantity of oxygen air, and heats the metal by means of a burning-glass -or otherwise: the consequence is, that the air is absorbed, the mercury -loses its fluidity, and is increased in weight. The metal gains the -_whole_ weight of the air absorbed; and, by another process, _all_ the -air and _all_ the metal, or very nearly so, may be obtained in their -original form. This experiment is so decisive, that nothing can be -said against it with any shadow of reason; but who _hath_ made, or who -_can_ make, similar experiments with the blood of a living man? Such -experiments indeed might be made, if _insensible perspiration_ did not -stand in our way. Common atmospherical air is about _eight hundred_ -times lighter than water. A cubic inch of distilled water, according to -Dr. Kirwan, weighs _two hundred and fifty-three grains and a quarter_. -Oxygen air is somewhat lighter than common air: we shall therefore -suppose that six hundred inches of it are equal to an inch of water. -If then the blood absorb three hundred and sixty inches of air in one -hour, it will in twenty-four hours have absorbed eight thousand six -hundred and forty inches, equal in weight to fourteen inches of water -and two fifths, which according to Dr. Kirwan’s estimate is between -seven and eight ounces. But the quantity of matter insensibly perspired -in that time is so much greater, that no calculation can be made. Here -is one mode of determining the quantity of oxygen inspired totally -impracticable in the human body, though quite easy and practicable in -the case of mercury. The other mode of determining it by the expulsion -of oxygen from the blood is equally impracticable. Dr. Girtanner indeed -has expelled oxygen from flesh; but we know not in what proportion, -nor can we determine whence it came. With regard to this last, indeed, -there are two sources allowed by Drs. Beddoes and Girtanner themselves; -viz. the absorption of oxygen by the lungs, and the quantity taken in -with the aliment. A third source was also manifest from Dr. Girtanner’s -experiments; viz. absorption from the atmosphere; for, by exposure to -the atmosphere, flesh, which had once parted with its oxygen, became -again impregnated with it. In this case therefore we must acknowledge -that the uncertainty of the absorption by the lungs must be extremely -great. A certain quantity of oxygen is undoubtedly thrown out in fixed -air. How are we to determine this quantity? Certainly not by the first -reverie that happens to occupy our imagination. It is a problem, the -solution of which must be attended with the utmost difficulty. We must -know, in the first place, how much oxygen was contained in the air -_inspired_. In the second place we must know the quantity of fixed -air _expired_. In the third place we must exactly know the proportion -of oxygen contained in the fixed air thrown out by the breath. In the -fourth place we must determine whether, by the conversion of oxygen -into fixed air, any change is made in its bulk. For, if this shall be -found to be the case, we should be led to suppose an absorption or -augmentation of air when no such thing took place. This point therefore -ought to be determined with the utmost accuracy. In the fifth place we -must exactly know how much _azote_, _septon_, _phlogisticated air_ is -contained in the atmosphere inspired, and likewise in that expired. -In the sixth place, we must be assured that there are no other fluids -in the atmosphere capable of being absorbed by the lungs, excepting -oxygen and azote. Whether there are any others or not, hath not been -determined. From an expression of Dr. Fordyce, he would seem to be -skeptical on the subject. “The atmosphere (says he) is found to consist -of various vapours, of which air, or, as it has been called, pure -air, or respirable air, (oxygen air) forms at present about a fourth. -Gas (probably fixed air) forms some part;[72] but the greatest part -consists of one or more vapours, which, _without any positive quality, -but from that indolence which makes mankind in their researches attempt -to find a resting place, have been considered by many chemists as one -individual species, under the names of phlogisticated air_,” &c. In -the seventh place we ought to know what quantity of _pure oxygen_, -unconverted into fixed air, or whether any such, is thrown out by the -breath. That a quantity of this kind of air is really thrown out, -is probable, because we can blow up a fire with our breath, and by -a blow-pipe excite a most intense heat, capable of melting the most -refractory metals, platina excepted. It is true that the eolipile, by -the mere conversion of water into steam, will blow up a fire also; -though, if the access of external air be denied, the blast of the -eolipile will put the fire out. Probably the breath would do the same; -but even this cannot be accounted a decisive proof of the oxygen being -totally exhausted; for the moist vapour with which the breath abounds -may extinguish the fire, even though some small quantity of oxygen -should remain in it. It is not, however, our business at present to -enter minutely into such discussions. From what has been already said, -it is evident, that the absorption of oxygen by the blood, instead of -being indubitably established, is of all things the most uncertain; the -requisites for determining it being absolutely beyond the investigation -of any person, however accurate. We may indeed, with great labour and -trouble, determine that some part of the air is absorbed in breathing; -but what that part is, we are unable to discover from any chemical -investigation. The opinion of the simplicity of metals, and their being -reduced to a calx by the adhesion of oxygen, has been so implicitly, -and in a manner universally, received, that it has given a new turn -to physiology, so that, by a kind of analogical reasoning, the human -body has been reduced to a mere chemical apparatus, the operations of -which may be calculated as we can do the event of experiments in a -laboratory. But, after a very long and tedious contest, Dr. Priestley -seems at last to have overthrown this doctrine of oxygenation, even in -the inanimate parts of the creation; so that we can much less apply it -to the doctrines of life and animation. His experiments are published -in the third number of the Medical Repository, volume II, and fully -demonstrate, that, though mercury absorbs oxygen during calcination, -this is not the case with all metals; that in many cases the oxygen -will unite with other substances in preference to the metal, which last -is nevertheless reduced to a calx as though it had united with the -oxygen; that in many cases the addition of weight gained by the calx -is owing to mere water, &c. He has likewise shown that phlogisticated -air (azote) is not a simple substance, as has been taught by the new -chemists, but consists, as well as fixed air, of an union of oxygen -with carbon, or at least with the black matter of burnt bones, with -which he made the experiment. These aerial fluids therefore being -so easily convertible into one another, and the uncertainty of the -changes in bulk which may occur in consequence of these conversions -so great, it is impossible to say whether a portion of the atmosphere -in substance, i. e. both oxygen and azote, is absorbed, as physicians -formerly supposed; or whether a portion of oxygen air alone be -absorbed, as Dr. Beddoes supposes; or whether only the elastic -principle itself is absorbed, and the diminution in bulk made in -consequence of the conversion of oxygen into fixed air; I say, these -matters depend on circumstances so much beyond the reach of our senses, -that if we come to any probable conclusion upon the subject, it must be -by analogical reasoning from other known facts, not from experiments -made directly upon the living body; which, in their own nature, must, -always be extremely vague and uncertain. - - [72] It is now acknowledged that common atmospherical air contains - a portion of what Dr. Black and Dr. Priestley have called fixed - air; but this portion is so small (not more than one fiftieth part, - according to Dr. Anthony Fothergill’s Prize Dissertation, and _none - at all_, according to Dr. Beddoes) I say, this proportion is so - small, that we cannot suppose it to constitute the quantity of fixed - air thrown out by the breath, which is very considerable. Besides, - fixed air, of all others, is the most readily absorbed; and, indeed, - if we could admit of absorption of any basis of air in the present - case, it certainly ought to be that of fixed air; but where such a - quantity is thrown out, we cannot well admit of any absorption. - -5. That, during the circulation, the blood charges itself with carbonic -hydrogen air, is an assertion which cannot be easily admitted. It has -already been observed, that, by the air-pump, venous blood does not -appear to contain any elastic fluid whatever; and it is also certain, -that animals cannot bear any quantity of air injected into their veins. -Dr. Girtanner himself tried several kinds, and all of them proved -fatal. Having injected a considerable quantity of oxygen air into -the jugular vein of a dog, the animal raised most terrible outcries, -breathed very quickly, and with the utmost difficulty; by little and -little his limbs became stiff, he fell asleep, and died in less than -three minutes. On injecting into the vein of another dog a small -quantity of phlogisticated air, the animal died in twenty seconds. -With carbonic acid gas (fixed air) a third dog died in a quarter of -an hour. A fourth was killed in six minutes by nitrous air.[73] From -these experiments, had no others ever been made on the subject, it -seems very probable, that no species of air can be safely admitted -into the blood in its elastic state. If any such therefore should -naturally be produced in the body, it must either be instantly thrown -out, or disease must ensue. Such objections to the Doctor’s theory -are so natural, that we might have thought he would have foreseen and -provided against them. Instead of this he grounds the whole upon such -slender evidence as could not be admitted in the most trifling matter. -“An incision (says he) was made in the jugular vein of a sheep, and -the blood which came from it was received into a bottle filled with -nitrous air. When the bottle was half filled, it was closed. The -blood coagulated immediately, and a separation of a great quantity -of blackish serum took place. The day after, on opening the bottle, -a very strong smell of nitrous ether (dulcified spirit of nitre) was -perceived, the nitrous air having been changed in part into nitrous -ether by the carbonic hydrogen gas of the blood. This experiment -proves, beyond a doubt, that the venous blood contains carbonic -hydrogen air; and that this air is not very intimately mixed with it, -but may be expelled with the greatest ease.” - - [73] Nitrous air is that suffocating vapour which arises when aqua - fortis is poured upon metals. When taken into the lungs it destroys - animal life more quickly than any other species. - -On reading the Doctor’s account of this experiment; it must be very -obvious, that, however decidedly he may be of opinion that it proves -_beyond a doubt_ the existence of hydrogen air in the venous blood, -yet there is not one solid reason; from what he says, for supposing -any such thing. How can any man determine from the mere _smell_ of -_sheep’s_ blood taken out of the body of the animal, and mixed with -a poisonous vapour, what is the composition of _human_ blood in the -living body? In the case of any substance suspected to contain elastic -air, the air-pump will always afford an _experimentum crucis_. But we -know that venous blood does not yield any elastic vapour by the pump: -if instead of blood, however; we should fill a portion of vein with -beer, cyder, or other fermented liquor, it would instantly discover, -by its swelling up, that it really contained air in an elastic state. -If then from the tumefaction of the vein when filled with fermented -liquor we conclude that the latter contains fixed air, why should we -not, from the non-tumefaction of it when filled with blood, conclude -that the vital fluid contains no air? If Dr. Girtanner was so well -assured that the venous blood contains hydrogen air, he ought to have -expelled some of it from a portion of the blood, noted the difference -between the blood which had lost its air, and that which had not, and -then, by adding the air to it again, restored the blood to its former -state. Nothing less then recomposition can prove the truth of a -chemical analysis; as division can only be proved by multiplication, or -multiplication by division. - -From all that has been said, we may fairly conclude, that no proof can -be brought sufficient to prove the existence either of oxygen air or -any other species of aerial fluid, in its elastic state, in the blood. -Neither can we prove that any part of the condensable part of oxygen -air is received by the breath in the lungs. It is, however, probable -that this condensable part may be received into the stomach with our -food; that having passed through the various channels of circulation, -and arrived at last at the surface, it there resumes its aerial nature -by combining with the superfluous heat of the body, and is evaporated -through the pores of the skin by insensible perspiration. The aerial -vapour which passes off by these pores indeed has been discovered to -partake of the nature of _fixed air_; but we know that this species -of gas always contains the basis of oxygen, being indeed composed of -it; and whether the oxygen be taken into the body in its pure state -or not, the result would undoubtedly be the same; for an union would -be formed between it and the carbonic particles to be thrown off from -the body. But thus we can never suppose the basis of oxygen or any -other air to be a permanent part of the composition of our bodies; nor -can the quantity of it be augmented by breathing any kind of air. The -readiest way to increase the quantity seems to be by drinking fermented -liquors. Thus, if the body is too hot, the superfluous heat will have -a proper subject to act upon, viz. the condensable part of the fixed -air; and hence we may perhaps account for the very grateful and cooling -sensation produced by drinking these liquors in some diseases. With -respect to the existence of _carbon, charcoal_ or _hydrogen_ in the -blood, it is probable that it exists in equal quantity at all times, -being indeed the fundamental material of the whole body, and probably -only a modification of that _dust_ from whence man was originally -taken.[74] When the blood therefore grows very black, when the teeth -are covered with a black sordes, the hands become foul, &c. we may say, -indeed we too surely _feel_, that, in such cases, there is a propensity -in the body to return to its original state of dissolution; but there -is not one solid reason for supposing the proportion of its materials -to be varied; that there is a collection of _oxygen_ in one part, -_hydrogen_ in another, or in short that nature can admit of any such -disproportion taking place. - - [74] In one of Dr. Priestley’s papers above quoted he says, that - _charcoal_ is entirely of _vegetable_ origin; but the conversion of - vegetable into animal matter which we daily see is an undoubted proof - that there cannot be any essential difference between them. Even the - bones are undoubtedly produced from vegetables in such animals as - feed upon vegetable substances; so that even the calcareous earth - they contain is plainly of vegetable origin. We may say indeed that - the calcareous particles had a previous existence in the vegetables - used by the animal as food; but we may say the same of the particles - of the blood, flesh, horns, &c. Besides, Dr. Priestley has shown that - _every_ particle of charcoal may be volatilized into inflammable - air, with as great accuracy as any human experiment can be made; so - that in this case the calcareous particles, if any such there were, - showed themselves to be as much charcoal as the rest. In the 74th - volume of the Philosophical Transactions, Mr. Watt has shown, that - dephlogisticated spirit of nitre may be changed into the smoking and - phlogisticated kind by means of red-lead or magnesia alba, as well - as by charcoal; of consequence there can be no essential difference - even there. In short, so wonderful and multifarious are the - transforming or metamorphosing powers of nature, that every attempt - to find out a substance upon which these powers cannot act, will be - found altogether vain, and our best conducted and most plausible - experiments, made with a view to discover the ultimate composition or - what we call the elements of bodies, will be found mere inaccuracy, - bungling and blunder. - -6. We must now consider Dr. Girtanner’s account of the origin of -animal heat, which is, that, “during the distribution of the oxygen -through the system, the heat which was united with this oxygen -escapes; hence the animal heat;” and, “that the great _capacity_ -of the arterial blood for heat is owing to the oxygen with which -it is united in the lungs.”--This leads us to consider in a more -particular manner the doctrine of heat, a subject hitherto much less -investigated than the importance of the subject requires. What little -we do know of this matter seems to be almost entirely owing to Dr. -Black, who hath discovered some very remarkable phenomena unknown to -former philosophers. His discovery here, as in that of fixed air, was -accidental. Making experiments on the water of different temperatures, -he found that the mixture would always be an arithmetical mean betwixt -the two quantities mixed. Thus, on mixing water at 50 degrees with -an equal quantity at 100, the temperature of the mixture would be 75 -degrees; but if instead of using water only he took snow or ice for -one of the quantities, the mixture was no longer an arithmetical mean -betwixt the two temperatures, but greatly below it; so that a quantity -of heat seemed to be totally lost and in a manner annihilated. His -attention was engaged by this unexpected phenomenon, and, prosecuting -his experiments, he found that, when water was converted into ice, it -really became warmer than it was before; and, by keeping the fluid -perfectly still during the time that cold was applied, he was able -to cool it to 27 degrees of Fahrenheit’s thermometer, which is five -degrees below the freezing point; but on shaking this water so cooled, -it was instantly converted into ice, and the thermometer rose to 32. On -reversing the experiment he found that mere fluidity in water is not -sufficient to melt ice. A considerable degree of heat is necessary; -and even when this is previously given to the water, the whole becomes -as cold as ice by the time that the ice is melted. The result of his -experiments in short was this: Water, when frozen, absorbs an hundred -and thirty-five degrees of heat before its fluidity can be restored: -that is, supposing a pound of ice at the temperature of 32 to be mixed -with a pound of water at the temperature of 32, by adding 135 degrees, -so that the temperature of the water is augmented to 167, the ice will -indeed be melted, but the temperature of the whole quantity of liquid -will be reduced to 32. In this case therefore the heat manifestly -assumes two different modes of action: one in which it acts internally -upon the substance of the body, without being sensible to the touch, -while in its other state it hath no effect upon the internal parts, but -affects bodies on the outside. The former state therefore the Doctor -distinguished by the name of _latent_, the latter by that of _sensible_ -heat. - -The same theory was applied to explain the doctrine of evaporation, and -that in the most decisive and satisfactory manner. The Doctor found, -that, in the distillation of water, much more heat was communicated -to that in the worm-tub of the still, than could be supposed necessary -to raise the water distilled to 212 degrees, which is the utmost that -water can bear. In prosecuting the experiment he found the quantity of -heat absorbed by the water, when raised into vapour, truly surprising; -no less than _a thousand_ degrees; an heat more than sufficient to -have made the whole quantity of fluid that came over red hot. Some -objections, however, were made to this theory, even by the Doctor’s -friends. Mr. Watt, particularly, though he could not deny the theory -derived from Dr. Black’s experiments, yet suggested one, which, had -it proved successful, would have overthrown the whole. It was this: -Let water be distilled _in vacuo_, where it boils with a heat of 97 -degrees, and the operation must be carried on with much less fuel, and -with much greater ease, than in the common mode. It was said that, in -this experiment, Dr. Black was equally concerned with Mr. Watt; but, -in a personal conversation with the Doctor himself, he assured me -that he had no farther concern than foretelling that the experiment -would not succeed, which it seems did not. The event was as follows: -Mr. Watt, determining at all events to try the experiment, caused to -be made a copper retort and receiver, joined together in one piece. -In the receiver he pierced a small hole, and, heating both retort and -receiver, plunged the latter into cold water. The consequence was, -that a considerable quantity of water entered the vessel, and was -easily poured back into the retort, as a subject for distillation. A -fire being now applied, the water was soon raised into steam, which -filled both retort and receiver, and in a great measure expelled the -external air. The small orifice in the receiver being now closed, and -the receiver itself plunged into cold water, the distillation went -on _in vacuo_; for, as soon as any of the steam was condensed, the -space which it had occupied (according to Dr. Black _one thousand and -sixty-six_ times more than the original water) was become absolutely -empty, and more steam, rarefied, not by any quantity of sensible heat, -but merely by that which it contained in a _latent_ state, would occupy -the place of the former. The event of the experiment showed the truth -of Dr. Black’s theory. The water boiled, and steam was raised as well -as if access had been given to the air; but with this difference, -that the upper part of the distilling vessel was never heated above -what the hand could easily bear. With the water in the cooler it was -quite otherwise. It became hot as usual, and, by the quantity of heat -it received, plainly demonstrated that the vapour, though destitute -of most of its _sensible_ heat, yet contained an immense quantity in -a _latent_ state. The saving of fuel therefore in the practice of -distillation, which was Mr. Watt’s object in making the experiment, was -quite trifling, and not equal to the trouble of filling the retort with -liquid. - -The doctrine of latent heat thus established, furnished a solution of -many phenomena which could not formerly be explained in a satisfactory -manner. Thus the melting of all kinds of substances was found to be -owing to an absorption of heat, while their condensation was attended -with the contrary. Fluidity in all cases was explained on the same -principle; and the more heat that was absorbed, the more fluid the -matter became. Thus water, when in a condensed or solid state, absorbs -135 degrees of heat before it becomes fluid. A thousand degrees more -convert it into vapour, and at last, by passing through the intense -heat of a glass-house furnace, it is converted into a brilliant -flame, and augments the heat of the furnace to a great degree. Hence -the practice in glass-houses of throwing water into the ash-hole, -the vapour of which, by passing through the burning fuel, makes the -furnace much hotter than it was. In a similar manner were explained -the phenomena of crystallization, the ductility of metals, the heat -produced by hammering them, and the hardness produced by the operation, -as well as the operation of annealing, &c. One other phenomenon, a very -curious one, shall be noticed, on account of its being connected with -the subject of this treatise. It is this: Let a small vessel filled -with vitriolic ether be put into a larger one of water, and both -included in the receiver of an air-pump. On exhausting the air, the -ether boils, and is converted into vapour, while the water freezes. -This shows that heat does not always act equally upon surrounding -bodies, but has a tendency to enter some in preference to others; -and from other experiments it appears, that this property has a -considerable connexion with the density of the bodies concerned. - -Thus one step was gained, and it was universally admitted that heat, -in some cases, entered bodies, and in others was thrown out of them; -but now the question arose, What is heat; and by what laws is it -regulated, or from what source is it derived? Here Dr. Black himself -was at a loss; for, as he supposed _cold_ to be a mere non-entity, -and only to consist in a comparatively smaller degree of heat, some -phenomena occurred which would not easily admit of solution upon such -an hypothesis. With these Dr. Black did not meddle much, but others -were bolder. Dr. Irving, Professor of Chemistry at Glasgow, undertook -to explain the whole mystery of latent heat upon the single principle -of attraction. One of the most puzzling phenomena in the way of Dr. -Black’s theory had been, that in some cases heat and cold seemed to -repel each other, and a very remarkable instance of this was, that, -in the morning, a little before sunrise, when the rays of light pass -through the atmosphere, a little above the surface of the earth, the -air then becomes manifestly colder than even at midnight. Dr. Irving’s -explanation of this was, that the sun’s rays _attracted heat from -the atmosphere_, and thus rendered it colder. Such at least was the -explanation given in an inaugural dissertation by Dr. Cleghorn, one of -Dr. Irving’s scholars; for the Doctor himself delivered his opinions -only to them. In other cases he supposed that different substances -had different _capacities_ for receiving heat; and, of consequence, -should the _form_, or rather the _internal constitution_, of the body -be changed, the _capacity_ of it for receiving heat must also be -changed; and as an attraction subsists, or is supposed to subsist, -between heat and all other substances, it is plain that while this -attraction subsists, if the capacity of any substance for receiving -heat be augmented, it will imbibe much more than it would have done -had its former constitution remained. Thus _water_ in its liquid state -contains a certain quantity of heat; we may therefore say that water -has a capacity for receiving heat equal to one to ten, or what we -please. Vapour has a capacity for containing heat ten times greater -than water. Water therefore, when converted into vapour, will imbibe -ten times the quantity of heat that the water contains; and, again, -on being re-converted into water, the _capacity_ becoming what it was -before, the superfluous quantity must be thrown out, as in Dr. Black’s -experiments. In like manner, when a metal is melted by the fire, the -capacity of it for receiving heat is changed: of consequence a great -quantity is imbibed, and again expelled by the change of _capacity_ -which takes place on its becoming solid; and thus, from the change of -capacity, in different substances, every phenomenon was solved. - -This doctrine of _capacities_ did not give general satisfaction. -Dr. Black himself said of it, that it was neither _probable_ nor -_ingenious_;[75] notwithstanding which, it continued to be received, -and even very generally adopted. Dr. Crawford, so well known for his -writings on this subject, has adopted the idea, and Dr. Girtanner, in -the passage above quoted from him, appears to be of the same opinion. -The doctrine, however, had several opponents, among whom were the -Monthly Reviewers. In their account of Nicholson’s First Principles -of Chemistry, they express themselves in the following manner: “We -only wish, that, in the doctrine of heat, he had avoided, which he -might easily have done, Dr. Crawford’s idea of bodies having different -_capacities_ for heat. In the melting of ice, for instance, a quantity -of heat is absorbed, without any increase of the temperature, that -is, without making the water sensibly warmer than the ice before its -liquefaction; which is said to be owing to the water having a greater -_capacity_ for heat, or being able to _hold more_ of it, than the -ice; and, in like manner, when converted into vapour, its capacity -is further increased, or it can hold more still. This appears to us -a very unchemical, and a very inadequate idea of the matter: for, -admitting water to have a greater capacity than ice, how is the change -from one state to the other to be effected? Can the properties which a -body is found to possess, after a change has taken place, be assigned -as a cause of the change itself? Or will it be said, that the heat -first enlarges the capacity, and then hides itself in that capacity -so enlarged? We should think it much better to say, consonantly with -the phenomena of other combinations in chemistry, that a certain -quantity of heat, uniting with the ice, first _liquefies_ it, as a -certain quantity of acid only neutralizes an alkali; that if any -surplus quantity must be introduced, that surplus, remaining free and -uncombined, must act and be sensible as heat in the one case, and -acid other; and that different bodies require different quantities of -heat or acid to be combined with them, for producing the changes in -question.”[76] - - [75] These words are to be found in the M. S. Copies of his lectures - circulated at Edinburgh. Dr. Black himself never published any thing - to the world upon the subject. - - [76] Monthly Review, for 1790, p. 165. - -Thus the Reviewers, as well as others, reasoned _a priori_, and several -facts were adduced to prove that no such changes in capacity could take -place. But however strong the arguments adduced, or however plain the -experiments might be, little or no notice was taken of them, and the -enlargement or diminution of _capacities_ has been repeated, seemingly -by rote, from one author to another, without the least inquiry or -investigation. Dr. Girtanner indeed says that “the oxygen united with -the arterial blood in the lungs” is the cause of the _great capacity_ -of the arterial blood for heat. But this is assigning a very doubtful -cause for a very doubtful effect. He ought to have proved in the -first place that arterial blood really has this capacity; for its -being _hotter_ than the blood of the veins, only shews that it parts -with more heat to surrounding bodies than venous blood does; which -is a proof that it contains _less_ heat, if there be any difference, -than that of the veins. But the truth is, that the _capacity_ for -containing heat depends neither on the oxygenation nor hydrogenation -of a fluid, but upon its density. The more fluid and the more easily -expansible into vapour that any substance is, the greater quantity -of heat it is capable of containing, and _vice versa_. This has been -fully ascertained by Mr. William Jones, an English clergyman, whose -observations on the generally received system of philosophy contain -many particulars worthy of attention. From his experiments it appears -that a piece of red-hot iron, thrown into water, imparts much less -_sensible_ heat to it, and is itself much more effectually quenched, -than by throwing it into an equal quantity of quick-silver of the same -temperature with the water. As the quick-silver therefore becomes much -hotter to the touch than water does upon throwing a piece of red-hot -iron into it, and as the iron itself is much more imperfectly quenched -by the metal than by the water, it follows that the latter is capable -of containing much more heat than the former. But such experiments -are not applicable to the blood. Though that of the arteries may be -somewhat hotter than the venous blood, yet the reason is obvious. The -heat is communicated directly to the arterial blood in the lungs; but -during the circulation a part of it evaporates, and the farther distant -any part is from the lungs, the more cool will the vital fluid be, -without regard to any alteration of _capacity_, which indeed never can -be shown to exist. - -But the most decisive experiments against any supposed alteration in -the capacities of bodies for containing heat are those lately tried -by Count Rumford, and related in the Philosophical Transactions for -1798. His attention to this subject was engaged by observing the great -degree of heat acquired by a brass gun during the time of boring -it,[77] and still more by the intense heat (much greater than that of -boiling water) of the metallic chips separated from it by the borer. -From a consideration of these things he was naturally led to the -following inquiries. “Whence comes the heat actually produced in this -mechanical operation? Is it furnished by the metallic chips which are -separated by the borer from the solid mass of metal? If this were the -case, then, according to the modern doctrine of caloric, the _capacity -for heat_ of the parts of the metal so reduced to chips, ought not -only to be changed, but the change undergone by them be sufficiently -great to account for _all_ the heat produced. But no such change had -taken place; for I found, that by taking equal quantities by weight of -these chips, and of thin slips of the same block of metal, separated -by means of a fine saw, and putting them at the same temperature, that -of boiling water, and putting them into equal quantities of cold water -(that is to say, at 59-1/2 of Fahrenheit) the portion of water into -which the chips were put, was not, to all appearance, heated either -less or more than the other portion in which the chips were put.” - - [77] Count Rumford was superintendant of boring the cannon in the - workshops of the military hospital at Munich. - -From this experiment, several times repeated with the same result, -Count Rumford inferred, that the heat could not possibly have been -furnished at the expense of the latent heat of the metallic chips. He -then proceeded to ascertain “how much heat was actually generated by -friction, when a blunt steel borer being so forcibly shoved (by means -of a strong screw) against the bottom of the bore of the cylinder, -[of the machine in use] that the pressure against it was equal to -the weight of about ten thousand lb. avoirdupois, the cylinder being -turned round on its axis (by the power of horses) at the rate of about -thirty-two times in a minute.” In this experiment the metallic dust -or scaly matter detached from the cylinder by the borer weighed only -837 grains troy; but, says the author, “Is it possible that the very -considerable quantity of heat produced in this experiment (a quantity -which actually raised the temperature of above 113 lb. of gun-metal -at least 70 degrees of Fahrenheit’s thermometer, and which of course -would have been capable of melting 6-1/2 lbs. of ice, or making near -five pounds of ice-cold water to boil) could have been furnished by -so inconsiderable a quantity of metallic dust, and this merely in -consequence of a _change_ of its capacity for heat? As the weight of -this metallic dust (837 grains troy) amounted to no more than one -948th part of that of the cylinder, it must have lost no less than -948 degrees of heat to have been able to raise the temperature of the -cylinder one degree; and consequently it must have given off more than -_sixty-six thousand, three hundred and sixty_ degrees of heat to have -produced the effects which were actually found to have been produced in -this experiment.” - -It was next considered whether the air did not contribute to the -generation of this heat; and our author determined that this could not -be the case; because the quantity of heat generated was not sensibly -diminished when the free access of air was prevented. From another -experiment it appeared that the generation of the heat was neither -prevented nor retarded by keeping the apparatus immersed in water. Here -the friction generated so much heat, that in one hour the temperature -of the water surrounding the cylinder was raised from 60 to 107 degrees -of Fahrenheit. In half an hour more it was raised to 142; at the end -of two hours to 178; at two hours 20 minutes to 200; and in two hours -and a half it boiled.[78] On the whole, Count Rumford concludes, that -“the quantity of heat, produced equably by the friction of the blunt -borer against the bottom of the hollow metallic cylinder, was _greater_ -than that produced equably in the combustion of _nine wax candles_, -each three quarters of an inch diameter, all burning at the same time -with a clear, bright flame.” From all these experiments, however, our -author does not draw any certain conclusion. “What is heat? (says he.) -Is there any such thing as an _igneous fluid_? Is there any thing that -can with propriety be called _caloric_? The heat produced, in the -author’s experiments, by the friction of two metallic surfaces, was -not furnished by small particles of metal, detached from the larger -solid on their being rubbed together. It was not supplied by the -air, because the machinery in three experiments was kept under water, -and the access of atmospherical air completely prevented. It was not -furnished by the water which surrounded the machinery, because this -water was continually receiving heat from the machinery and could not -at the same time be giving to and receiving heat from the same body; -and because there was no chemical decomposition of any part of this -water.” At last he observes, that the source of this heat, whatever it -is, must evidently be inexhaustible, adding, that “any thing, which -any _insulated_ body, or system of bodies, can continue to furnish -_without limitation_, cannot possibly be a _material substance_; and -it appears to me to be extremely difficult, if not quite impossible, -to form any distinct idea of any thing capable of being excited and -communicated, in the manner the heat was excited and communicated in -these experiments, except it be MOTION.” - - [78] The quantity was two gallons and a quart, wine measure. - -On this last paragraph, however, it is obvious to remark, that the -whole force of the argument rests upon an _insinuation_, that the -cylinder and borer were _insulated_, or cut off from all communication -with any other material substance. Had this been the case, then no -doubt it would follow that an _endless_ supply of any thing _material_ -could not be furnished by them; but if, as Dr. Boerhaave and many other -learned and intelligent persons have supposed, fire be an element -universally present, and which becomes sensible to the touch only in -consequence of a particular mode of action, it will follow, that no -substance in nature can be _insulated_ with respect to it; but, in -whatever place, and for whatever length of time, any substance shall -be affected in such a manner as to agitate this fluid, there we shall -perceive a production of heat _without limitation_, even though heat -itself be no more than the action of a fluid essentially _material_, -though invisible to us. - -Considerations of this kind occurred long ago to the writer of this -treatise, when by the nature of his employment it was necessary for -him to speculate upon these subjects. It could not then but appear -to him that the theory of Dr. Black was far superior to any that had -been published. The opinion of those who supposed fire to consist -in the vibratory motion of the particles of solid bodies, seemed -altogether untenable. It is impossible to explain the phenomena of -heat upon ordinary mechanical principles, because, with respect to -all terrestrial substances, heat constantly appears as an _agent_, -while they are merely _passive_; and no man can explain the nature of -a cause from its effect. Thus one of the most obvious effects of heat -is _expansion_, or enlargement of bulk, in such bodies as are heated. -But if from this fact we infer that the parts of elementary fire are -repulsive of one another, our reasoning is certainly erroneous. In like -manner, when we are not sensible of heat, we are not authorised to -conclude that it is not present; for Dr. Black has demonstrated that it -may be present in very great quantity, though indiscoverable either by -our senses or by a thermometer. - -But, with regard to the theory published by Dr. Black himself, it -is evident that, though one part of it rests on the solid basis of -experiment, the other is founded entirely upon hypothesis, and that too -an hypothesis which cannot admit of being proved by any experiment, -viz. that _cold_ is a mere negative, and hath no real existence in -nature. Among many phenomena which militate against this opinion, the -following experiment of M. Geoffrey seems to be the most remarkable. He -took a small bason filled with water, and set it on a support in the -middle of a large tub of water, in such a manner that the temperature -of the water in the tub might communicate itself to that in the bason. -This being ascertained by a thermometer placed in the bason, he threw -a quantity of burning coals into the tub. The effect of this, on the -supposition that cold is a mere privation of heat, ought to have been, -that the heat of the coals, communicated to the water in the large -tub, would in a short time pervade the small bason, and affect the -thermometer there. The latter would therefore rise; but instead of this -it fell several degrees before it began to rise; for which it doth -not appear that any other reason can be assigned than that the cold -is partly repelled by the heat of the coals, and therefore, entering -into the small bason of water, it causes the thermometer to sink -previous to its rising. To the same purpose we may urge the phenomenon -already taken notice of, viz. that the sun’s rays, when passing at some -distance above the surface of the earth, cool the lower part of the -atmosphere. The natural solution is, that the heat of the sun partly -repels the cold downwards; and as for the doctrine of _attracting_ heat -from the atmosphere, Count Rumford has shown that this does not happen -in a case where we might with much more probability expect it; not -to mention the violence done to the common perceptions of mankind by -supposing the sun’s rays, which are most evidently the source of heat, -to have any occasion to _attract_ heat from the atmosphere or any thing -else. - -Lastly, with regard to the _capacities_ of bodies for containing heat, -the doctrine appears to involve a radical error, of such enormous -magnitude, that it is impossible to make any thing of it. This is no -less than confounding the heat which flows out from bodies with that -which they contain as an essential part of their composition, and which -they cannot emit without being changed into some other form. Thus the -capacity of aqueous vapour for containing heat, according to Dr. Black, -is 1000 degrees; yet without decomposing the vapour it would have been -impossible to have known this; for vapour is often extremely cold to -the touch, and a thermometer immersed in it will sink greatly. In -short, all that we can know about the capacity of bodies for retaining -heat is, that they either continue to absorb it, or we may continue -to force it into them, till they be reduced to vapour. It is doubtful -whether they can receive more; for from the experiment with Papin’s -digester, formerly mentioned, it appears that the additional quantity -of heat, which the water was made to receive, very quickly left it as -soon as the steam had room to expand. - -But, to come to a conclusion upon this subject: If we will investigate -the nature of heat, we must do it as in other cases, viz. by making the -_igneous fluid_, _caloric_, or what we please to call it, the object of -our senses; for we cannot reason fairly, or indeed come to any rational -conclusion at all, by doing otherwise. In this investigation it is -necessary to attend to the particulars mentioned by Count Rumford. The -fluid must be omnipresent in its nature, infinite in its quantity, and -equable, uniform and incessant in its action; as far as these epithets -can be applied to any material being. There are only two fluids which -we know that can answer to these characteristics. The one is the light -of the sun, which pervades all the celestial spaces; the other the -electric fluid, which penetrates every terrestrial substance. Both of -these produce heat, unlimited in quantity, as well as in duration, -provided their action be continually kept up. The mode in which both -produce heat is exactly the same, viz. by converging into a focus; and -the greater the quantity, the greater is the heat, and that without any -limitation either as to intensity or duration. With regard to the solar -rays, it has long been known that by concentration they would produce -heat; nevertheless it was unaccountably doubted whether the rays -themselves were the matter of heat. One objection to this was, that on -the tops of high mountains the air is exceedingly cold, though the sun -shines very bright. But this objection was founded upon an erroneous -notion that, wherever the matter of heat exists, there we must feel it; -which doth not follow any more than that wherever air exists there we -must feel a wind blowing upon us. _Wind_ is air in motion, and _heat_ -is a more subtile fluid in motion. One demonstration of this is, that, -on the tops of the highest mountains, a burning lens or mirror will -set fire to combustible bodies as readily as in the vallies at the -foot of them. Neither has heat, properly so called, anything to do -with air. The focus of a burning-glass will heat bodies _in vacuo_ as -well as in the open air; and Sir Isaac Newton has observed, that if a -thermometer be included in the vacuum of an air-pump, it will acquire -the temperature of the room nearly in the same time that another will -when included in a similar glass without any exhaustion. - -The science of electricity is but of late date; and most violent and -hypothetical disputes have taken place concerning the nature of the -fluid. Its luminous and burning properties naturally led a number of -people to suppose that it was elementary fire; but this was opposed by -others with as much violence as if there had been something criminal -in the supposition. The opposition, however, was founded upon the same -error with that about the solar light. It was imagined that wherever -elementary fire existed, there heat must be felt; and it was especially -urged, that electricity, though it produced light, did not produce -any heat, except when it exploded with such violence as to penetrate -the internal substance of bodies, agitating their particles, and by -this agitation producing heat. It has now, however, been found, that -the electric _aura_, as it is called, when made to converge in great -quantity to the point of a needle, will heat it to such a degree as -to set fire to gun-powder. This shows that heat is occasioned by the -convergence of this fluid to a focus, and to its divergence from it. In -the focal point, heat will always take place. From the experiments of -Hauksbee, Beccaria and Priestley, it likewise appears, that electricity -will render transparent the most opaque bodies, such as sealing-wax, -pitch, &c. which even the most intense light of the sun cannot do. As -to the intensity of the heat produced by it, experiments have shown, -that it cannot be exceeded even by that of the most powerful mirror. -Globules of gold have been vitrified, platina melted, and the most -infusible substances reduced to glass, by means of the electric shock. -From so many evidences, therefore, it appears to me impossible to -conclude otherwise than that the light of the sun and the electric -fluid are the same thing; and, according to the different modes in -which they act, they produce the phenomena of heat and light in all -their varieties, besides a multitude of other effects of which we -cannot have any perception. We may indeed, if we please, suppose that -some other thing exists which is heat itself, and that the light or -electric fluid sets in motion, attracts, repels, or acts otherwise upon -this unknown something; just as it comes into our heads to fabricate -our system. But, until our senses can discover in some way or other -this hidden substance, _reason_ will always suggest that it has no -existence. We may say that without such a supposition we cannot solve -the phenomena of heat. But do we ever expect to solve these phenomena; -or do we know all that the solar light and electric fluid can perform? -If we do not know what they _can_ do, neither do we know what they -_cannot_; and the invention of other fluids must be accounted not only -chimerical but useless. - -But, to be more particular: on the subject of heat people have -embarrassed themselves more with philosophical reveries than by any -real difficulty, and rendered the matter more obscure than nature -has made it. We have already observed, that by the convergence of -light, or of electricity, heat is always produced. Here we can see the -mode in which the fluid acts, viz. first by _converging_, and then -_diverging_. When the light falls upon a solid body, it is evident, -that if it be allowed to flow out as easily as it flows in, no internal -agitation of the parts, or of any fluid contained in them, can take -place. Transparent bodies therefore are never heated. Again, if the -light be not allowed to enter the substance of a body, but is entirely -reflected, the body cannot be heated; and hence it is very difficult -to melt a polished metal even by a strong burning-glass. M. Macquer’s -burning mirror, which vitrified flints, could not melt silver. But, -when the light falls upon a body capable of allowing it to enter its -substance, at the same time that it cannot get out without difficulty, -it is plain that the force of the fluid will be exerted in order to -overcome that difficulty; the body will be expanded in all directions; -the fluid will be thrown out in the same manner, and the more that -the internal action of the light prevails over that power by which -the parts of the body cohere, the more will the phenomena of heat be -perceptible. - -Again, let us suppose that the etherial fluid enters the substance of -any body capable of being dilated to a great degree, it is equally -plain that the action of the fluid must for some time be directed only -upon the internal parts, and consequently will be imperceptible on the -outside. This then is called _latent_ heat; and where the pressure on -the outside balances that on the inside no heat will be perceptible -to the touch. But by whatever means this balance is broken, heat will -instantly be perceptible; and experiments show that the balance may -be broken either by an increase of cold or heat. Thus, in the case -of water, the internal pressure remains equal to the external, until -the fluid is cooled to a few degrees below 32. The balance is then -broken, and the internal action prevails; a quantity of what is called -_sensible_ heat escapes, and the water is converted into ice. Again, at -the temperature of 32, little or none of the water evaporates; but by -the addition of heat, by which the internal action of the subtile fluid -we speak of becomes greater than the external, the water is converted -into vapour; and it is remarkable that the same effect takes place on -greatly augmenting the degree of cold; for the evaporation from ice, -even in frosty weather, is found to be very considerable. - -On the whole, from innumerable experiments it appears, that there -exists in nature a certain invisible fluid, by the action of which, -when diverging from a centre, heat is produced in the central point. -By a certain other power this diverging force is limited, so that in -some cases it is not perceptible beyond the surface of the body in -which it acts, and then it is called _latent_ heat. In other cases -it is perceptible in a certain degree, and the degree in which it is -perceptible hath been called the _temperature_ or _sensible heat_ -of the body. On mixing different substances together it is found, -that very often the proportions between the external and internal -actions are varied. This has been already observed, when giving an -account of Dr. Black’s discovery of _latent_ heat, viz. that when -snow and warm water are mixed together the temperature of the mixture -differs very considerably from the arithmetical mean between the -temperatures of the two substances employed. Dr. Crawford prosecuted -the experiment further, and found that there were few substances -which, on being mixed, did not shew a temperature different from -that of the arithmetical mean between the temperatures of the two -originally employed. This difference he unfortunately used as the -foundation of a rule for determining the _capacities_ of different -substances for containing heat, and upon this erroneous principle has -raised a superstructure, which upon no occasion can be of service to -science, but must always produce obscurity and confusion wherever it is -introduced. - -With regard to the power which sets bounds to the expansion of the -fluid acting as heat, it is natural to think that it can be no -other than the same fluid acting in a contrary direction, or from a -circumference towards a centre; and thus we shall always find that the -same fluid, by limiting its own operations, may produce those phenomena -which have been hitherto deemed so difficult of explanation. In what -manner this limitation is in all cases effected, or indeed in any -case, we cannot pretend to explain. It is sufficient to observe, that -wherever there is a perpetual _efflux_ of any thing, there must be -also a perpetual _influx_ at the same time, and in proportion to the -one the other will be. These two are directly contrary to one another, -and, as we suppose the fluid to be universal, it is evident, that if -any part of it be put in motion in a particular direction, the rest -will press towards that part where the motion is, in order to keep up -the equilibrium. Hence we may easily account for the heat produced by -percussion or by friction. By hammering a piece of iron, as Dr. Black -justly observes, the fluid is forced out from between the parts of the -metal. The emission of this fluid in all directions is heat itself; -and no sooner is one quantity thrown out than another supplies its -place with great rapidity, and so on, until the pressure of the rest in -some way or other counteracts the emission of any more, and the heat -ceases. Just so with friction. The heat produced by it is always in -proportion to the pressure employed. By this pressure the parts of the -two substances are forced into such close contact, that an agitation -and emission of the fluid pervading their substance takes place. This -agitation, as we have already noticed, is heat itself, and, as long as -the friction is continued, more and more heat will be produced, without -any limitation, as Count Rumford has observed. - -Some bodies have a greater disposition than others to emit this subtile -fluid; and these we say are naturally of a warmer temperature than -others. The _temperature_ is nothing else than the efflux of the fluid -from them, continually kept up by the action of the surrounding fluid. -By mixture with different substances the temperatures of various bodies -may be changed; by some the influx, and by others the efflux, may be -augmented. In the former case we say the body becomes colder, in the -latter hotter, than before; and in not a few cases the agitation of -the fluid becomes so great that the matter actually takes fire. In all -these cases, however, we can discover nothing more than the bare fact, -that so and so is the case. We know that the bodies do grow hot by the -convergence of the etherial fluid towards them, and its emission from -them; but why it should converge or diverge we know not. - -Thus much with regard to heat in general. We must next consider another -fluid which has very generally been accounted the source and fountain -of heat, viz. _air_. This is indeed so much the source of heat in all -our operations, that it was natural to think it the only one; but -experiments have now determined that air itself is a mere creature of -heat and light;[79] for, by employing these in a proper manner, airs -or gases of all kinds have been produced. Thus, by exposing water in a -glass vessel for some time to the rays of the sun, a quantity of very -pure oxygen air may be obtained; by concentrating the sun’s rays upon -charcoal, inflammable air may be had; and by distilling, with a strong -heat, substances of various kinds, we may obtain a great variety of -aerial vapours. From all this we may reasonably conclude that heat, -attached to some other substance, dissolved in it in such a manner as -to become invisible, forms the substance of air. Heat therefore being -the agent in the composition of air, it is reasonable to suppose that -it is the agent in its decomposition also, or in its transformation -from one species to another, of which the conversion of oxygen into -fixed air by combustion is an instance. When air is taken into the -lungs the blood is warmed by the action of that invisible fluid, -which has already given elasticity to the air. In consequence of a -considerable quantity of this fluid being then converted from a latent -into a sensible state, part of the elastic principle must be lost, and -the air diminished in bulk. The reason why this must constantly take -place is, that part of the heat evaporates from the surface of the -body, during the course of circulation. Were it not so, the quantity -thrown out by the lungs would be exactly equal to that which the blood -received, and consequently there could be no diminution between the -bulk of the air expired and that which was inspired; but, on account -of the waste just mentioned, the blood must always receive somewhat -more than it gives out by the breath. Thus, while the air we breathe -continues the same, and the organization of the body is not changed, -the natural operations will go on smoothly, and health will continue; -but, as we have formerly observed, by an alteration of either of these, -disease must ensue; and we must now endeavour, from the principles laid -down, to examine the mode in which epidemic diseases, and particularly -the plague, may be produced. - - [79] Dr. Priestley thinks water is an _essential_ in the composition - of air. - -The air is so evidently connected with human life, that it has been -from the earliest ages accounted the source of pestilential diseases, -though, as none of the more obvious qualities of it, such as heat, -cold, moisture, or dryness, appeared to be connected with them, they -were generally supposed to proceed from the action of some unknown -natural cause, or from that of the Deity himself. Some, however, have -also been of opinion that plagues might originate from the obvious -qualities of the air in conjunction with certain effluvia from putrid -vegetable or animal bodies. Thus, in several plagues mentioned in -ancient history, we find swarms of dead locusts, grasshoppers, the -carcases of those slain in battle, crowded houses, and filth of all -kinds, assigned as causes. This opinion was adopted by Dr. Mead, -and he gives the following account of the origin of the plague in -Egypt. “Grand Cairo is crowded with inhabitants, who for the most -part live very poorly and nastily; the streets are narrow and close; -it is situate in a sandy plain, at the foot of a mountain, which, by -keeping off the winds that would refresh the air, makes the heats very -stifling. Through the midst of the city passes a great canal, which is -filled with water at the overflowing of the Nile; and, after the river -decreases, is gradually dried up: into this canal the people throw all -manner of carrion, filth, &c. so that the stench which arises from -this and the mud together is insufferably offensive. In this posture -of things, the plague every year preys upon the inhabitants, and is -only stopped when the Nile, by overflowing, washes away this load of -filth; the cold winds, which set in at the same time, lending their -assistance by purifying the air.” He then proceeds to account for the -plagues in Ethiopia in the manner above related, viz. by the prodigious -swarms of locusts, which sometimes occasion a famine by devouring the -fruits of the earth, and, when they happen to be cast by the winds -into the sea, occasion a pestilence; the putrefaction being heightened -by the intemperance of the climate, which here is so great that it is -infested with violent rains for three or four months together; and -it is particularly observed of this country, that the plague usually -invades it whenever rains fall during the sultry heats of July and -August. He next takes notice of what the Arabians say of the origin -of the plague in Ethiopia, viz. that it is brought on by unseasonable -moistures, heats, and want of winds. But, whatever truth may be in the -account given of the Ethiopic plagues, the testimonies already produced -in this treatise are sufficient to render it very doubtful, at least, -whether the plague ever does originate in Cairo, or any other place -in Egypt. Besides, if we once admit the existence of any thing as a -cause adequate to the production of a certain effect, wherever that -cause exists the effect ought certainly to follow, unless where we -plainly perceive something which prevents its action. It is not fair -reasoning to say that the action of the cause is prevented by something -unknown, for we might as well say that this unknown something is the -cause originally, and acts only upon certain occasions, of when it -thinks proper. Now, if the filth of the canal of Cairo be the cause of -the plague in that city, it ought to recur annually at the season when -that filth exists in greatest quantity, and in the most putrid slate. -Nevertheless we have the express testimony of Mr. Eyles Irwin, that at -the time he was in Cairo there had not been any plague for seven years. -The account he gives of it is a kind of contrast to that above quoted -from Dr. Mead. “_Misir al Kaira_, says he, or the _City of Anguish_, so -called from the frequent visits which it has received from the plague, -but commonly called _Grand Cairo_ by us, is situated in lat. 30 degrees -3 minutes N. on an artificial branch of the Nile. Old Cairo nearly -faces the river; but the new city is removed above a mile from it, and -approaches to the range of mountains which runs through Upper Egypt, -and abruptly breaks off here. It is undoubtedly one of the finest -cities in the east; which, from the present style of architecture that -reigns among the orientals, is but a faint commendation. The houses -are in general built of stone, and, being elevated to several stories, -would make a grand appearance, notwithstanding the inelegance of their -structure, were not the effect destroyed by the excessive narrowness -of the streets. This is one of the causes to which the ingenious Dr. -Mead ascribes the birth of the plague in this capital; but experience -evinces that it arises from _foreign and adventitious_ causes. _There -has not been a plague here these seven years_; which is rendered more -remarkable by the commencement of the Russian war at the date of its -cessation. No one can account for this; though a year seldom passed by -before without a visit from it.”[80] - - [80] Irwin’s Voyage up the Red Sea p. 335. - -From this it plainly appears, that, however these putrid effluvia may -concur with other circumstances in producing the plague, they are by no -means the _only_ cause; otherwise not a single year could have passed -in Cairo without a pestilence; and the very same thing we shall find -to hold good in every other, let us choose for a cause what we will. -In order to investigate this matter fully, we must now consider what -causes have been assigned by physicians for other epidemical diseases; -and here, to avoid prolixity, we shall chiefly confine ourselves to -those enumerated by Dr. Fordyce as the causes of fever; a gentleman -whose very extensive experience must give the greatest weight to his -testimony.[81] The principal causes assigned by him are, - - [81] At the time of writing his treatise Dr. Fordyce informs us, that - he had been “for upwards of twenty years one of the three physicians - of St. Thomas’s Hospital (in London) whose walls have contained - nearly four thousand patients every year, where the proportion of - fevers to other diseases is much greater than the general proportion.” - -1. _Infection_, or “a peculiar matter generated in the body of a man in -fever, which is carried by the atmosphere, and applied to some part of -the body of a person in health, and which causes fever to take place -in him.” That such a cause exists, he proves from observing that “of -any number of men, one half of whom go near a person ill of a fever, -and the other half do not, a greater number of the former will be -infected, in a short period afterwards, than in those who do not.” He -says he has known, in such circumstances, seven out of nine infected -with the disease. This infection is not discoverable by smell or any -other organ of sense; neither can the greatest attention to cleanliness -disarm it of its malignity. Of this the Doctor says that he has known -instances; nay, of a person going into a room where a feverish patient -was, and bringing with him the infection, which was communicated to -others in the room to which he came. He owns, however, that by allowing -the air to stagnate in which feverish patients are, the infection will -become extremely violent and fatal. This may naturally be supposed, -even without having recourse to putrid effluvia; because, independent -of these, the imperceptible infectious matter itself will undoubtedly -be accumulated in the atmosphere of the room, and act more powerfully -than it could have done had it been partly carried off and diluted by -attention to cleanliness and ventilation. He also says, that “when a -number of persons live in a small space, supposing even that they are -kept as clean as possible, it happens frequently that fever arises in -some, often in many of them. It has been in this case supposed, and is -extremely probable, that some peculiar species of matter is _produced_, -capable of producing fever, on being applied to the body.” - -2. _Effluvia from putrid animal or vegetable matters._ Of this our -author seems to be less fully ascertained than of the former, as he -does not say that he has observed any instances of fevers arising from -this cause; and he concludes by observing that “either the cause of -fever, consisting of matter produced in the body of a person affected -with this disease, seems probably different from that produced by -putrefaction, or might be generated without any putrefaction taking -place.” - -3. _Cold._ Our author “is not disposed to allow that sudden exposure to -cold occasions fever to take place, unless some symptom of the disease -follows immediately. If a man had been suddenly exposed to cold, and -continued in perfect health for _twenty-four_ hours, the author would -never allow that fever, or any other disease, was occasioned by it. -In this case (exposure to cold) the evidence is much stronger than in -that of infection; for the author (Dr. Fordyce) has seen many instances -where, from exposure to cold, the commencement of the attack was -instantaneous; and many are to be found in the records of medicine.” - -4. _Moisture._ On this subject the Doctor observes, that the -application of water to the body is not a cause of fever, unless the -air has particles of water floating in it; in which case fever has -ensued more frequently than in other cases. Water may exist in the -atmosphere in three states. 1. In small drops suspended in it like -dust in water. 2. In vapour. In this case the transparency of the air -is not impaired, and a _chemical_ combination, as it is called, between -the air and water takes place. If the atmosphere be hot or dense, it is -capable of combining chemically with a larger proportion of water. If -therefore the atmosphere should in this manner be saturated with water, -at any particular degree of heat or density, by diminishing either of -these the vapour will be condensed, and the water reduced to the former -state of suspension in small particles. 3. Water, heated to the boiling -point, emits a steam, which combines chemically with the atmosphere, -till the latter be saturated, after which it assumes the form of small -particles; and _this last is the only state_ which has been found to -produce fever. - -Moisture will also produce fever when applied to the body by wearing -wet clothes. Those which imbibe or part with heat most slowly, are -least apt to produce fevers on being heated. The warmer the atmosphere, -the more liable people are to fevers from moisture. - -It has been observed, that moisture from marshes, stagnating canals, or -where the water runs very slowly, is more apt to produce fevers than -what proceeds from the sea, lakes or rapid rivers. “This (says the -Doctor) has given occasion to suppose that some other vapours proceed -from such marshes beside water, and produce the disease. It certainly -often happens, that a considerable degree of putrefaction takes place -in marshy grounds, and more especially in warm climates; but it is -by no means to be concluded that moisture in the atmosphere always -produces fever in consequence of putrefaction. Putrefaction can only -take place in vegetable or animal substances. If water therefore, not -impregnated with either, should be in such a situation as to produce -moisture in the atmosphere, no putrefaction can take place; therefore, -if fevers ensue, they are certainly in consequence of moisture, not -putrefaction. Many instances of this may be brought, as in the war -which took place in Flanders, between the tenth and eleventh year of -the present century, an army encamped upon sandy ground, in which -water was found in digging less than a foot deep, and occasioned a -great moisture in the air, which produced in a few days numbers of -fevers, although the army was perfectly healthy before, and no more -fevers were produced on shifting their ground. There are a vast many -other instances of the same thing having taken place. Besides, fever -has often arisen immediately in persons sitting in rooms, the floors of -which had been just moistened with pure water.” - -5. _Certain kinds of food._ On this Dr. Fordyce observes, that, though -food of difficult digestion undoubtedly produces a number of diseases, -he has never seen it productive of fever excepting once. Dr. Girtanner -relates, that the emperor of Germany, having forced a number of his -subjects to serve as soldiers, and sent them into an unwholsome part -of Walachia, where he fed them with a kind of paste made of bread and -water instead of meat, many of them died of the scurvy. The Doctor, -however, does not ascribe this to any positive cause, but to three -_negatives_, viz. the abstraction of the stimulus of _nutriment_, by -feeding on the paste just mentioned; of the stimulus of _oxygen_ in the -corrupted atmosphere of Walachia; and lastly of the _nervous stimulus_, -the most powerful of all; the greatest part being engaged by force -against their will. This corroborates what Dr. Fordyce has said, that -bad food is very seldom the cause of fever; for among so many, who used -the _imperial_ paste just mentioned, some would certainly have been -affected by fevers, had it been capable of producing them; but, as it -did not, it is most evident that the deficiency of _stimuli_ is not the -cause of fever. - -6. _Passions of the mind._ These are looked upon by Dr. Fordyce to -be among the less frequent causes of fever, though it is certain -that they have been productive of multitudes of diseases, and even -of sudden deaths; and Dr. Falconer, in his Prize Dissertation, -ascribes to the passions very considerable effects in fevers, and -even in the plague itself. “Contagious fevers (says he) afford -strong instances of the influence of mental affections, both as -prophylactics and remedies. The plague is a remarkable example, and -the same reasoning extends to other disorders of a febrile, contagious -nature. Fear, it is well observed by Dr. Cullen, by weakening the -body, and thereby increasing its irritability, is one of the causes -which, concurring with contagion, render it more certainly active, -which he ascribes to its weakening effect on the body, by which its -irritability is increased. Against this therefore he directs the mind -to be particularly fortified, which is best done by giving people a -favourable idea of the power of preservative means, and by destroying -the opinion of the incurable nature of the disorder, by occupying the -mind with business or labour, and by avoiding all objects of fear, as -funerals, passing-bells, and any notice of the death of particular -friends. Even charms might be used with good effect, could we promote -a strong prepossession of their efficacy, either by the confidence -they inspire, or by their engrossing the attention of the mind. -It is no less certain, that a studious regard to promote hope and -confidence in recovery, is equally necessary for the cure as for the -prevention of such disorders. We know that contagious fevers have a -peculiar tendency to diminish the energy of the brain, and of course to -debilitate the whole system; and that this is especially the case with -the plague, which produces the most considerable effects in weakening -the nervous[82] system or moving powers, and in disposing the fluids -to a general putrescency; and Dr. Cullen is of opinion that to these -circumstances, as the proximate causes of the plague, regard should -chiefly be had, both for the prevention and cure of this disorder. -It must therefore be highly necessary, during the course of this -disease, to attend to the support of the spirits, as on these the vital -principles greatly depend; and they can by no means be so effectually -kept up as by inspiring a confidence of recovery.” - - [82] “An intense head-ach, uncommon giddiness, and a sudden loss of - strength, were the first complaints of those who were seized with - this distemper.” - - (Russel on the Plague at Aleppo, p. 230.) - -Dr. Zimmerman presents us with a great number of examples of the -influence of the passions in producing diseases, or death itself; some -of the most remarkable of which follow. “All the passions (says he) -when carried to excess, bring on very formidable diseases. Sometimes -they occasion death, or bring us at least into imminent danger. The -most reputable physicians agree in opinion that terror may occasion -apoplexy, and death; and indeed they consider apoplexy as the most -common effect of violent passion. Without being carried to excess, a -passion will sometimes occasion a difficulty of breathing, together -with a sense of stricture in the breast, and an hesitation to speak; -the tongue remaining as it were immoveably fixed on the palate. -Hysterical and hypocondriacal affections are sometimes the effects -of grief in the most healthy people. Joy is much more dangerous to -life than sudden grief. Sophocles died through joy at being crowned -on account of a tragedy he had composed in his old age. The famous -Fouquet died on being told that Louis XIV had restored him to -liberty. The niece of the celebrated Leibnitz, not suspecting that a -philosopher would hoard up treasure, died suddenly on finding under -her uncle’s bed a box containing sixty thousand ducats. Violent anger -has sometimes produced hæmorrhages and subcutaneous extravasations; -or, some vessel of the brain being ruptured by these transports, a -fatal apoplexy has taken place. There have been instances of excessive -anger being succeeded by epilepsy, colic, or a violent degree of -fever. Sometimes it has occasioned an increased flow of bile. In some -this produces vomiting; in others it goes off downwards, and causes -diarrhœa; or being retained, from a stricture of the gall-ducts, will -perhaps be absorbed, and occasion jaundice. In cases where anger has -been succeeded by extreme grief, obstructions have taken place in the -liver. The effects of terror are similar to those of anger, but in -general more violent. Sometimes excessive terror seems to give to men -a preternatural strength, as is the case with madmen and drowning -persons. In some cases it has not only excited immediate convulsions, -but caused them to return periodically. Fear has been said to make the -hair stand upright, and to contract the pores from which the hairs -issue in the same manner as cold does. There are instances in authors -even of the colour of the hair being changed by excessive fright. -Philip V died suddenly on being told that the Spaniards had been -defeated, and, on opening him, his heart was found ruptured. Timid -people are more liable than others to fall sick. A firmness of mind is -one of the best preservations against contagion. Willis has very well -observed, that they who fear the small-pox the most are generally the -first to be attacked with it. Cheyne assures us that fear is extremely -prejudicial in all epidemical diseases. Dr. Rogers remarks, that fear -constantly increases the ravages of a contagious disease. Rivinus -attributed the propagation of the plague at Leipsic wholly to fear. The -French physicians, who wrote on the plague at Marseilles, went so far -as to deny its being contagious, and ascribed its propagation chiefly -to fear.” - -As for the cause of the plague itself, Dr. Fordyce supposes it to be -produced by an infection of a particular kind. That which takes place -in Syria and Egypt, he says, has only been clearly described by Dr. -Russel; and it cannot be gathered from the accounts whether this may -be originally produced without having been propagated as the first -class of infections above mentioned are. “That disease (says he) called -the plague, which ravaged this country (England) on considering the -histories of the disease, seems to have been a _fever_,[83] produced by -infections of the first class which have been enumerated.” Dr. Moore -has given an account of the origin of a plague, which, if it could -be depended upon, would decide the question concerning the origin of -this dreadful distemper without previous infection. This passage is -extracted from the History of the Royal Medical Society for the years -1777 and 1778. “Dr. Mitchell, physician to the hospital at Smyrna, -appears, according to a memoir of which he is the author, sent by M. le -Baron de Tott to the Medical Society to believe in the spontaneity of -the plague (or that it arises of itself without any predisposing cause -in the body) for proof of which he cites the following circumstance: -A solitary shepherd, having no communication with any body, fell sick -while he was tending his flocks; he went into an inhabited part, where -he communicated the plague with which he found that he was attacked. -This circumstance would prove much, if it was certain that the shepherd -had no communication with others; if it were known how long, and with -what precaution, he had been secluded from company: but the proofs of -these are too difficult to be established to allow of any conclusion -to be drawn from the fact. We are obliged therefore to acknowledge [it -to be a doubtful matter] whether it is in fact a country that is the -cradle of the plague; what country this is, supposing that such an one -exists; or, finally, whether it sometimes appears spontaneously, and -whether the first whom it attacks becomes the focus from whence it -emanates.” - - [83] This is expressly denied by Dr. Hodges, who had innumerable - opportunities of seeing the distemper. - -Dr. Fordyce, in treating of the origin of fever, seems inclined to -think that it may arise without any predisposing cause; and after -having enumerated the various causes already mentioned, and fully -considered them, gives it as his opinion, that “there must undoubtedly -be other causes than those which give occasion to the disease, but -which are at present _totally unknown_.” In like manner Dr. Moore, -speaking of the nervous fever, sums up what may be known concerning -the cause of it in the following words. “Upon the whole, we know that -people of delicate, exhausted and sickly constitutions, and those whose -minds are saddened by depressing passions, are greatly predisposed -to this disease, the immediate seeds of which, we also know, may be -generated in places where human effluvia are collected and confined. -And this is the most essential part of our knowledge respecting -the cause of this disease; and even this little is disturbed with -uncertainty: for we sometimes meet with instances of people of _robust -constitutions_, who are seized with the disease in all its malignity, -when they are under no _depressing passion_, when the disease is _not -epidemic_, to whom we cannot trace it from any place where the human -effluvia could be confined in any uncommon degree, or from any person -in the disease, of which perhaps there is no other person ill in the -neighbourhood for several miles round; and, in short, when we cannot -connect it with any of the causes supposed to be the sources of the -distemper. On extraordinary occasions of this kind we have nothing -for it but to suppose that, notwithstanding the apparent vigour of -the patient, his body has been peculiarly predisposed to catch the -infection, and that some contagion, not forcible enough to infect any -other person, has by some means, unobserved, been conveyed to him; or, -if so many suppositions displease, we may suppose at once that there -is in some cases a source of this fever which has not been suspected. -For, although the numerous observations that have been made give us the -strongest reason to think that human effluvia produce this disease, -we have no right to infer that it cannot arise also from some other -source.” - -To the same purpose I subjoin the very respectable opinion and -testimony of Dr. Patrick Russel. “In some epidemical distempers, the -sudden alternations of the air have constant and manifest influence; in -others, though the influence of the air must be equally admitted, it -seems not to depend on sensible alteration or succession in the common -properties of the atmosphere, but on some _inexplicable_ combination, -some _occult, new, unknown_ quality. Amongst epidemics of this last -kind must be reckoned the plague.... Should ever that state of the -air, without the concurrence of which the contagion of the pestilence -never spreads, or ceases to act, be discovered, and ascertained by -unequivocal marks, the dread of the plague, universally prevalent, -would be greatly diminished; more effectual means of preservation would -be found out, and the application of them might safely be limited to -certain seasons. - -“Experience in Turky, where, generally, no precautions are taken in -the times of pestilence, clearly evinces, that, in a certain state -of the air, a communication with infected places may subsist without -any material consequence. The return of the plague at Aleppo happens -at irregular periods; the intervals are of considerable, but unequal, -length; and in those the commerce with Egypt, Constantinople and -Smyrna remains uninterrupted. In the intervals between 1744 1760, and -from 1762 to 1780, the plague raged several times in the places now -mentioned, without affecting Aleppo; and even in two or three years -subsequent to 1762, though it was at Marash, as well as other places -not far distant, with which Aleppo has continual intercourse, no -instances were discovered of communicated infection: if such happened, -they must have escaped my utmost vigilance; and the daily exercise of -my profession led me to be very much among the natives of all ranks. At -the same time I have reason to suspect that infected families from some -of those places took refuge in Aleppo; and I know, with certainty, that -not only some merchants of that city, who happened to be at Marash when -the plague broke out there, returned to their families in the summer of -1763, but that caravans of various merchandise arrived in the course of -the same summer. - -“I consider it therefore as an established fact in the Levant, that -commerce and intercourse with infected towns is sometimes attended -with no bad consequence. The same thing may perhaps be asserted, -without restriction, of all countries; but till the signs indicating -a pestilential constitution be ascertained, no particular year can -be declared exempt from danger. Predictions founded on _planetary -conjunctions_ have been long exploded; and signs derived from the known -properties and alterations of the air, are almost equally fallacious. -The seasons concomitant with plagues in England, as well as elsewhere, -have been very dissimilar; and the same visible concurrence, usually -deemed pestilential, has often, in the revolution of years, been -observed to return, in various countries, without producing the dreaded -consequences. Upon the whole, from all I have been able to collect, -the pestilential constitution seems hitherto to be known only from its -effects; _neither its approach nor its retreat can be predicted and its -nature remains wrapped up in_ MYSTERIOUS DARKNESS.” - -Having thus seen, that, of the causes commonly assigned for epidemical -diseases, not one can be accounted certain and determinate, it now -remains to consider one more, and that is - -_Contagion._ Though this has been generally accounted the same with -_infection_, yet by some it has been reckoned otherwise; and indeed -there seems to be a necessity for such a distinction; for, though we -should prove, ever so clearly, that a disease once communicated to one -person should from that person be communicated to another, yet the -difficulty is to know from whence the first person had it. This source, -if any such can be found, is what we may with the greatest propriety -distinguish by the name of _contagion_, and is the sense in which it -shall for the future be used in this treatise, the matter communicated -from one person to another being always called _infection_. This -indeed differs from what many celebrated physicians have said upon the -subject; but the distinction certainly must exist. Dr. Cullen speaks -rather indistinctly upon the subject. “We have supposed that _miasmata_ -are the cause of intermittents, and _contagions_ the cause of continued -fevers, strictly so named; but we cannot with propriety employ these -general terms. The notion of _contagion_ properly implies a matter -arising from the body under disease, _miasma_, a matter arising from -other substances. But, as the cause of continued fevers may arise -from other substances than the human body, and may in such cases be -called a _miasma_, and, as other miasmata also may produce contagious -disorders, it will be proper to distinguish the cause of fevers by -using the terms _marsh_, or _human_ effluvia, rather than the general -ones _miasma_, or _contagion_.” - -From this it is not very easy to determine what the Doctor means when -he speaks of _specific contagion_ as the cause of the plague. Dr. -Russel plainly ascribes it to human effluvia. “The plague (says he) is -a contagious disease; that is, an _emanation from a body diseased_, -passing into one which is sound, produces, in time, the same disease,” -&c. There must, however, undoubtedly have been something originally -distinct from the human body which gave rise at least to the _first_ -plague that was in the world; and some plagues recorded in history are -said to have arisen in this way. Thus, Ammianus Marcellinus says that -the plague which broke out in the Roman army in the time of Marcus -Aurelius arose from a pestilential vapour confined in a golden coffer -dedicated to Apollo. Upon opening this, the _contagion_ diffused -itself all around, and the _infection_ spreading from one to another, -produced an almost universal pestilence. Ammianus indeed is the only -historian who relates this; another account of its origin is given, -p. 14, but whether we believe the account of Ammianus or not (which -indeed does not appear probable) it is sufficient to show what were -the received opinions at the time. In like manner every one has heard -of pestilential effluvia breaking out from the earth, from graves, -&c. so that we certainly look upon this doctrine of _contagion_ as -the cause of diseases to have been pretty generally received. We are -also informed by Dr. Mead, from M. Villani, who wrote the history of -those times, that the great plague of 1346 began in China, where, -according to the report of some Genoese sailors, it was occasioned -by a great ball of fire that either burst out of the earth, or fell -down from heaven. This is thought incredible by Dr. Mead, and no doubt -is so, but it shows the general opinion, that the original cause or -_contagion_ which produces a plague is distinct from the _infection_ -which is afterwards communicated from one to another. In the French -Encyclopedie, we have this account of the ball of fire, or fiery -vapour, without any comment. - -As to the opinion of pestilential vapours arising out of the earth, -though we are assured that people have been suddenly killed by -explosions, probably of the electrical kind, or by lightning issuing -from under their feet, yet we are not furnished with any well -authenticated accounts of a _plague_ having arisen from any such cause. -About 19 years ago a violent fever raged epidemically through a small -district in the north of Scotland, which was said to have originated -in the following manner. Some young men having heard that a certain -place in their neighbourhood had, in the time of a plague been a -burial ground, took into their heads to dig into it. They did so, and -one of them immediately fell sick, but recovered. The father of two -of the young men, exceedingly displeased at the conduct of his sons, -and apprehensive of the consequences, filled up the hole they had dug -in the ground, soon after which he fell sick and died, and the fever -continued to rage in the neighbourhood for some time. The mother of -another of the parties concerned also died, and boils broke out on -various parts of the bodies of the sick. This was the account given in -some of the news-papers of the time, and had the matter been thoroughly -investigated and attested, would have been decisive in favour of -pestilential contagion being capable of taking up its residence in the -earth. As it stands at present, it can only draw our attention to what -may happen in another case, should any similar one occur.[84] - - [84] Though the writer of this Treatise was not at that time on the - spot where this event took place, yet he has as good evidence as any - one can have of what has not fallen under his immediate inspection, - that these graves were opened, that the father of one of the young - men died; and the mother of another, and one of the young men himself - was taken ill with the eruption of boils on some parts of his body; - but whether there was any person previously affected with fever in - the neighbourhood from whom it might have been derived, or any thing - which might have strongly predisposed those people to it, is unknown. - It is indeed no easy matter to discover who was the first person - affected with an epidemic, as no body chooses to own that either - they, or any of their relatives were the authors of mischief, however - involuntary, to the community. M. Chaptal, however, in his Elements - of Chemistry, has some curious, as well as useful observations on the - propriety of burying bodies in a sufficient space and at a sufficient - depth; and on the accidents which may arise from opening vaults - and burying grounds. An instance of this he gives of the ground of - a church in Paris being dug up, which emitted a nauseous vapour, - affecting several people in the neighbourhood. - - From M. Chaptal’s observations it appears, that bodies do not soon - dissolve in such a manner as to emit no disagreeable or noxious - effluvia, when buried. M. Becher, he says, “had the courage to make - observations during the course of a year upon the decomposition of - a carcase in the open air. The first vapour which rises, he says, - is subtle and nauseous: some days after, it has a certain sour and - penetrating smell. After the first weeks the skin becomes covered - with a down, and appears yellowish; greenish spots are formed in - various places, which afterwards become livid and black; a thick - glosey or mouldy substance then covers the greatest part of the - body: the spots open and emit a sanies.” In such as are buried the - decomposition is much more slow; our author thinks _four times_ at - least. According to M. Petit, a body buried at the depth of four feet - is not decomposed in less than three years, and, at a greater depth - the decomposition is still more slow. This decomposition is favoured - by the presence of water, and likewise by some kinds of earth more - than others. It has been proved by Lemery, Geoffroy, and others, that - argillaceous earths have very little effect in this way: porous and - light earths much more: the roots of vegetables also by absorbing - the putrid effluvia contribute greatly to the final decomposition of - bodies buried in places exposed to the open air; but in churches and - other covered places the case is vastly different. “Here, says our - author, is neither water nor vegetation; and consequently no cause - which can carry away, dissolve or change the nature of the animal - fluids: and I cannot but applaud the wisdom of government which has - prohibited the burying in churches; a practice which was once a - subject of horror and infection. - - “The decomposition of a body in the bowels of the earth can never - be dangerous, provided it be buried at a sufficient depth, and that - the grave be not opened before its complete dissolution. The depth - of the grave ought to be such that the external air cannot penetrate - it; that the juices with which the earth is impregnated may not - be conveyed to its surface; and that the exhalations, vapours, or - gases, which are developed or formed by decomposition, should not be - capable of forcing the earth covering which detains them. The nature - of the earth in which the grave is dug, influences all its effects. - If the stratum which covers the body be argillaceous, the depth of - the grave may be less, as this earth difficultly admits a passage - to gas and vapour; but, in general, it is admitted to be necessary - that bodies should be buried at the depth of five feet to prevent all - these unhappy accidents. It is likewise necessary to attend to the - circumstance, that a grave ought not to be opened before the complete - decomposition of the body. The term of decomposition is various; - according to M. Petit of three years in graves of four feet, and - four years in those of six feet. The pernicious custom which allows - a single grave to families more or less numerous, ought therefore to - be suppressed; for, in this case the same grave may be opened before - the time prescribed. It is likewise necessary, to prohibit burying in - vaults, or even in coffins.” - -With regard to epidemics occasioned by the action of electricity, we -cannot indeed produce any instance; but we have one of a distemper -more dreadful than even the plague itself; and that is of a person -suddenly struck by an electric flash (generated either in his own body, -or in the room where he was) and by this stroke reduced to a most -deplorable condition, which soon ended in death. The account stands -on the authority of Mr. Joseph Battaglia, surgeon at Ponte Bosio, who -transmitted it to Florence, and is as follows. - -“Don G. Maria Bertholi, a priest residing at mount Valere in the -district of Livizzano, went to the fair of Filetto, on account of some -business which he had to transact, and after spending the whole day -in going about through the neighbouring country, in order to execute -commissions, in the evening he walked towards Fenille, and stopped at -the house of one of his brothers-in-law, who resided there. No sooner -had he arrived, than he desired to be conducted to his apartment, -where he put a handkerchief between his shoulders and his shirt, -and, when every body retired, he began to repeat his breviary. A few -minutes after, a loud noise was heard in Mr. Bertholi’s chamber; and -his cries having alarmed the family, they hastened to the spot, -where they found him extended on the floor, and surrounded by a faint -flame, which retired to a greater distance in proportion as it was -approached, and at length disappeared entirely. Having conveyed him to -bed, such assistance as seemed necessary was given him. Next morning -I was called, and after examining the patient carefully, I found that -the teguments of the right arm were almost entirely detached from the -flesh, and hanging loose, as well as the skin of the lower part of -it. In the space contained between the shoulders and the thigh, the -teguments were as much injured as those of the right arm. The first -thing, therefore, to be done, was to take away those pieces of skin; -and, perceiving that a mortification was begun in that part of the -right hand which had received the greatest hurt, I scarified it without -loss of time; but notwithstanding this precaution, I found it next day, -as I had suspected the preceding evening, entirely sphacelous. On my -third visit, all the other wounded parts appeared to be in the same -condition. The patient complained of an ardent thirst, and was agitated -with dreadful convulsions. He voided by stool bilious putrid matter, -and was distressed by a continual vomiting, accompanied with a violent -fever and delirium. At length the fourth day after a comatose sleep of -two hours, he expired. During my last visit, while he was sunk in the -lethargic sleep of which I have spoken, I observed with astonishment, -that putrefaction had already made so great progress, that his body -exhaled an insupportable smell. I saw the worms which issued from it -crawling on the bed, and the nails of his fingers drop of themselves; -so that I thought it needless to attempt any thing farther, while -he was in this deplorable condition. Having taken care to get every -possible information from the patient himself, respecting what had -happened to him, he told me, that he had felt a stroke, as if somebody -had given him a blow over the right arm, with a large club, and that at -the same time, he had seen a spark of fire attach itself to his shirt, -which in a moment was reduced to ashes, though the fire did not in the -least injure the wrist-bands. The handkerchief which he had placed upon -his shoulders, between his shirt and his skin, was perfectly entire, -without the least appearance of burning, his drawers were untouched, -but his night-cap was destroyed, though a single hair of his head was -not hurt. That this flame under the form of elementary fire, burnt the -skin, reduced the shirt to ashes, and entirely consumed the night-cap, -without in the least touching the hair, is a fact which I affirm to be -true: besides, every symptom that appeared on the body of the deceased, -announced severe burning. The night was calm, and the circumambient air -very pure: no bituminous smell could be perceived in the chamber, nor -was there the least trace of fire or of smoke. A lamp, however, which -had been full of oil, was found dry, and the wick almost in ashes. We -cannot reasonably suppose this fatal accident to have been occasioned -by any external cause; and I have no doubt that if Maffei were still -alive he would take advantage of it to support an opinion which he -entertained, that lightning is sometimes kindled in the human body and -destroys it.” - -Another account, to the same purpose, is given in Mr. Battaglia’s -paper. “On the 21st of April, 1781, the first battalion of the brigade -of Savoy set out from Tortona, in order to go to Arti, when the weather -was excessively hot. On the 22d, having made rather a forced march, the -soldiers suffered a great deal from the ardour of the sun, so that, at -the village of Serre, where they halted, one of them, named Bocquet, a -man of twenty-five years of age, whose skin being very hard and thick -had not perspired, sent forth a loud cry, which seemed to announce -some extraordinary commotion, and instantly fell down. Mr. Bianet, -surgeon major to the regiment, found the patient in convulsions. -When he was carried to the hospital the upper part of his body, to -the thighs, appeared to be withered and black, and in a gangrenous -state. Mr. Bianet employed scarifications, but without effect; it was -impossible to make him swallow any thing; and it was found necessary to -abandon him to his dismal fate. His body soon exhaled a putrid smell, -and he died at the end of five hours. That his disorder might not be -communicated to others, he was interred together with his clothes. Upon -inquiry, after his death, it was found that this man was addicted to -the constant use of spiritous liquors, and that he had even drank of -them to excess upon the march.” - -Other instances there are, still more terrible, of people actually -taking fire and being consumed to ashes by some internal cause; but, as -nobody was present either at the beginning or during the continuance of -these extraordinary inflammations, nothing certain can be said about -them. That such things, however, have happened, is certain, of which -one of the most remarkable instances is that of Signora Corn. Zangari, -an Italian lady. She retired to her chamber in the evening somewhat -indisposed, and in the morning was found in the middle of the room -reduced to ashes, all except her face, legs, skull and three fingers. -The stockings and shoes she had on were not burnt in the least. The -ashes were light, and on pressing them between the fingers vanished, -leaving behind a gross, stinking moisture, with which the floor was -smeared; the walls and furniture of the room being covered with a moist -cineritious soot, which had not only stained the linen in the chests, -but had penetrated into the closet, as well as into the room overhead, -the walls of which were moistened with the same viscous humour. This -lady had been accustomed to use a bath of camphorated spirit of wine -when indisposed. - -Dr. Zimmerman, from the 64th volume of the Philosophical Transactions, -relates the case of a poor woman who perished in this miserable manner -at Coventry in England in the year 1772. “She fell out of bed, and was -found next morning burnt to death, though the fire in the grate had -been small, and the furniture in the room had suffered but little. -Except one thigh and leg, there were not the least remains of any skin, -vessels or viscera; and the greater part of the bones were completely -calcined, and covered with a whitish efflorescence.” - -On these unfortunate people it has been observed that they were -generally intemperate in the use of spiritous liquors. Of the poor -woman at Coventry, whose case has been just now related, it is said, -that she had been in the practice of drinking from half a pint to a -quart of rum every day, and this she continued, notwithstanding her -being affected with jaundice and other complaints. Mr. Wilmer, who -communicated this case to the Royal Society, concludes it with these -words: “That her solids and fluids were rendered inflammable by the -immense quantity of spiritous liquors she had drank, and when she was -set fire to she was probably soon reduced to ashes.” - -On other cases of a similar nature it has been remarked, that the -miserable sufferers were “for the most part advanced in years, -remarkably fat, and had been much addicted to the use of spiritous -liquors, either in their drink, or applied in friction to the body; -whence it has been concluded that these people perished by their whole -substance spontaneously taking fire, the principal seat of which had -been the entrails, or the epigastric viscera; and that the exciting -cause was naturally found in the phlogiston of the humours, called -forth by that of the spiritous liquors combined with them.”[85] But -solutions of this kind cannot by any means be admitted. We have not -the smallest reason to think that either the solid or fluid parts of -the bodies of hard drinkers are more inflammable than those of other -people; neither is it credible that any person could live with his body -in such a state. Besides, the most inflammable bodies will not begin to -burn unless fire actually be applied to them, while others much less -inflammable to appearance, will yet take fire spontaneously. Thus, even -spiritous liquors themselves, though they flame violently when thrown -into a fire, or when a burning body is applied to them, yet there -is not an instance of such liquors taking fire of themselves; nay, -they cannot even be set on fire by pouring them upon a red-hot iron, -while, on the other hand, heaps of wet vegetables, which we should -think scarce at all inflammable, do yet very frequently take fire -spontaneously. The author lately quoted, however, justly observes that -M. Bartholi, the unfortunate priest above mentioned was plainly struck -first by electricity from without, a spark of fire attaching itself to -his shirt, and a faint flame surrounding his body; so that the fire did -not seem to have been generated in his body, but in the atmosphere. -There are instances of people being surrounded with these luminous -appearances without being hurt; particularly of a woman at Milan, whose -bed was surrounded with a light of this kind. Mr. Loammi Baldwin, of -this country, was also surrounded by an electric light, while raising -a kite in the time of a thunder storm, and Dr. Priestley makes mention -of a gentleman, who, after having worked an electric machine for a -long time in a small room, perceived, on leaving it, a luminous vapour -following him. But the instances most to our present purpose are some -recorded in the Philosophical Transactions, of luminous vapours coming -from the sea, attaching themselves to corn-stacks, and setting fire -to them. One of this kind is particularly mentioned in Lowthorp’s -Abridgement of the Transactions, as having taken place in Ireland, -coming repeatedly from the sea, and setting fire to corn and hay, so -that the people were greatly alarmed. At last they found that it might -be driven off by making a great noise, and that it would avoid any -sharp-pointed iron instrument. Had such a vapour attached itself to a -human body, it is possible that it might have set fire to it as well as -to the stack of corn or hay. Whether these accounts render the story of -the Genoese sailors concerning the ball of fire occasioning the plague -of 1346 more credible, we leave the reader to judge. They certainly -show, however, that the electric fluid will sometimes interfere with -the human body in a very terrible manner, producing, where it does not -kill instantaneously, symptoms equal to those of the very worst plague, -as in the case of the priest and soldier above mentioned. - - [85] American Museum vol. xi, p. 148. - -Another hypothesis concerning the origin of pestilential diseases is -that of swarms of little animals invisibly existing in the atmosphere; -which, being taken into the body by the breath, are supposed to corrupt -or otherwise vitiate the blood and other parts of the body, as we -see in the plague and other epidemic disorders. This hypothesis, so -generally exploded, and so apparently improbable, seems to receive -some support from a discovery of an insect made by Mr. Henry Baker, F. -R. S. and published in his work entitled “The Microscope made Easy.” -He called it the insect with net-like arms. “It lives (says he) only -in cascades, where the water runs very swift. Some of them being kept -in a vial of water, most died in two days, and the rest, having spun -themselves transparent cases, which were fastened either to the sides -of the glass, or to pieces of grass put into it, seemed to be changed -into a kind of chrysalis; but before they assumed this form, they -altered their shape (in a manner he represents by a figure.) None of -them lived above three days; and, though fresh water was given them -two or three times a day, yet in a few hours it would stink to a degree -scarce conceivable, and that too at several yards distance, though, in -proportion to the water, all the included insects were not more than -as one to _one million, an hundred and fifty thousand_. This makes it -probable that it is necessary for them to live in a rapid stream, lest -they should be poisoned by the effluvia issuing from their own bodies, -as no doubt they were in the vial.” - -From this account it is not difficult to conceive that animals, though -exceedingly small, may yet emit such poisonous effluvia as will -destroy much larger ones in their neighbourhood. It will by no means -be incredible that, had one or two such offensive animals been thrown -into a jar containing gold-fishes,[86] the whole of these beautiful -inhabitants would have perished at once. Let us suppose such a thing -to have actually happened; that a malicious person had put them in -over night, and in the morning the proprietor of the fishes finds -them all dead, and the water offensive to the last degree. He sends -for a neighbouring philosopher, who, happening to be ignorant of the -existence of such animals, endeavours to account for the phenomenon -upon some of the received principles of philosophy. How much theory -would here be wasted, and what endless disputes might ensue without -even a _possibility_ of arriving at the truth! Just so it is with -epidemic diseases. The cause is invisible, and, until it becomes -discoverable by our senses, it can never be known; for, as has already -been observed, a cause never can be known merely by its effects, unless -we have seen it, or somebody who has seen it gives us information. And -this will certainly be found to hold good in every instance, even from -the Supreme Cause himself to the diminutive insect just mentioned. - - [86] The gold-fish is a small species of carp, brought originally - from China. They are adorned with the most beautiful and resplendent - colours, and are frequently kept in jars for pleasure. They subsist - entirely on the water, without any other food. This is by Dr. - Fordyce said to be the case with all fishes, provided the water be - impregnated with oxygen. - -Lastly, I shall consider another _possible_ source of epidemics, which -has been hinted at by others. Allowing that infectious matter proceeds -from the body of a diseased person, as much must issue from a single -patient as is sufficient to bring the disease upon thousands, and -with regard to the small-pox and some other distempers we certainly -know that it is so. This infection is dissipated in the atmosphere, -and intimately combined with it, so that it becomes imperceptible and -harmless; but we have no reason to suppose that it is annihilated, or -cannot be re-produced in its pristine state. Water, though perfectly -dissolved, and to appearance deprived of existence in the air, may -yet be precipitated from it, and pour down upon us in deluges. What -happens in one case may happen in another. The infectious matter, -dissolved in the air, may by some natural cause be precipitated from -it, overshadowing whole regions, and, if it be not powerful enough to -produce the epidemic of itself, may certainly _predispose_ to it in -such a degree, that the slightest additional cause will bring it on. - -Something indeed of this kind would seem really to be the case, -otherwise we cannot well conceive why there should be such a -distinction of diseases. Thus the infection of the small-pox is the -same all over the world. The variolous matter will never produce the -measles in any country, nor will the typhus produce a pleurisy. The -plague manifests itself to be the same distemper in all its various -degrees of malignity, though even this dreadful disease is sometimes -so mild that it does not confine the patient to his bed. There must -therefore be some certain constitution in the nature of the cause -which produces such and such diseases, as certainly as in the seed -of particular vegetables, which gives to each its proper appearance -and shape. The cause of the disease so modified we may call, with Dr. -Cullen, its _specific contagion_. - -Having thus treated so largely upon contagion of different kinds, it -now remains to consider the objections that have been made to the -doctrine altogether. It is indeed surprising that in so great a length -of time, after the world hath so often and so dreadfully suffered from -the violence of plagues, the simple fact, whether it be infectious -or not, should not have been determined: nay, that it should still be -questioned by physicians of no mean reputation whether such a thing as -contagion or infection _can possibly exist_. Dr. Mosely in his treatise -on tropical diseases treats the whole doctrine of contagion with the -utmost contempt; calling it “a field for speculation, which has long -amused the pedantry of the schools, and should never be entered into by -practical writers.” Notwithstanding this, however, he doth enter into -it, and with such bad success, that in the very first paragraph he is -obliged to derive the cause of diseases from the stars! “There are some -diseases we know, (says he) which follow the changes of the atmosphere; -but there are others which make their revolutions, and visit the earth, -at uncertain periods; for which we can trace no cause, depending on -combinations, in which, perhaps, the _influence of the planets_ may -have some share.” Here we have a still wider field for speculation than -even _the schools_ have given us; for the Doctor ought to remember that -the influence of a _planet_, producing a disease, is as truly contagion -as the effluvia of a _dunghill_; and if we have a wide field to -traverse when tracing it through the earth, we have one infinitely more -extensive in pursuing it through the heavens. But we may be assured -that planetary influence _does not_ produce diseases; for, if it did, -they would in all times of pestilence overspread the face of the earth, -as the influence of the planets, if they have any, certainly does. - -The arguments used by this author against _terrestrial_ contagion are, - -1. “It has often happened that hundreds of men in a camp have been -seized with the dysentery, almost at the same time, after one shower of -rain, &c. People under similar circumstances must be subject to similar -diseases: and yet it often happens that dysentery begins with a few -people, and spreads itself by degrees until a multitude are affected.” - -This argument rather militates against himself; for, if dysentery -or any other disease was occasioned by an _evident_ general cause -operating upon persons in similar circumstances, all of them ought to -be taken ill at once; but Dr. Mosely owns that they frequently are -not. There must, of consequence, be something _less evident_ which -determines the disease to particular persons, while the general cause -operates equally upon all. This less evident cause we call _contagion_. - -2. “It is incredible that the smelling a little human blood, that -had stood some months in a phial, gave the man a dysentery mentioned -by Pringle; or that the person Forestus speaks of got the plague -by only putting his hand into an old trunk; or that the shaking an -old feather-bed, which had lain by seven years, raised a plague at -_Wratislau_, which destroyed five thousand persons in twelve weeks, as -related by Alexander Benedictus, &c.--Such things _may be true_, but, -when probability is shaken, reason always inclines to skepticism.” - -Here our author most evidently contradicts himself; for in the -beginning of the paragraph he tells us that the things related are -_incredible_, and in the end of it, that they _may be true_. The -argument, if it may be so called, is mere assertion. It is _incredible_ -that the smell of putrid human blood in a vial should produce the -dysentery. Why should this be more incredible than that smelling to -a charged vial should ensure an electric shock to the person who did -so? This is entirely a question respecting a matter of fact, not -of speculation. The same is the case with the rest. It is not more -incredible that, if the infection of the plague was in a trunk, a man -should get the plague by putting his hand in it, than that he should -be burnt if he put his hand into a trunk full of hot ashes. Before the -Doctor decided in such a positive manner, he ought to have proved that -no infection could be contained in a trunk; but this, though the very -point in question, he takes for granted, first telling us that the -contrary is incredible, and then that it may be true! - -3. “We observe in camps and hospitals, that those people _whose dirty -employments_ subject them in a particular manner to a _depravation of -their habits_, seldom escape the present epidemic; and this gives rise -to the vulgar expression, and very incorrect notion, of _catching_ -the disease. And we observe that others from the slightest deviation -from regularity lose the power by which the body resists diseases, and -they are also attacked. But these attacks are not to be attributed to -infection: for those people who keep the vital and animal powers in -uniform confederacy, by temperance and calmness of mind (for fear, by -lowering the vital energy, subjects the body to disease) nourishing -diet, proper clothing and cleanliness, and keeping a free and regular -passage for all excretions, are proof against the assaults of foul and -pestilential air. Such people seldom suffer even by the plague itself: -while all around them perish.” - -The first sentence of the above paragraph is so obscurely worded, -that it is difficult to know the author’s meaning. I know not of any -lawful employment so _dirty_ that it necessarily subjects the person -who practises it to a _depravation of habit_. The next ascribes every -thing to intemperance and fear; from which, it seems, we are to infer -that none but drunkards, cowards, and dirty, naked ragamuffins, are -ever seized with epidemic diseases. But of this we are able to bring a -direct disproof. I suppose Dr. Mosely will not say that the celebrated -Prince Eugene of Savoy was either a coward or a drunkard; that he had -a _dirty employment_, wanted proper food or clothes, or was deficient -in personal cleanliness; yet, when in the marshy parts of Hungary, he -was in danger of death from an epidemic dysentery, notwithstanding -that he was so careful in respect of diet, that he had pure water -brought him every day, probably from a considerable distance. How -came he to be affected by the distemper under such circumstances, -while Count Boneval, though as an inferior officer he probably enjoyed -fewer advantages, remained free from it, taking only a small quantity -of Peruvian bark daily? It is uncertain whether the bark did really -preserve him or not; but the case of Prince Eugene plainly shows that -sobriety, temperance, valour and cleanliness are not sufficient to -ward off an epidemic disease, if people come in the way of infection. - -4. “It should follow, if contagion were supported by infected bodies, -that no person should ever escape infection (as at Oxford assizes in -1577[87]) who was within the sphere of its action; and that those -who were entirely secluded from it, and free from all contiguity to -infected people, or substances, as the collegers were in the town of -Cambridge, when the plague was last in England, should be exempt from -it. - - [87] Sir John Pringle, from Stowe’s Chronicle, gives the following - account of these assizes. “On the 4th, 5th and 6th days of July were - the assizes held at Oxon, where was arraigned and condemned Rowland - Jenkins, _for a seditious tongue_; at which time there arose amidst - the people such a damp, that almost all were smothered. Very few - escaped that were not taken. Here died in Oxon three hundred persons; - and sickened there, but died in other places, two hundred and odd. - - “The sessions at the Old Bailey in Westminster, in 1650, proved also - fatal to many; of which Sir John also gives an account. ‘I have been - informed (says he) that, at those Sessions, about a hundred were - tried, who were all kept in close places as long as the court sat; - and that each room was but 14 feet by 11, and seven feet high. The - bail-dock is also a small room taken off one of the corners of the - court, and left open at the top: in this, during the trials, are put - some of the malefactors who have been under the closest confinement. - The hall in the Old Bailey is a room of only 30 feet square. Now - whether the air was most tainted from the bar by some prisoners then - ill of the jail distemper, or by the general uncleanliness of such - persons, is uncertain; but it is probable that both causes concurred. - And we may easily conceive how much it might have been vitiated by - the foul steams of the bail-dock, and of the two rooms opening into - the court in which the prisoners were the whole day crowded together - till they were brought out to be tried. It appeared afterwards, that - these places had not been cleaned for some years. The poisonous - quality of the air was aggravated by the heat and closeness of the - court, and by the perspirable matter of a number of people of all - sorts, penned up for the most part of the day, without breathing - the free air, or receiving any refreshment. The bench consisted of - six persons, whereof four died, together with two or three of the - counsel, one of the under sheriffs, several of the Middlesex jury, - and others present to the amount of above forty; without making - allowance for those of a lower rank, whose death may not have been - heard of; and without including any that did not sicken within a - fortnight after the sessions.’” - - (Pringle’s Observations p. 329 & seq.) - -“But, in opposition to this, _Rhazes_ lived 120 years, an often -practised in plagues. _Hodges_ remained in town, and attended the sick, -during the great plague in 1665. _Kaye_ was in the midst of practice in -the sweating sickness in 1551, without any inconveniency. _Procopius_ -informs us, that during a terrible plague at Constantinople, in 543, -which almost destroyed the whole city, no physician nor other person -got the plague by attending, dressing or touching the sick. Yet most -of the Capuchins, the Jesuits, the Recollets, the Observantines, -the Barefooted Carmelites, the Reformed Augustines, all the Grand -Carmelites, the Grand Trinitarians, the Reformed Trinitarians, the -Monks of Loretto, of Mercy, the Dominicans, and Grand Augustines, who -kept themselves secluded in their several convents, and took every -precaution to avoid the plague, while it raged at Marseilles, perished -by it. - -“There are no epidemical nor contagious diseases that attack every -person who breathes the same air, or that is in contact with the -infection, else whole regions would be depopulated. The habit must -be graduated, or adapted, for the reception of a disease. In some -constitutions of body the access is easy, in some difficult, in others -impossible. _But where the revelation of this mystery is to be found, -none can tell._” - -In this, which our author seems to have designed as his _grand -argument_, it is plain that the deficiency is as great as in any of -the rest. If we suppose the plague, or any other epidemic disease, to -arise from some general cause, let that cause be _contagion_ or any -thing else, it ought to operate upon all who come within its sphere -of action, as Dr. Mosely observes of _infection_. If experience -shows that it does not, the argument will hold equally against a -constitution of the atmosphere, putrid effluvia, heat, cold, or any -thing else; and in fact the Doctor fairly gives up the point at last, -by resolving the whole into an _unrevealed_ mystery. With regard to -what he says about the plague at Marseilles getting into the convents, -of which he presents us with such a catalogue, it is impossible to -know what precautions were used, and we are assured that in Turky it -is thought necessary for the Europeans not only to guard against a -communication with their own species, but some of the brute creation -also. Cats particularly are dreaded so much, that a general massacre -of them commences among those who use precautions, the favourites -of that species must be sent to a distance, and M. Volney mentions -two merchants who had shut up their houses, and yet had the plague -imported by a cat. In short, considering that infection is supposed to -be altogether invisible and imperceptible, it is impossible to say how -it may be conveyed, or to what extent it may occasionally act when once -brought into a country. Dr. Fordyce is of opinion that the distance at -which infection may act depends on the disposition of the air at the -time; and he observes, that a difference in this respect is observable -in the odoriferous effluvia of vegetables. “If the air be loaded with -moisture, they reach to a much greater distance. Vapour arising from -a field of beans, for instance, or a putrid ditch, is sensible to the -nostrils at a greater distance if the air is moist.” He observes indeed -that this has never been verified with regard to infection; but as it -is evidently the case with putrid effluvia, which very often accompany -infection, we may reasonably conclude that it is the case with the -latter also. - -Let us next take a view of what is advanced by the authors of The -Science of Life upon this subject. Mr. McLean, who puts his name to -this part, informs us of his conviction “that no general disease, which -affects a person more than once during life, can ever be communicated -by contagion;” and he defines contagion “a specific matter, generated -in a person affected with disease, and capable of communicating that -particular disease, with or without contact, to another.” It would -here be no improper question, by what means he comes to know that a -contagious disease can affect a person only _once_. But even this -question is unnecessary. Dr. Guthrie gives an account of a gentleman -who had the courage to inoculate himself for the plague, in consequence -of which he had the disease with the concomitant symptoms of buboes, -&c. Here then we see the plague communicated by “a specific matter -generated in a person affected” with the same disease, i. e. by -_contagion_, according to Mr. McLean’s own definition. The dispute -therefore might stop, as this fact seems to be decisive on the subject; -but as he has at great length insisted upon the argument last quoted -from Dr. Mosely, it seems necessary to follow him a little farther. - -“If a person (says our author) be affected with any disease, it will -necessarily be communicated to every other person who comes within the -infectious distance, and _is not at the same time labouring under some -disease higher in degree_.” This proceeds upon a supposition that his -theory is absolutely perfect and infallible; which, however plain it -may appear to himself, will not probably be admitted by others without -some proof. Indeed he himself afterwards adduces some facts which -decisively overthrow it. “A child (says he) here and there is exempted -from small-pox, even though exposed to its contagion.” How comes this -to pass? The disease, we are told, is contagious, the child is exposed -to the contagion, and yet is not affected. In _all_ such cases it would -be ridiculous to suppose the subjects labouring under a disease higher -in degree than the contagion could produce. In numbers of instances of -this kind the children were evidently in good health, and yet would -perhaps be seized at an after period when no more exposed to contagion -than they had been at first. - -“Small-pox, measles, and other general diseases, which occur only once -during life, never disappear, until _the whole_ of those who have been -within the infectious distance, and were not at the time labouring -under some disease higher in degree, have received the infection. As -these diseases are _very mild_, children sometimes resist the power of -contagion from the superior force of some other diseases, although they -may be so slight as to escape _common_ observation.” - -In this paragraph we have the favourite maxim of our author repeated, -_twice_ indeed, without a single fact to support it. Instead of this -we find hypothesis heaped upon hypothesis, as the giants are said to -have heaped mountains upon one another in order to get up to heaven. -He first supposes that the infection of the small-pox seizes on _the -whole_ of those on whom it falls. The exceptions to this maxim he -explains by another _supposition_, viz. that the contagion of the -small-pox is counteracted by another disease. The second hypothesis -is supported by a third, and that a very extraordinary one, that -the small-pox (a disease which has destroyed innumerable multitudes) -is _very mild_; and this third by a fourth, that the diseases which -counteracted the contagion were so slight as to escape _common_ -observation. It was incumbent on Mr. McLean to have pointed out some -of those diseases, and to have informed us how they came to counteract -this contagion. But it is needless to argue with one who writes -so extravagantly. Far from the mode of reasoning followed by Dr. -Fordyce, who decided from the majority of facts, our author determines -every thing by his own preconceived opinions. “That the power which -occasioned disease at the Oxford assizes (says he) was not contagious -matter, is proved by its producing diarrhœa in some, while it produced -fevers in others.” But, if it was not contagious matter, what kind of -matter was it? Or how comes our author to know that those who were -affected by the diarrhœa were not likewise affected by fever? How many -fevers are attended by diarrhœa, or how many cease when diarrhœa comes -on! It would have been equally conclusive to say that the matter was -not contagious, because some died and some recovered. - -I shall only take notice of one assertion more, it being both tedious -and unnecessary to follow him through the whole. “From _every_ record -of epidemic and pestilential diseases, it would appear, that they have -their stated periods of recurrence; that these periods are such months -as are most remarkable for vicissitudes of the atmosphere; that they -become general only in those years in which these vicissitudes are -extreme; that they do not occur in seasons when the heats or colds, -however intense, are equable; nor in years when the state of the -atmosphere is tempered throughout; and that they uniformly cease with -the establishment of an equable state of the atmosphere, whether the -weather be cold or hot.... In Aleppo, according to Dr. Russel, the -Europeans regularly shut themselves up in their houses _every year_, -at some period between April and July; and the rich natives begin to -adopt the same plan, &c.... From this fact it appears, that the plague -occurs at Aleppo, in a state more or less mild, almost annually, and -_that it commences and ceases at certain known periods_. But it has -been remarked that, in its most severe state, this disease recurs only -at periods of ten years, or _thereabouts_: a regularity which cannot, -upon any known principle, be attributed to a power of such casual -application as contagious matter.” - -In the beginning of this paragraph our author makes a bold appeal to -_every_ record of epidemic and pestilential disorders; but here we -may ask, Has he consulted _every_ record of these disorders? That he -has not, we may readily believe; but even those which are hinted at -seem either to have been very inaccurately consulted, or wilfully -misrepresented. To evince this I subjoin the following abstract of -what Dr. Alexander Russel says of the plague in general, with the -annotations of his brother, Dr. Patrick, taken from Russel’s Natural -History of Aleppo. - -The inhabitants of Aleppo suppose that the plague visits them once in -ten years, and that it is always imported; and the most severe plagues -are thought by some to come from Damascus, while others contend that -they come from the northward. Dr. Alexander Russel thinks this popular -opinion of the return of the plague not altogether unfounded; and he -thinks it also probable that it never invades Aleppo without having -previously attacked either Damascus or Khillis, Aintab, Marash or Uufa. -He thinks that its appearance always is in one of the maritime towns of -Syria; if in Sidon, Byroot or Tripoli, Damascus is commonly the channel -by which it reaches Aleppo; but, if it shows itself first at Scanderoon -or Byass, its approach is by the way of Khillis or Aintab. - -On this Dr. Patrick Russel observes, that the account of Aleppo being -visited only once in ten or twelve years is confirmed by a letter from -an English gentleman, in 1719, who had resided there for 30 years. The -dates of the plagues which Dr. Patrick had procured were, 1719, 1729 -and 1733. Another began in 1742, and terminated in 1744; from which -time there was no return till 1757 or 1758, when it continued at Aleppo -till 1762, and did not entirely quit the country till 1764. The plague -of 1719 was said to come from the northward, but this appeared to want -confirmation; but all accounts agree that it raged at Tripoli, Sidon, -&c. two months before it appeared in Aleppo. Egypt was ravaged by the -plague in 1728, as was also Byass and the neighbouring parts in the -same summer; and next year it appeared at Aleppo. In 1732 it raged at -Sidon, Tripoli and Damascus; next year it seized Aleppo. - -Dr. Alexander goes on to inform us, that the disease never spreads much -in winter. It advances with the spring, comes to its height in June, -declines in July, and terminates in August. “None (he says) are ever -seized with in September and October, not even in the plague of 1742, -which returned three years successively;” but Dr. Patrick says that -this was not confirmed by his experience in 1760, though he owns that -the distemper declines remarkably at that period; and the natives are -greatly inclined to have it believed that the distemper has totally -ceased, and to deceive the Europeans in this respect. The times at -which the Europeans shut up and come out of their confinement show -only the increase or decrease of the disease, but not its beginning or -ending. The plague of 1719 made terrible havoc. Europeans then shut -up about the middle of March, and kept confined till the middle of -July. In 1729 they did not shut up till the middle of May, and were -not confined above a month, the number of sick being small. In 1733 -they were confined from the middle of March to the middle of July, -but the distemper was less violent than in 1719. In 1742 the time of -confinement much as in 1729. In 1743 shut up April 11, and opened the -middle of July. The plague violent, but less so than in 1733. In 1744 -few shut up, the number of sick being inconsiderable. In 1760 they shut -up on the 30th of June, and continued about a month. In 1761 shut up -May 28, rode out Aug. 1, and opened completely the 10th of that month. -In 1762 they were confined from the last week in May to the first of -August. From 1762 to 1787, a larger period than usual, the city was -free from the plague. In 1787 it broke out among the Jews in the month -of April, increased in May, raged violently in June, and terminated in -July. - -From these accounts it appears, as Dr. Alexander Russel informs us, -that the plague of one year differs remarkably from that of another; -but he says, that, at Aleppo, it is never attended with such scenes of -horror as have been known in European countries; for which Dr. Patrick -assigns the following reasons: 1. The markets are constantly supplied -with provisions. 2. The dread of the contagion is much less. 3. The -sick are less liable to be deserted by their attendants (but this, -according to his own observation, is not always the case) and 4. The -regular, speedy interment of the dead prevents a spectacle far from -uncommon in the European plagues, and which of all others is the most -shocking to humanity. - -“Extreme heat (says Dr. Alexander) seems to check the progress of the -distemper. July is a hotter month than June, and the season wherein the -plague ceases at Aleppo is that in which the heats are most excessive.” -His experience did not confirm a popular opinion at Aleppo, and which -has likewise been adopted by many medical writers, that the moon has -any influence on the distemper. To have had the distemper once does -not secure a person against future attacks. Numbers of people who were -alive when he left Aleppo had it twice or oftener; and he had instances -of some being infected thrice in one season. Dr. Patrick Russel has -observations to the same purpose. - -From this it appears, that the popular opinion at Aleppo, which Mr. -McLean wishes to establish as a certainty, is by no means so well -founded that we can build any theory upon it. The misfortune is, that, -wherever a theory is built upon any thing said to be constant and -invariable, a single failure overturns the whole. Now, in the dates -of plagues above mentioned, the variations are so great that it is -impossible to draw any certain conclusion from them. In the first -three instances of 1719, 1729 and 1733 there is indeed a coincidence of -the first two, but the last falls short by no less than _six_ years. -What then does Mr. McLean mean by his “ten years, or _thereabouts_?” -Can _thereabouts_ imply a difference of more than half? The English -gentleman’s testimony who resided 30 years in that country could extend -no further than to three plagues, and even these are not mentioned. The -fourth instance in 1742 is deficient in one year; the fifth in 1757 or -1758 exceeds by three or four years, and the sixth from 1762 to 1787 by -no less than fifteen years. - -An anonymous writer in a Scots periodical publication entitled “The -Bee,” has partly adopted the above opinion, but adds others for which -he has not thought proper to adduce any authority. “It visits _most -parts of Asia_ once in ten or twelve years, and carries off an eighth -or tenth of the inhabitants. There have been plagues which have carried -off one fourth of the inhabitants. The farther east you go, the less -frequent it is--every 20th, 40th, and, even at Bassorah, every 90th -year; but then this scourge is most dreadful. The last plague at -Bassorah, which had not visited the city for 96 years, carried of -more than nine tenths of the inhabitants.”[88] It is astonishing that -people will write in such a manner as to subject themselves to endless -criticism on account of their inconsistency. The plague, this writer -says, visits _most parts_ of Asia once every ten or twelve years, and -yet it goes no farther east than Bassorah; a space scarce equivalent to -the twentieth part of Asia! Even in this small space, it varies from -ten or twelve, to twenty, forty, or even ninety years; and, to complete -the whole, instead of giving any instance of the periodical return -of the plague at an interval of _ninety_ years, we have one of its -disappearance for _ninety-six_ years! - - [88] Bee, vol. xviii, p. 282. - -From all this it is evident, that no dependence can be placed on such -vague accounts with regard to the periodical returns of the plague. -Even the time of shutting up the houses in Aleppo is not accurately -related, for, from the above abstract it is plain, that they are -sometimes shut up in March; while Mr. McLean would have us to believe -that it is always between April and July. It is needless to wade -through a jumble of unsupported assertions, which, being backed by no -evidence, fall to the ground of themselves. “I will _venture to assert_ -(says he) that no person in perfect health ever was or _can be_ exposed -to the power of contagion, without receiving the specific disease which -that contagion produces; excepting in small-pox, measles, &c. when -the person has previously had the disease.”--How comes he to know all -this? Or, though our author ventures to assert, must we of necessity -_venture to believe_? When he ascribes the origin of epidemics, and -the plague itself, to the vicissitudes of the atmosphere, not a single -fact is adduced in support of his hypothesis. One very strange proof -indeed he brings from Dr. Rush, viz. that the latter had been informed -by a gentleman who resided in tropical countries, that, in the month -of July, several weeks before the yellow fever became general, he had -observed a peculiar and universal sallowness of complexion in the -countenances of the people of Philadelphia, such as he had seen in -those of the more southern countries before the appearance of bilious -fevers in them. Surely it is a very strange mode of argument to tell -us of the colour of people’s countenances instead of the states or -vicissitudes of the atmosphere, which we are made to believe were the -causes of that change. Another quotation is made from the same author -in which a warm, dry, stagnating air is _conjectured_ to have been -the cause of _diseases_; but he does not even quote Dr. Rush saying -that it was the cause of yellow fever, much less of all epidemic -diseases. Besides, to say that any thing is occasioned by a _state_, or -_vicissitude_ of the atmosphere, is such a vague mode of expression, -that it must either mean nothing, or be contradictory to itself. A -_state_ of the atmosphere we must suppose to mean that it continues for -some time either to be wet or dry; a _vicissitude_, when it changes -from one to the other. If an epidemic then is produced by a _state_, -it cannot also be produced by a _vicissitude_, of the atmosphere: or, -if some epidemics are produced by states, and others by vicissitudes, -we ought to be informed which produce one kind, and which another. But -throughout the whole of this dissertation we have neither distinctness -nor regularity, nor indeed any thing but assertion, supported only by -an imaginary theory. - -Dismissing at length therefore these conjectural theories, let us -endeavour to deduce from certain and undoubted facts the connexion -between the state of the body, and the operations upon it of other -causes, invisible indeed to our eyes, but discoverable by our rational -faculties, and in some measure capable of being made the objects of our -senses also. - -1. From the account given of the structure of the human body, it -undeniably follows, and has already been observed, that all parts of -it are so connected together, that none can suffer any very grievous -injury without affecting all the rest. - -2. The life of man depends immediately on the air. From this element -the _blood_ receives heat and a vital spirit diffusing itself from the -blood along the nerves, and thence expended in the operations of life -and sensation. - -3. From undoubted experiments[89] it appears, that this vital spirit -possesses in a great degree the properties of electricity, insomuch -that many suppose them to be the same. This is indeed denied by the -celebrated anatomist, Dr. Monro, but he allows that the nervous fluid -is similar to electricity, and it is certain that the electrical fluid -can affect it in such a manner that we may reasonably believe them to -be the same. - - [89] Those of Galvani and others on _animal electricity_. - -4. The air acts upon the blood by the _latent_ heat it contains. The -air itself is composed of something volatilised by heat. In some cases -this is evidently a terrestrial substance, as in that of inflammable -air, or hydrogen, which is formed of charcoal volatilised by heat, -with the addition of a little water. In the case of oxygen, or -dephlogisticated air, the combination seems to be the matter of heat -(which I shall hereafter distinguish by the name of the _ethereal -fluid_) with water deprived of its carbonic principle. This coincides -with the opinion of Dr. Priestley, who says that the basis of -dephlogisticated air seems to be _dephlogisticated water_. But, let -the basis be what it will, the ethereal fluid which volatilises it is -the _agent_; the basis is entirely _passive_, and only modifies or -restrains the action of the other fluid, so that it does not exert -itself except in particular cases. Fixed air, or carbonic acid, is -composed of the base of oxygen united with a certain portion of carbon, -and the whole volatilised by the ethereal fluid. Phlogisticated air, -azote, or septon, according to Dr. Priestley, consists of the basis -of dephlogisticated air along with a certain proportion of carbon -different from that which produces fixed air, volatilised by the same -agent;[90] and so we may determine concerning every other species of -air. - - [90] See Medical Repository, vol. ii, No. iii. - -5. In certain cases the ethereal fluid quits those substances with -which it is united: the air is then decomposed, the substance into -which the other fluid enters is heated, or rendered more fluid than -before (perhaps both) while the basis either unites itself to the -moisture of the lungs, or is thrown out by the breath. Whether in any -case the basis can pervade the membranes, and thus mix itself with the -blood, notwithstanding the positive assertions of Dr. Girtanner and -others, is very doubtful, and does not admit of any positive proof. - -6. The blood, being a _fluid_, must be subject to the same laws with -other fluids. A certain quantity of _latent_ heat must be contained -in it, in order to give the degree of fluidity naturally belonging to -it. If this quantity be augmented, the fluidity will be augmented, and -the blood will become thinner; if it be diminished, the contrary will -take place; and if we suppose a great proportion of this latent heat to -be abstracted, it is not unreasonable to suppose that something like -a congelation may take place, and the blood be changed into a solid -substance of such a nature as cannot any more be made to resume its -former qualities. - -7. By augmenting the sensible heat, the blood is affected in the same -manner as any other fluid; it suffers expansion, by which the vessels -are dilated in proportion, and, if this expansion and dilation be -carried to a certain length, a rupture of many of the small vessels, -and apoplexy, or some other grievous disease, may ensue. - -8. By breathing certain kinds of air, the fluidity, heat and expansion -of the blood, and of consequence the dilation of the blood-vessels, -are affected. Thus, when a person breathes a quantity of the fume of -charcoal, containing much fixed air, he feels himself affected with -pain and a sensation of fulness in his head; he becomes sleepy, and, -if the quantity be sufficiently great, he falls into an apoplexy, and -dies. From dissections it appears that such as die in this manner have -the capillary vessels greatly distended, and even ruptured; the heat -of the body is vastly augmented, and even continues some time after -death. Hence it is evident, that, by breathing this kind of air, too -much _sensible_ heat is conveyed to the blood. In like manner when we -breathe the steam of water, if any quantity of that steam be condensed -in the lungs, the whole quantity of latent heat contained in that -steam discharges itself upon the lungs, and increases the sensible -heat of the body; and from this we may learn why on some occasions -our sensations should so ill correspond with the thermometer, and why -a warm air almost saturated with moisture should always appear much -hotter than a dry one, though the thermometer stand at an equal height -in both. Oxygen air seems to convey to the blood a much larger quantity -of what we have called _vital spirit_, than any other kind. Whether -this vital spirit be the same with the latent heat of the blood, we -know not; but, as this kind of air is evidently capable of supplying -the blood both with latent and sensible heat, it seems most probable, -that, by breathing a considerable proportion of it, both these kinds of -heat, as well as the vital spirit itself, will be augmented. In this -case, wherever the air naturally contains a larger quantity of oxygen -than usual, the blood ought to be mere fluid, as well as warmer, than -usual, provided there be no evident cause why it should be otherwise. -Accordingly in warm climates it is always found that the blood is -thinner and more fluid than in such as are colder; but at the same -time the temperature of the body is colder than in other countries. -Zimmerman tells us, that, “at Curassau, Europeans gradually lose their -fresh colour and vivacity: their natural heat even becomes three or -four degrees less than it was at their arrival.” The reason of this -last, however, is evidently the excessive perspiration, which is more -than sufficient to carry off the superabundant quantity of sensible -heat thrown into the body, either by the rays of the sun, or by the -superior quantity of oxygen naturally existing in the atmosphere; for -it is now found, contrary to the opinions hitherto received, that in -the warmer climates the atmosphere contains a larger proportion of -oxygen than in the more temperate.[91] - - [91] That this is the case with the atmosphere at Martinico is now - determined by a letter from Dr. George Davidson to Dr. Mitchell of - New York, inserted in the Medical Repository, vol. ii, p. 279. With - equal parts of nitrous and atmospheric air there was an absorption of - 67 parts out of 100; but when two parts of atmospheric air were used - to one of nitrous, the absorption was only from 52 to 58 parts; with - a mixture of iron filings and sulphur, upwards of four tenths of the - air were absorbed. These experiments were attested by a number of - medical gentlemen who were present. In a letter subjoined from Dr. - Chisholm, he says, that, having made a trial with iron filings and - sulphur, the absorption was forty parts of an hundred, or exactly - four tenths, with the eudiometer fifty-six. “It appears to me (says - Dr. Chisholm) to be a singular circumstance, that, although the - ground on which the Ordnance Hospital Hands is a perfect morass, - partially drained, yet a result almost exactly similar to that given - by the experiments made with the eudiometer at my house, should take - place, with the same instrument and in circumstances very different. - The proportion at the Ordnance Hospital, I think, has been 58 out of - 100, and at your house, a situation less swampy, and nearer the sea, - it has been 67. An explanation of so singular a result, in situations - so different, is perhaps more to be wished than expected.” - -From this discovery it appears, that, whatever may be the cause of -the frequency and violence of epidemics in warm climates, it _is not_ -the want of oxygen. Nay, we should rather be tempted to think that -they were produced by too great an abundance of it; and this the -more especially when we know that animals confined in oxygen air are -supposed to die of a burning fever; and it is likewise known that this -kind of air is prejudicial to consumptive people, and even brings on -the disease on those who had it not before. From the experiments -mentioned in the note, it seems probable that there are but few even of -swampy places in hot climates, where oxygen does not predominate; and -in these the heat thrown into the blood must still be augmented by that -produced from the quantity of vapour decomposed or condensed in the -lungs, which, as the condensation depends upon unknown circumstances, -can never be foreseen, or ever prevented, but by a removal from the -place. - -With regard to other kinds of air, such as inflammable, phlogisticated -air, &c. experiments are yet wanting to determine their effects upon -people who breathe them habitually. The proportion in which they -occasionally exist in the atmosphere on particular occasions has not -been ascertained, and from the experiment made by Dr. Priestley with -offensive air taken from a manufactory, as well as from Dr. Chisholm -just mentioned, the probability is, that, even in the most offensive -places, the proportion of azote is by no means so great to the oxygen -that we could suppose the excess capable of producing a disorder of any -consequence, much less a violent epidemic. Fixed air is always produced -in the putrefactive process, and from its quality above mentioned of -rarefying and heating the blood, might reasonably be supposed to have -some share in producing epidemics, were it not that this kind of air is -so readily absorbed by water, as well as a number of other substances, -that, except at the very moment of emission, we can scarce suppose it -to have any considerable effect. - -Mr. Watt in a letter to Dr. Beddoes gives an account of a kind of air, -seemingly more noxious than any yet discovered, which he produced by -distillation from flesh and from wool. The effects upon himself were so -disagreeable that he determined to make no more such experiments, lest -he should to his own hurt discover a mode of producing some grievous -disease. But we cannot, from an artificial air of this kind, argue to -a natural one; as the one produced by Mr. Watt was totally different -from any species of air naturally known. All that we can say is, that, -as far as we can trace the connexion between our bodies and the -different kinds of air which may be breathed, the latter act chiefly -by the heat they contain, and which they impart to the body in various -proportions; by which means the latent or sensible heat of the blood, -and consequently of the whole body, may be occasionally augmented -or diminished. Thus the body may be considerably altered in its -constitution, and rendered more liable to diseases than it was before; -but still it is found that diseases continue to appear at uncertain -intervals, though all the causes we are able to discover, or at least -all that are constantly evident to our senses, continue to operate -without intermission. Though the obvious qualities of air and climate -therefore may _predispose_ to an epidemic, we cannot affirm any thing -farther: the direct _cause_ is always different, and hath hitherto so -much eluded our researches, that we can have little hope of discovering -it, except by reasoning from facts less obscure. - -8. In all the operations of nature which we have access to investigate, -the action of electricity is so much concerned, that we can scarce -suppose it to be wanting in any of them. That it is concerned in -preserving the health of the human body is likewise certain, if it -be the fluid which acts in the nerves, as most probably it is. But -whatever preserves health will also bring on disease, if it be applied -to that purpose; and we have already seen that this fluid is capable -of bringing on the most dreadful symptoms, viz. mortification in its -highest stage, fever, convulsions, bilious discharges, lethargy, &c. -If it be capable of producing all these, can we say that it is not -capable of producing those of an inferior kind, or of varying diseases -and symptoms without end, according to the immense diversity of its -action? It may be said that this disease was occasioned by a violent -stroke of electricity, similar to lightning; but how many people have -declared, that, in the beginning of some violent epidemics, they have -felt a sudden stroke at the time of seizure! Dr. Hodges mentions this -in the plague of 1665 at London, but treats the accounts as effects of -a distempered imagination. Procopius relates the same of the plague in -his time, viz. that many of the diseased felt a stroke. It is true that -they said such strokes were given by spirits in human shape, in which -we know they must have been deceived; but, though they were mistaken -in supposing that they had been struck by a spirit, it does not from -thence follow that they felt no stroke at all. The people mentioned -by Dr. Hodges did not say that they were struck by a _spirit_, yet he -treats their accounts with as great contempt as though they had. Where -people have no interest in deceiving, we ought certainly to look with -a favourable eye upon their testimony; for, even although some part of -it should be incredible, we have still reason to believe that there -is some foundation for what they say. Thus, the poor sailor, so much -frightened at the sight of a large bat in New Holland, was certainly -mistaken in saying that he had seen the devil; he was even mistaken in -saying that he had _horns_;[92] but from all this it would have been -doing him great injustice to say that he had seen nothing. In like -manner, when numbers of people in Procopius’s time said that they were -struck by spirits, when we find others in Dr. Hodges’s time saying that -they were struck by some invisible agent, when we know that electricity -_can_ strike in an invisible manner, it certainly is more reasonable -to conclude that violent diseases sometimes do begin by an electric -stroke, than that _all_ who said they were struck in this manner were -madmen or liars. - - [92] In the account of this sailor’s speech a most essential part of - the devil’s character was omitted. The speech, according to Capt. - Cook, was, that the devil “was about the size of a one gallon keg, - and very like it. He had horns and wings; and he was so near, that, - if I had not been _afear’d_, I might have touched him.” (See p. 105, - n.) - -It may now again be asked, if the plague, or violent epidemics, be -produced by electric strokes, why are they not much more frequently -felt, or by what are those milder diseases produced which are not -accompanied by any sensible stroke? Here we can be at no loss to say, -that whatever produces the highest disease, may also produce the -lowest. But, besides this argument, we have positive evidence that -commotions in the electric fluid will not only produce sickness, but -very extraordinary and seemingly miraculous effects upon inanimate -bodies. It has frequently been remarked that people are sick during the -time of earthquakes, when the electric matter is in violent agitation. -This has been accounted for from the motion of the earth, as the motion -of a ship produces sea-sickness. But Dr. Hillary mentions a slight -earthquake in Barbadoes where people were affected with sickness and -vomiting for _some hours_ after the phenomenon had ceased altogether; -which undoubtedly shows, that a certain state of this fluid will -disorder the human body, independent of every other circumstance, -either of the heat or cold of the atmosphere, or the oxygen, hydrogen -or azote contained in it. Again, we find that a certain state of the -electric matter is not only capable of producing very extraordinary -effects by itself, but also of communicating a power to the human -body to do the same. A good number of years ago, a powder-mill near -London was blown up. The explosion, as might be expected, was violent -and tremendous; but the most remarkable circumstance was, that the -electric matter, for a great way round, was thrown into unusual, though -invisible, commotions, which discovered themselves by the rattling and -breaking of china dishes though sitting apparently undisturbed upon -their shelves. This phenomenon did not suddenly cease, and, during -the time of it, some people appeared to be infected by an electric -_contagion_; the power of breaking china seemed to reside in their -bodies, so that if they approached or touched this kind of ware, -it would instantly fly to pieces. Accounts of this extraordinary -circumstance were published in many of the periodical works of the -time, particularly in Dodsley’s Annual Register; and the fact seems -to be established beyond controversy. It proves that what has been -advanced by Dr. Priestley concerning electrical operations, on a small -scale, holds good also on a large one, viz. that the fluid, when -once set in motion, is not easily quieted. It establishes the fact, -also, that by great explosions of gun-powder the electric matter is -violently agitated; and the consequence of these agitations we cannot -know. It may be said, indeed, that in the operations of nature the -electric matter is often violently moved without any sickness taking -place; neither in fact did any ensue at the time the powder-mill in -question was blown up. But it must be remembered, that, in the ordinary -course of nature, if the electric matter is moved, a receptacle is -also provided for it. In a thunder-storm, where immense discharges -of electricity are made from one cloud, there is another cloud of an -electricity opposite to the former ready to receive them, or if not, -the earth itself is frequently struck. In eruptions of volcanoes, the -smoke receives the electricity discharged, and becomes charged with -lightning of a more dangerous kind than that of ordinary thunderstorms; -and Sir William Hamilton relates, that in the great eruption of -Vesuvius, in 1794, lightning of this kind proceeded from the smoke for -no less a space than _seventeen_ days. But in artificial commotions -of this fluid, where nature has not provided any receptacle, the -phenomena must be quite different; and though we may with safety to -ourselves interfere with the operations of fire and electricity to -a certain degree, yet we may at last rouse these terrible elements -into such action as will prove fatal to great numbers. Hence possibly -may arise in part some of those sicknesses which take place after -battles, in violent sieges, &c. An instance of this is said to have -happened at Valenciennes, when last besieged by the Duke of York. A -disease prevailed chiefly among women, children, and persons of a weak -constitution; great numbers of whom died so suddenly that it was at -first thought to be a plague, until it was found not to be infectious. -The blood was found greatly dissolved, and the physicians ascribed it -to the monstrous bombardment and cannonading which took place during -the siege. Such was the account published in some of the newspapers -of the time, and from the subsequent considerations it will not seem -improbable that such things may take place. - -From the experiments of Mr. Bennet (an English gentleman who has made -several discoveries in electricity) it appears, that we can neither -brush a piece of chalk, open or shut a book, or do several of the most -trifling actions, without agitating this subtile fluid in a perceptible -manner. It is well known that in some cases we cannot stroke a cat’s -back without making the electric matter visible, and in some positions, -by putting our fingers near the ears of the animal, very pungent sparks -will be received. If then we can neither open or shut a book, if we -cannot stroke a cat’s back, or approach a finger to her ear, without -agitating the electric fluid, is it reasonably to think we could burn -a book, or kill a cat, without doing the same? Certainly it is not. -If we cannot burn a book or kill a cat without affecting this fluid, -it cannot be supposed that we can burn a house or kill a man without -producing a still greater commotion; and in proportion to the extent -of our devastations, and the multitude of our massacres, the invisible -agitation of this element must become still greater and greater. In -all these transactions it must be remembered that the fluid is forced -out of its natural mode of action; for electric matter is made for the -preservation, not the destruction, of life: but if, by long continued -and extensive application of its power to a contrary purpose, we in -some measure pervert its action, no wonder that we then feel the -consequences of our own proceedings by its partly turning its power -against the human race altogether. - -Again, the human body is not made for the habitation of an infernal -spirit, but for one of a quite different character. The boisterous -passions of fury, discord and hatred ought never to disturb the -mind, which is made for the habitation of endless peace and joy. The -tumultuous passions are enemies to health; and this is so well known -to physicians that they are very careful to prevent their patients -from being any way ruffled or disturbed by violent passions. It is -true these passions act upon the rational soul, which we may suppose -to be distinct from that merely animal spirit, probably no other -than the electric fluid, which runs along the nerves; but experience -shows that each of these can act upon the other; a disorder in the -body, particularly in the nervous system, will sometimes disturb the -rational soul in such a manner as almost entirely to deprive it of -all its faculties; while on the other hand a violent commotion in the -rational soul may at once extinguish all the powers of life, as has -already been shown from Zimmerman. Now, let any one consider what -must be the sensations of those who engage in war. Whatever pity or -humanity may be pretended, it is evident that in the day of battle all -these sensations must give way to horror and fury on the part of the -conquerors, and terror and dismay on that of the vanquished. That these -passions never do entirely subside, is evident from the treatment of -conquered countries and conquered people. When Jenghiz Khan beheaded -his prisoners by hundreds of thousands, when Tamerlane pounded them in -mortars, when Khouli Khan caused those who offended him to be carried -from place to place, and a piece of flesh to be cut from their bodies -at each stage, what must have been the sensations of these miscreants, -and those whom they employed in such horrid scenes? On the other hand, -what must be the sensations of those who see their dearest relations -torn from them and slaughtered or treated even worse than if they were; -themselves driven from their peaceable abodes to wander like beasts, -while their cruel enemies exult in the miseries they have brought upon -them, and glory in doing all the mischief they can, and spreading -devastation as wide as possible? Thus, every passion, inimical to -health, must, on both sides, be carried to its utmost height; and if -these horrid scenes overspread a great part of the earth, for hundreds -of years together, is it any wonder that plagues should ensue? If man, -forgetting the dignity of his nature, converts the habitation assigned -him by his Maker into a kind of hell, and himself into a devil, can -we wonder that, in such circumstances, the spirit of life, originally -appointed for his use, should become to such a being the spirit of -death? Dr. Moseley seems to speak slightly of Helmont for assigning -_moral_ causes to fever; but if we consider the matter attentively it -will certainly be found that the moral conduct of the human race in -general has more connexion with the diseases which befal them, than we -are perhaps willing to believe. - -Most authors speak of some hidden, unknown and unsearchable power in -the atmosphere as the occasion of plagues and other epidemics; and, -from what has been already laid down, it seems by no means improbable -that this hidden power resides in the electric part of it. But we -know that electricity proceeds from the earth, as well as from the -air; so that in some countries the evaporation of electric matter -from the earth may affect the health of the inhabitants, as well as -the constitution of the atmosphere. Hence some spots may be naturally -unhealthy, and incurably so, independent of either the perceptible or -imperceptible properties of the air; their healthiness may occasionally -increase or decrease by means entirely beyond the reach of our -investigation. Here then our inquiries must stop. We may indeed make a -general conjecture that such differences are produced by the action of -the electric matter; but, unless this action be pointed out, and some -connexion traced between the situation of the country and a particular -mode of action of the fluid, we may as well own our ignorance at once. - -9. From all that has been said, then, we may conclude, that none of the -obvious properties of the atmosphere, or of any constituent part of -it, or of any variation in the proportion of its ingredients, can be -accounted the cause of epidemic diseases; that the hidden constitution -of the atmosphere may with probability be attributed to the agency of -the electric fluid, and that by the action of this secret cause, along -with the other more obvious properties of the air, such as heat or -cold, moisture or dryness, &c. the human body may be so predisposed to -diseases, that they will readily break forth; and that the conduct of -mankind themselves may greatly contribute to this predisposition; the -question then is, supposing every thing to be thus laid, like a train -of gun-powder, what is the spark which first sets it on fire. Does the -disease arise spontaneously in the first person affected by it, or does -it come from without? - -In answer to this we must in the first place observe, that the accounts -of all plagues mentioned in profane history trace their progress from -one place to another; whence the probability is, that at its origin the -disease was confined to a few, perhaps to a single person. In very few -cases, however, has it been possible to trace it to an individual; and, -even when this has been done, the unfortunate individual is always said -to come from some other place. The instance quoted from Dr. Moore is -perhaps the only one upon record where the plague arose spontaneously -in any person separated from society; and from a single instance little -can be inferred. In those terrible examples we have given of people -being burned to death without any accident from terrestrial fuel, the -agent seems almost certainly to have been electricity. In the plague of -Procopius, said not to have been infectious, the strokes complained of -by many patients seem to indicate an action of the same fluid. The same -in the plague at London, which was infectious, and likewise of others. -But, in cases of plagues which are not infectious, another question -arises--By what means do such diseases spread from place to place? -for even this dreadful pestilence of Procopius did not overspread the -earth at once, but is said to have begun at Pelusium in Egypt. To this -no answer can be given. To suppose an omnipresent contagion in the -atmosphere, proceeding either from contagion or any thing else, cannot -be admitted; for upon this supposition the whole world must have been -infected at once. The cause, whatever it was, plainly moved from one -place to another, or was successively generated in different places. -Recourse may be had to the precipitation of the contagious matter -of former plagues from the atmosphere; but to account for this in -succession will be found very difficult; and the same difficulty will -attend every other solution which may be attempted. Mr. Gibbon indeed -censures Procopius for supposing it not to have been infectious; and -perhaps the spreading of the disease by infection is the only way by -which we can account, in a satisfactory manner, for the way in which -it diffused itself over the world, which was, by first infecting the -maritime places, and afterwards those which were more inland; always -visiting the second year those whom it had spared the first. - -10. Lastly, to form some idea of the nature of contagion, or infection, -as it is more properly called, we must consider, that as the ethereal -fluid, acting as heat, pervades the human body, so doth it likewise -under that particular modification which we call electricity. Some -kinds of air, indeed most of those with which we are acquainted, seem -to act by augmenting or diminishing the latent or the sensible heat of -the body. Such, when taken in moderate quantity, may produce slight -diseases, as head-ach, &c. and, when taken very largely, may even put -an end to life at once, either by rarefaction of the blood and rupture -of the small vessels, as is the case with fixed air, or by oppressing -the lungs entirely with their basis, which cannot be thrown out by the -breath as in ordinary respiration. Others may affect the electricity -of it, or what in this treatise has been called the _vital spirit_, -as well as the latent or sensible heat. The consequence of this will -be diseases of a more serious nature; for upon this principle in all -probability depend not only the secretion and proper regulation of -the nervous fluid, but what has been called the _crafts_, or proper -consistence of the blood and other fluids. Hence it is possible that -such an instantaneous shock may be given to the body, as will not only -injure the organization in an irreparable manner, but may be felt -throughout the whole body like an electric stroke, even though there be -no visible fire, or sensation of burning, as in the case of the Italian -priest and others, who perished in such a miserable manner. - -Formerly all acute diseases were supposed to depend on morbific matter -taken into the body, and absorbed by the blood: the cure was thought -to be accomplished by the expulsion of this morbific matter from the -body by sweat, or some of the other natural evacuations. The doctrine -was attended by many difficulties, and in many cases did not admit -of a satisfactory explanation. It was therefore laid aside, and the -debility or excitement of the nervous system arose in its place. But -this new system admitting of _miasmata_ and _contagion_, it was plain -that morbific matter still kept its ground. With a view, it would seem, -to render the nervous theory more complete, it has been found necessary -to deny the doctrine of contagion and infection entirely. This has -been done, wherever there was a possibility; but the phenomena of the -small-pox and measles, as well as those arising from poisons, still -militated strongly in favour of morbific matter. To avoid the force -of arguments drawn from these sources, the doctrine of absorption was -denied, and contagions of all kinds were said to act immediately upon -the nervous system without affecting the blood or other fluids. At last -the matter seemed to be decided by the experiments of the Abbe Fontana -on poisons. He found that some proved fatal by being mixed with the -blood, others by being applied to the nerves, and others by being taken -into the stomach. Even this did not give satisfaction. It was contended -that the effects of poisonous bites were too quick to be accounted for -on the principle of absorption; that, after the most violent symptoms -had commenced, they might be removed by cutting out the part affected; -and consequently that, instead of any absorption by the blood, we were -only to believe that the nervous system was irritated. - -“Poisons, (says Dr. Girtanner) remedies, and, in general, all -surrounding bodies, acting only on the irritable fibre, it follows that -they act upon the system in a similar manner, and that every substance -capable of producing the greatest possible effect upon the fibre, that -is to say, every substance capable of exhausting all the irritability -both of the fibre itself and of the system, in an instant, as for -instance, laurel water, or white arsenic, is also capable of producing -all the inferior degrees of action, either by acting on a fibre less -irritable, or by acting upon the same fibre, but in a less quantity. -Laurel water, opium, white arsenic, ammoniac, are of course both -medicines and poisons capable of _healing_, as well as of _producing_, -_all maladies whatsoever, without exception_.[93] And this is -confirmed by a number of experiments which I have made upon different -animals. This _truth_ seems to me _of the utmost importance_; and the -Abbe Fontana, who made more than six hundred experiments to prove that -ammoniac is no remedy against the bite of a viper, would have saved -himself the trouble, had he known it. If, instead of applying the venom -of the viper to so many animals, and afterwards applying ammoniac to -the wound, he had made a single comparative experiment, and applied -ammoniac to a wound made by a lancet that was not poisoned, he would -have found that ammoniac itself, applied in this manner, would have -produced a disease exactly analogous to that caused by the venom of -the viper; and, consequently, so far from removing the malady, must -necessarily increase it, by exhausting the irritability of the fibre in -a much less time than the venom of the viper by itself was capable of -doing. Mr. Fontana has made more than six thousand experiments upon the -poison of the viper; he employed more than three thousand vipers, and -caused to be bit more than four thousand animals; and the conclusion -he drew after this truly enormous number of observations was, that -the poison of the viper kills all animals, and produces the disease -by its action on the blood. But why did Mr. Fontana neglect to make -the decisive experiment, the _experimentum crucis_ of Bacon? It is -well known that frogs, and many animals with cold blood, live a long -time without the heart, and entirely deprived of blood. If therefore -the poison of the viper kills animals by its action on the blood, it -will not destroy frogs without blood. But experiment contradicts this -reasoning. The poison of the viper will kill frogs without blood in -as short a time as it kills those animals who have not lost their -blood. It is not therefore by its action upon the blood that the -venom of the viper destroys animals; and thus does it happen that a -single experiment frequently overturns all that _six thousand_ other -experiments have apparently established. According to my experiments, -poisons operate upon the blood just as they do upon the muscular fibre, -by depriving it of its principle of irritability, or of its oxygen. -After having made this observation upon the experiments of Mr. Fontana, -I must do him the justice to add, that I have found all his experiments -very accurate, and that in all those which I have repeated, the result -has been exactly conformable to the account given by him; it is in his -conclusion only that he appears to be deceived.” - - [93] This is an assertion so extravagant, that is difficult to - imagine what could induce any one to make it. Did our author ever - hear that laurel water, &c. produced the venereal disease, the - plague, yellow fever, gout, stone, small-pox, &c. &c. or to what - patients and in what diseases did he ever administer this remedy - with success? I mean not to deny that these substances will cure - _some_ diseases as well as produce others; but such an unqualified - expression that they can not only produce but cure all diseases - without exception, never can be admitted. - -On this I must in the first place observe, that since _philosophers_ -and _truth_ seem to be so far distant from each other that even _six -thousand_ experiments cannot bring them together, it were greatly to -be wished that in their researches they would pay a little more regard -to humanity. If the Author of Nature has set man at the head of the -creation, if inferior animals must patiently resign their lives to -preserve ours, are we therefore authorised to torment and put them -to death by thousands for every idle whim that comes into our heads? -After Spallanzani, Fontana, Girtanner and a multitude of other learned -_barbarians_ had cut in pieces, boiled alive, poisoned and tortured -thousands of inoffensive animals, new massacres it seems must be made, -and new tortures inflicted, because an _experimentum crucis_ is still -wanted! If knowledge is to be obtained only by such means as these, it -certainly must be derived from a very polluted source. - -2. The experiment on which Dr. Girtanner builds so much is far from -being above suspicion. Though we may cut the heart out of an animal, -and let it bleed as freely as possible, yet we certainly overrate our -abilities if we say that _all_ the blood is taken out of it. The more -perfectly an animal is bled, the less irritability it has; which gives -a reasonable suspicion, that, if _all_ the blood could be taken away, -the irritability would cease entirely. In frogs, and all other cold -blooded animals, the blood contains fewer red globules than in such as -are warmer; the circulation is more languid than in such as have warm -blood, and, of consequence, the blood will retain its irritability -for a longer time, and it will likewise be more difficult to deprive -the body of all its blood. In making this experiment, therefore, Dr. -Girtanner ought to have brought unexceptionable proofs that he had -deprived the frog of _all_ the blood it contained. But, as this was -not done, we shall be ready to suspect that some was left; in which -case we should be still as uncertain as before whether the poison acted -on the irritable fibre, or on the blood. But the decisive experiment, -or _experimentum crucis_, seems to have been made by Fontana himself, -by injecting a little of the diluted poison of the ticunas into the -jugular vein of a rabbit. Here the poison was applied to the blood -itself. It could get at no other part of the fibre but the inside of -the vein, which is not accounted very irritable; and the quantity -injected was so small, that the Abbe thought his experiment had -failed; yet the animal died as if by lightning. The moment he turned -his eyes towards it, it was absolutely dead, without discovering the -least convulsive agony, or other sign of some little life remaining, -generally observable for some time in animals killed by the common -methods. On applying the same poison to a large nerve of another animal -of the same species, no injury followed. - -3. The dispute is of no consequence, and the experiment will prove the -same thing whether we suppose the poison to act upon the irritable -fibre (the nerves and muscles) or upon the blood. The only important -point to be ascertained is, whether there be in nature any substance -which, applied to the internal parts of the body, or to a wound, will -instantly disorder the whole in such a manner as to bring on a violent -disease which may prove mortal in a short time. If any such there is, -that substance, whether solid or fluid, visible or invisible, may with -propriety be called _contagion_; and if any such proceeds from the -body of a diseased person to one in health, the vapour so proceeding is -_infection_. As to the _mode_ of its operation we are little concerned; -the sudden manner in which people are affected shows that poisons -kill by suppressing in a very short time the principle of life, which -seems to be analogous to electricity, or rather the very same with -it; neither is it more incredible that the poison of a serpent should -kill by disturbing the natural electricity of the body, than that the -stroke of a torpedo, or electrical eel, should kill by the same means. -The only difference is, that, in the case of poisons, the pernicious -substance is introduced into the body itself; in the torpedo, it comes -with violence from without. The former we may compare to the silent -discharge of an electrified jar by a point, the latter to its discharge -with a violent flash by a knob. But that in poisonous bites the blood -is greatly affected, and that in a very short time, we certainly know. -There are some kinds of serpents whose bites are so suddenly fatal, -that no cure can be applied: one of these, called the small _laharra_, -is mentioned by Mr. Bancroft in his Natural History of Guiana. Mr. -D’Opsonville, in his Philosophic Essays, takes notice of one in the -East-Indies, which he calls the _poison serpent_ or _serpent poison_, -which seems to be as bad as the _laharra_ mentioned by Bancroft. This -too is but small, viz. two feet long, and very slender. Its skin is -freckled with “little traits of brown, or a pale red, and contrasted -with a ground of dirty yellow: it is mostly found in dry and rocky -places, and its bite proves mortal in less than one or two minutes. In -the year 1759, and in the province of Cadapet, I saw several instances -of it; and, among others, one very singular, in the midst of a corps of -troops, commanded by M. de Bussy. An Indian Gentoo merchant perceived -a Mahometan soldier of his acquaintance going to kill one of these -reptiles, which he had found sleeping under his packet. The Gentoo flew -to beg its life, protesting that it would do no hurt if it was not -first provoked; passing at the same time his hand under its belly, to -carry it out of the camp; when suddenly it twisted round, and bit his -little finger; upon which this unfortunate martyr of a fanatic charity -gave a shriek, took a few steps, and fell down insensible. They flew to -his assistance, applied the serpent-stone, fire, and scarifications, -but they were all ineffectual; his blood was already _coagulated_.[94] -About an hour after I saw the body as they were going to burn it, and I -thought I perceived some indications of a _complete dissolution of the -blood_.” - - [94] There must certainly be some error here; for as he mentions a - _dissolution_ of the blood so soon afterwards, we should think it - impossible that any coagulation would have taken place. Perhaps the - word only imports that the circulation was completely stopped. - -The bite of the _brulan_ or _burning serpent_, according to the same -author, is almost as terrible. “This is nearly of the same form with -the last, its skin is not quite so deep a brown, and is speckled with -dark green spots: its poison is almost as dangerous, but it is less -active, and its effects are very different. In some persons it is a -devouring fire, which, as it circulates through the veins, presently -occasions death; the blood dissolves into a lymphatic liquor resembling -thin broth, without apparently having passed through the intermediate -state of _coagulation_,[95] and runs from eyes, nose and ears, and even -through the pores. In other subjects the poison seems to have changed -the very nature of the humours in dissolving them; the skin is chapped -and becomes scaly, the hair falls off, the members are tumefied, the -patient feels all over his body the most racking pains, then numbness, -and is not long in perishing.” - - [95] The blood certainly does not coagulate in the vessels, in any - case whatever, unless by injecting something into them. - -From these accounts it is plain that poisons do operate very powerfully -on the blood; and if they do so in one case it is reasonable to think -that they do so in all. According to the degree of strength of the -poison, however, we are sure that the effects will be more or less -visible to us; but, though we should not be able to perceive any -alteration whatever in the consistence or colour of the vital fluid, we -cannot positively say that it has not undergone any change; for the -spirit which operates in it is too subtile for our observation. In the -beginning of almost all diseases, perhaps, blood drawn from a vein will -not be perceptibly different from that of a person in health; and Dr. -Fordyce particularly takes notice of this in fevers; but as the disease -goes on, an alteration becomes very perceptible, which gives just -ground for suspicion, that there had been some alteration from the very -first, though invisible to us. - -After all our disputes, however, we shall find that the controversy, -though ultimately important, begins more about words and trifles than -any thing else. Dr. Brown used the word _excitability_, Dr. Girtanner -uses _irritability_, and the author of this treatise, the words _vital -spirit_ and _electricity_, to express something equally unknown to -them all. The only difference is, that Drs. Brown and Girtanner speak -of their excitability and irritability as a kind of power essentially -inherent in living bodies, acted upon indeed by certain substances, -but incapable of deriving any supply from without; the author of this -treatise considers it only as a modification in the human body, or an -_organization_, if we please to call it so, of that fluid which he -believes to be universally diffused, under the names of heat, light -and electricity. Hence that portion modified or organized in the human -body must be under an entire and absolute dependence upon the immense -mass of surrounding fluid, and, by any alteration in the motions of it, -must be often very perceptibly affected; nevertheless as this fluid was -originally created to preserve and not to destroy human life, there is -much less danger from a _natural_ than from an _artificial_ commotion -in it. In some visible bodies, such as poisons, the fluid acts in such -a manner as to counteract the operation of that part which is organized -in the blood or nerves, or both. Hence on the introduction of such into -the body the disorder flies like lightning through all parts of it, -and in a very short time brings on death. In those vapours properly -called _contagions_, the opposite action is less violent, and therefore -the disorders they produce are in proportion. Hence such diseases may -either be promoted or retarded by the perceptible properties of the -atmosphere, which in poisons have little or no effect. There is indeed -a remarkable difference in the strength of the poison secreted in the -bodies of serpents at certain seasons of the year, or according to -their food. M. D’Opsonville observes that the poison of serpents is -in general more powerful, the more they live in hot and dry places, -where they feed upon insects that are full of saline, volatile and -acrimonious particles. But, notwithstanding this difference in the -strength of poisons according to the circumstances of time and place, -there is not the least reason to suppose that poison of a given -strength would not produce the very same effects, let the state of the -atmosphere be what it would. - -If therefore we certainly know that there are some kinds of aerial -vapours which when applied to the human body do exert a power directly -opposite to the vital principle, there is no reason to doubt that -such vapours may be confined among certain soft substances, such as -cotton, wool, &c. and remain there for an unknown length of time, -again exerting their malignant powers, when a fresh object comes in -their way. Besides, as all kinds of air with which we are acquainted -consist of a basis united with the ethereal fluid and volatilised by -it, there is reason to suppose that contagions themselves are formed -in the same manner. Some kinds of air also are very easily decomposed, -in which case the basis attaches itself to some terrestrial substance, -the ethereal fluid which volatilised it diffusing itself around in an -invisible manner, but generally with a perceptible heat. Fixed air -affords a notable example of this; for, by exposing it to lime-water, -or even dry lime, alkaline salt, volatile alkali, or common water, a -decomposition of the air very readily takes place, and its basis is -found to be attached to those substances. What happens to fixed air -may also happen to _contagion_. The basis of it may have a tendency -to unite itself to cotton, or such like substances, and thus may -not only infect them, but concentrate itself to such a degree as to -produce a disease much more violent than that of the person who gave -the infection; and something of this kind has even been observed with -regard to infected cotton. But now another question occurs: As fixed -air, by being attached to terrestrial substances, loses its aerial -property, why should the basis of contagious effluvia still retain its -malignant quality though in a state of decomposition? Here we are again -helped out by analogy. Fixed air is known to be capable of resuming -its aerial properties occasionally, from causes unknown to us, though -we cannot suppose them to be any thing else than the invisible action -of the ethereal fluid so often mentioned; which, being guided by laws -unknown to us, we cannot possibly comprehend. The fact, however, -is certain, that the basis of fixed air does very often quit the -substances to which it is attached, and assume an aerial state in great -quantity, and with very mischievous effects. Thus the old lavas of -volcanoes, if chemically tried will be found at _all_ times to contain -great quantities of the basis of fixed air, but it is only at _some_ -times that the mofetes which are supposed to be the air itself, break -forth.[96] In like manner the strata under ground always contain great -quantities of the aerial basis, but the _damps_ in mines, which are -certainly known to consist mostly of fixed air, do not always appear; -neither do they gradually accumulate, but come suddenly, spreading -unexpected destruction among those who unfortunately come in their way. -The same may take place with contagion. After remaining some time in a -state of decomposition it may have a tendency to become volatile again, -or it may lie dormant entirely; and this last will explain what is -quoted from Dr. Russel, p. 178, that sometimes commerce may be carried -on with infected places without danger. - - [96] See p. 128, note. - -Thus we see that the dispute, originally begun about a word, involves -at last a matter of the utmost importance; for, if it be found -unreasonable to believe that any such thing as contagion exists or can -exist, it follows of course that it is also unreasonable to take any -precautions against it. Mr. McLean even goes a step beyond those who -deny the existence of contagion; for we find him also denying that -putrid effluvia can produce epidemics; according to which doctrine, it -seems, we may not only safely visit places accounted the most dangerous -on account of infection, but live in all manner of filth and nastiness -with impunity. It is plain that no person can ever prove that it is -impossible for contagion or any thing else to _have an existence_. -Indeed if nothing had ever induced people to believe that it did exist, -it would have been superfluous to say any thing about it. But when we -have innumerable testimonies to the contrary; when the opinions of the -greatest physicians, as Dr. Lind, Dr. Clarke, Dr. Mead, Dr. Sydenham, -Dr. Fordyce, Dr. Russel, &c. agree that not only the plague, but every -kind of fever, is infectious; when we know from the analogy of nature -that contagion _may_ exist; when we know that there certainly _are_ -powers in nature able to produce it; is all this to be thrown aside -merely on the strength of a theory, and a theory too which can never -be proved? for it is impossible to prove the _non-existence_ of any -thing, much less the _impossibility_ of its existence. The lives of -mankind are too precious to be sported with on philosophical theories; -and prudence will always suggest, that wherever danger may at any time -arise, there it is proper to be on our guard. - -Dismissing at length the subject of contagion in general, we now enter -upon the question, Whether doth it appear from fair investigation of -testimony, that the plague has, at any time, been communicated by -contagion or not? And here I shall confine myself to what has been -adduced by Dr. P. Russel on the subject; for, if we find that the -disease has only _once_ been introduced by contagion, it signifies -nothing though we were able to prove, which we never can do, that it -had been _an hundred_ times bred in some other way. The matter is of -too great importance to allow even a _chance_ of its importation by the -neglect of the precautions necessary to prevent it. - -Our author begins with observing, that though the infectious nature -of the plague had been a question much agitated in the schools, “it -was less to be expected that physicians who had been engaged in -practice among the infected should have persisted in the opinion that -the disease was never communicated by contagion.” Such, however, has -been the case. In 1720 some French physicians laboured exceedingly to -prove that the plague which then raged at Marseilles and throughout -Provence arose from corrupt humours bred in the body in consequence -of irregularity in the seasons, and bad aliment; that it was spread -by the same means, in concurrence with terror, grief, despondence, -or other debilitating affections of the mind; but was neither bred -nor disseminated contagion. Dr. Russel mentions in a note, seemingly -with surprise, that “_so late_ as the year 1778, Dr. Stoll of Vienna -should have written expressly against the doctrine of pestilential -contagion.” To this professor he thinks it a sufficient answer to quote -the following passage from Mr. Howard on Lazarettos, “It must appear -very strange, that he should go back to Livy’s Roman History for proofs -to establish his point, totally neglecting all the facts concerning the -numerous visitations of the plague recorded in modern medical books, -or which had happened during his own time. I suppose professional men -will lay very little stress upon all that can be said on pestilential -diseases, in general, which happened in wars and sieges two thousand -years ago, as applied to the plague properly so called, a disease -then confounded with various others from which the accuracy of latter -observations have sufficiently distinguished it.” - -Dr. Russel complains of the French physicians at Marseilles having -made unfair representations; particularly that while they produce as -irrefragable arguments against contagion their own escape unhurt, amid -circumstances of supposed danger, they pass slightly over, or omit -all mention of numbers of the medical assistants whom they saw perish -in the exercise of their profession. M. Dedier, however, who at first -opposed the doctrine of infection, at last renounced his opinions so -far as to allow that the disease might be communicated to dogs by -injecting pestiferous bile into their veins; and he likewise admitted -that it might be communicated from one human creature to another, by -drawing in for a considerable time the breath of a diseased person, -putting on his shirt, lying in the same bed-clothes, and touching the -wounded parts of one’s own body with hands embrued with the sweat or -blood of one infected. He affirms, however, that the atmosphere of a -person in the plague is no more to be dreaded than that of a venereal -patient; and that the touching or dressing of buboes or carbuncles -is not attended with any danger. He restricts the infectious quality -of the humours to the bile; but the _inoculation_ of a person by the -matter of a pestilential ulcer[97] undoubtedly decides this point -against him. - - [97] See p. 196. - -On the subject of contagion Dr. Russel observes, that the vague manner -in which the word has been used has given rise to much confusion. Some, -taking advantage of the inaccurate mode of expression on this subject -used by Dr. Mead, attacked him with sophistical nonsense. The following -may serve as a specimen, from a pamphlet entitled “Distinct Notions -of the Plague, &c. by the _Explainer_.” This _explainer_ observes, -that, according to Dr. Mead, “air and his other causes propagate and -spread contagion, not the plague; and therefore either contagion and -the plague are the same, or else the plague is not considered; if the -first, then his causes propagate the plague; and the plague accompanies -the plague; an excellent defence! But, if the plague is out of the -play, then contagion accompanies nothing.”--From writers like this we -certainly can expect nothing. - -The opinion of Dr. Cullen concerning contagion has been already -noticed, p. 179; but though he supposes it to be a matter floating in -the atmosphere, he observes that contagions are never “found to act -but when they are near to the sources from whence they arise; that is, -either near to the bodies of men, from which they immediately issue, -or near to some substances which, as having been near to the bodies of -men, are embued with their effluvia, and in which substances these -effluvia are sometimes retained in an active state for a very long -time. The substances thus embued with an active matter may be called -_fomites_; and it appears to me probable, that contagions as they arise -from fomites, are more powerful than as they arise immediately from -the human body.” This opinion concerning the great power of contagion -imbibed by certain substances is conformable to what was above laid -down by reasoning _a priori_ on the nature of contagion.[98] It is -doubted by Dr. Russel, but Dr. Lind adopts it, and Van Swieten gives -his opinion to the same purpose. “I am convinced, that the body of the -diseased, kept exactly neat and clean, is not so liable to impress the -taint, as his late wearing apparel, dirty linen, and uncleanliness of -any sort about him long retained in that impure state. I say, these -last contain a more concentrated and contagious poison than the newly -emitted effluvia or excretions of the sick.” - - [98] See p. 226. - -With regard to the original cause, our author observes, “that the -plague is bred or produced originally from vitiated human effluvia, is -a matter which has by no means been established on proper authority.” -Setting aside therefore inquiries of this kind, he thinks it sufficient -to inquire whether the infection be not communicated from a sick to a -sound person by immediate contact; whether it be not also communicated -at some distance through the medium of the air; and whether substances -of various kinds do not imbibe the infectious effluvia, and retain them -for a considerable time. So far as these points admit of proof from -the experience of times past, the question concerning pestilential -contagion will admit of a solution, independent of all theoretic -reasoning whatever. - -2. On the subject of contagion people have been embarrassed by -confounding the true plague with other malignant diseases. This -has been done, not only by the ancients, but by some moderns; and -our author quotes Dr. Pye, saying “that any epidemic sickness, -which rages with more than ordinary violence, and which occasions -extraordinary mortality amongst mankind, may be, and is, properly -termed a pestilence, or the plague.” By not attending to the proper -distinctions, in these cases, circumstances belonging to what are -commonly termed malignant or pestilential fevers will often come to be -very improperly applied to the true plague. - -3. “It may be remarked, that those who contend in favour of contagion, -from zeal for accumulating proofs, have collected a number of -facts from historical records of very unequal authority, and often -with little critical skill in discrimination. Of this error their -antagonists availing themselves, have selected from the mass the -instances most liable to doubt or objection, and have endeavoured, by -their manner of arranging them, to place the whole in a ridiculous -light; while more important instances are either evasively past over, -misstated in the representation, or invalidated by general declamation -on the little credit due to historians in matters of physic, or -the prejudices prevalent in ancient times of ignorance, and on -contradictions to be found in the arguments of those who support the -system of contagion.” - -To this the Doctor adds the great quantity of hypothetical reasoning -which has been introduced into the controversy, and above all the -unfair dealing of the parties in carrying on the dispute, which has -reduced the matter from “a calm inquiry in pursuit of truth, to a -wrangling contest for victory.” Lastly he insists, that, had it not -been for the misrepresentations and sinister dealings of those who -have written against contagion, “the question seems to have been -properly resolved in the affirmative;” and he complains greatly of the -conduct of the Montpelier physicians in this respect, insomuch that -“their misstating of circumstances, and the partiality so evidently -discoverable in their narrative of cases, will serve more effectually -to remove doubts on the subject, than any arguments that could be used -against their hypothesis.” - -On the subject of contagion our author observes, that some difficulties -still remain; but these, though proper subjects of future inquiry, -“do not appear to be of force sufficient to invalidate facts already -established. It is well known, that the same person who has been -inoculated two or three times for the small-pox without effect, even -in an epidemic season, has afterwards received the infection upon -repeating the operation at a distance of time when the disease was -hardly sporadic. The cause of this remains unknown; but ignorance of -it was never produced as an argument against the reality of variolous -contagion.... If, of one hundred persons exposed to the infection -of the plague by a near aproach to the sick, ninety should fall sick, -shall human inability to assign satisfactory reasons for the escape of -the other ten be converted into a positive proof against the disease -having been caught by contagion? If persons retired from all commerce -with the infected and their attendants, breathing the same air with -the rest of the inhabitants, and nourished by the same aliment, remain -untouched during the ravage of the plague, as long as they continue -secluded, but, upon unguarded communication, are taken ill like others; -can any rational doubt be entertained about the cause of their former -security? Or if through stealth, or neglect of requisite precautions, -substances tainted by the sick should be conveyed into these secluded -retreats, and persons living temperately as before, ignorant of what -had happened, and consequently in the midst of imaginary security, -happen to be seized with the distemper; can it with any show of -reason be ascribed, not to contagion, but to terror, or to colluvies -in the stomach and bowels, produced by intemperance and bad aliment? -The instances here alluded to are not the _creation of fancy_, but -_strictly consonant to repeated experience_ in Turky; to say nothing at -present of what has been observed at Marseilles and in various cities -in Europe.” - -“But a greater difficulty than that of all persons not being equally -susceptible of the infection arises from the cessation of the plague, -at a period when the supposed contagious effluvia, preserved in -apparel, furniture, and other fomites, at the end of a pestilential -season, must be allowed to exist, not only in a much greater quantity -than can be supposed to be at once accidentally imported by commerce, -but in a state also of universal dispersion over the city: the fact, -however unaccountable, is unquestionably certain; the distemper seems -to be extinguished by some cause or causes equally unknown as those -which concurred to render it more or less epidemical in its advance -and at its height. In Europe something may be ascribed to the means -employed for the cleansing of houses and goods supposed liable to -retain the latent seeds of infection; but, at Aleppo, where the -distemper is left to take its natural course, and few or no means of -purification are employed, it pursues nearly the same progress in -different years: it declines and revives in certain seasons, and, at -length, without the intervention of human aid, ceases entirely.” - -On this we shall remark in general, that the failure of contagion -in some cases to produce the usual effects may proceed from some -constitution of the body, disposing it not to allow the cause to -produce its usual effects at one time, though at another, the -constitution may be so far changed as very readily to admit it. -This opinion has been very generally received among medical people, -who have, to this singularity of constitution given the name of -_idiosyncrasy_. It is, however laughed at by Mr. McLean. “As the -fact (says he) cannot be denied, that a great majority have escaped -after contact with persons ill of diseases supposed to be contagious, -attempts may perhaps be made to account for it by supposing a certain -peculiarity of constitution, which exempts from, or disposes to, -disease. Is it the many who escape that have this happy peculiarity -of constitution; or the few who are seized that are so unfortunate as -to possesses it? The former are evidently too numerous to admit such -an hypothesis. The property must therefore, I conclude, be given to -the latter. But a child here and there is exempted from small-pox, -although exposed to its contagion. In order to preserve a consistency, -this fact must be accounted for by the same or another peculiarity -of constitution. Peculiarities of constitution, then, exempt from -contagion in one case, and dispose to it in another; and thus a -term, which in reality means nothing, may be made to account for any -thing. For my own part I confess my inability to comprehend any other -_peculiarities_ of _constitution_, or _idiosyncrasies of habit_, than -what are constituted by the different degrees of health and disease; -the different states of the excitability.” - -In the same manner that Mr. McLean argues with regard to disease, -let us argue concerning bodily strength. Some men are able to lift -a weight of 6 or 700 pounds, but a great majority cannot lift above -300. Whence proceeds the difference? Is it the few who lift the great -weight that _by nature_ have _more_ strength, or is it the many who can -lift only the smaller that _by nature_ have _less_? This is precisely -his argument, and there needs no other refutation than stating it in -this manner. What he calls the states of excitability are as much -_idiosyncrasies_ at the time as any thing else. Mr. McLean will not -deny that a person debilitated by certain causes is more liable to be -seized with typhus fever than one who is not. What does this proceed -from, but that the body of the one is prepared for the disease, is -_constitutionally_ disposed to receive it, or has an _idiosyncrasy_ of -habit disposing to it, which the other has not? It is true, that unless -we point out the circumstances which constitute this idiosyncracy we -do nothing; but Mr. McLean’s scheme, of resolving every thing into -_excitability_, would forever prevent us from doing so. This is the -great deficiency of the Brunonian system altogether; for, by attending -only to the animal life of the body, he seems to have absolutely -forgot that we had any thing in common with vegetables. The bones, -for instance, or indeed any part of the body, cannot be formed by the -power which governs it after it was formed. The growth of the human -body is as strict vegetation as that of a tree; and therefore we find -that after the excitability is entirely gone, after death has taken -place for a considerable time, the body still retains its form, and -would do so forever, did not other powers interfere with it. Human life -therefore is a compound of the vegetable and animal life, the former -being the basis of the latter; and it is the vegetable life which is -much more commonly the subject of disease than the animal life. In -vegetables we observe an _idiosyncracy_ of habit, as well as among -animals. Some, even of the same species, are much more vigorous than -others, and, among some, diseases are much more common than others. In -like manner among the human race some are strong, others weak; in some -the blood is much more confident, and coagulates on exposure to the -air much more firmly than in others. Excitability, or excitement, is -common to all, and the degrees of it (though enumerated by Yates and -McLean in a kind of thermometrical scale) must be merely imaginary, -because excitability is not the object of our senses. The obvious -properties of the body itself, independent of any excitement whatever, -are principally to be considered in medicine. These constitute the -peculiar constitution, or the _idiosyncracy_ of habit, belonging to -each individual. Yet, in defiance of every confederation of these -obvious properties, which all have access to observe, the new system -leads us only to consider an invisible and unknown being called -_excitability_. Hence diseases peculiar to certain constitutions more -than others are said to be occasioned only by certain degrees of -excitability common to all, or perhaps to consist in these very degrees -themselves. Thus a peculiar mode of practice has been introduced, in -which almost the whole materia medica is rejected. We have already -quoted Dr. Girtanner, saying that _all diseases whatever_ may be -_cured_, as well as _produced_, by only _four_ articles; but in the -following quotation he goes still farther. “The art of pharmacy and -the science of prescription will become useless; a phial of alcohol or -laudanum will supply the place of that enormous quantity of drugs which -crowd the shops of apothecaries. The trade of the druggist----but hold; -if I continue this prophetic language, I shall only expose myself to -ridicule,” &c. Reveries of this kind certainly deserve the most severe -reproof. People may no doubt amuse themselves with _theories_ as well -as any thing else, while these theories continue inoffensive; but when -the belief of them leads to a rejection of what has been established by -the _experience_ of many ages, they begin to assume a consequence which -they originally had not. We have already seen that a disbelief of the -doctrine of contagion leads people into a practice accounted dangerous -by many, and which cannot be proved to be safe. A total rejection of -medicines, the efficacy of which have been attested by thousands, and -which never can be proved to have _no_ efficacy, must be attended with -still worse consequences, as thus we should be deprived of the means -of curing those diseases which our imprudence in rejecting the former -doctrine might have brought on. But, to return to the subject of the -plague. - -The disappearance of the disease, while all the causes that we suppose -capable of producing it remain in full force, is a demonstration that -it depends on something entirely distinct from the human body, and from -all those powers which perceptibly act upon it. It proves that this -unknown power has only a temporary existence, coming to perfection -at one season, and dying away in another; sometimes capable of being -revived, and sometimes not. This corresponds entirely with what has -been laid down concerning contagion itself, viz. that like other -aerial vapours it is capable of decomposition, and remaining for an -uncertain length of time in a dormant state; but that occasionally it -may revive, and appear unexpectedly, as _mofetes_ arise from lavas, -or damps in mines. After a city has been thoroughly infected with a -pestilential disorder, therefore, there can be no security against its -re-appearance; it being impossible to know whether the contagion may -not be still existing and capable of being revived by some unknown -cause, though it has been dormant ever so long. In such cases it may -with propriety be said to have arisen _spontaneously_, though, had it -not been there at a former period, there could be no reason to think -that it would have appeared at that time. - -Dr. Russel next takes into consideration the plague at Marseilles in -1720, of which he says the accounts “are more full, and circumstances -better authenticated, than most of the accounts of anterior plagues -to be met with in books.” From the opposition to the doctrine of -contagion at the time, he also supposes that the facts relative to its -introduction would be severely scrutinized, and falsehoods detected: -“but (says he) if, instead of such detection, the most material -have been passed over in silence, and little more than hypothetical -reasoning opposed to others, the main facts may be considered as -established, if possible, more firmly than they were before.” These -facts are stated as follows: “1. That the plague did not exist in -France before the 25th of May, 1720. 2. That it was imported in goods -from the Levant, by a ship which left the coast of Syria the beginning -of February, and arrived at Marseilles the 25th of May. Two days after -her arrival one of the sailors died; an officer of quarantine who had -been put on board died on the 12th of June, and a cabin boy on the 23d. -Some porters employed in opening the merchandise at the lazaretto also -died about this time. Three others were taken ill in the beginning of -July, with buboes in the groin and axilla. This alarmed the surgeon of -the lazaretto; a consultation was held with two other surgeons on the -28th; the disease was unanimously declared to be the plague, and the -three patients died next day: the surgeon of the lazaretto, with part -of his family, and the priest who attended the sick, were also taken -ill and died.” - -From the lazaretto the disease made its way into the city, and began to -appear about the 20th of June. By what means it was introduced is not -directly said; but it seems to have been by smuggling infected goods. -In the beginning of July it began to spread; but a kind of pause having -taken place between the 12th and 23d, the physicians were reproached -with having mistaken the distemper. During this supposed interval, -however, it was discovered on the 18th of July that the disease had -spread in a certain part of the city. A surgeon, employed to examine -into the matter, declared the distemper to be the worm-fever; and -about the 23d the council of health were informed of the death of -fourteen persons in that quarter, and of several others falling sick. -The surgeon still adhered to his opinion, but a physician declared it -to be the true plague. About the end of the month it had got into the -suburbs; four physicians declared it to be the true plague, but their -report was not believed; they were insulted in the streets, and it was -not until some of the inhabitants of better rank were taken ill, that -the true state of the matter gained credit. - -“Such (says Dr. Russel) was the rise of the plague at first, and -its progress afterwards in the months of June and July; whence it -appears, that persons on board the suspected ship, those employed in -airing the goods, a surgeon and a priest, who attended the sick, were -among the first infected; that the passengers from the several ships, -all of which ships, the first excepted, brought foul patents, were, -together with their baggage, admitted into the city, after preforming a -quarentine of little more than eighteen days; that the distemper from -the 20th of June till towards the end of July advanced very slowly, -and sometimes seemed to pause; that it attacked chiefly the poorer -sort of people, and was found in distinct quarters of the city; and -lastly, that, _during the first forty days, few or none of the infected -recovered_; a circumstance entirely consonant to what was observed in -the beginning of the plague at Aleppo.” - -Three other facts are mentioned by our author, viz. that the disease -was evidently communicated by infection; that those who were careful -to seclude themselves from all communication with the sick and with -infected goods, were not infected; and lastly, that the disease, which -began to rage violently in August, continued to do so through that and -the following month, but declined fast in the months of October and -November, and seemed to cease in the middle of winter. Some accidents -happened in 1721, between the months of February and July, which gave -occasional alarm; but the distemper did not spread, and ceased entirely -after the summer solstice of that year. - -To all this, however, objections have been made. 1. That the irregular -seasons of the former year, a bad crop, and unwholesome aliment, -had produced a malignant epidemic, all which, joined to the popular -dread of contagion, were sufficient to produce the plague without any -imported infection. To this Dr. Russel replies, that these positions, -assumed as facts, had no existence; for which he refers to the -publications of the times. 2. It was objected that there were instances -of the plague in Marseilles before the 25th of May. These instances are -only five in number, produced by M. Deidier, “who saw not the cases -himself, yet (says Dr. Russel) from the very imperfect accounts he had -been able to glean, he thought himself justified in declaring they bore -all the marks of the true plague. Nothing (adds the Doctor) but extreme -partiality to an hypothesis could have led any one practised in the -plague, into such a declaration; the cases bearing every internal mark -of belonging to a different class from the plague. I shall endeavour to -show this in a few words. - -“Of the five supposed infected patients, three recovered, two died, and -all had eruptions. One who died had a parotis (the most ambiguous of -all pestilential tumours) without any concurrence, so far as appears, -of pestilential symptoms. The tumour had appeared six days before the -woman’s death, but how long she had been sick remains unknown. The -other died the 16th or 17th day, a very unusual period in the plague. -She also had a parotis, which did not make its appearance till the -10th or 11th day of the disease. No pestilential symptoms whatever -are mentioned. Of the three who recovered, one was very ill with a -fever and carbuncle; but neither the invasion nor the duration of the -disease are mentioned. Another had a carbuncle and a small tumour -on the thigh; and the third (which bears the nearest resemblance -to a very slight infection) had also a bubo in the thigh; but the -tumours in neither of these patients are described in such a manner -as distinguishes them from ordinary tumours; and the apothecary, who -gives the account from memory, had in all likelihood never seen a -pestilential bubo before.” - -“Of the persons infected for some time after the arrival of the ships -from the Levant, none had eruptions, and all perished after a few -days illness; which agrees entirely with what was observed at Aleppo -in the beginning of the plague: hardly any of the sick recovered, and -the major part died in three or four days, without any appearance of -buboes. Upon the whole, therefore, I think it very clearly established, -that the plague did not exist in France before the month of May, 1720. -Prior to M. Deidier, however, I find a M. Pons had endeavoured to prove -that the plague was in Marseilles, not only before the month of May -1720, but even in the preceding year. I have not had an opportunity of -examining that gentleman’s book.” - -3. It is objected that the disease was not brought from the Levant by -infected goods. “Captain Chataud’s vessel, supposed to have brought -the infected goods, arrived with a clean patent, or bill of health, -having left the coast of Syria before the plague broke out there; she -consequently cannot reasonably be thought to have transported the -plague, which was not in the ports from whence she came.” - -To this Dr. Russel answers, that on commercial accounts the Turks -carefully conceal the appearance of the plague from the Europeans. -Should reports of accidents get abroad, they are variously and -contradictorily represented, and pestilential marks and tumours -fraudulently concealed. Though Chataud obtained a clean patent, the -plague broke out soon after his departure, and three vessels with foul -patents arrived at Marseilles a few days after Chataud. “To this (says -Dr. Russel) it may be further added, that, notwithstanding his clean -patent, persons acquainted with the Levant will think it far from -improbable, that the plague might actually have been in Sidon when -he sailed, though unknown to the magistrate, by whom the patents are -granted.... A clean bill of health imports that the place has been free -from plague, and all suspicion of plague, for a certain space of time; -but the clean patents of the two first arriving from the Levant, after -the cessation of the plague, are, according to Mr. Howard, deemed foul -at Marseilles, and the passengers are obliged to perform a quarantine -of thirty-one days. The French consuls lying under an obligation to -insert in their patents a detail of circumstances, it must appear -strange, when the condition of Syria at that time is considered, how -Captain Chataud should have obtained a clean patent.” - -Though this must certainly be deemed a sufficient answer to the -objection, Dr. Russel goes on to give an account of what had happened -the preceding year, when the plague had raged violently at Aleppo; and -shows that, from the condition of the whole coast of Syria, a return -of the plague was certainly to be expected; that the French consuls -could not be ignorant of this, neither could the council of health -at Marseilles be unacquainted with what had happened at Aleppo the -preceding year. “The facility with which the patents seem to have been -issued in Turky, and the partial indulgence of the council to Chataud’s -ship, notwithstanding the very extraordinary mortality which had -avowedly happened on the voyage, together with their easy confidence -afterwards in the reports of the surgeon of the lazaretto, can only -be accounted for from the prevailing influence of private commercial -interest over a sense of official duty.” - -Our author next proceeds to take notice of what happened during this -ship’s voyage to Marseilles. On the 31st of January he left the coast -of Syria with a clean patent, before the plague broke out. On the -25th of May he arrived at Marseilles, from Sidon, Tripoli and Cyprus. -On the voyage, or at Leghorn, he lost six of the crew; but, by the -certificates of the physicians of health at Leghorn, these died only -_of malignant fevers caused by unwholesome provisions_. These last -words in the Traite de la Peste are said to have been interpolated at -Marseilles. At any rate, as Dr. Russel observes, they could relate only -to those who died at Leghorn, not to the others, whom the physicians -had not seen. - -The other account is much less favourable. According to it, Chataud -“left Sidon the 31st of January with a clean patent. The plague -discovered itself there a few days after his departure. Having -sustained some damage by bad weather, he put into Tripoli, where he -embarked some merchandise; he took in also some Turks, passengers -for Cyprus, together with their luggage. Soon after the ship had -left Tripoli, one of these passengers fell sick and died. Two of the -sailors employed to throw the corpse overboard desisted at the desire -of the pilot, and the rest of the ceremony was performed by the other -Mahommedan passengers; the ropes with which the body was lowered down, -being by way of precaution thrown into the sea. Within a few days the -two sailors who had handled the corpse were taken sick and died. At -Cyprus the ship put her remaining passengers on shore, and made a very -short stay. Soon after her departure from that island, a third sailor -and the surgeon died of an illness of a few days duration. The captain, -justly alarmed by these accidents, ordered the bedding and other things -used by the deceased to be thrown into the sea; and kept himself -carefully separate from the crew during the remainder of his voyage. -Some time after this three more sailors fell sick, and, there being no -surgeon on board, the vessel put into Leghorn, where the three sick -men died, and the physician and surgeon of the lazaretto declared the -disease to be a malignant pestilential fever.” - -Our author considers the above account as a full proof of the plague -being imported by Chataud’s vessel: he declines entering into the -question about the _possibility_ of importing contagion in merchandise. -How this _might_ take place has already been explained; and the -present instance of its having been imported is as clearly proved as -can be expected. A collateral proof, with regard to the contagion of -the small-pox, we have from Dr. Huxham. A beggar, ill of that disease, -approached a certain town in England, but was not suffered to enter, -for fear of infection. The beggar died, and the infected clothes were -burnt at some distance from the town; but the smoke being blown upon -it by the wind, the small-pox in a short time made its appearance, -beginning in that part upon which the smoke was blown. This clearly -proves that _one_ species of contagion may adhere to clothes, and is a -very strong presumption that any other may do the same. It also shows -that contagion, when once produced, is by no means easily destroyed; -and consequently that all kinds of purification, even when used with -the utmost care and diligence, are scarce sufficient to ensure safety. - -It would now be superfluous to enter farther into the subject of the -plague being communicated by infected goods, did not our author quote a -work of Dr. Pye of London, in which the latter from the very _Journal_ -(which has been used as containing arguments in favour of contagion) -makes inferences directly opposite. “The facts related in this journal -(says Dr. Pye) seemed to me to make so clearly against the modern -doctrine of contagion, that if this writer had not mentioned them as -undeniable instances in his favour, I should not have thought there had -been any persons here in England so dull of understanding, or so much -blinded with prejudice, as to stand in need of having these facts put -into a more obvious light: but, having this occasion, I shall consider -them more largely than otherwise I would have done, and show that the -porters, who died in the lazaretto at Marseilles, received no hurt or -infection from the goods. - -“To leave no room for objection, I shall take notice, that a guard -of quarantine died on board Chataud’s ship the 12th of June; but, as -this officer was no ways concerned either in unloading or opening the -goods, he could receive no hurt from them; and besides, this must have -been fourteen or fifteen days after the goods had been carried out of -the ship into the lazaretto. Further, six of their men are said to die -at Leghorn; but the town of Leghorn was not infected from thence, which -would have been more likely if there had been any infection in the -case, than that Marseilles should be afterwards infected. - -“If any infection or infectious _aura_ can be supposed to be packed -up, and brought in goods, such infection or infectious aura must -necessarily issue forth from them in greatest abundance, and with the -greatest force, at the first opening or unpacking of them; and, as -it must continue to fly off every moment, and be thereby continually -diminishing, it is likewise certain, that in a very few days the goods -must be in a great measure, if not entirely, cleared of it. Wherefore, -if the porters could have been infected from the goods at all, it must -have been at the first opening of them: but, even according to this -journal, the porters that first fell sick were not taken ill before the -23d of June, whereas Chataud’s ship arrived the 25th of May preceding; -so that the goods of that ship, in purifying which the porter first -mentioned was employed, had been airing and purifying for twenty-six -or twenty-eight days before this accident happened; and it cannot be -conceived that after so long a time they should not have been entirely -purged of all infection or infectious aura, if any could have been -brought with them. Or if it can be supposed, which I think impossible, -that any part might still be left, it must withal be supposed so much -less than at first, as not to be capable of doing, those porters -especially, the least hurt: to suppose otherwise would be to argue -that the same man who some days before had received and borne a very -great quantity and force without any injury, could then be killed by a -quantity and force infinitely less. - -According to the report of merchants, _Frenchmen are not subject to the -plague in Turky_; and it cannot be conceived that so small a quantity -of infectious air as can be packed up and brought in a bale of goods, -should destroy them in France, or in an air and climate distant and -different; when the whole atmosphere of the same infectious air is -found not to injure them in very infected places, and wherein it is -allowed to be bred and generated.” - -Thus far Dr Pye.--Let us now hear Dr. Russel in answer. - -“The death of the quarantine officer was mentioned in order to leave -no room for objection; but still it may be objected that he has -omitted the death of the sailor on the 27th of May, and asserted, in -contradiction to the journal, that the former six sailors died at -Leghorn. That Leghorn was more likely to be infected than Marseilles, -is a strange notion. The ship had landed no goods there, nor had any -intercourse with the shore; for the physician who visits the sick on -board, remains at a distance from the ship, in a boat, and the dead -bodies are sunk in the sea. As to the circumstance of the goods of -Chataud’s vessel being all in the lazaretto before the 12th of June, -it is a supposition to be attributed to Dr. Pye’s unacquaintance with -matters of that kind; for it is impossible a ship which arrived the -25th of May should discharge the whole of her cargo in two or three -days. The dispatch would have been miraculous, considering the ship -lay near two leagues from the lazaretto, and was unloaded, and the -boats navigated, by her own crew. It did not occur to Dr. Pye, that -some time, previous to the vessels beginning to unload, is taken up in -examination and other forms at _Pomegue_, and the council of health. -The loss of six men on the voyage was an extraordinary circumstance, -that required deliberation; and it appears that on the 29th, after the -death of the sailor on board Chataud’s vessel, the council determined -the quarantine of his cargo to be forty days, commencing from the -landing of the last bale; which was double the time usually allowed for -a ship with a clean patent. It is very probable, therefore, that the -ship did not begin to unload till after the 29th of May, and possibly -had not finished when the quarantine officer died, the 12th of June, -who must have been taken ill two or three days before. - -“In regard to the time requisite for the complete evaporation of the -infectious aura, in what proportionate gradation its activity is -impaired by ventilation, and the specific quantity required to produce -effect on the human body, they are matters which I apprehend will -not readily be admitted to be clearly and certainly known. That the -first porters were not taken ill before the 23d of June, is very true; -but that the goods had been airing and purifying for twenty-six or -twenty-eight days, has been shown above to be an error. The Doctor also -makes two other suppositions equally erroneous. The first, that the -whole of the cotton contained in a number of bales is equally imbued -with infectious aura; the second, that all the bales of a ship’s cargo -are opened nearly about the same time. But, as the cotton contained in -these bales may not only have been collected from different villages at -different times, but packed up under various circumstances relative to -the materials used for embalage, and the persons employed in embaling -or steeving them; it may easily be conceived how the cargo of a ship, -coming even from a place where the plague actually rages, may be only -partially infected, or not infected at all. The warmest advocate for -contagion never contended for every bale of a ship’s cargo being -equally infectious. As to the airing of the bales, it is a laborious -and a tedious process. Where there is a considerable number, it takes -up several days to open and arrange them, goods of different kinds -must be disposed separately, accounts taken, and the cordage, &c. -laid up with care where it may be found again. The laborious part of -these operations is performed by the porters, who also transport the -goods from the water side to the enclosure where they are to be aired: -and, as the days of quarantine do not begin to be reckoned till all -the goods are landed, the porters for some days at the beginning are -sufficiently employed in receiving and arranging the cargo, that being -the business requiring the first dispatch. When these circumstances -are considered, it will appear no extravagant supposition, that some -of the last opened bales of Chataud’s cargo might still retain enough -of infectious aura to infect the porter on the 23d of June. To set -this retardment, almost unavoidable in the opening of bales, in a -still clearer light, it should be observed, that, by the regulations -at Marseilles, all suspected goods are subject to what is termed -_sereines_; that is, a certain number of bales are taken out of the -hold, and, being opened at both ends, are exposed to the air for -two, three, or six days, by way of trial, in order to see if any -signs of infection should appear among those employed in handling the -merchandise. When these have been aired, more or less, according to -circumstances, another parcel is opened and exposed to ventilation in -like manner: so that, according to the burden of the ship, there may -be several of these sereines, each of several days duration. In this -manner, independent of accidental impediments from wind and weather, -in sending the goods from the ship, it maybe supposed, were it at all -necessary to make the supposition, that the porters, not only on the -23d of June, but on the 7th and 8th of July, were infected upon opening -some new bales. As to the porter being infected by goods from another -ship, Dr. Pye thinks it impossible, because the ship had been twelve -days in port, and the goods must have been eight or nine days in airing -and purifying: had he been acquainted with the practice of the sereines -in quarantine, he would have been at no loss to make the accident agree -exactly with his notion of the infectious aura.... The plain matter of -fact, as it stands in the journal, is this, that six porters, employed -in purifying suspected merchandise from the Levant, died of the plague; -and their death was followed by that of the surgeon who attended them, -and part of his family.” - -From this the reader will be able to judge how far the question -is decided in favour of the fact that the plague at Marseilles -was actually produced by imported contagion. It seems needless to -follow our author through his investigation of those facts which -his adversaries have misrepresented; for these must of course be in -his favour; every misrepresentation by a disputant being plainly an -abandonment of his cause. Indeed the argument against contagion at that -time was properly but one, and is set forth in no stronger language -now than formerly. Even as long ago as 1665 Dr. Russel quotes one -Gadbury an astrologer stating the difficulty as strongly, and giving a -solution of it as clearly, upon _his_ principles, as the best modern -theorists can do upon _theirs_. “If the pestilence, (says Mr. Gadbury) -be infectious, and really catching in itself, it must be so equally to -all persons that approach it, or that it approacheth; or else it must -be infectious to some particular persons only. If it be infectious to -all persons, or catching to all alike, then all persons, that come -into the sight or within the scent of it, must necessarily be subject -unto it. If not infectious unto all, but unto some particular persons -only, I say then it ought not to be deemed or esteemed infectious at -all, at least not any more infectious than are all other diseases, -viz. small-pox, scurvy, pleurisy, ague, gout, &c. since (though the -notion of infection be laid aside) there is not a person born into the -world that hath not at some time of his life (as his _nativity_ shall -truly show) some one disease or other. Never was any person subject to -violent diseases, as plague, &c. but had a violent _nativity_ to show -it, and _e contra_.” - -The answer to this has been already given.--Let any other cause than -contagion or infection be supposed, and the difficulty remains equally -great. The probability is in favour of contagion, rather than a general -disposition of the atmosphere, because in the latter case the disease -would, contrary to experience, begin in a great many places at once; -but the plague begins in such a secret manner that we scarce know -whence it comes. Like fire, or a ferment in liquors, it diffuses itself -far and wide, and lastly, like an immense inundation, the source of -which is dried up, it seems to lose its power by extending too far, -and dies away altogether. We cannot penetrate into the causes of those -things, but, without any speculation at all, we can observe that the -disease falls upon people of a certain constitution more than others, -and this may be of use in preserving ourselves from it, as shall be -explained in the next section. - -It is still necessary to say something of the infection spreading -from one person to another, and being kept off by refraining from -communication with the diseased. This indeed naturally follows from -its proceeding originally from the cotton: for as all the infected did -not touch this cotton, there can be no other cause assigned from its -spreading than by communication from one to another; and, therefore, -if such communication was cut off, we should naturally think that the -disease would not spread. But, in opposition to this, we have already -quoted Dr. Moseley giving a long list of convents infected, though -they kept themselves strictly shut up. Dr. Russel cites, in favour -of prevention by shutting up, two certificates, one by the bishop of -Marseilles, the other by the sheriff of the same place. To these he -adds the testimony of M. Langeron, who was actively employed throughout -the whole time that the plague continued, first as a commodore of the -gallies, and afterwards as governor of the town and its dependencies. -In opposition to these, however, he takes notice of two passages “in -books of acknowledged authority,” which he is at pains to answer; -the one is from the Journal already quoted, which says, “and what is -unaccountable, those who have shut themselves up most securely in their -own houses, and are the most careful to take in nothing without the -most exact precautions, are attacked there by the plague, which creeps -in no one knows how.” The other passage is taken from the _Relation -Historique_, “that, in the height of the pestilence, the infection -penetrated into places which had till then remained inaccessible; that -monasteries and houses shut up in the most exact manner were no longer -places of security.” - -To the former of these our author answers, that “from the manner of -stating the case, one would think that all these religious had been -close shut up, without any communication with persons without doors; -and this was certainly intended by an author who has made remarks -upon it; but it will be found, upon looking into the beginning of the -very paragraph cited, that the greatest part of them are represented -as martyrs who had meritoriously exposed themselves. Of the twelve -different orders mentioned on this occasion, the Grand Augustines only -are said to have kept in their convent. But, supposing the Augustin -convent to have been actually shut up, and in that state infected; it -would by no means invalidate the instances brought of the preservation -of the convents, the certificates concerning which were granted -deliberately, after all was over; whereas the journal, written from day -to day, marking circumstances rapidly as they occurred, the author, -amongst various other affairs, had not always leisure or opportunity to -examine minutely into circumstances. It is in this light I am inclined -to consider the houses being infected which took in nothing without -the most exact precautions; and the rather, because I met with several -instances of the like kind at Aleppo, in the houses of the Christian -and Jewish nations: but in the sequel it generally appeared there had -been some improper communication carried on by the domestics, unknown -to the family at the time.” - -“That the atmosphere, in a city so dreadfully circumstanced as -Marseilles, may become so highly tainted as to convey the plague into -houses shut up, cannot confidently be affirmed to be impossible, by -those who hold mediate contagion; and the concurrence of circumstances -at that period in Marseilles, renders it highly probable that such -accidents happened. But, in general, the pestiferous effluvia once -emitted into the air, do not appear to operate at any great distance -from their source; and M. Deidier asserts, that two monasteries -(from their situation, one near a burial ground, the other near a -pest-house) very dangerously situated, remained nevertheless untouched, -which he thinks an argument against infection being conveyed by the -air.” - -From this long and contested account of the manner in which the plague -was received into Marseilles, we see how very difficult it must be to -come at a true state of facts, when a number of people think it their -interest to misrepresent or conceal them. The limits of this treatise -will not allow us to follow our author through the numerous details -of misrepresentations and unfair methods which the adversaries of the -doctrine of contagion have made use of to establish their opinion: -neither shall we enter into any discussion concerning the origin of -other plagues, as we should in them find the same opposite kinds of -evidence without such documents for distinguishing the true from the -false as Dr. Russel has produced in the case of Marseilles. A single -fact only, mentioned by Mr. Howard in his Treatise on Lazarettos, shall -be related, and which, if allowed to be _fact_, decides the question as -effectually as a thousand. - -“When the plague raged at London in 1665, it was conveyed to the -remote village of Eyam near Tideswell in Derbyshire. In this place it -broke out in September 1665, and continued its ravages upwards of a -year, when two hundred and fifty of the inhabitants had died of it. -The worthy rector, Mr. Mompesson, whose name may rank with those of -Cardinal Borromeo of Milan, and the good bishop of Marseilles, at its -breaking out, resolved not to quit his parishioners, but used every -argument with his wife to quit the infected spot. She, however, refused -to forsake her husband, and is supposed to have died of the plague. -They sent away their children. Mr. Mompesson constantly employed -himself, during the dreadful visitation, in his pastoral office, and -preached to his flock in a field, where nature had formed a sort of -alcove in a rock, which place still retains the appellation of a -church. He survived, and the entries in the parish register relative to -this calamity are in his own hand writing, viz. - - In 1665, Sept. Died 6 - Oct. 22 - Nov. 5 - Dec. 7 - 1666 Jan. 3 - Feb. 5 - March 2 - April 12 - May 5 - June 20 - July 53 - Aug. 78 - Sept. 14 - Oct. 17 - Nov. 1 - -This plague is said to have arisen from a box of clothes sent from -London while the distemper was at its height in that city. But whether -this be admitted or not, it cannot well be supposed that in a small -village there could either be a peculiar constitution of the air, -collections of filth, immoderate heat, cold, or in short any general -cause from which a plague could be supposed to arise, that would not -have affected the country for a great way round. How then came this -insulated spot to be so violently affected, except by contagion? No -matter whether by clothes or any thing else. The very particular manner -in which the numbers who died are recorded, leaves no doubt as to the -fact of the distemper having been there; neither is it possible to -account for its rise on any other principle than contagion. - -Mr. Howard, previous to his going abroad, had been furnished, by Dr. -Aikin and Dr. Jebb, with a set of queries relative to the plague, to -be put to the physicians in the different countries through which -he travelled. This commission he executed with great fidelity and -exactness. The physicians to whom he proposed them were, _Raymond_ -of Marseilles, physician; _Demollins_ of do. surgeon; _Giovanelli_, -physician to the lazaretto at Leghorn; _They_, to do. at Malta; -_Morandi_, physician at Venice; _Verdoni_, at Trieste; _Jew_ physician -at Smyrna; _Fra. Luigi di Pavia_, prior to the hospital of San Antonio -at Smyrna. The questions proposed were as follow: - -1. Is the infection of the plague frequently received by the French? - -Though this was not asking in direct terms whether the plague is -infectious or not, all to whom it was proposed seem to have viewed -it in this light, Raymond of Marseilles only excepted, who answered -directly, “Sometimes it is.” All the rest, except Giovanelli, agreed -that it might be communicated by the touch, or by the breath. Verdoni -gave an instance of its being communicated by a flower which three -persons smelt at; two remained free, but the third sickened and died in -twenty-four hours. - -2. Does the plague ever rise spontaneously? - -In this Verdoni alone answered positively in favour of the spontaneous -rise of the plague. _They_ spoke ambiguously. - -3. To what distance is the air infected? How far does actual contact, -wearing infected clothes, or touching other things, produce the disease? - -To this question Verdoni answered in a manner seemingly inconsistent -with his former answer; allowing not only that the plague was -infectious, but that infected things might communicate the disease -after an interval of many years. All agreed that the strength of the -infection was greater or less according to circumstances; the distance -at which it could act was likewise uncertain. Raymond said that the -sick might be safely conversed with, across a barrier, at a few paces -distance; the Jew said at _two ells_ distance, provided the chamber -windows be not all shut. Giovanelli said it had been proved that the -infection did not extend beyond five geometrical paces. The touch of -infected clothes, or drawing in the breath of the sick, was looked upon -by him and Fra. Luigi to be very dangerous. - -4. What are the seasons in which the plague chiefly appears; and what -is the interval between the infection and the disease? - -To this it was answered by Raymond, that the two solstices are the -times in which it has least power. The others agreed that hot and -moist weather was favourable to its ravages; the spring, summer and -first month of autumn are dreaded. These circumstances, however, -must be variable in different countries. As to the time in which the -infection shows itself, the answer was various. According to _They_, -it “sometimes acts slowly, sometimes like a _stroke of lightning_.” -According to Verdoni, “the disease generally shows itself at the -instant of touch, _like an electrical shock_.” Sometimes the infection -will be communicated from a sick person to a sound one, who without any -disease may communicate it to a second, and that second to a third, in -whom alone it would become active. - -The other questions, relative to the symptoms, prevention and cure of -the distemper, will be taken notice of in the course of the treatise. -In the mean time having discussed, with a prolixity almost exceeding -our bounds, such preliminaries as seemed most likely to throw some -light on the nature of the distemper, we shall now proceed to the -medical history of the plague, as we find it laid down in different -authors. - -Though this distemper has most frequently been accounted a _fever_ in -the highest degree, yet, as we have already noticed, it seems to be -essentially different.[99] The testimonies there quoted are sufficient -to establish the fact; and, were it needful, many others might be -brought from authors both ancient and modern. In the plague said to -have taken place in the days of Romulus,[100] Plutarch relates, that -the people died without any sickness. To this very ancient testimony -we shall add that of Dr. Patrick Russel, who closes the account of -his first class of patients with the following paragraph: “That the -plague, under a form of all others the most destructive, exists -without its characteristic eruptions, or other external marks reckoned -pestilential, can admit of no doubt; and it is to be regretted that -mankind have so often, from the absence of these, been betrayed into -errors of fatal consequence on its first invasion; at which early -period human prudence can only be exerted in the way of defence with -any probability of success.” - - [99] See p. 102 _et seq._ - - [100] P. 19, note. - -The symptoms of this fatal disease were sometimes a sudden loss of -strength, confusion or weight in the head, giddiness at intervals, -oppression about the præcordia, dejection of spirits, taciturnity, an -anxious aspect, but without any symptoms of fever. In these, death -ensued within twenty-four hours; some were said to have died within a -few hours, but our author saw none of these, and is inclined to doubt -the truth of the accounts, having in several instances, where this -is said to have happened, found upon inquiry that matters had been -inaccurately stated, and that the patients had really been ill one or -two days. - -In others the disorder was more perceptible. In a few hours the eyes -became muddy, the surface of the body cold, with drowsiness, lethargy, -and pain at the heart. In the progress of the distemper they frequently -lost the power of speech, the skin seldom recovered its warmth, or, -if it did, it was only by irregular flushings. The pulse sometimes -remained nearly in its natural state, but was, for the most part, low -and quick. They were “by turns delirious, confused and sensible, but -the comatose disposition was most prevalent. Towards the end they -suffered extreme inquietude. Vomiting in some occurred the first night; -in others a diarrhœa next day; both accelerating the fatal period; but -these symptoms were less frequent than in some of the other classes. -Buboes appeared only in a very few who survived the third day.... -The total absence of buboes in such patients as perished suddenly I -have no doubt of, nor of their being in general very rare in others -of this class; though I suspect that the buboes might sometimes have -been concealed, where the disease ran out to the fourth or fifth day, -and for the same reason that the reports concerning the state of -the corpse were sometimes not true.... It was very rare to find -suspicious marks of infection on the bodies [of those who died within -24 hours].... Carbuncles were seldom visible till the month of May, -which was later than this form of the disease. It prevailed chiefly at -the rise of the plague in 1760, and its revival in the two succeeding -years, decreasing as the distemper spread; and though they were found -dispersed in every stage of the pestilential season, yet the number -of this class was proportionably small, compared with that of others. -Petechiæ, vibices, or broad, livid, roundish spots, occurred sometimes, -but were not common, and the two latter were seldom visible till after -death.” - -This account of the most malignant form of the pestilence differs -considerably from that of Dr. Hodges, who seems to think that the -_tokens_, as he calls them, very generally were to be found on the -bodies of those who died suddenly. He mentions indeed a young man who -was suddenly seized with a violent palpitation of the heart, and thus -continued till his death, which took place in a few hours. In this case -the Doctor supposed that there might be a carbuncle broke out on the -heart. Dr. Russel has considered the description of the tokens given by -Dr. Hodges, and compared it with that of others called by Diemerbroeck -_maculæ mortis_, _spots_ or _tokens_ of _death_; and by this comparison -it appears that the former has spoken somewhat indistinctly on the -subject, confounding two different kinds of eruptions together. Dr. -Hodges, however, as we have already seen (p. 10) asserts, in his -_Loimologia_, that the tokens rise from within, and are broadest at -their bases, where he also supposes the pestilential poison chiefly to -lie. To the same purpose, in his Letter to a Person of Quality he says, -“The tokens have their original and rise from within, and afterwards -externally show themselves; which is evident, because the basis of them -is larger than their outward appearance, and the internal parts are -found very often spotted, when there is no discoloration visible on -the skin.” Dr. Russel, after quoting Diemerbroeck, makes the following -observations: “The author (Diemerbroeck) is diffuse on this subject, -and thinks it a mistaken though prevalent notion, that the maculæ -are merely superficial in the skin, proceeding from putrefaction, -ebullition, &c. in the blood or humours: on the contrary he affirms, -they arise from the internal parts, even the periosteum, broad at the -base, and tapering to their termination in the skin, being produced -by the _extinction_ and _extravasation_ of the vital spirits. Now -(says Dr. Russel) this answers exactly to one species of the tokens -described by Hodges, which therefore may be reckoned the same with the -_maculæ mortis_, and was probably the only one observed at Nimeguen,” -&c. On the same subject he quotes a book entitled _Medela Pestis_, in -which the author says that by careful dissection the _tokens_ may be -traced half-way deep in the flesh, and some, in the muscles of the -breast, have been followed by the incision knife even to the bone. -By the directions given by authority to the searchers in 1665, they -were ordered to look narrowly for these tokens, which were described -as “spots arising on the skin, chiefly about the breast and back, but -sometimes also in other parts. Their colour is something various, -sometimes more reddish, sometimes inclining a little towards a faint -blue, and sometimes a brownish mixed with blue; the red ones have often -a brownish circle about them, the brownish a reddish.” - -On the subject of tokens Dr. Hodges further observes, that they -differed also in their degrees of hardness, some being easily -penetrated with a needle or penknife, while others, more callous or -horny, were penetrated with more difficulty. They so strongly resembled -warts, that they could scarce be distinguished from them; and Dr. -Hodges himself was often obliged to have recourse to a needle for -this purpose. They seemed hard to the touch, not unlike kernels under -the skin, the superfices being smooth. “When I essayed to prove some -of them (says he) I found them _almost impenetrable_.” Another very -remarkable circumstance relative to them was, that they were often -quite insensible, and this distinguished them from the carbuncle, which -is always very painful. Hodges also remarks, that a quick sensibility -in the skin was always a good sign, and those that went no farther than -the skin would sometimes slough off. - -Along with these tokens we can scarce doubt that _petechiæ_ and -_vibices_ made their appearance. The former, even in the inferior -degrees of the distemper, were dangerous, the latter always fatal, -never appearing till the patient is within a few hours of death, -sometimes indeed not till death has taken place. Of the petechiæ Dr. -Russel says, that for the most part they predicted death, but not -without exception. Such as he observed were round, somewhat smaller -than a recent flea-bite. They were distinct, few in number, and -scattered irregularly about the breast and mastoid muscles. When they -did not appear till the approach of death, they were from the first -livid, or very dusky; but if they appeared early, they were of a less -deep colour, changing afterwards to livid. Hodges speaks of them as -deeper coloured than the spots of malignant fever, not fixed in any -particular spot, sometimes few, but commonly very numerous; the colour -sometimes red or purple, sometimes yellow, and sometimes livid or -black. From Gotwald, Russel quotes a description of these spots, which -he divides into four species. 1. Reddish, like flea-bites, soon growing -brown or black; appearing on all parts of the body except the face. 2. -In the form of lentils, spreading like the former all over the body; -ruddy at first, but in 24 hours growing dark or ash-coloured. 3. Large -brown spots, scattered here and there, sometimes intermixed with the -lentil kind. 4. Not unlike the measles, spreading all over the body, -rising afterwards in small blisters without any matter, vanishing about -the fifth day. Russel also takes notice of a species of petechiæ which -were very numerous, confluent, and of a dark red or dusky colour and -irregular figure. These were sometimes remarked in the interstices of -the former. Such instances occurred but rarely. - -The vibices were much larger than the petechiæ. Gotwald says that -they covered the face as high as the nose, and from thence spread to -the forehead, disfiguring the patient in a frightful manner. They -did not appear till a short time before death. Often they appeared -unexpectedly, shooting up like lightning from the breast to the -face, in spots of various colours, blue, green, brown and yellow. -Diemerbroeck describes them as oblong spots of a livid or black -colour, like strokes drawn with a pen; sometimes they were larger, -the biggest resembling the strokes of a whip. Russel takes notice of -a kind of marbled appearance which took place at the height of the -disease, or a few hours before death; the colours being a faint blue, -and darkish red, both more or less obscure at times, but never bright. -It was not permanent, vanishing in one place, without leaving any -trace, and returning at short intervals. “The skin in various places -was sometimes deformed by narrow streaks of reddish purple, or livid -colour. When such took possession of the face they gave a frightful -appearance to the countenance, and frequently made such an alteration -in the features, and so completely disguised the patient, as to render -him hardly _knowable_ by his acquaintance. A streak nearly of the same -kind was sometimes observed darting from the edges of the buboes and -carbuncles. The vibices or weals were much longer and broader, and -more exactly resembled the marks left in the fleshy parts by blows or -stripes; they were found chiefly on the thighs, buttock, and back, -and made their appearance several hours before death, in some cases, -but in others not till after. Large blue or purple spots, the _maculæ -magnæ_ of authors, were sometimes observed with or without the vibices, -a little while before the patient expired, but most commonly were -discovered only on the corpse. Their figure in general was round, -sometimes irregular.” - -Whether all these mortal signs appeared on such as died very suddenly -of plagues, and were by the English writers confounded under the -general name of _tokens_, cannot certainly be determined. Dr. Russel -saw none who died within the twenty-four hours, and few who died -within thirty hours, so that we cannot from him expect any particular -account of the situation of those who died suddenly. In general, -however, he says, that “in the most destructive forms of the plague, -the vital principle seems to be suddenly, as it were, extinguished, or -else enfeebled to a degree capable only for a short while to resist -the violence of the disease; in the subordinate forms, the vital and -animal functions, variously affected, are carried on in a defective, -disorderly manner, and denote more or less danger accordingly.” It -seems probable therefore that in those who are suddenly killed, the -same effects take place in a short time which are observed to take -place after a longer space in those who die gradually, buboes only -excepted, which require for their formation a longer time than is -allowed to the patient to live. Internal mortifications, or rather -eschars, are therefore to be suspected, and dissections have evinced -that this was really the case; but besides these there was an -appearance observed in the plague at Marseilles which is not taken -notice of by former physicians; viz. a preternatural enlargement of -the heart. M. Deidier on that occasion communicated an account of nine -dissections, but of these only one had died without eruptions. This -was a woman of 40 years of age, who lived till the third day. In her -“the mediastinum[101] was torn towards the upper part; the pericardium -of a livid colour; the heart larger than in its natural state, by the -swelling of its ventricles; full of thick, black blood. The liver was -also very large, and of a livid colour, with a carbuncular pustule on -the side of the gall-bladder, which was filled with very black bile.” -In others who had eruptions, and who of consequence we must suppose -to have lived longer, the enlargement of the heart was still more -remarkable. In one who lived eleven days, the heart was of double the -bigness, having scarce any blood in the ventricles, whose cavities -were filled each with a large polypus, that on the right side having -dilated the auricle to the breadth of four inches. The liver also -was larger than ordinary, and the gall-bladder full of a black and -green bile. The appearances were much the same in all the rest, but, -as the time they sustained the disease is not mentioned, we cannot -determine whether the enlargement of the heart took place at the very -first, or was only an adventitious symptom after the fever had come on. -Dr. Russel takes notice that such patients as he attended complained -greatly of their heart. “A sense of oppression about the præcordia -(says he) which the sick were at a loss to describe, was, in one -degree or other, a constant attendant on the plague, except in very -slight cases of infection; and where it came on early, or persisted -in a high degree, was always a dangerous symptom. The sick showed how -severely they suffered by their perpetually changing their posture, -in hopes of relief; but, when asked where their pain lay, they either -answered hastily they could not tell, or, with a fixed, wild look, -exclaimed _kulbi! kulbi!_ (my heart! my heart!) This anxiety increasing -as the disease advanced, terminated at length in mortal inquietude, -the patient, for many hours, in the last stages, incessantly writhing -his body and limbs as if in agony. Though pain at the heart was often -conjoined with the symptom just mentioned, and by the sick seemingly -blended together, it appeared to be different, and to exist separately. -They often exclaimed as in the other, my heart! my heart! pointing also -towards the scrobiculum cordis, but then would add _eujani kulbi_, my -heart pains me; or _naar fi kulbi_, my heart is on fire.” This last -pain the Doctor supposes might have its seat in the upper orifice -of the stomach; the extreme anxiety may be accounted for from the -enlargement of the heart; but as neither of these symptoms took place -in such as died in a very short time, we must be apt to consider this -enlargement not as any primary and essential symptom of the disease, -but as one which takes place when the vital powers are able to oppose -for some considerable time the cause of the disease. - - [101] The Mediastinum is a membrane by which the cavity of the - breast is longitudinally divided. The tearing of it in any disease - seems altogether unaccountable, unless we suppose an extraordinary - loss of cohesion to have taken place without any mortification. The - pericardium is a membrane surrounding the heart, and in a natural - state contains some water, condensed from vapour after death. - -In his account of the origin of the plague, Dr. Russel takes notice of -the opinion that, at the communication of the infection, the sick were -sometimes sensible of having received it. This has been observed by -Dr. Lind in malignant fevers; it has also been observed in plagues, -as we have seen from Dr. Hodges, Verdoni, and others; but Russel says -he never saw any instance of this. He owns, however, that he has seen -instances of the disease quickly succeeding a panic fear of being -infested. “In cases (says he) where the disease was not discovered to -be the plague, till upon the eruption of buboes after two or three -days, I have known several persons who had, till then, without the -least suspicion, frequented the sick, struck suddenly with a panic, -and imagine themselves ill. They felt shooting pains in their groins, -confusion in the head, and a loathing. Though in some these complaints -were merely imaginary, and soon vanished, in others they proved real; -the symptoms increasing, and being followed by eruptions. In such cases -I suspected the latent infection to have been excited by terror.” - -In the instance formerly quoted from Dr. Guthrie at Petersburg, -we have a notable example of this sudden seizure by a stroke. His -information was derived from the physician-general of the Russian -army. This gentleman assured him, that “he had seen men, in apparent -good health, instantaneously drop down, as if shot by a musket ball, -by the sudden action of the pestiferous miasma, and upon duty again -in 24 hours, perfectly recovered by the operation of a strong vomit.” -Whether or not these men _felt_ any stroke at the instant of their -falling we are not told: possibly it might be only a syncope very -common in the plague, which took place at the very first invasion. -Russel informs us, that “the sudden loss of strength, and disturbance -of the functions attributed to the brain and heart, are reckoned, in a -particular manner, symptoms of the plague. In their highest degree they -distinguish the most fatal forms of the disease; and, under different -modifications, adhere to all its varieties.... The early appearance of -faintness was very remarkable in the plague,” &c. - -Thus we see that the plague attacks without fever in two different -modes; one, by attacking and destroying the solid parts of the body, -the other, without any disorganization of the body, attacking the -vital principle itself, or rather the blood, from which this principle -is derived, so that a temporary suspension of all the functions -ensues. The analogy between the cause of pestilence and those visible -substances called _poisons_, is very remarkable in some things, though -in others it totally fails. In the Medical Repository[102] we have a -dissertation upon this analogy by Dr. Edward Miller. He observes, that -this analogy has been generally overlooked, chiefly on account of the -invisible nature of the aerial poison, and the suddenness of death -from poisons, more frequently than from pestilential diseases. This -he accounts for from the largeness of the dose of poisons compared -with that of contagion; “but (says he) by diminishing the quantity to -an appropriate amount, these noxious substances (the poisons) may be -made to exhibit the course, duration, and nearly all the phenomena, -of what is called a malignant fever. But, above all, the attention -of physicians has been diverted from this analogy between miasmata -and poisons, by the febrile part of the character which generally -belongs to pestilential diseases, and which, in common apprehension, -is constantly connected with them. Yet these diseases are by no means -universally accompanied with what is strictly called _fever_. There is -often a degree of virulence in the Asiatic plague, in the yellow fever, -and in all the other forms of pestilential and malignant diseases, -which altogether transcends the process of fever, and extinguishes -life in a more summary manner. In the worst cases both of poison and -pestilence, the febrile part of the symptoms excites little attention.” - - [102] Vol. ii, p. 409. - -Our author does not say in what this virulence consists. In the cases -of those who die with the _tokens_ upon them, the cause is plainly -within the body; the destroying power acting with greatest efficacy -below the skin in the soft substance of the flesh. Where the patient is -suddenly seized in the manner described by Dr. Guthrie, the cause seems -to be something foreign to the body suddenly inhaled, the effects -being similar to those of fixed air when drawn in by the breath, and -of consequence easily expelled by a vigorous action of the powers of -the system. Guthrie observes, that, in such cases, it seems “as if the -contagious matter existed in a very loose state in the first passages -at the beginning of the disease.” - -In the production of those _tokens_ mentioned by Dr. Hodges, we know -that there must have existed in the body a certain cause capable -of totally destroying the parts, and reducing them to an hard -eschar, similar to that produced by fire or by a caustic. As we are -unacquainted with any thing capable of producing this effect but fire, -we can attribute the origin of these tokens to nothing else but the -emission of the latent heat of both the solids and fluids which compose -these parts, and their consequent transmutation into an hard, and as -it were charred, substance. That such an emission of latent heat does -in some cases take place is evident from the production of a great -quantity of sensible heat when certain substances are mixed together. -Thus, upon mixing together oil of vitriol, oil of turpentine and strong -spirit of nitre, the whole mixture will take fire and burn violently, -though two of the ingredients, viz. oil of vitriol and spirit of nitre, -are by themselves incapable of being inflamed. In like manner if strong -spirit of nitre be poured upon oil of cloves or sassafras, the mixture -will burst out into a violent flame. Water poured upon quick lime -occasions great heat, and seems in great part to be converted into a -solid substance; for only a small part evaporates, and the slaked lime -falls into a powder to appearance perfectly dry, and from which the -moisture cannot be expelled without a very violent fire. In this case -Dr. Black is of opinion that the heat comes from the water, which, -as we have already seen, contains a great quantity of it in a latent -state. But, according to his experiments, the emission of 135 degrees -of heat is sufficient to reduce water to a state of solidity; and the -heat of lime when slaking is so much superior to this, that ships -have frequently been set on fire by it. We must therefore either say -that water in certain circumstances can part with much more than 135 -degrees, or that the lime itself emits part of the heat it contains. -This last indeed seems to be the more probable supposition of the two; -for though fluids contain more heat in proportion to their bulk than -solid bodies, we have no reason to suppose that the latter contain none -at all: on the contrary the experiments formerly mentioned, especially -those made by Count Rumford, show that they are furnished with an -almost unlimited quantity. - -The cause of the most violent kind of plague then we must suppose -to be something received into the body, which in a certain time, -probably sooner or later according to the strength of the contagion, -disposes to an irregular emission of its heat, which coming by a kind -of explosions, or, as Dr. Hodges calls them, _blasts_, produce those -eschars which have been called _tokens_, and seem to be no other than -partial combustions, by which the parts affected are reduced to a state -of charcoal, or nearly so. - -In assigning this cause for the most deadly kind of plague, we must -naturally ask the question, how can all this take place without any -pain? for of those who died in this manner, many felt neither pain -nor uneasiness till within a few moments of death. This can only be -accounted for by the sudden and perfect destruction of the parts, -which did not allow time for any sensation of pain to take place; and -indeed in the application of caustic for an issue, the patient often -feels but little pain. It is impossible to avoid perceiving a very -strong connexion between this kind of plague and the dreadful cases of -spontaneous combustion related p. 182–186. In the case of the priest -indeed the fire seems to have come from without, though even this -cannot be ascertained beyond a doubt; but in those who were absolutely -consumed to ashes, it seems equally probable that it may have arisen -from within; and as none of the unfortunate persons seem to have made -any noise or struggle, the priest alone excepted, it seems probable -that the first attack had deprived them of all sensation, and that, -notwithstanding the terrible ideas with which such extraordinary -occurrences must have inspired those who saw them, the sufferers may -have died without feeling any pain. The priest seems to have felt -nothing after the first stroke. - -Should this cause be admitted (indeed whether it is admitted or not) we -see that it is in vain to attempt to solve the phenomena of pestilence -by the doctrine of stimuli, excitement or debility. There is no degree -of stimulus, fire exepted, which can convert part of the body into -an hard eschar, neither can it be done by any degree of debility or -exhaustion. Besides, the irregular manner in which these eschars -are scattered up and down, shows that the cause has not acted from -a regular diffusion all over the body, but in a number of insulated -spots, between which the connexion can by no means be traced. In all -pestilential eruptions indeed the action of fire seems to be very -perceptible. Gotwald mentions his having observed in two patients what -he calls _papulæ ardentes_ “burning pimples,” which Dr. Russel supposes -to be a modification of carbuncular pustules. Gotwald calls them also -_fire-bladders_, and says that they were as broad as a shilling, of an -irregular shape, and the skin seemed as if _shrivelled with fire_. The -carbuncle itself approaches much to the nature of the eschar, and is -attended with violent heat in the adjacent parts. Gotwald, who gives an -account of the plague at Dantzic, distinguishes the carbuncle into four -kinds, (to be afterwards described.) Of these he says in general, that -they all _burn_ very violently at first, &c. - -From all these accounts it seems plain, that in the plague there are -partial discharges of heat, from _some_ cause, upon various parts of -the body; and that, in many instances, this heat destroys the texture -of the parts entirely. When this is done instantaneosly the patient -feels no pain, but if more gradually, the pain is excessive, as in the -case of buboes and carbuncles; which the Journalist of the plague year -in London informs us were attended with such horrid pain as to make the -patients cry out in a lamentable manner. This extraordinary heat must -either come from without or within, and we have all the reason in the -world to believe that it comes from within. Mr. Hunter, in his Treatise -on the Blood, informs us that in a local inflammation there is always -an increase of heat in the inflamed part. Should this heat arise, as -it probably does, from an emission of part of the latent heat, we may -conclude, that such a quantity might be emitted, as entirely to change -the texture of the parts. Thus mortifications or destructions of those -parts may ensue, of all kinds, from the mild _pus_ to the pestilential -eschar. - -In the effects of pestilential contagion we observe, if not a -_superiority_, at least a _different mode of action_ from what takes -place in poisons. All these seem to act by dissolving the blood, or -infecting it in such a manner that it supplies no sufficient quantity -of animal spirits; of consequence, the creature soon faints and -dies. In the plague, the blood does not appear to be much affected, -nevertheless it emits, in various places, certain explosions which -convert the parts into an eschar. Poisons always seem to produce the -petechiæ or purple spots which sometimes appear in the plague. In -Dr. Miller’s Treatise, already quoted, we find, among the symptoms -occasioned by arsenic, “red or dark spots appearing on the skin, and -rapid putrefaction, which renders speedy interment necessary.” Herein -it differs from the plague, for the bodies of such as die of that -distemper are not more liable to speedy putrefaction than others. Of -the vegetable poisons he also observes, that, “after death, sometimes -before, livid spots are observed on the body, the appearance of the -blood is dark and dissolved, and putrefaction speedily takes place.” -Of animal poisons--“The bite of the poisonous serpents is generally -followed by tumour, and livid colour of the part bitten, extravasation -of dark coloured blood into the adjacent cellular membrane, nausea -and vomiting, sudden prostration of strength, paralysis of the limbs, -convulsions, yellowness of the skin, hæmorrhages, &c. Livid appearances -of the body, a dark coloured and dissolved state of the blood, and a -rapid putrefaction, are observed after death.” - -From all these accounts, however, it is plain, that, whatever may be -the analogy between the action of poisons and malignant fevers, they do -not in any manner operate like the contagion of the true pestilence. Of -this the constant effect is to produce buboes, carbuncles, and other -eruptions, resembling much more the effects of fire than any thing -else; or, if the patient is cut off without the appearance of these, -similar effects are observed on the internal and vital parts. Dr. -Miller’s conclusion seems therefore liable to exception; in which he -says, “that only the lighter cases of pestilence are unlike the effects -of poison, but that, in proportion to the degree of malignity, the -resemblance grows stronger.” It doth not appear that any poison hath -produced one of the characteristic symptoms of the true plague, or any -thing but what is common to animals dying of various diseases, the red -spots on the skin only excepted. - -In the eighth volume of the Philosophical Transactions abridged by -Martyn, we have an account of a number of experiments by M. Deidier -and others, made upon dogs into whose veins he injected, or poured -into wounds made in the miserable animals, the bile of people dead -of the plague at Marseilles. “The consequence was, that they became -melancholy, drowsy, and without caring to eat. All of them died in -three or four days, with the essential marks of the true plague, -declared by buboes, carbuncles, and gangrenous inflammations in the -viscera, in the same manner as in the human carcases from whence the -bile was taken.” - -The poisonous bile affected the creatures differently according to the -vicinity of the place of injection to the heart. In the jugular vein it -killed them in twenty-four hours, injected in the quantity of a drachm -to two ounces of water. In this short time were brought on gangrenous -inflammations, the heart was stuffed with _thick and black_ blood, the -liver was swelled, and the gall-bladder full of green bile. This shows -a very essential difference between the action of the pestilential -poison and that of others; the former, in some parts of the body at -least, coagulates the blood; the latter, in all parts, dissolves it. - -In the crural vein (the vein of the leg) the effects were less violent. -In about an hour they became heavy. In the former case they instantly -became drowsy. In the second experiment they contracted such a loathing -for food, that they would neither eat nor drink any thing after the -injection was made. On the third day there appeared considerable -tumours under the _axilla_ (the fore leg I suppose) and on their -thighs, about three inches from the wound. The wound itself turned to a -gangrene, and the creatures died usually on the fourth day. - -In another experiment the animal had convulsive motions all over -immediately after the injection, followed by a lethargy. Next day a -carbuncle appeared on the great pectoral muscle on the right side. -On the third, a bubo appeared on the thigh, and the same day the dog -died. From the time of the injection he had neither eat nor drank. On -dissection the fore part of the breast under the teguments was found -entirely gangrened, the inward parts and viscera full of black clotted -blood, the outward surface of the lungs was all purple, the heart was -swelled as big again as usual, and the four cavities were full of black -clotted blood. The bile of this dog, injected into the crural vein of -another, produced similar symptoms, only the latter eat a little boiled -meat, which he vomited up again in two hours. He died the third day, -with the same symptoms of the plague as the others. - -The bile of people who died of ordinary malignant fevers was much less -powerful. A quantity (not mentioned how much, but probably a drachm) -mixed with four ounces of warm water, was partly injected into the -jugular vein of a dog, and a compress soaked in the rest of the liquor -applied to the wound. He appeared heavy and sleepy, and would neither -eat nor drink till the third day, when he did both willingly. On the -fourth day the compress fell off, the wound was found to be diminished -one half, and healed by degrees, the dog recovering perfectly. In -another experiment with the bile of a patient who had died of a -malignant fever, the dog not only had about a drachm of it put into a -wound in his thigh, but was made to swallow some of it; notwithstanding -which he was not seized with any distemper, and the wound healed in -fifteen days. This bile was as black as ink, in great quantity, and -very thick. In the other subjects it was of a deep green. In another -experiment, with the same bile applied on a compress, the dog likewise -escaped without any apparent disorder; but in a third, the animal died -in twenty-three hours, though at first he had shown no sign of being -affected, only that he seemed to be thirsty, and drank with greediness. -On opening him his heart was found still to beat with violence, and, -after the beating ceased, no blood was to be found in it, either in -the auricles or ventricles. “This liquor, crowded together in the -great vessels, appeared of a lively red, and very fluid, without any -of those concretions that we constantly observed in those who died of -the plague. Here appeared neither external nor internal marks of the -plague.” The bile of a person who had died of an erysipelas, injected -into the crural vein of a dog, produced no bad effect. A dog was killed -by half a drachm of Hungarian or blue vitriol injected into the jugular -vein. He died in universal convulsions: the heart was full of grumous -blood, reduced to a kind of thick pap, but without any clots. The bile, -applied to two wounds in another dog, produced no bad effect. - -From other experiments it appeared that even the pestilential poison -itself, taken into the stomach of dogs, did not produce any deleterious -effects. “A dog of the Hospital of the _Mail_ in Marseilles, who -followed the surgeons when they went to dress the sick, used greedily -to swallow the corrupted glands, and the dressings charged with pus -which they used to take off the plague sores: he licked up the blood -that he found spilt on the ground in the infirmary; and this he did -for three months, being always gay, brisk, well, full of play, and -familiar with all comers.” The health and briskness of this unfortunate -dog proved his ruin, by making him the subject of philosophical -experiment. A drachm of the pestiferous bile injected into the crural -vein, killed him in four days. He had a considerable hæmorrhage from -the wound the night before he died, and he had also a disagreeable -smell both while living and after he was dead. Two other dogs, which -had swallowed a quantity of pestiferous bile, became heavy and -melancholy, refused their food, and showed other signs of disorder; -but all these went off in a short time, and no signs of the distemper -appeared. - -These experiments induced M. Deidier to suppose that the contagion of -the plague lay only in the bile; but the following experiment shows -that the blood was equally infected, and capable of communicating the -disease, and that of the most malignant species. It was made by M. -Couzier, physician to the infirmary at Alais, and in the Philosophical -Transactions we have the following account: “I took a quantity of blood -from a person dead of the plague, and mixed it with warm water, which -mixture I attempted to inject into the crural vein of a dog, but the -end of the syringe being too large to enter the vein, the experiment -did not succeed. This made me resolve to try to lay some of the same -infected blood upon the wound. This I accordingly did, and covered it -with a dressing, which the dog got off in the night. I found the next -morning that the dog had licked the wound, and that he refused his -food. Towards night he began to bemoan himself, and gave signs of an -approaching death. The next morning I found him dead, the wound being -considerably swelled and gangrened, and the edges round the swelling -were likewise gangrened. - -“Upon opening the body, we found the liver something larger than usual, -with spots of a livid purple, as in the bodies of persons dead of -the plague. In the stomach was found a quantity of black coagulated -blood, of the size of a hen’s egg. This in all likelihood was what he -had swallowed upon licking the wound. The heart was very large, with -a black grumous blood in the ventricles, and the auricles were turned -blackish and gangrenous.” - -This last experiment naturally brings to remembrance those of Dr. -Home at Edinburgh, in which he inoculated the measles by means of -the blood of patients ill of that disorder. From the accounts he has -given in his treatise entitled Medical Facts and Observations, we can -have little doubt that _his_ experiments succeeded, however others -may have failed. One thing, however, is very obvious, viz. that if we -mean to communicate a disease by means of the blood, we must use a -much greater quantity than if we make the experiment with the matter -of an abscess. The case of contagious diseases seems to be the same as -in fermenting liquors. With a small quantity of yeast we can easily -induce fermentation in any proper liquor, but, if we skim off the -yeast, and use only the pure fermenting liquor, we must use a much -greater quantity; and to inattention to this circumstance we may with -probability ascribe the difficulty which Dr. Home himself met with in -introducing the disease, and the total want of success in others. In M. -Couzier’s experiment a considerable quantity must have been used, as he -says that in the dog’s stomach it equalled the size of an hen’s egg. A -much smaller quantity of matter taken from a pestilential abscess is -capable of producing the disease in a human body, as is evident from -the case formerly quoted of that gentleman who inoculated himself for -the plague, and of which Dr. Guthrie gives the following account: “This -was Mathias Degio, one of the surgeons of the hospital at Bucharest, a -building appropriated to the cure of the plague in the Russian army. -He, perceiving the gentlemen of his profession _condemned in a manner -to death, if punctual in the discharge of their duty_[103] had the -resolution to inoculate himself for the plague, in the full confidence -of its efficacy, and ever afterwards found himself invulnerable, whilst -his companions around him were falling victims to its fury. He produced -the disease by inserting, with the point of a lancet, under the -epidermis of his arm, matter from a pestiferous abscess, and followed -the cold regimen observed in the small-pox, as he had imitated its -mode of inoculation. On the fourth day of the puncture the fever -declared itself, and he, being perfectly devoid of fear, got through -the disease without feeling more inconvenience than if it had been that -which he imitated. He drank freely of cold water, with vinegar, or a -little wine, and kept generally out of doors. This beverage was the -only thing that had the appearance of medicine,” &c. - - [103] This, among innumerable other instances that might be brought, - is a proof of the infectious nature of the plague. - -From a careful attention to all these histories, it is plain that the -plague is naturally an eruptive disease, as, in all the animals in -which it was artificially brought on, eruptions took place, provided -the life of the creature was sufficiently prolonged to allow them to -come out. Dr. Russel says, that, from his diary, he noted down the -cases of _two thousand seven hundred_ patients, _all_ of whom had -eruptions of one kind or other. In this it agrees with the small-pox, -which Dr. Mead justly considers as an inferior kind of plague. In the -latter, however, the eruptions seem to resemble those called by Dr. -Hodges the _tokens_, only that the cause which produces them is less -violent in its nature; but why the eruptions of the small-pox should be -in distinct pustules, and not one continued boil all over the body, is -undoubtedly inexplicable on any theory whatever. The same is true of -the plague. No man can explain why the tokens, for instance, instead -of being collected into one great eschar, are dispersed into small -distinct pieces; or why, instead of buboes in the groin and armpit, or -instead of carbuncles in different parts of the body, there should not -be a single one equivalent in bulk and power to them all. This appears -similar to the phenomena of rain, hail or snow, which fall in distinct -drops, fluid or congealed, or in flakes, instead of being equally -diffused all over the spot on which they fall. In the latter case we -say that the phenomenon is occasioned by _electricity_: we may say the -same, if we please, of the small-pox and plague, with equal emolument. - -From the accounts we have just now quoted, it appears that there is -between malignant fevers and the true pestilence a very essential -difference; the latter tending to thicken the blood, the former to make -it thinner. In this respect therefore the poisons seem to resemble -malignant fevers very considerably; for M. Fontana observed that by -mixing animal poisons with blood drawn from a vein, it was prevented -from coagulating. In the instance above related where a dog died in -consequence of bile injected into his veins from one who died of a -malignant fever, the blood was found extremely fluid. In some who died -of the hospital fever, Sir John Pringle informs us, that suppurations -had taken place in the brain; but in the true plague the tendency to -mortification always prevailed above every thing. - -Lastly, that the plague proceeds from too great a quantity of heat, -either emitted from the body itself, or some how introduced into it, -seems to be pretty plain from the effect it has of augmenting the -venereal appetite to an almost inconceivable degree. This was taken -notice of in the plague of Marseilles, and indeed in many others. -Russel quotes two remarkable passages to this purpose; one in a plague -at Genoa, the other in Messina. “Amidst so many dreadful fears and -terrors, amid so many fetid and putrefying bodies, amid the shrieks, -the sighs and the groans of the sick, what would you have expected? -That the people, struck with dread and horror, remained sad, modest -and quiet. You are mistaken. They sung, played on instruments, danced, -intrigued, and Genoa never was seen so shameless, debauched, and -disorderly. I have said before, that God in this plague gathered in -a harvest for heaven; but it seemed to be also a vintage for the -lascivious of of the earth. If not so, how came so many marriages -to be celebrated in the Lazaretto of Consolation, and that so many -women, without shedding a tear for the death of their husbands, -immediately entered into new engagements? One day, in particular, five -marriages were performed, four of the bridegrooms being buriers of the -dead, and dressing themselves and their brides in clothes stripped -off from the bodies of the deceased.” On the plague of Medina he -quotes the following extract of a letter written by a gentleman who -resided in that city during the plague in 1743. “It has always been -observed, that, after _every_ plague, those who recover are addicted -in an extraordinary degree to lewdness and incontinence, which was -surprisingly visible at Messina, and carried to such a degree of frenzy -and bestiality, that many were known to violate the bodies of dead -virgins!” - -That an extraordinary propensity to venery may be produced by -introducing into the body a quantity of heat, admits now of a kind -of demonstration from a fact mentioned by M. le Roy concerning -phosphorus.[104] This substance is exceedingly apt to take fire on the -application of a small degree of heat, and even by slight friction. It -is now introduced into the materia medica, and is found to be a very -powerful medicine, though dangerous on account of its inflammability, -the heat and air contained in the human stomach being sometimes -sufficient to set it on fire. The taking such a substance into the -body therefore seems not much different from taking actual fire into -it; and indeed M. le Roy mentions the case of a woman who had taken -only a single grain, and who he says had been recovered, _by it_, from -a putrid fever, but died suddenly from some imprudence. In this woman -the whole substance of the body was found luminous upon dissection, and -the hands of the operator continued luminous even after being washed. -M. le Roy, having taken three grains of this fiery substance, found -himself extremely incommoded by it for some hours, and was obliged -to drink great quantities of very cold water. Next day he found his -muscular powers amazingly increased, and had an _almost insupportable -venereal irritation_. This we see was the consequence of throwing into -the body a quantity of heat from without; but if the body itself emits -that heat which it invisibly contains, the effects must be the same as -though an extraneous quantity had been thrown into it. Neither are we -to imagine that the _quantity_ of heat contained in our bodies is small -or inconsiderable; for we have already seen that heat consists in the -efflux from any substance, of an invisible and most subtile fluid, in -all directions. When this flux is gentle, the heat is moderate, but in -proportion to the activity of the discharge, the temperature becomes -hotter and hotter, and if very violent, the cohesion of the parts is -dissolved entirely, and the substance is said to be on fire. There is -required therefore only some cause to begin the emission of this fluid; -for as soon as this begins, the immense quantity with which we are -surrounded, will supply more in abundance,[105] and continue so to do, -as long as the original cause subsists, or until the substance can no -longer bear the power which operates upon it. - - [104] Memoires de Societe Medicale, &c. - - [105] If we consider the composition of the atmosphere which - surrounds us, we must acknowledge that by far the greater part of - it consists of fire and electric fluid, the latter being properly - the element in a comparatively quiescent state. In deflagrating - dephlogisticated and inflammable air, the mixture has sometimes - shrunk up into a three hundredth part of its bulk; which shows that - of these airs two hundred and ninety-nine parts are fire, the single - remaining part only being earth, water, or some solid matter which we - call the _basis_ of air. - -From this view of the causes of the plague, and from the facts which -have been laid down concerning it, we cannot help perceiving a very -strong similarity between the plagues mentioned in the Old Testament -and those which still exist in the world. In one of the passages -formerly quoted it is called an _inflammation_, an _extreme burning_; -and from the testimonies of different authors above quoted, it is plain -that the disease still deserves the name bestowed upon it in the sacred -writings. From the account given of its proximate cause, it is plain -that plagues of all degrees of intensity may take place, from absolute -accension of the body, and its reduction to ashes, to the mildest -state of the disease, in which the patient is not confined to his bed; -and all this from the single principle of emission of heat from the -body itself. It likewise appears that there may be either in the body -itself, or in the element which surrounds it, such a constitution as -will dispose that element which is the natural and immediate preserver -of our life, suddenly to attack and destroy it, of which the case of -the Italian priest is a most remarkable instance. In other cases, such -as the Italian lady, and the woman at Coventry, the body itself seems -to have given out its heat, though this could not be done without a -concurrence of the surrounding ethereal fluid. In a stage still lower, -the body is partially consumed, or rather partly charred into a kind -of cinder, as where the _tokens_ are produced; and when the cause acts -with still less violence, a fever is produced. In the Old Testament -we find these different kinds of plagues very distinctly mentioned. -In some cases the offenders died by actual fire, which either struck -them from without, or was kindled within their bodies. In others, they -seem to have died by that very deadly kind of plague of which we have -already said so much, which kills in a few hours. This was probably the -plague which destroyed the army of Sennacherib, and this in the tenth -chapter of Isaiah is by some thought to have been prophesied of under -the title of a _burning like the burning of a fire_. - -Of these things I the rather take notice, as I perceive, in a late -oration, not only the doctrine of the plague being propagated by -contagion severely ridiculed, but the scripture itself treated in a -most indecent and scandalous manner. “In the earliest ages of the world -(says he) when ignorance and superstition led men to attribute all -extraordinary phenomena to the direct agency of supernatural beings, -pestilence was supposed to be immediately imported from heaven. This is -the opinion which appears to have prevailed among the ancient Hebrews, -and may be ranked at the head of the catalogue of absurdities on this -subject. The dominion of prejudice over the minds of that ignorant and -obstinate people appears in this instance particularly striking. Such -was the depth of their blind bigotry in favour of the healthfulness of -the globe they inhabited, that they would seem to have considered it -as even superior to that of the celestial regions. Hence, unwilling -to believe that their favourite earth could give origin to an evil so -dreadful as the pestilence, they imported the seeds of this calamity -from the more unhealthful climate of heaven!!” - -In this extraordinary paragraph we find the matter so much -misrepresented, that every vestige of truth is swallowed up in it. -The Hebrews believed that they were under the immediate inspection -and government of the Deity; a doctrine which, however our author -may _disbelieve_, he cannot _disprove_. But, notwithstanding this -immediate inspection and government, the Deity never did bring upon -them any plague but by the intervention of natural causes. The agents -which he had originally created were sufficiently able to execute -his purposes. The Creator never employed any power but what already -existed in the world, and the power that he generally did employ was -_fire_. This agent he directed to exert its force in such degrees as -he pleased, and against whom he pleased. It is a mistake to think that -miracles were _immediately_ the effects of supernatural power. They -were all accomplished by the very powers which exist in the world at -this moment, only these powers were by the Creator at particular times -directed to act in a manner that they would not have done had they -been left to the mechanism of their own nature. When we read therefore -of people being consumed by fire from the Lord, there was neither -importation of fire from heaven nor any where else; the element exerted -its power on these particular persons, either by lightning proceeding -from the cloud which represented the Deity, or their bodies threw out -the latent heat which they contained, and consumed of themselves. That -in cases of this kind there was no _importation_ supposed, is evident -from an expression used about bringing water from the rock. It is not -said that the water fell from the stars, or came down with the tail -of a comet, but that the rock gave out the water which it previously -contained. At the present day the same powers exist, and sometimes -produce the same effects that they did in former times, with this -difference, that now, having no intelligent agent to interfere with -their natural mode of action, they exert their force indiscriminately, -and as the mechanism of their nature happens to be stimulated, they -destroy every thing promiscuously before them. In all this I cannot -perceive the smallest absurdity, or any thing but what a reasonable -man _may_ indeed _must_ believe, if he makes use of his reason. As to -the causes which Dr. Caldwell so much insists upon, viz. filth and -corruption, it is extremely probable that (while the Israelites were in -the wilderness) these had no existence. By their law they were enjoined -such frequent ablutions, that their bodies must always have been -perfectly clean. Human excrements were not allowed to lie above ground. -The offals and dung of their sacrifices were carried to a distance, and -they were expressly told, that they must not allow of any uncleanness -in their camp, lest God should turn away from them and abhor them. Add -to all this the great heat and dryness of the desert in which they -wandered, which would quickly parch up and carry off the moisture from -any dead carcases or putrefying matters that might be allowed to remain -notwithstanding the injunctions to the contrary. Indeed if we consider -the dryness of the climate where these people were, and that they were -constantly attended by a large stream of water, it is difficult to -conceive any situation upon earth more healthy than that of the Jews in -the wilderness. If plagues therefore came upon them, it is difficult -to say how they could have happened according to the ordinary course -of nature; and, if not according to this, it must have been by an -alteration of it, or by miracle. - -The plague, as has already mentioned, in its very severe state appears -most commonly in the beginning of an epidemic season, and is neither -very common nor very infectious. The most common mode in which it -invades the patient is with the symptoms of a malignant fever; and -of cases of this kind Dr. Russel has made up his five classes of -patients, the first or deadly kind having been already described. -In his second class, the next in malignity to the fatal kind, the -disease made its attack with a slight shivering, succeeded by fever -with giddiness, vomiting, head-ach, and sometimes looseness. In the -night the fever increased, the thirst was excessive, and the patient, -harassed by the vomiting, &c. passed a very unquiet night, frequently -with delirium or coma. Towards morning the fever abated, the sick -recovered their senses if delirium had taken place, but if coma, it -continued through the day, and the remissions were less. Throughout -the first day, and part of the second, the pulse was full and strong, -but on the second it began to alter, and some of the characteristic -signs of the disease to appear. The principal of these was a certain -muddiness in the eyes, which sometimes took place even on the first -day. This is by our author accounted a symptom very difficult to be -described, and, though he recounts the descriptions given by several -authors, none are found adequate to the real appearance. “It resembled -(says he) somewhat the dull, fixed eye observable in the last stage of -malignant fevers; but the dullness was different, muddiness and lustre -being strangely blended together. It continued with little alteration -in the remissions, and even where the patient appeared sensible and -composed it did not increase in the febrile exacerbations, but the -eyes acquired a redness that added wildness to the look, which abating -or going off in the remissions, the muddiness remained behind. It -was this which contributed chiefly in composing that confusion of -countenance which I shall not attempt to describe, but which enabled me -to pronounce with tolerable certainty whether the disease was or was -not the plague, though not independently of other symptoms. When this -muddiness disappeared or abated, it was constantly a favourable sign. -After a critical sign it often disappeared suddenly, but where there -was a succession of sweats, or where no visible crisis happened, its -disappearance was slow and gradual.” - -Along with this muddiness the patient had a peculiar confusion of -countenance; the pulse quick and equal, or low and fluttering, but -rarely intermittent; the external heat moderately feverish, at other -times intense, with irregular flushings, with pain at the heart, -or oppressions about the præcordia; burning pain at the pit of the -stomach, and incessant inquietude. When to these symptoms were added a -faltering in the tongue, loss of speech, while the surface of the body -became cold and damp with clammy sweat, death was inevitable. In the -evening of the second day all the symptoms became worse; and in the -morning the patient appeared to lie quiet more from his strength being -exhausted than from any change to the better. When the vomiting had -ceased, however, there was frequently such a remission on the third day -as gave the attendants great hopes of a favourable event; but these -hopes were always fallacious and of short duration. Sometimes where -vomiting, looseness or hæmorrhage had preceded, the patient died on -the third day: at any rate, none of this class recovered, whether the -disease was left to itself, or treated with medicine. The appearance -of buboes was of no consequence, for they never came to maturity, and -the little advances they made neither accelerated nor retarded the -termination of the disease, which happened sometimes on the third, but -more frequently on the fifth or sixth day. - -The third class of patients were equally unfortunate with the other -two. “The difference between the second and third consisted in the -absence of vomiting at the beginning, the later accession of coma -and other bad symptoms, and a slight tendency to perspiration, which -very rarely occurred in the second.... From the second or third night -the course of symptoms in both classes varied very little, and the -termination of the disease was in both the same: it may be added they -reigned together through all the periods of the pestilential season, -but were most prevalent in its augment; for at its height, and in its -decline, they gave place to varieties of the disease less destructive.” - -The fourth class was the most numerous of all. Its distinctive marks -were, “the continuance of the inflammatory or febrile symptoms with -less interruption than in the other, a pulse more constantly sustained, -or soon recovering itself when hurried in the exacerbations; the -length and vigour of the exacerbations decreasing in the advance of -the disease; and, above all, the prevalent tendency to a favourable -discharge by the skin, with the critical sweats on the 3d, 5th, or -subsequent days.... Vomiting was a concomitant in about one fourth of -the sick. The fever, for the most part, was very moderate the first -night, very rarely accompanied with delirium, and almost never with the -comatous disposition.... The buboes and carbuncles commonly made their -appearance the first day; but it was not unusual to see a successive -eruption of these in the course of the disease.... The morning sweat, -on the third day, in some cases proved completely critical, but more -commonly produced only a remission so favourable as to encourage the -expectation of a more favourable crisis on the fifth; but, where the -patient neither sweat on the third, nor a sensible remission took place -on that day, some degree of danger was always to be apprehended.... -After the sweat on the fifth, the subsequent exacerbations proved -slighter and slighter, and the buboes for the most part advancing -favourably, little or no fever was left remaining after the beginning -of the second week, except perhaps symptomatic heats occasioned by the -eruptions.” In this class the patients sometimes appeared only to have -a slight attack, and yet at last were seized with mortal symptoms, -while others who deemed to be much worse at first yet happily recovered -and did well, In general the severe pestilential symptoms did not come -on till a considerable time after the attack. - -To the fifth class our author refers all cases of slight infection, -wherein the more formidable symptoms of pestilence never concurred, -and _all_ the infected recovered. “The access here was often attended -with so little apparent disorder, that the eruptions gave the first -alarm; and the fever which came on afterwards was frequently so slight -as not to confine the sick to the house. Others found themselves -indisposed for two or three days, but were not sensible of any -febrile heat whatever. But in this class the disease did not always -invade thus insensibly. The febrile symptoms, especially the first -three days, sometimes run pretty high; and the fever afterward, in -nocturnal exacerbations particularly, run out to the end of the week -or longer: but, as there was no concurrence of alarming symptoms, and -the exacerbations, terminating for the most part in sweats, gradually -diminished in force after the third or fourth night, it was not -difficult in the worst cases to foretel the event at that period, nor -necessary in others to defer the decision so long. - -“_All_ the infected had buboes or carbuncles, and very often both -eruptions concurred in the same subject. Persons not confined -by indisposition were often, by the inguinal buboes, prevented -from walking abroad. The carbuncles constantly formed the _black -crust_,[106] and then suppurated; the buboes in one third of the sick -dispersed. The dispersion of the buboes was never observed to be -attended with bad consequences, notwithstanding the general neglect of -purging in the decline of the disease: indeed very few had recourse -to remedies, topical applications excepted, unless perhaps a bleeding -at the beginning, where the febrile symptoms ran high. This class was -_nearly as numerous_ as the fourth, but began to predominate rather -later, and reigned most of all in the decline of the plague in 1762.” - - [106] This is in favour of what has already been observed, that - the pestilential eruptions in _all_ cases showed a tendency to - mortification. - -The sixth class must be omitted, as containing dubious, anomalous -and extraordinary cases. We shall therefore proceed to consider the -accounts of the plague given by other physicians, which, without -questioning the accuracy of Dr. Patrick Russel in relating what _he_ -has seen, may serve to throw some light on the subject, by relating -what _others_ have seen. Dr. Alexander Russel, in his Natural History -of Aleppo, gives the following description of it. “The distemper -in itself is the most lamentable to which mankind are liable. The -torments of heat, thirst and pain frequently unite in some patients; an -unspeakable dejection and languor in others; and even those who escape -with life do not cease to suffer from painful and putrid ulcers, the -painful remains of the disease. The desertion of relations, of friends, -and of domestic servants, the want often of the common necessaries -of life, and the difficulty of procuring medical assistance, are -circumstances likewise which aggravate the miseries of the sick, and -contribute greatly to augment the general horror. - -“But, as no disease incident to mankind is in its nature more terrible -and destructive, so none is more difficult to observe. Its symptoms -are scarcely in all respects alike in any two persons, and even vary -extremely in the course of an hour in the same subject. The disease, -attended in the beginning with symptoms not highly alarming, often ends -fatally in a few hours; while the most formidable attacks, by a sudden -and unexpected alteration, sometimes terminate happily. - -“The first complaints of those seized with this distemper, were, -in general, a coldness or shivering; sickness; a vomiting of large -quantities of porraceous bile, which often had a very offensive smell; -anxiety, or an inexpressible uneasiness about the pit of the stomach; -pain in the back or loins; an intense head-ach; uncommon giddiness, and -a sudden loss of strength. Some were sensible of a sharp shooting pain -darting at intervals into the parotid, axillary or inguinal glands. -To these symptoms succeeded a violent fever; in which, while the sick -complained of extreme inward heat, their skin, externally to the touch -felt little hotter than usual. Sometimes this heat became general -and intense; at other times particular parts only were affected; but -it seldom continued long in the same degree, having several unequal -remissions and exacerbations in a day. In these exacerbations the face -became florid, but would often from a deep scarlet change to a livid -colour, like that of a person almost strangled, and, again suddenly -changing, it would assume a cadaverous paleness. The eyes, soon losing -their natural lustre, acquired a kind of muddiness; and the countenance -of most of the sick was ghastly and confused beyond description. The -pulse the beginning was somewhat quicker and lower, but in other -respects varied little from the natural state. Within a few hours it -commonly increased in quickness and strength, but seldom remained -the some for an hour, nay scarcely many minutes together; incessantly -varying, both as to strength and quickness, and without any manifest -correspondence with the other febrile symptoms. - -“In such as complained of pains darting either into the parotids, -the arm-pits, or the groins, a small hard, deep-seated tumour, with -external discoloration of the skin, was discovered by the touch in the -part, and these were the incipient pestilential buboes. - -“The appearances now described were those of the distemper on the -first day, till evening, when the sick always suffered a severe -exacerbation, in which the heat both internal and external became -excessive; and, as they generally were by that time delirious, it was -often with difficulty that they would be kept within doors; they were -greatly disposed to talk, but faltered so in their speech, that what -they said was hardly intelligible, the tongue having shared with the -other organs in the general debility. The exacerbation lasted the -most part of the night; but the heat, delirium, and inquietude abated -towards morning, and a manifest remission took place. Some recovered -their senses entirely, some partially, and then complained of intense -head-ach, or of pains from the buboes; it was usual in this interval -also that those who had carbuncles began to complain of _burning_ pain -in those _fiery_ eruptions. The morning remission was commonly of very -short duration; the rigours, anxiety and delirium soon returning more -violent than before, attended with a strong and frequent subsultus -tendinum. These febrile symptoms did not increase regularly as the day -advanced; but went away and returned at intervals leaving short but -alarming intermissions; for each exacerbation surpassed that which -preceded it either in violence or duration. In the evening the pulse -could hardly be counted, by reason of its depression and quickness; the -patient became comatose, and the respiration was quick, laborious, and -interrupted. The buboes which, some hours before, seemed manifestly to -advance, often subsided, and sometimes almost entirely disappeared; -the carbuncles, mortifying at the top, resembled a _great eschar made -by a caustic_: and at this period also livid or black spots, of various -dimensions, often were found scattered universally on the body. - -“Under these circumstances, dreadful as they seemed, some hope of -recovery still remained; for, though many of the sick died on the third -day, several had a favourable crisis on that day, by a profuse sweat; -some struggled to the fifth day, a few to the seventh, and, here and -there one, even to the eleventh; before any critical alteration took -place. Where a copious sweat happened on the third day, if it did not -prove perfectly critical, it at least always considerably abated the -fever; which, in that case, was generally totally removed by a second, -though less profuse sweat, on the fifth: and then besides weakness the -chief remains of the disease consisted in the pain of the eruptions. - -“Nothing could be predicted with respect to the event of the disease -from the manner of its invasion; those who had the most favourable -escape having been often in the beginning attacked with as alarming -symptoms as others were who died in a few hours. Sometimes the febrile -paroxysm, which had set in with such formidable violence, dissolved -in a few hours, and left the patient languid indeed, and weak in an -extreme degree, but free from other complaints except the pain arising -from the bubo, which from that period increasing in size, and advancing -favourably to maturation, was, in many cases, ready to open in twelve -or fifteen days: the patient all the while, except the first day, -walking about as usual. Great numbers happily escaped, not only in the -manner just described, but likewise where the buboes never advanced; -for these tumours, so far from coming always to maturation in such as -recovered, very often discussed without any bad consequence. Carbuncles -often began to digest before the termination of the fever in a critical -sweat. - -“All the infected had buboes, except such as expired suddenly, or -survived the first attack a few hours only. Instances of this dreadful -kind were more particularly observed in March 1743. The sick were -seized in the usual manner; but the head-ach, vomiting, and pain -about the præcordia, increasing every moment, proved suddenly mortal, -or terminated within a few hours in fatal convulsions.” Dr. Patrick -Russel observes, that such instances of sudden death were very rare in -the plague of 1760, 1761 and 1762; and in these they happened only in -the winter, or early in the spring. In such sudden deaths few had any -appearance of buboes; but in general the armpits and groins, or the -inside of the arms and thighs, became livid or black, and the rest of -the body was covered with confluent petechiæ, livid pustules being here -and there interspersed: but all these appearances were more especially -observed after death. - -In the plague of 1760, vibices as well as livid and black spots were -frequently found on the corpse, but not constantly. They were always -suspicious in conjunction with other circumstances, but their absence -was no proof, though frequently urged as such, that the distemper was -not the plague. The vibices sometimes appeared several hours before -death, but the livid spots seldom or never. - -The tongue in some was quite moist, and continued to be like that of -a healthy person throughout the disease; in others, white at first, -then yellow; at last black, and covered with a dry, foul scurf or fur. -The thirst was generally very great, but never constant; returning at -regular intervals, and never appearing to correspond with the danger -of the fever. Sometimes it was so little that the patient could not be -prevailed upon to drink a sufficient quantity. The appearance of the -urine was equally variable, and afforded no certain prognostic; being -seldom alike in any two patients in the same stage of the distemper, -and varying in the same patient every day. The vomiting commonly ceased -after a few hours, excepting where the sick were induced by thirst to -load their stomach, in which case it always returned. Sometimes the -patients were costive, in others a diarrhœa took place, but in most -the discharges were natural. No critical solution by urine or stool -seemed ever to take place. A few cases of hæmorrhages from the nose and -uterus were observed; and if they happened after the second day, were -soon followed by a plentiful sweat, which commonly proved critical; -“a circumstance different from what has been usually observed in the -plague at other places. - -“From the preceding account of the plague it will readily be conceived -that nothing can be more difficult than to form any judgment or -prognostic of the event of the disease; in which, as it is justly -remarked by Morellus, our senses and our reason deceive us, the -aphorisms of Hippocrates are erroneous, and even Hippocrates (as I am -inclined to think) might have erred in his judgment.” - -Innumerable other histories of the distemper might be given, but the -following, it is hoped, will be sufficient, along with what has been -already detailed, to show that the plague in former ages was the same -as at this day. In the terrible plague which broke out in the time of -Justinian, the distemper sometimes began with delirium, and the patient -instantly despaired of life; but more generally people were surprised -by the sudden coming on of a slight fever; so slight that no danger -was apprehended either from the state of the pulse or colour of the -body. This, however, was quickly followed, sometimes even on the same -day, sometimes on the second or third, by buboes or parotids (swellings -behind the ear) which when opened were found to contain a black _coal_, -or _eschar_, of the size of a lentil. If these swellings suppurated -kindly, the patient recovered, but if not, a mortification ensued, and -death was the consequence, commonly on the fifth day. Black pustules or -carbuncles, covering the body, were signs of immediate death, as was -likewise a vomiting of blood in weak constitutions; for this terminated -in a mortification of the bowels. Pregnant women generally perished, -but women were less susceptible of the infection than men; and young -persons were in more danger than old. Many, who recovered, lost the use -of their speech, and such were not secure from a relapse. - -In the last plague at Moscow, the symptoms were various, according -to the persons, constitution and the weather; in general, head-ach, -giddiness, shivering, loss of strength, slight fever, sickness and -vomiting, redness of the eyes, white and foul tongue, with a dejected -countenance, buboes and carbuncles appearing on the second or third -day, but seldom on the fourth. The buboes were seated chiefly in the -glandular parts, the armpits and groin, but sometimes made their -appearance in the neck, cheeks, &c. Sometimes these suppurated -perfectly, and then they proved beneficial, but not otherwise. -Sometimes they suddenly disappeared, after having attained the -size of walnuts; and this retrocession was always supposed to be a -sign of approaching death. Sometimes they neither showed any sign -of inflammation nor were painful, and in such cases afforded no -relief. Similar swellings sometimes occured in the parotid glands, -but they were never equally beneficial with the buboes. _Carbuncles_ -were gangrenous spots on the skin, resembling a burn, with black, -livid or red vesicles, bordered with an inflammatory ring, and soon -terminating in a hard, black eschar. The _anthrax_ is more prominent, -penetrating deeper into the adipose membrane, and attended with more -pain and inflammation. The disease was likewise attended with petechiæ -similar to those in putrid fevers, but larger; also with vibices, -which resembled the mark of a whip, and were considered, as well as -the petechiæ, as mortal signs. No distinct account of the pulse could -be given; as, after the disease became general, physicians did not -choose to feel the pulses of their patients but through a glove or -tobacco-leaf. Worms called _teretes_ were frequently discharged both -upwards and downwards. Women with child generally suffered abortion, -and were carried off by an uterine hæmorrhage.[107] - - [107] Bonetus relates, that in 1676 in a malignant fever at Borgo di - Safia, the patients discharged live worms by the mouth, and adds that - they were sooner killed by wine than any thing. - -According to Sydenham, the plague begins with chilliness and shivering, -like the fit of an intermittent, succeeded in a little time by violent -vomiting and oppression at the breast, accompanied with its common -symptoms. These continue till the disease proves mortal, or the -kindly eruption of a bubo or parotis discharges the morbific matter. -Sometimes, though rarely, the disease is not preceded by any fever; -the purple spots, which denote immediate death, coming out even while -persons are abroad about their business. But this hardly ever happens -but in the beginning of a very fatal plague, and never while it is on -the decline, or in those years in which it is not epidemic. Sometimes -swellings appear without having been preceded either by a fever or -any other considerable symptom; but he conceives that some slight and -obscure shivering always precedes the seizure. - -Mariti, in his travels through Cyprus, &c. says that the plague of 1760 -began with loss of appetite, pain in the shoulders, head-ach extremely -violent, delirium, vomiting, with a most excruciating pain in that -part where the tumour by which the plague is characterised, is about -to break forth. Death often took place on the third day, and very few -lived beyond the thirteenth. - -The Abbe’s definition of what he calls the plague, and which seems to -be the _pestilential bubo_ of the physicians, is somewhat singular. -“The plague (says he) is an oblong tumour, shaped like a pumpkin, which -is at first of a flesh colour; but it gradually becomes red, and at -length blueish; and this is a sign that the disease is incurable. If it -continues red, and a little after inclines to yellow, it is a sign that -a suppuration will take place: the swelling is then opened, and the -patient is sometimes cured.” - -According to our author, the symptoms of the plague do not appear -till fifteen days after the infection is received; and this is the -reason of a law which subjects to a proof of twenty days every person -suspected of being diseased. In this plague it was observed that people -of the soundest constitutions were the most subject to it, and the -least capable of resisting it. On the other hand, it appeared to spare -weak and delicate persons, whose cure, in case of an attack, was much -less difficult. A greater number of Moors than of any other nation -were attacked by it; and when once they were seized, their case was -absolutely desperate. Those who had recovered from the disease were -less liable to a second attack, but were not absolutely safe. “I have -known some (says our author) who have been ill seven times, and have -died of it at last.” - -Dr. McBride informs us that in the plague which raged at Marseilles and -the adjacent places in 1720, people on their first seizure seemed as if -intoxicated with drink; they lost the power of their limbs entirely, -and became so dejected that they gave themselves over to despair from -the very first attack. Along with the bilious vomitings and purgings -which generally took place on the second day, quantities of small worms -like ascarides were thrown off. The more plentiful these evacuations -were, the more salutary; for those who vomited and purged but little -sunk down, oppressed with the disease, and died before the fourth day, -covered with livid blotches and petechiæ; those who had the largest -evacuations had also the most plentiful eruptions of buboes and parotid -abscesses. When these appeared, the patients rose, walked about, and -became remarkably hungry; the heat and thirst subsided, but the face -continued pale and languid, the pulse hard and frequent. On the sixth, -seventh, or eighth day, if the suppuration stopped, and the humours -went back, then came on oppression, difficulty of breathing, furious -delirium and convulsions, which ended in death. When carbuncles, or -biles, with mortified sloughs, appeared in different parts of the body, -either alone or accompanied with the glandular swellings, the patients -scarcely ever escaped. In great numbers of people tumours appeared -without any previous febrile symptom, and, in a few cases, went off by -resolution; in others they continued in a schirrous state; but it was -best when the tumours came to suppuration. - -These are the most remarkable symptoms of this fatal disease, which -have been recorded by the physicians of greatest eminence who have -written upon the subject. It remains still to give some particular -description of the buboes and carbuncles, which are supposed to -constitute in a particular manner the characteristic signs of the -distemper. Of these the following account, given by Dr. Alexander -Russel, seems to be sufficiently clear and explicit. - -Only a very few, and such as died suddenly, were exempted from buboes, -but only about one half had carbuncles. In the latter plagues their -proportion was still smaller; but they seldom appeared earlier than in -the months of April or May. In 1742 and 1743, the buboes often appeared -on the first commencement of the distemper, sometimes not till twelve -hours after; in a few instances not till two or three days; but in -1744 they were sometimes the first symptoms of the disease. The buboes -were generally solitary, the inguinal and axillary more frequent than -the parotid. “The inguinal bubo for the most part was double; that is, -two distinct glands swelled in the same groin. The superior, which in -shape somewhat resembled a small cucumber, lay obliquely near the large -vessels of the thigh, lower than the venereal buboes are usually found, -and it was that which commonly came to suppuration; the inferior was -round, and in size much smaller. I once met with a case in which an -axillary bubo divided in like manner into two parts, one of which got -under the pectoral muscle, the other sunk deeper into the armpit: both -grew painful and inflamed, but that in the armpit only suppurated.” - -The bubo was at first a small hard tumour, painful but not inflamed -externally. These indurated glands were deeply seated, sometimes -moveable, at others more or less fixed, but always painful to the -touch. Sometimes they would increase to a considerable size in a few -hours, with intense pain, then suddenly subside; and these changes -would take place several times in twenty-four hours. “An exacerbation -of the pestilential symptoms immediately upon the decrease of the -bubo, sometimes prompted me to imagine it owing to the retrocession -of the tumour; but this did not happen so constantly as to make me -think it was so in reality. The buboes, as far as I could learn, never -advanced regularly to maturation till such time as a critical sweat -had carried off the fever. In ten, twelve, or fifteen days, from the -first attack, they commonly suppurated; having been all along attended -with the usual symptoms of inflammatory tumours. But I have known -them sometimes, nay, frequently, disappear soon after the critical -sweat, and discuss completely without any detriment to the patient. -At other times, though grown to a pretty large size, the tumour, -about the height of the disease, would sink and mortify, without any -fatal consequences; for, as soon as the crisis was complete, the -mortification stopped, and the gangrened parts separating gradually, -left a deep ulcer, which healed without difficulty. I met with no -instance of a bubo in which fever did not either precede or follow the -eruption.” - -On the subject of carbuncles, Dr. Patrick Russel observes, that “there -are certainly varieties in them, but perhaps these varieties have been -unnecessarily multiplied, from the same eruption having been viewed -in different stages of its progress; for all of them sooner or later -are covered with a black eschar.” Dr. Alexander Russel describes -them as follows: “The carbuncles were commonly protruded the second -day of the disease; and though the muscular and tendinous parts were -more especially affected, no part whatever could be said to be free -of them. The carbuncle at first resembled an angry confluent pock in -its inflammatory stage, but was attended with intense, burning pain, -and surrounded by a circle of a deep scarlet hue, which soon became -livid. By a progress very rapid, it then spread circularly, from the -size of a silver penny to an inch and an half, two inches, nay, even -three inches, diameter; and the supervening gangrene often penetrated -deep into the substance of the parts affected. In such of the sick -as recovered, the gangrene usually ceased spreading on the third day; -and, a day or two after, signs of suppuration were observed at the edge -of the black crust, the separation of which, advancing gradually, was -completed rather in less time than that of the eschar in issues made -by caustic. In cases where the patient died, I was informed (for I saw -none of those cases myself) that a quantity of ichorous matter oozed -from beneath the eschar, which remained itself shrivelled and hard, -without any favourable signs of separation or digestion.”[108] - - [108] Dr. Gotwald, formerly quoted, describes four varieties - of carbuncles, the differences between which seem to be pretty - distinctly marked. 1. “One kind rises pretty high, is of a dark - brown colour, the cuticle appearing as if it were burnt, and it is - surrounded with a lead-coloured circle. In the beginning it is no - bigger than a pea, but, if not prevented, soon grows to the size - of a crown piece; inwardly it is moister than the rest, and may be - more easily separated. Its seat is generally in the fleshy parts, - as on the shoulders, neck, hips, arms and legs. 2. The second lie a - little deeper, and do not rise so high; the eschar in the middle is - entirely dark and ash-coloured, full of small chops, as if it would - burst by too great dryness: it has a strong lead-coloured circle, - behind which the sound flesh looks red and shining. It eats into - the flesh round about it, and takes deep root: it generally fixes - in the most fleshy parts, as the buttocks, calves, &c. 3. The third - is not very large at first; it appears like a blood swelling, not - so dark as the former, with a wrinkled skin; as it increases, small - blisters arise in the middle, and form an eschar, in little clusters, - which, as an ingenious physician observed, were small carbuncles. - They commonly are situated in membranous and tendinous parts about - the knees, toes, and behind the ears, &c. 4. The fourth is the most - curious, as Purman, in his treatise on the plague, has well observed. - Sitonius calls them pale, livid, ulcerous papulae: they appear with a - high, yellowish blister, which seems full of corruption: the circle - round it is first red, then of an ash colour: the blister soon - falls, and, with the carbuncle, appears scarce so big as a pepper - corn, continually eating deeper and wider. They are seated upon the - cartilaginous or gristly parts. Gotwald found them near the pit of - the stomach, upon the cartilago ensiformis and short ribs. All the - four take root and burn very violently at first, but the two former - most of all.” - -Dr. Alexander Russel also describes another kind of pustule, which he -says appeared in a small number of the sick, but which his brother Dr. -Patrick had no opportunity of observing in 1760. It had no livid or -discoloured circle surrounding it, but was filled with laudable pus; -and, when dry, the crust fell off, as in the distinct small-pox. This -was looked upon as a favourable symptom, all who had it happening to -recover. - -We have now detailed, at considerable length, the symptoms of the -plague as mentioned by authors of great eminence. To give a detail -of _all_ that has been said upon this subject would be impossible; -neither indeed can it be thought necessary in the present treatise. -Whatever may have been omitted or too slightly mentioned in this -section, will naturally be considered when we come to treat of the -cure. It now therefore only remains to say, whether the approach of a -plague may be known by any visible signs, so that people might in some -measure prepare themselves for the ensuing calamity. - -Were we in possession of an accurate and authentic history of the -world, this question might be very easily decided; but the uncertainty -of ancient records, the mutilated state of those which we do possess, -the diversity of opinions among mankind, and the unhappy disposition -to _misrepresent_, so common in all ages, render it very difficult to -say any thing upon the subject. If the theory hinted at in this section -(that plagues arise from some commotion in the electric fluid) can be -allowed to have any foundation in nature, then it ought to follow, that -the forerunners of pestilence would be some electric phenomena; and, -from a perusal of the first and second sections of this work, it will -appear that such an opinion is not altogether unfounded.[109] - - [109] See p. p. 61, 62. - -The appearance of immense numbers of insects has likewise been -accounted a sign of approaching pestilence; but if we suppose their -appearance to be a _sign_, we can scarce imagine their putrefaction -to have been a _cause_, of pestilence. In the east we are informed -by Dr. Russel that the inhabitants of Aleppo account the appearance -of insects, and even _eclipses_, as presages of the plague. They -suppose also that the stillness of frogs is a sign of pestilence; -but the same author informs us that all these signs failed in 1760. -Violent earthquakes and famines seem to be more certain signs, though -even these are not always to be depended upon; it being evident -from historical accounts that pestilence has sometimes preceded, -and sometimes followed, earthquake and famine. Mr. Gibbon, however, -ascribes to the above-mentioned causes, viz. insects, earthquakes, and -even _comets_, the dreadful plague which took place in the reign of -Justinian. At least, all these preceded it; but perhaps the _insects_ -were only meant to be accounted the cause of the plague. The cause -of the _insects_ must remain in obscurity. According to him, “In a -damp but stagnating air, this African fever is generated from the -putrefaction of animal substances, and especially from the swarms of -locusts, not less destructive to mankind in their death than in their -lives.” - -This dreadful plague was preceded by comets and most violent -earthquakes. A remarkable comet appeared in 536, supposed to be the -great one observed by Sir Isaac Newton in 1680. This, we are told by -astronomers, revolves round the sun in a period of 575 years; but the -failure of astronomical predictions in the return of the expected -comets of 1759 and 1789, shew the futility of such calculations. -Another comet appeared in 539, and these comets were attended with -an extraordinary paleness of the sun. Mr. Gibbon observes, that -earthquakes, which he calls a fever of the earth, “raged with uncommon -violence during the reign of Justinian. Each year is marked by the -repetition of earthquakes of such character, that Constantinople has -been shaken above forty days; of such extent, that the shock has been -communicated to the whole surface of the globe, or at least of the -Roman empire. An impulsive or vibrating motion was felt; enormous -chasms were opened, huge and heavy bodies were discharged into the air, -the sea alternately advanced and retreated beyond its ordinary bounds, -and a mountain was torn from Liburnia, and thrown into the waves, where -it protected as a mole the new harbour of Botrys in Phenicia.” - -According to Dr. Sydenham the plague at London in 1665 was preceded -by a very cold winter; the first continued till spring and went -off suddenly towards the end of March. Peripneumonies, pleurisies, -quinsies, and other inflammatory disorders, then made their appearance, -along with an epidemic fever of a particular kind, which did not yield -to the remedies successful in other epidemics. About the middle of -the year the plague began, and increased in violence till the autumnal -equinox, when it began to abate, and by the ensuing spring was entirely -gone. Our author says that the plague seldom rages violently in England -but once in thirty or forty years; but since his time, which is upwards -of a century, no plague hath appeared. He supposes the plague and -other epidemics to depend on some secret constitution of the air, -but pretends not to say what that constitution is. But, besides this -constitution, he is of opinion that there must be another circumstance, -viz. the receiving the effluvia or seminium from an infected person. -Thus he supposes that a single infected person is sufficient to poison -a whole country; the general mass of atmosphere being infected by the -breath of the diseased and the effluvia of the dead bodies. “Thus -(says he) the way of propagating this dreadful disease by infection is -rendered entirely unnecessary; for though a person be most cautiously -removed from the infected, yet the air received in by breathing will -of itself be sufficient to infect him, provided his juices be disposed -to receive the infection. I much doubt, if the disposition of the air, -though it be pestilential, is of itself able to produce the plague; -but the plague being always in some place or other, it is conveyed by -pestilential particles, or the coming of an infected person from some -place where it rages, to an uninfected one, and is not epidemic there, -unless the constitution of the air favours it. Otherwise I cannot -conceive how it should happen, that, when the plague rages violently in -one town in the same climate, a neighbouring one should totally escape -it, by strictly forbidding all intercourse with the infected places; an -instance of which we had some few years ago when the plague raged with -extreme violence in most parts of Italy; and yet the Grand Duke, by his -vigilance and prudence, entirely prevented its entering the borders -of Tuscany.” As to the nature of the disease, when once produced, -Dr. Sydenham is of opinion that it is altogether inflammatory; for -which he gives the following reasons: 1. The colour of blood taken -away that resembles that in pleuritic and rheumatic disorders. 2. The -carbuncles resemble the mark of _an actual cautery_. 3. The buboes are -equally disposed to inflammation with any other tumours that come to -suppuration. 4. The season of the year may be adduced in proof of this; -for between spring and summer, inflammatory disorders, as pleurisies, -quinsies, &c. are common. - -Before we put an end to this section, it may now be proper to say a -few words by way of apology for the many apparent digressions from -the subject which have appeared in it. In the first place, then, the -work being intended for general inspection, and not merely for medical -readers, it became absolutely necessary to introduce a number of things -which for medical readers would have been totally superfluous. It was -to be supposed that the book might come into the hands of some who had -not read any thing concerning the structure of the body, who had not -heard of any of the systems of medicine now prevalent, or the different -doctrines they contain. It was impossible to write in an intelligible -manner for such people without giving some few hints concerning all -these subjects: the same consideration made it necessary to enter -pretty largely into the discoveries concerning the composition of -the atmosphere and various kinds of elastic fluids, concerning heat, -&c. In doing this the writer was under a necessity either to adopt -some of the doctrines he took notice of, or to animadvert upon them. -If he has ventured freely to give his sentiments, it is not with a -view to establish a theory of his own, but to direct the attention of -the reader to those natural agents which seem to be at present too -much overlooked, principally because they are less accessible to our -senses, and of consequence less subject to experiment, than others. -If therefore in this treatise it is suggested that the atmosphere -acts on the human body by its internal or latent heat, and by its -electricity, as well as by its other properties; if the writer is -inclined to believe that these are in fact the most powerful parts of -it; that we never can act without them, and that in short our life -and health are in immediate dependence upon them; I say, that none of -all these things are in opposition to any fact hitherto discovered, -either of the medical kind or any other. On the other hand, in all ages -physicians have sought for some constitution in the air, inexplicable, -and perpetually unknown, to which diseases might be ascribed that could -not be supposed to originate from any of its ordinary properties. To -explore this constitution is as great a desideratum at the present -moment as two thousand years ago; and any attempt to investigate it, -or a conjecture relating to it, cannot be supposed inconsistent with -any thing already discovered and ascertained. There are many things -which lead us to think that electricity is very much concerned in -diseases, and among the rest we must account the new discovery of Dr. -Perkins’s metallic conductors a very notable proof of it. These, when -first ushered into the world, were made by many a subject of ridicule; -but the evidence in favour of their efficacy, both in America and in -various parts of Europe, seems now to be decisive in their favour; -and, if they act at all, it is almost impossible to suggest any other -principle than that of electricity to which their efficacy can be -owing. No doubt it is difficult to draw the line properly betwixt -credulity and skepticism, but where credible testimony determines any -thing to have actually happened, or where solid reasoning gives room to -suppose any thing to be probable, it never can be invalidated by any -argument _a priori_ formed against the _possibility_ of such a thing -taking place. - -In page 128 it is said, that M. Lavoisier, by introducing the new -chemical nomenclature, “has entailed the greatest curse upon the -science it ever met with.” All apology for this bold assertion is -absolutely necessary, and the quotation made from Dr. Ferriar may be -deemed inadequate, or perhaps misapplied. In passing this censure on -the nomenclature I wrote from experience. The new nomenclature, instead -of promoting _my_ improvement in chemistry, hath had a direct contrary -tendency. An instance of the inconvenience and ambiguity arising from -it is given p. 135, when speaking of Dr. Girtanner’s theory. But a -much more remarkable example is to be met with in the review of Dr. -Monro’s Chemical Treatise, where we find him censured for the very -same ambiguity taken notice of with regard to Dr. Girtanner. “He might -have observed (say the reviewers) the distinction between the hydrogen -and inflammable air, and between the oxygen and pure air, as well as -between the azote and impure air: he has mentioned these as synonimous, -whereas they are terms that express bases, or substances in a concrete -state (what I have called the condensable part) and the compounds -of these substances and heat, when they assume the form of gases or -elastic fluids.” (Monthly Rev. for 1790, p. 26.) - -That the terms invented by Lavoisier and others have not been received -with perfect unanimity by the chemists of the present day, is evident -from Dr. Pearson’s “Translation of the New Chemical Nomenclature,” -which is not only a _translation_, but a _vindication_ of it. In the -course of his work he quotes the translator of the Chemical Dictionary -saying, that, “from the zeal of reforming language, such a number of -reformers may arise, that our ears will not be less stunned, nor our -understandings less perplexed, than if we were exposed to the clamour -of Babel, or the _thaw of words_ of Sir John Mandeville.” To this -Dr. Pearson replies, that there is no reason to fear any such bad -consequences. “The distinguished superiority of a system produced by -a _De Guyton_, a _Lavoisier_, or a _Bergman_, would surely supercede -the work of persons of _inferior ability_.” It is impossible to know -the persons here designated, unless the Doctor points them out. If he -chooses to call _himself_ one of them, we can have no objection. He -certainly has dissented, in one article, from “the system produced -by De Guyton, Lavoisier and Bergman,” and this is with regard to the -word _azote_. This is the term announced to us as the most proper for -denoting a certain kind of air. But Dr. Pearson determines _nitrogen_ -to be more proper. Even this has not given entire satisfaction, -for Dr. Mitchell has adopted the word _septon_ in preference to -both _azote_ and _nitrogen_. Thus, instead of the original phrase -_phlogisticated air_, used by Dr. Priestley, we have four; for as -long as the works of Dr. Priestley remain, the original term will -be used by some, while with others it will be so much disused that -perhaps they will not understand it when it happens to occur. Nor are -corrections of this kind all that we have to fear. Professor Wiegleb, -who has written a System of Chemistry in quarto, has therein changed -almost all the nomenclature invented by Lavoisier. Instead of it he -gives a nomenclature of his own, in which he makes very much use of -the termination _cratia_, from a Greek word signifying strength; thus, -instead of saying the _acid of fluor_, we are to say _fluoricratia_. I -must confess that to me the perpetual repetition of this termination -has a very ridiculous appearance; but the misfortune is, that in the -case of nomenclatures we have no choice. We cannot choose one and -reject another: good or bad, we must take both; and were an hundred -new ones to arise, we must be condemned to learn them all. Nor is even -this the worst. Wiegleb’s scholars, for instance, accustomed to the -language of their teacher, will be apt to put it into their writings, -perhaps without proper explanation; and thus such writings must be -unintelligible both to old and new chemists: and thus it will be with -as many others as choose to invent new chemical terms. - -Were this a proper place for entering into a discussion of Lavoisier’s -nomenclature, it might easily be shown that the terms are not more -proper than those which preceded them; but no real inconvenience can -arise from the propriety or impropriety of a mere name. It is the -_resemblance_ of the terms to one another, and the facility with -which mistakes may be made, that gives just ground of complaint. -Nor is it any just reason to accuse a person of want of judgment or -carelessness because he hath mistaken these terms. We see that even -Dr. Monro has not attended to every circumstance; and if a man of his -experience and accuracy hath been inaccurate in this respect, what -is to be expected from others? How easily may the words _sulfate_, -_sulfite_, _sulphuret_ and _sulphure_, be mistaken for one another, -either in writing or conversation! Yet a mistake of this kind would -totally pervert the meaning of the person who used it. The scripture -finds fault with those who make people offenders for a _word_; but here -we are in danger of being made offenders for a _letter_. In short, -taking into account the inconveniences arising from this nomenclature -itself, the numberless corrections and amendments (no matter whether -real or imaginary) to which it may be subjected, and the number of -others totally different from it which may arise, I cannot help looking -upon the introduction of it into chemistry as an evil of the first -magnitude; an evil which cannot be remedied by any art, but must -continually become worse and worse. - - - - -SECTION IV. - -_Of the best Methods of Preventing the Plague._ - - -These methods may be classed in the following manner: 1. Those most -proper for avoiding the infection, supposing the disease to be -infectious. 2. The proper mode of resisting or removing those local -causes which may give rise to it, or may co-operate with the infectious -matter in giving greater force to the disease, should it happen to be -introduced; and, 3. The best method of preparing the body for resisting -pestilential attacks, should we happen to be so situated that no -external method of defence could be used. - -With regard to the first of these intentions the flying from places -infected has been so universally recommended, and so generally -received, that the precept has been made up into the following -proverbial Latin distich: - - “Hæc tria tabificam tollunt adverbia pestem - Mox, longe, tarde, cede, recede, redi.” - - _These words prevent the plague’s infectious pain, - Go_ quick, _fly_ far, _and_ slow _return again._ - -This maxim hath been put in execution in all ages, but often with so -little regard to humanity that it cannot by any means be recommended -without very considerable limitation. The reparation of the sick from -all promiscous intercourse with the sound, in times of pestilence, -seems to be dictated by common sense; but this may be done without -killing them, or leaving them to expire in the miserable state to which -they are reduced by the disease. Mr. Howard informs us that in some -places ships which have the plague on board are chased away and burnt; -and instances of cruelty with regard to infested individuals have been -formerly mentioned. Dr. Mertens is of opinion that cutting off all -the communication between the infected and healthy is the only means -of preventing the disease from spreading. The good of this practice -was observed in one of the hospitals at Moscow. All the avenues to it -were shut up, but one which was strictly guarded, and every suspected -article prohibited from entering. Infected clothes and utensils were -burned, and the houses where the sick had lived were purified by the -fumes of vinegar and gun-powder. - -In this mode of prevention it is of the utmost consequence to ascertain -the distance to which the contagion extends; in the next place to know -whether by means of clothes, cotton or other kinds of merchandise it -may be imported from one place to another; and in the third place -how long the infection may remain in these kinds of goods; so that -people may know when the danger is over. As to the distance, it seems -to be generally agreed, that it is but small. Some of the answers to -Mr. Howard by the physicians of whom he inquired, have been already -related. Of the infection of the plague he speaks in the following -manner: - -“In my opinion this distemper is not generally to be taken by the -touch, any more than the gaol-fever or small-pox; but either by -inoculation, or by taking in with the breath the putrid effluvia which -hover round the infected body; and which, when admitted, set the -whole mass of blood into fermentation, and sometimes so suddenly and -violently as to destroy its whole texture, and to produce putrefaction -and death in 48 hours. Those effluvia are capable of being carried -from one place to another, upon any substance where what is called -_scent_ can lodge; as upon wool, cotton, &c. and in the same manner -that the smell of tobaco is carried from one place to another. - -“The infection in the air does not extend far from the infected object, -but lurks chiefly (like that near carrion) to the leeward of it. I am -so assured of this, that I have not scrupled going, in the open air, -to windward of a person ill of the plague to feel his pulse. The rich -are less liable to the plague than the poor, both because they are more -careful to avoid infection, and have more large and airy apartments, -and because they are more cleanly, and live on better food, and plenty -of vegetables; and this I suppose is the reason why Protestants are -less liable to this distemper than Catholics during their times of -fasting, and likewise why the generality of Europeans are less liable -to it than the Greeks, and particularly Jews. - -“It is remarkable that, when the corpse is cold of a person dead of the -plague, it does not infect the air by any noxious exhalations. This -is so much believed in Turky, that the people there are not afraid to -handle such corpses. The governor of the French hospital at Smyrna told -me, that, in the last dreadful plague there, his house was rendered -almost intolerable by an offensive scent; especially if he opened any -of those windows which looked towards the great burying-ground, where -numbers every day were left unburied; but that it had no effect on the -health of himself or family.” - -It is likewise a matter of the utmost importance to ascertain the time -at which the disease is introduced into any town or district. Dr. -Canestrinus, in a treatise on this distemper, published at Saltzburg, -complains greatly of the dissensions among physicians concerning the -nature of the distemper, owing to which its existence is frequently -denied, and thus its ravages are propagated immensely beyond the -limits which might otherwise circumscribe them. Of this he gives the -following remarkable instance: “In the year 1770 a disease with -uncommon symptoms prevailed at Bodrogh in Upper Hungary, which carried -off a number of persons in a short time. A physician of the county -of Zemplin was sent to inquire into the nature of the malady. He -reported that the disease was of a suspicious nature, having a great -resemblance to the plague. His report was received by the nobility and -health-officers with indignation, as if untrue. Another was sent, who, -without hesitation, pronounced the disease an epidemic scurvy. In the -mean time the disease, being left to itself, spread wider, and raged -with such violence as to carry off seventeen persons in one house. -The nature of the disease now becoming apparent, proper measures were -taken, and the infected separated from the sound, by which means the -disease was confined within a small district.[110]” With regard to the -infection of the disease, or _contagion_, as it is commonly called, -he expresses himself as follows: “The air is not capable of diffusing -the contagion to any considerable distance from the infected subject -unimpaired in its power, but, like other poisonous matter, it is -capable of dilution in the atmosphere, so as to be rendered at length -innoxious. The contagion of the plague will be entirely prevented from -spreading if all access to, and all intercourse with, the sick be -strictly prohibited: whence the following forms a safe and infallible -prophylactic of the disease: - - [110] Medical Review, vol. iii, p. 257. - - “Mox, longe, tarde, cede, recede, redi. - _Go_ quick, _fly_ far, _and_ slow _return again._” - -“No change in the habit takes place previous to the action of the -contagion, but the body is from the first equally susceptible of it -as of the itch, or any other infectious disease. Whilst the plague -ceases in the civilized parts of Europe spontaneously, or by human -precautions, its revival is prevented, from the care that is bestowed -in purifying or destroying every infected substance. In the east, -on the contrary, this precaution is totally neglected; whence it is -probable that the disease is not reproduced anew, but that it is -perpetuated by the former fomes, as happens with us in the small-pox. -The matter producing the ordinary epidemics is widely diffused in the -atmosphere, and capable of infecting through a widely extended space. -The pestilential poison, on the contrary, is confined to the vicinity -of the affected body, and becomes so dilute at the distance of a few -paces only as to be incapable of further action. Hence it appears that -the plague is much easier avoided than epidemic disorders. The more -abundant the contagious matter is, the further probably is the power of -its infection carried. This is the reason that the mere separation of -the sick and suspected from the healthy is so much more efficacious in -destroying it at its commencement than at a later period. To restrain -epidemics within bounds is impossible; but with the contagion of the -plague, it is certain that it can be confined by art to a narrow spot.” - -Of the truth of this last assertion our author gives a remarkable, -instance in his own practice about the time that the plague stopped -at Bodrogh. Having been sent into Cassovia, along with two other -physicians, they were informed by the surgeon of the lazaretto, that -an unusual disease had broken out in the district of Zboina, which had -suddenly proved fatal to many. On inquiry it was found that it had come -from Bodrogh in the following manner: Two young men, returning from the -vintage at Tokay, slept a night in an infected house, and stole some -clothes belonging to those who had died of the plague. He who carried -the clothes died by the way: his father carried home the bundle, kept -them unpacked for some weeks, but having at last worn them, he and -all his family fell victims to the same disease. The pestilence began -to spread, and shewed an appearance of great malignity. Our author -did not hesitate to declare its true nature, and in consequence of -his declaration all communication was cut off between the adjacent -countries and the infected spot, by a cordon of the military. The -infected were separated from such as were only suspected, and these -last from the sound: three infected houses were destroyed by fire, -and other means (to be afterwards related) were used with a view to -destroy the contagion itself. Thus the disease was prevented from -spreading; and none but such as had been previously suspected were -seized. - -To the same purpose the Abbe Poiret thinks it an easy matter to -extinguish the plague entirely. He was a witness to the ravages of -the disease in Barbary, and thinks it the most easily avoided of -any distemper; but the misfortune is, that there are many things in -their own nature very easily accomplished, which the inattention or -perverseness of mankind render utterly impracticable. Such, it is to be -feared, is the extinction of the plague by the means just mentioned; -for though these means might be enforced in a country district or small -town, yet, where the pestilence enters a large and populous city, -there are so many modes of concealing its existence, and the unknown -intercourse of the sick with the sound must be so frequent, that it -seems scarce possible to prevent the malady from spreading. - -In London, whether it arose from a neglect of using the precautions -for too long a time, or from any other cause, cannot well be known; -but the attempts of the magistrates to separate the sick from the -sound certainly were not attended with any good consequence. “The -consternation (says Dr. Hodges) of those who were thus separated from -all society, unless of the infected, was inexpressible, and the dismal -apprehensions it laid them under made them but an easier prey to the -devouring enemy. And this seclusion was on this account much the more -intolerable, because, if a fresh person was seized in the same house -but a day before another had finished the quarantine, it was to be -performed over again; which occasioned such tedious confinements of -sick and well together, as sometimes caused the loss of the whole. -Moreover, this shutting up of infected houses made the neighbours fly -from theirs, who might otherwise have been a help to them on many -accounts; and I verily believe that many who were lost might have -been alive, had not the tragical mark upon their doors driven proper -assistance from them. And this is confirmed by the examples of other -pestilential contagions, which have been observed not to cease until -the doors of the sick were set open, and they had the privilege of -going abroad.” The Doctor sets forth also the arguments on the other -side; but whatever _might_ have been the advantages of a separation -of the sick from the healthy, if conducted in a manner less capable -of hurting the feelings of humanity, it is evident that in the London -plague the methods attempted to prevent the disease at least did no -good. - -In countries where the plague generally prevails, and the Europeans are -_united_ in the opinion that it is necessary to separate themselves -from the natives, the method of shutting up is attended with the most -salutary effects, as has been attested by almost every traveller who -has resided there for any time. Accidents among them are very rare, -though not altogether without example. At Alexandria in Egypt, M. -Volney tells us, that as soon as the plague makes its appearance the -European merchants shut themselves up in their _khans_ and have no -communication with the rest of the city. Their provisions are deposited -at the gate of the khan, and received there by the porter, who takes -them up with iron tongs, and plunges them into a barrel of water -provided for the purpose. If it is necessary to speak to any one, they -keep at such a distance as to prevent touching with their clothes, or -breathing on one another; by which means they preserve themselves from -this dreadful calamity, unless by some accidental neglect of these -precautions. Some years ago a cat, which passed by one of the terraces -into the houses of the French merchants at Cairo, conveyed the plague -to two of them, one of whom died. This state of imprisonment continues -for three or four months, during which time they have no other -amusement than walking in the evening on the terraces, or playing at -cards. - -The doctrine of predestination, and still more the barbarism of the -government, have hitherto prevented the Turks from attempting to -guard against this destructive disease: the success, however, of -the precautions taken by the French, has of late begun to make some -impression upon many of them. The Christians of the country who traffic -with the French merchants, would shut themselves up like them; but this -cannot be done without permission from the Porte. A lazaretto was some -years ago established at Tunis; but the Turkish police is every where -so wretched, that little can be hoped for from those establishments, -notwithstanding their extreme importance to commerce and the safety -to the Mediterranean states. The very last year afforded a proof of -this; for as violent a plague as ever was known broke out there. It was -brought by vessels coming from Constantinople, the masters of which -corrupted the guards, and came into port without performing quarantine. -Water carriers have never been attacked by it. - -Mariti says, that in the island of Cyprus, and on the continent of -Syria, every European, on the slighted appearance of the plague, after -taking the necessary precautions, shuts himself up with his family. -The Mahometans alone, more intrepid, go abroad as usual, converse with -each other, give such assistance to each other as may be necessary, and -often fly to the relief of a Christian when deserted by his friends. -This arises from their belief in predestination. The Mahometans of -Syria, however, less familiarized with this scourge, make use of some -precautions, which were augmented in 1760. They published an ordonnance -forbidding every vessel attacked by the plague to enter their ports: -but their vigilance in this respect was so remiss, that it was not -sufficient to prevent the contagion. The governor of Acre checked -the progress of this plague, by giving the inhabitants the means of -retiring from its ravages; and these means, though absolutely contrary -to the dogmas of the Mahometan religion, were eagerly embraced. The -Europeans became their models; and the governor, after deriving -from them every necessary information, shut himself up, after their -example, together with his numerous family. The mufti alone, being the -protector of the Mahometan law, cannot imitate a conduct which that -law condemns. Instead of shutting himself up in a prudent confinement, -he thundered forth against this new method, reproached the governor for -his conduct, and, having treated him as an impious person, threatened -him with all the vengeance of Heaven. The governor, however, only -laughed at this pious folly of the mufti, and sent a detachment of -soldiers to impose on him a fine of two hundred and fifty sequins, for -having dared to ascribe to him, in matters of religion, an ignorance, -from every suspicion of which his age ought to have secured him. - -In the time of plague, the proper precautions are, to shut one’s self -closely up, and to receive no provisions or other things, except those -on which the plague has no influence. The people of Syria, however, in -1760, admitted every kind of provisions without fear, but not without -using certain precautions. They did not receive warm bread; flesh of -every kind was thoroughly washed, and milk was strained through a -linen cloth, in order to free it from the smallest particle of animal -hair. All kinds of pulse were soaked in water, and they abstained from -peaches, apricots, and other fruits which are covered with a downy -rind. Fowls were cooked out of the house, for fear that some small -feather might adhere to them. Flowers were altogether proscribed. -Letters were opened by the person who brought them; and they were never -read until they had been steeped long enough in vinegar to be purified -without effacing the writing. Every thing was received into the house -by means of a rope of herbage suspended from a window. The governor -employed every precaution which he thought likely to guard him from the -contagion; and, by shutting himself closely up, he set an example which -the rest of the Mahometans did not neglect to follow. Besides this he -caused the streets to be cleansed; and carried his vigilance so far as -to forbid the caravans which arrived from Damascus, where the plague -swept off four or five thousand people every day, to enter the city. -He obliged them to submit to a proof of eight days without the walls, -and established regulations of the same kind respecting vessels coming -from Alexandria or Damietta. One precaution taken in the time of plague -is, to prevent _cats_ from entering houses: an open war is therefore -declared against these animals; and, wherever they are found, they are -knocked on the head with large clubs. This is a cruelty absolutely -necessary; for there is no vehicle that will convey the infection -with more certainty or rapidity than the hair of cats. Rats and mice -multiply in consequence of their destruction; but there is no instance -of their ever having propagated the plague. This disease, when it -attacks men, spares quadrupeds and birds. The furs of the one, and the -feathers of the other, however, attract and communicate the infection. -People ought particularly to keep from goats and sheep; from horses and -oxen little is to be apprehended. - -All these precautions were sometimes ineffectual. The French at -Acre, who there, as well as throughout Syria, are collected into one -quarter, used every precaution that could be thought of, yet, on the -30th of March, 1760, five of them were infected. They belonged to the -hospital of the Holy Land, and the monks were instantly ordered to shut -themselves up. They did so; and eight of them died, one only escaping. - -Mr. Howard likewise gives particular accounts of the precautions used -in several different countries through which he travelled. In Malta two -kinds of quarantine are performed; one for ships with clean bills, the -other for those with foul. The former lasts 18 days.[111] The crews -and passengers are allowed to buy provisions, and converse by means of -enclosures with stone posts and palisadoes. A letter received from a -Turkish ship was taken by a pair of iron tongs, dipped in vinegar, put -into a case, and laid for about a quarter of an hour on a wire grate -under which straw and perfumes had been burnt; after which the letter -was taken out and opened by one of the directors. In this island ships -with foul bills must perform quarantine eighty days; but, at the end -of forty, may change their station. The different kinds of goods are -separated and placed in proper order under cover. The cottons are -taken out of the bags containing them, and placed on rows of piles on -boards, laid on stone pillars about 18 inches from the floors; and, in -repacking them they are flung over a man who gets into the bags, and -treads down the cotton; the consequence must be the exposing him to -great danger, should any infection remain. - - [111] At Aleppo 20. (Russel.) - -Mr. Howard took a voyage to Venice in a ship with a foul bill, on -purpose to know every thing relative to the performance of quarantine. -“A messenger (says he) came in a gondola to conduct me to the new -lazaretto. I was placed, with my baggage, in a boat fastened by a cord -ten feet long to another boat in which were six rowers. When I came -near the landing place the cord was loosed, and my boat was pushed with -a pole on the shore, where I was met by the person appointed to be my -guard. Soon after unloading the boat, the sub-prior came and showed -me my lodging; a very dirty room, full of vermin, and without table, -chair or bed. That day and the next morning I employed a person to wash -my room; but this did not remove the offensiveness of it, or prevent -that constant head-ach which I had been used to feel in visiting other -lazarettos and some of the hospitals in Turky. My guard sent a report -of my health to the office, and, on the representation of our consul, -I was removed to the old lazaretto. Having brought a letter to the -prior from the Venetian ambassador at Constantinople, I hoped now to -have had a comfortable lodging. But I was not so happy. The apartment, -consisting of an upper and lower room, was no less disagreeable and -offensive than the former. I preferred lying in the lower room, on a -brick floor, where I was almost surrounded by water. After six days, -however, the prior removed me to an apartment in some respects better, -and consisting of four rooms. Here I had a pleasant view; but the -rooms were without furniture, very dirty, and no less offensive than -the sick wards of the worst hospital. The walls of my chamber, not -having been cleaned perhaps for half a century, were saturated with -infection. I got them washed repeatedly with boiling water, to remove -the offensive smell, but without any effect. My appetite failed, and -I concluded I was in danger of the slow hospital fever. I proposed -whitewashing my room with lime slaked in boiling water, but was opposed -by strong prejudices. I got this, however, done one morning through the -assistance of the British consul, who supplied me with a _quarter_ of -a bushel of fresh lime for that purpose. The consequence was, that my -room was immediately rendered so sweet and fresh, that I was able to -drink tea in it in the afternoon, and to lie in it the following night. -On the next day the walls were dry, as well as sweet, and in a few -days I recovered my appetite. This room was lime-whited in November, -and in a very rainy season. In the following March, in complaining -to the under sheriffs in Newgate of their inattention to the clause -which orders this in the act of parliament for securing the health of -prisoners, their excuse was, that they were afraid of dampness.” - -An health-office was established at Venice in 1448, in the midst of a -very destructive pestilence. The old and new lazarettos are both built -on little islands, surrounded not only by canals, but high walls. -They have only a ground floor, and one over it, and are divided and -subdivided into a great number of apartments, each having an open -court in front, with plats of grass, which is not suffered to grow too -high; nor are any trees suffered to grow within this district, or a -good way from it. The internal government is managed by a prior, who -must not be related to the magistracy nor any of its ministers. He -must have no interest nor concern in shipping nor in trade. He must -see all the gates and doors of the apartments locked every evening by -sunset; he takes the keys into his possession, and suffers them not to -be opened before sunrise; and, in case of any suspicion of infection, -the gates must be kept constantly locked, and opened only for necessary -occurrences in presence of the prior. He must not suffer dogs, cats, -&c. to lodge in the lazaretto. He must neither buy nor sell, nor suffer -others to do so, within the lazaretto. No fishing boats or other small -craft to come within a certain distance, or keep communication with -those performing quarantine. Provisions are received by poles seven -or eight feet long, and the money dipped in vinegar and salt water -before it is received. The prior and his substitute must carefully -avoid touching either goods or passengers in quarantine, and for this -purpose they keep a cane to make those who approach them keep their -proper distance; but if by an unfortunate accident they should be -contaminated, they must perform quarantine. Any person maliciously -touching them is liable to punishment. - -Ships are strictly forbid to use any ropes but such as are tarred. -Wool, silk, cotton-wool, woollen and linen clothes, and furs -especially, are accounted the most dangerous goods. Animals with long -hair are subject to full quarantine; but short haired ones purged by -swimming ashore; feathered animals, by sprinkling with vinegar till wet. - -The celebrated Dr. Mead, though an enemy to the cruel mode of -abandoning the sick, or treating them with any kind of harshness, was -perfectly sensible of the necessity of using every precaution for -preventing pestilential contagion from being imported. In his opinion -it is not sufficient that ships should perform quarantine, “the only -use of this being to observe whether any die among them. For infection -may be preserved so long in clothes among which it is once lodged, -that as much, nay, more of it, if sickness continues in the ship, may -be brought on shore than at the beginning of the forty days, unless -a new quarantine be begun every time any person dies; which might -not end but with the destruction of the whole ship’s crew.” He is -therefore of opinion that lazarettos ought to be established on small -islands near the sea-coast; and in this Mr. Howard agrees with him. -The latter recommends the lazaretto at Leghorn as the best in Europe. -Dr. Mead also very much insists on the utility of destroying the -clothes of the sick, because, says he, they harbour the very _essence -of the contagion_. He quotes in favour of this opinion what Boccacio -says he _saw_ at Florence in 1348; viz. that two hogs, finding in the -streets the rags which had been thrown out from off a poor man dead of -the disease, after snuffling upon them, and tearing them with their -teeth, fell into convulsions, and died in two hours. This is one of -the things which Dr. Moseley looks upon to be incredible. It is indeed -very marvellous, and seems to be contradicted by M. Deidier’s account -of the dog at Marseilles who swallowed with impunity the filthy pus -and pestilential matter adhering to the dressings of plague sores: -but, when a person of credit informs us that he _saw_ any thing, -we scarce know how to contradict him. The evidence of pestilential -contagion adhering to clothes, does not depend on such accounts. That -lately quoted from Dr. Canestrinus is decisive on the subject; and he -informs us that one of the methods used by himself to stop the plague -in Zboina, above mentioned, was, the burning of the clothes of infected -persons. He says that the pestilential contagion resembles that of the -small-pox, in being of a fixed nature; and that all who studiously -avoided communication with the sick, or with whatever fomes might carry -the contagion, escaped it altogether. “That the contagion of the plague -(says he) may lie dormant for a considerable time, and be carried to -a great distance by the medium of packages, &c. and again revive with -its former violence, is proved by various circumstances. _Chenot_ -relates, in his treatise on the plague which raged in Transylvania, -that the infection was revived a whole year after it had disappeared; -and other similar instances are adduced.” If this revival happened -from infected clothes or soft goods, it shows them to be dangerous -in the extreme; but of this we have not any direct proof, neither -indeed is such a belief quite consistent with what takes place in all -plagues, viz. that the clothes of the infected are worn by the sound, -without producing any reinfection. In the great plague at London, for -instance, where an hundred thousand probably perished, and a much -greater number must have been infected, we cannot suppose that all the -clothes belonging to such an immense multitude were burned, or never -made use of again. It is of necessity therefore that we suppose the -pestilential contagion to become effete, and to lose its virulence, -after some time; and this seems to be very much hastened by exposure to -the atmosphere. The doing of this, however, by obliging people to put -their naked arms into bales of suspected goods, has such an appearance -of cruelty, that Dr. Mead has proposed to judge of the presence or -absence of infection by allowing little birds to fly about among them; -“because (says he) it has been observed, in times of the plague, that -the country has been forsaken by the birds; and those kept in houses -have many of them died.” But, though he says this upon very great -authority, no less than that of Diemerbroeck, yet we can by no means -look upon the fact to be absolutely determined. Dr. Russel indeed says -that the desertion of the birds is looked upon by the Turks to be the -_sign_ of an approaching plague; but this failed in 1760. Thucydides -says that birds of prey deserted the territory of Athens during the -great plague in his time; and he supposes them to have been poisoned by -feeding upon the bodies of such as died of the disease. It is possible -that such food might be disagreeable to them, but no proof is brought -of any of them having been actually poisoned by it. As for birds kept -in houses, it is possible that in a time of general calamity they might -have been neglected, and died for want of proper food, &c. Dr. Mead -also quotes an instance which cannot be credited in a consistency with -undoubted testimonies that pestilential contagion does not extend but -for a very little way. Upon opening an infected bale of wool in the -field near Cairo, “two Turks employed in the work were immediately -killed, and some birds which happened to fly over the place dropped -down dead.” Such accounts have arisen from a supposition that the whole -mass of atmosphere was violently infected; but this would be totally -inconsistent with the life of any human creature, and we may well put -down this, as that of pestilential infection arising from cities -like a cloud, as merely chimerical.[112] It is too well known that -pestilential contagion, instead of soaring in the air, keeps very near -the ground. - - [112] About the mouth of the river Gambia in Africa, after the annual - inundation of the river, the putrefaction of the mud, mixed with - animal and vegetable substances, becomes so great, that the birds - manifest their disgust by soaring to an immense height in the air. - This is a natural consequence of the levity of putrefactive vapours - compared with the common atmosphere. As these vapours, however, are - composed of several kinds of gases, it is possible that some may - descend, while others ascend; and thus the contagious part, tending - to the earth, may violently affect the people who are confined among - it, while the birds escape; but there is still wanting some positive - evidence that ever the true plague did arise from this cause. - -We now come to the second mode of prevention, viz. removing these -local causes which, in the opinion of some, may produce a plague in -any country, and, in that of others, may increase or set in action the -contagion previously existing. These causes have been enumerated by the -late Dr. Smith,[113] in a Dissertation on the pestilential Diseases -which at different times appeared in the Athenian, Carthaginian and -Roman armies, in the neighbourhood of Syracuse. They are, 1. The -climate and season. 2. The situation of the armies; and, 3. Their -condition. The climate of the island of Sicily in general he observes -is extremely pleasant at some seasons of the year; in the neighbourhood -of Syracuse particularly storms are so infrequent during the former -part of the year, that the sun is never obscured for a whole day. -Even in the month of January, however, the weather is warm, and as -the season advances the heat becomes insupportable. In autumn it is -rendered somewhat unpleasant and unhealthy by the frequent rains and -chillness of the evenings. But, in particular places, during the -hottest season, nothing can exceed its unhealthiness. According to -Barichten, “the least stagnant water is sufficient, in the heats of -summer, to poison the atmosphere: its effects on the countenances of -the poor people who live in its vicinity are evident; and a stranger -who travels through the island in this season ought to avoid ever -passing a night near them.” De Non says, that “as soon as the sun -enters the Lion, this country becomes the house of death: fevers of -the most malignant kind seize on the imprudent or unfortunate wretch -that spends a night near them (ponds and marshes) and few escape with -life when attacked by so virulent a disorder.” - - [113] Med. Repository, vol. ii, p. 367. - -To the poisonous effluvia of these marshes the Doctor attributes, in -an especial manner, the plagues which took place in the armies. In the -second year of the Peloponnesian war, the Athenian army was encamped, -as we are told by Thucydides, “upon marshy and unwholesome ground;” -and that such kind of encampments will produce diseases in an army -is well known. In the time of Dionysius, when the Carthaginian army -under Imilco suffered so dreadfully, or rather was totally destroyed, -his camp was situated on an eminence between two morasses, the heat -at that time being excessive. Hannibal, the predecessor of Imilco, -had also lost great part of his army by a plague, though he had been -encamped in a healthy situation; but, in order to raise a wall which -should overlook the city, he had taken the materials of the tombs -found in the common burial place, the city at that time containing -two hundred thousand inhabitants. “From the uncovering and disturbing -of so many dead bodies (says our author) arose a terrible pestilence, -which carried off immense numbers of the Carthaginians, and amongst the -rest the general himself.” To the unhealthy situation of the armies -also the Doctor ascribes the plague which took place in the Roman -and Carthaginian camps in the time of the second punic war; and the -Carthaginians suffered most, by reason of their being nearer to the -marshes. The state of mind, the cleanliness of the person, &c. also -must be taken into account; and our author shows that neither of these -could be supposed favourable to the Carthaginians. - -That personal cleanliness, and breathing pure air, should contribute -to the health of individuals, or to any number of them collected -into camps or cities, seems to be agreeable to reason and common -sense; nevertheless we find that this has been denied, and even Dr. -Canestrinus says that “in the plague of Lyons and Marseilles it was -observed, that the most populous parts of these cities, _where the -streets were narrow and filthy_, suffered _less_ from the disease than -those which were more airy and clean. At the time of the plague in -London in the time of Charles II, the physicians advised that all the -_privies_ should be opened and exposed; the fetid odour from which -having pervaded the city, the plague was stopped! Is it from this cause -(the author asks) that the plague has seldomer visited Spain, the towns -of which are intolerably offensive from their want of cleanliness?”[114] - - [114] Medical Review, vol. iii, p. 260. - -This certainly seems a very strange doctrine, nevertheless the fact -that Spain is but little subject to the plague seems undeniable, and as -it is no less certain that the towns are excessively filthy, it would -seem that cleanliness is not effectual in preventing it. But, however -agreeable the smell of human excrements may be to the Spaniards, or -to the English physicians in former times, it seems to be less so at -present. “I am persuaded (says Dr. Ferriar) that mischief frequently -arises from a practice common in narrow back streets of leaving the -vaults of privies open. I have often observed that fevers prevail most -in houses exposed to the effluvia of dunghills in such situations.” -In Spain the opinion seems to have been but lately eradicated; for -some years ago, an order having been issued by government that the -streets of Madrid should be kept somewhat cleaner, the people were -so much exasperated at being threatened with the loss of the savoury -odour, that a rebellion had almost ensued, and the physicians declared -the smell of human excrements to be the most wholesome thing in the -world.[115] - - [115] It seems, however, of late, that at least the city of Madrid is - kept clean. Swinburne says, speaking of the palace at Madrid, “To the - west it has the town, the three principal streets of which terminate - in the Pravo. These are three noble openings, excellently paved, and - clean even to a nicety; indeed so are most of the streets of Madrid - since the edict for paving and cleaning them.[116] The foreigners - that resided here before that time, shudder at the very recollection - of its former filth. Some of the natives regret the old stinks and - nastiness; as they pretend that the air of Madrid is so subtil as - to require a proper mixture of grosser effluvia, to prevent its - pernicious effects upon the constitution. The extremes of cold and - heat are astonishing in this place, and the winds so searching, that - all the Spaniards wear leathern under waistcoats, to preserve their - chests; for they pervade every other kind of clothing.” - - The former filthiness of Madrid, together with its being situated in - a climate exposed to the vicissitudes of extreme heat and cold, and - its exemption from the plague under those circumstances, certainly - presents a most solid objection to the theory of the domestic origin - of plague. To the same purpose see below the remarks on the climate - of China. - - [116] Dillon has a like remark in his “Travels through Spain.” - -That the confinement of human effluvia, along with heat and want of -water, will produce a malignant fever, is certain from the example -of the unfortunate people confined in the Black Hole at Calcutta. In -this case the distemper seems to justify the opinion that plague may -be artificially produced, perhaps more than any other upon record; for -Dr. Ferriar informs us that it was attended with eruptions resembling -those of the true plague. In this case, however, the confinement was -beyond example in any situation which can be supposed incident to a -city or camp. There is no country in the world where the inhabitants -are equally numerous with those of the empire of China, its population -at present being estimated by Sir George Staunton at _three hundred -and thirty-three millions_, a number equal to _one third_ of the -supposed inhabitants of the whole globe; of consequence the cities -must be immensely crowded with inhabitants; yet it remains free from -plagues. Human effluvia therefore, in the most populous state in which -mankind can exist in society, _are not_ able to taint the atmosphere -of a country or city. The following is Dr. Clark’s account of that -celebrated empire: “The whole empire of China is represented to be -extremely delightful; the soil rich, the air pure, and the industry of -the inhabitants astonishing. As it produces every luxury and necessary -of life, it is justly esteemed one of the most fertile countries in the -world. As the Chinese prohibit emigration, and seldom or never engage -in war, their country is extremely populous. Every river maintains a -proportion of inhabitants adequate to the land, whose families live -continually in boats, without having any other place of residence. -Their number of people lays them under the necessity of carrying -industry to the greatest height; for otherwise their country, fertile -as it naturally is, would be insufficient to maintain the inhabitants. -Every inch of land is cultivated; no forests nor woods, nor even a -single tree, is suffered to obstruct the labours of the husbandman. -Canals are cut every where to water the fields, and marshes are manured -for the cultivation of rice. By these means health and plenty are, in a -great measure, the portion of its inhabitants through all the seasons -of the year. The only terrible and fatal diseases to which they seem to -be subject are the small-pox and leprosy.” - -But, though our author determines in general that the air of China is -pure, this cannot apply to every part of it without exception. On the -contrary he describes in the following manner Wampoa, a village about -fourteen or sixteen miles below the city of Canton, on Canton river: -“It is the usual station of all European ships in this river. On one -side the land is low, marshy, and covered with water, forming swamps -fit only for the cultivation of rice. The extent of these swamps is -considerable; the tide rises high, and overflows great part of them; -but the intersection of the rivers renders them more pure than they -would otherwise be; and consequently the air is much healthier than one -could expect from the unfavourable aspect.” - -In like manner Canton city he says “is built on a very extensive plain, -and is large and populous. Here the government allow the English, -Dutch, French, Danes and Swedes separate factories on the banks of the -river. The city, though paved, is very wet in rainy weather; and the -water makes its way under the factories of the different nations every -tide. The houses are built with bricks; the apartments are in general -small, and not very lofty, and the ground stories are very damp. When -the business of the season is over, the supercargoes remove to Macao, -a Portuguese island, subject to the Chinese government. The city of -Macao is situated on a rising ground; the whole island is dry, rocky -and barren; it is, however, plentifully supplied with provisions by -the Chinese; and, though the air is very sultry, yet it is tolerably -healthy.” - -From the preceding account it is plain, that the causes which operate -in the production of plagues and epidemic diseases in other countries, -though they exist in China, do not act there with equal efficacy. -At Wampoa the marshes in the neighbourhood must, in the hot season, -emit noxious effluvia as well as any where else, and there can be no -certainty that the overflowing of the tide is sufficient to put a stop -to their malignant influence. At Canton the water penetrates below the -floors of the houses, and we have seen from Dr Fordyce[117] that _in -other countries_ the sprinkling of a floor with clean water, and the -encampment of an army upon ground where water was found at a small -depth below the surface, were sufficient to produce fevers; yet here -it is not so. In this city also the inhabitants are numerous, and the -apartments small; so that neither the perspiration of multitudes, nor -the moist exhalations from water stagnating in the streets, nay, under -the houses themselves, are able to produce the diseases in question. -Again, at Macao the sultry heat of the air has as little effect as the -rest. - - [117] See p.p. 171, 172. - -Lastly, in Pekin, the capital, the population and the crowd are -immense. According to Sir George Staunton,[118] the city is about one -third larger than London; but, as he supposes[119] it to contain three -millions of inhabitants, the population must be twice and a third-part -as great as that of London in proportion to its bulk. “The low houses -of Pekin (says he) seem scarcely sufficient for so vast a population; -but very little room is occupied by a Chinese family, at least by -the middling and lower classes of life. In their houses there are no -superfluous apartments. A Chinese dwelling is generally surrounded by -a wall six or seven feet high. Within this enclosure, a whole family -of three generations, with all their respective wives and children, -will frequently be found. One small room is made to serve for the -individuals of each branch of the family, sleeping in different beds, -divided only by mats hanging from the ceiling. One common room is used -for eating.” - - [118] Authentic Account of an Embassy, &c. vol. ii, p. 54. - - [119] Ib. p. 39. - -Where diseases are prevalent, circumstances of the kind just mentioned -would certainly be urged as evident _causes_ of them; but in China -we see that _something_ disarms such causes of their power. People, -however, seldom want a salvo for any thing. “The crowds of people, -at Pekin (says our author) do not prevent it from being healthy. The -Chinese indeed live much in the open air, increasing or diminishing the -quantity of their apparel according to the weather. The atmosphere is -dry, and does not engender putrid diseases; and excesses productive of -them are seldom committed.” But, if the dry air at Pekin contributes to -the health of the people, why does not the moist air of Canton produce -diseases? Besides, in this empire there are multitudes of people who -live entirely upon the water, in a kind of houses constructed upon -junks, employed in carrying grain from place to place, or for other -purposes.[120] Sir George Staunton computes the number of inhabitants -on a branch of a single river to be no less than an hundred thousand. -What then must they be throughout the whole empire! Yet these people, -though continually exposed to moisture, as well as to an almost -inconceivably crowded situation, are yet no more subject to epidemics -than others. Our author does not specify the _excesses_ which produce -disorders. Intemperance in drinking no doubt is one of them; but Dr. -Patrick Russel expressly says, that he never saw an instance of the -plague being brought on by intemperance. - - [120] Authentic Account, &c. vol. i, p. 290. - -Lastly, with regard to living in the open air, Mr. McLean has ascribed -to the vicissitudes of this element the principal if not the _only_ -cause of epidemics. “A fact worthy of notice (says he) is, that aged -persons and children are both seldomer and less severely attacked by -epidemics and pestilential disorders than the young and middle aged, -and women seldomer and less severely than men. Now, if contagion was -the source of these diseases, the case would be exactly reversed. Old -people, women and children, being more in the way of contagion, would -be more frequently and more severely attacked. But the young and middle -aged, being more exposed to the _vicissitudes of the atmosphere_, -the principal source of those diseases, they are consequently more -severely attacked. It has been a puzzling question to solve why old -people and children are less exposed to plague, &c. but the solution -will be no longer difficult if it should be proved that these diseases -are _always_ produced by certain states or vicissitudes of the -atmosphere, together with the application of other powers co-operating -in the production of indirect debility.” In the country we speak of, -however, this solution fails in a manner almost as evident as can be -imagined. “The removal of the embassy, (says Sir George Staunton) -was a disappointment to several persons belonging to it, who had -made arrangements for passing the winter at Pekin. Judging of its -temperature by the latitude of the place, a few minutes under 40° -north, they were not aware of the violent effect of the great range -of high Tartarian mountains, covered perpetually with snow, upon that -capital, where the average degree of the thermometer is under twenty -in the night during the winter months, and even in the day time is -considerably below the freezing point. The usual inhabitants were -guarded against cold, not only by habit, but by an increase of clothing -in proportion to its intenseness, consisting of furs, woollen clothes -and quilted cottons. They are not accustomed to the presence of fire. -They have no chimneys, except to kitchens in great hotels. Fires, on -which Englishmen chiefly depend against suffering by the sharpness of -the atmosphere, could not well answer that purpose in houses which -are so constructed as to admit the external air almost on every side. -Stoves are, however, common in large buildings. These stoves are -situated frequently under the platforms on which the inhabitants sit -in the day time, and rest at night. The worst weather experienced -in that capital might be considered as mild by the Tartars, coming -from a climate still more rude; but other foreigners are said to feel -themselves less comfortable at Pekin in the winter than in the summer, -though the heat is then raised to the opposite extreme. In both they -seem to require a seasoning. _Several individuals of the embassy fell -ill during their stay; and all did not recover._ The human frame seems -calculated for the hottest rather than the coldest atmosphere, and to -exist at the equator rather than the pole.” - -Here we are involved in difficulties much greater than before. It -appears that even the fine climate of China is healthful only to its -own inhabitants. They can bear the _vicissitudes_ of the air, which -Europeans cannot. The prevention of plagues or mortal diseases then -must consist in some mode of living by which people can accommodate -themselves to the country which they inhabit, and without which every -other precaution will be ineffectual. The diseases with which the -attendants of the ambassador were seized could not be owing to any -slovenliness or dirtiness in their lodgings or food, or to want of -apparel; nor were they more exposed to the inclemencies of the air than -others; only they were in a strange country, where that inexplicable -constitution of the elements acted upon them in a manner different from -what it did on the natives, and, while it was friendly to the latter, -proved pernicious to the former. But there was a time when even China -was as unhealthy as other countries; for the great plague in 1346 began -in the northern part of it. We have seen, in a former section, that -this was preceded by the most dreadful and violent wars throughout the -whole Asiatic continent. Since the cessation of these violent wars -the Chinese have staid at home, and applied themselves to the arts of -peace, particularly to agriculture, which they have carried, we may -say, to its utmost perfection. This seems therefore to be the true -method of removing all those local causes which produce epidemics, or -at least of preventing them from doing hurt; and, without attention to -the natural duties and occupations of man, it is to be feared that all -artificial modes of prevention will be found not only precarious but -ineffectual. - -Dr. Smith in the dissertation above mentioned observes, that “it may -be doubted whether any _moral_ cause would be sufficient to protect, -for a long period, an unaccustomed resident in a marshy situation from -the usual consequences.” This is no doubt very probable but, from the -example of Lord Macartney’s attendants in China, it appears equally -probable that it makes little difference whether the country be marshy -or not. Dr. Lind has many excellent observations upon the subject of -unhealthy countries, and gives particular directions for strangers how -to act, when obliged to expose themselves to the inclemencies of the -weather; but none of these being effectual in preventing the access -of the true pestilence, we must still adhere to the old Latin adage -already quoted, p. 302. Flight seems to be the most effectual method. -To avoid migrations to those countries where it usually rages, and, -if it were possible to persuade the inhabitants of such countries, -to imitate the example of Chinese industry, instead of allowing the -greater part of the territories they possess to lie waste, would in all -probability gradually lessen both the frequency and violence of this -terrible disease. Migrations of large bodies of people, especially for -the purposes of war, are greatly to be dreaded. If a few Englishmen, -possessed of every thing necessary, could not keep their health at -Pekin, what must have been the probable consequence of landing an -army of an hundred thousand, with a view to conquest? Or what could -we expect if the Chinese were to “pour forth by millions” into other -countries in order to conquer them? Dr. Lind takes notice that even -of the first Portuguese adventurers to Africa, such as escaped the -first sickness continued afterwards to enjoy good health. He likewise -observes that many who left Britain, after being seasoned to the -countries to which they went, chose rather to remain abroad for life, -than to run a new risk by going back to their own country. It is not -therefore so much the greater unhealthiness of the country to which we -go, as the _change_, which is to be dreaded. If therefore great bodies -of men will employ themselves in constant rambling from one country to -another, no wonder that diseases break out among them, unknown, either -in the countries they have left, or those to which they go. - -We come now to the third mode of prevention, viz. that of destroying -the infection after it has begun to exist. This is varied according -to the nature of those things which we suppose to be infected. The -general notion of infection taking place in the atmosphere has been -already spoken of; but the uncertainty of this hypothesis, and the -apparent impossibility of altering a constitution of the atmosphere, -must certainly leave very little room for hope in this case. It hath, -however, been attempted by various methods. Hippocrates adopted the -opinion that all diseases were produced by the air, and from him it was -borrowed by Lucretius, as we are informed by the annotator on Creech’s -Translation of that author. “In his book _de Flatibus_ (of winds) says -the annotator, after a long narration of the effects that the air -produces, he at length falls on the subject of diseases, all of which -he affirms to be bred and generated in the bodies of animals by means -of the air. First (says he) I will begin with the most common fevorous -disease, which accompanies, in a manner, all diseases whatever. For -there are two sorts of fevers, one that is promiscuous, and common to -all, and is called the _plague_; the other, by reason of unhealthful -diet, is peculiar only to such as use that diet; but of both these -kinds of fevers the air is the sole author and cause, for the common -fever or plague happens alike to all, because they all breathe the same -air; and it is certain that the like air, being alike mingled in like -bodies, must beget like fevers.” In consequence of his theory, this -great physician advised to have recourse to fire as a purifier of air -in times of pestilence. But experience doth not warrant the success of -this method; neither indeed can we suppose that it could be successful, -unless people were able to kindle such fires as would absorb the whole -atmosphere of a country. This method was tried in London without the -least success; nay, seemingly with bad effect; for, the very night the -fires were lighted, more than four thousand people died; and, a few -days after, an end was put to the experiment by such violent rains as -extinguished all the fires at once. - -The burning of infected clothes has already been taken notice of; but -though this must certainly prevent any new infection from arising from -_these_ clothes, it will not prove that the infection may not evaporate -during the time of burning, and, being volatilized even beyond its -natural pitch, by the heat, may do mischief at a greater distance than -could have happened had they been let alone. The instance, formerly -quoted from Dr. Huxham, of the small-pox being disseminated by the -smoke of burning infected clothes, if not a _proof_, affords at least a -strong presumption, of the danger of such a practice. The only way of -perfectly ensuring safety in such a case would be to burn them by the -sea-side, when the wind blows from the shore. Were the smoke allowed to -pass over land, and great piles burnt at once, it is impossible to say -how far the contagion might be carried.[121] - - [121] In the time of the great fire at London, in 1666, ashes are - said to have been carried to sixteen miles distance. - -Another mode of purification is by exposing suspected goods to heat, -to the vapour of vinegar, &c. fumigating with gun-powder, sulphur, &c. -and on this principle various powders of fumigation have been invented; -some of which are said to have been very successful in Russia; and the -composition of one is given by Dr. Alexander Russel in his Natural -History of Aleppo; but all these are undervalued by Dr. Guthrie,[122] -who calls the practice of fumigation or smoaking, an “inadequate and -ineffectual ceremony.” Dr. Mitchel, also discommends them, saying that -they are advised “without any proof that these destroy pestilential -matter, and while, at the same time, it is certain that they diminish -more or less the wholesomeness of the atmosphere with which they are -mingled.”[123] Of late the vapours of pure nitrous acid (the _nitric_, -according to the new nomenclature) has been recommended, with the -boldest appeal to experience; but the consideration of this naturally -belongs to the second part of this work, where we shall have occasion -also to consider the theory of the septic acid. In the mean time -we must go on with some farther account of the different modes of -fumigation. - - [122] Duncan’s Med. Comment. vol. viii p. 350. - - [123] Med. Repos. vol. ii, p. 433. - -“There is no better corrective (says Allen from Diemerbroeck[124]) -of a pestilential air, than fire; as much experience has taught us. -Hippocrates subdued and extinguished that famous plague, which came -amongst the Grecians from Ethiopia; for he commanded great fires to -be kindled throughout the whole city, especially in the night time, -to purge away the pollutions of the air. It is believed that a fire -made with juniper-wood or ash, tends much to correct the venomous -corruptions of the air. The kindling of sulphur and gun-powder purify -the air, and drive away its corruptions; so does the burning of amber, -pitch, frankincense, &c. so do the fumes of vinegar raised with red-hot -irons, or bricks.” According to Etmuller, “Hippocrates drove away _that -famous plague_ in Greece by the use of sulphur; the fumes of it are -very much commended to correct the air, and make drink more wholesome; -it prevents all manner of corruptions and alterations, as well as the -putridinous alteration of the blood. In a great degree of malignity, -the shirt and clothes may be impregnated with the fume of sulphur.” - - [124] Synopsis, vol. i, p. 80. - -Here we have accounts of a disease, called _that famous plague_, driven -away by two different methods; and, to complete our dilemma, Dr. -Canestrinus tells us that the _plague at Athens_ is said to have been -staid “by sprinkling the streets with wine.” What an expensive remedy, -when the odour of _privies_ was afterwards found to answer as well! -“Whilst the plague was raging at Oczakow, an _earthquake_[125] happened -on the very day that it began to decline. In this case did any vapour -issue from the earth destructive of the pestilential contagion? or did -former noxious exhalations cease in consequence of the convulsion of -the earth?[126] Sorbait relates, that, in the time of the vintage in -the neighbourhood of Moselle, the plague ceased like a miracle, while -the must was in a fermenting state. At Vienna likewise it was observed -that, during and at the close of the vintage, the disease manifestly -declined; which may have been owing to the great quantity of fixed air -in the atmosphere.” - - [125] Earthquakes, as we have already seen, might be accounted - rather a _sign_ or _cause_ of the beginning of pestilence, than of - its departure. A great quantity of electricity in the atmosphere - has accordingly been enumerated among the signs of an approaching - pestilence. Thus in Burnet’s Thesaurus, p. 699, we find among the - previous signs of a plague, “plurima et fere continua nocturna - fulgora, sine pluviis et tonitruis, cœlo non nubiloso existante.” - Very much and almost continual lightning at night, without rain or - thunder; the sky in the mean time not being covered with clouds. - - [126] Before we can attach any degree of probability to either of - these suppositions, it must be proved that plagues arise out of the - earth. But this, though as plausible as many other hypotheses, is not - yet supported by any direct proof. - -To this our author adds, that “places adjoining to spice-shops have -generally remained free from infection; and, in the plague of London, -all those employed in shipbuilding escaped the disease. Smiths also -and cooks remained uninfected.” M. Volney tells us that, in Egypt, -water-carriers are exempted; and Baldwin, that oilmen are in the same -happy predicament; while on the other hand Allen quotes Boerhaave -saying, that “Forestus, Diemerbroeck, the French, English, and Germans, -observed, that all dealers in soap, washers, and all who by their -business used soap, nay, _who only wore shirts washed with soap_, -presently died of the plague.” - -From so many and so discordant opinions, the only conclusion we can -draw is, that, when once a pestilence has invaded a country, there is -not any possibility of operating upon the contagion in such a manner as -to destroy it. If the plague ceases, it must do so naturally, and we -_cannot_ accelerate this cessation. This is entirely conformable to the -opinion of Dr. Patrick Russel. Speaking of the decline of the plague at -Marseilles, and the vigorous exertions of the magistrates to put a stop -to it, he says, “The causes now enumerated might no doubt have some -effect, but a more powerful and general cause had begun long before to -restrain the havock of the pestilence, which had declined visibly in -the month of September, and in those of October, November and December -declined with a rapidity not ascribable to the exertions of the most -vigorous police. This cause is generally supposed to be some change in -the constitution of the air; but which has hitherto been defined with -no better success than that peculiar state of the atmosphere which, -in conjunction with contagion, is absolutely necessary to render the -plague epidemical.” - -Dr. Russel takes notice of the methods of extinguishing contagion -already mentioned, by kindling fires, &c. and disapproves of them. -We shall not therefore spend more time in considering whether or not -there is any probability of eradicating or mitigating the violence of -a plague when once it is introduced. However this may be impracticable -in so large a space, it seems that it certainly may be done in -smaller spaces, ships for instance; or, if not with the true plague, -at least with malignant and infectious fevers. Dr. Trotter, in his -Medicina Nautica, has laid down methods for accomplishing this, and -expresses the highest confidence in their success. He adopts the -doctrine of _contagion_, of which he gives the same definition that -in this treatise is given of _infection_, viz. “Something propagated -from diseased bodies, or from substances that have been in contact -with them, producing a similar disease in other persons[127]--the -propagation of contagion, as well as its reception into the healthy -body. A more aggravated degree of malignity will generate a greater -quantity of infection, and, as it may be confined in a larger or -smaller space, it will be less or more noxious. A fever may be called -malignant, when, with the symptoms of debility, there is a cadaverous -smell arising from the body, an unusual fœtor of the breath, stools, -and other excretions, the tongue black and parched, the eye dusky or -yellow, the countenance bloated and dejected, and the skin sallow. -In approaching a sick bed of this kind, a person not much accustomed -to such visits will be very liable to receive the infection; and the -unpleasant smell will be much sooner perceived than by the physician -or other attendants. We conclude that a malignant typhus is more apt -to generate contagion, because slight cases are found not to extend to -others, even though no mode of precaution has been used. The disease -itself is incapable of generating infection, till after a certain -period; but this period is uncertain: it seems to depend on the -nature of the symptoms, whether they are mild or malignant. _We are -assured of this fact, from a timely separation having prevented the -farther progress; and by this means_ ALONE, _I apprehend, we eradicate -contagion in_ SHIPS, _or_ ANY WHERE ELSE. In the small-pox[128] the -disease seems incapable of infecting another person before the second -or third day of the eruption. With the measles it is otherwise. The -disease may be propagated at the most early stage of the eruption; and, -if I was to be allowed to conjecture on the subject, I would say, that -the contagion is the offspring of the catarrh (the cough and hoarseness -resembling a cold) which accompanies the measles. - - [127] Medicina Nautica, p. 173, _et seq._ - - [128] In the plague, Dr. Russel has observed, that those who die in - a very short time are much less ready to communicate infection, than - those who live longer. He also takes notice, that “the plague, though - a contagious disease, is not equally contagious in every period of - the pestilential season. In the beginning those frequenting the sick - often escape unhurt, or one only, out of several, is infected. The - escape of persons employed about the sick, proves a frequent cause - of misleading the popular opinion of the disease, and has in many - instances occasioned much mischief, by encouraging the neglect of due - precautions till too late.” - -“Substances imbued with the exhalations from infected bodies, if not -exposed to the air, have their powers of communicating the disease -increased; or, in other words, the infection from _fomites_ (infected -cotton, clothes, &c.) is said to become more virulent than it was when -first separated from the body. - -“I am of opinion, with others, that the exhalations or excretions of -the sick are the vehicles of contagion. It is these which impregnate -the atmosphere with noxious matter: they affect in like manner -bed-clothes, or apparel, and every thing that can imbibe them, when -in contact with the diseased body. When bed-clothes, or body-linen, -but particularly silk or woolen cloth, have been exposed to these -exhalations, and then heaped together for a length of time, the noxious -effluvia are, as it were, multiplied, and will more certainly infect -others than they did at first. The bales of goods which brought the -plague to Marseilles, and affected the people that opened them so -suddenly, had their virulence increased by not being duly ventilated. -When the jail-fever was brought into court by the prisoners at Oxford -assizes, and more lately at the Old Bailey, the fever was propagated -from the clothing of the prisoners; no doubt, from being confined in -impure, ill-aired cells, this infection became more virulent. The -highly concentrated state of contagion, in the bales of goods, could -only have been brought to that degree of virulence from the closeness -of the package: it cannot be supposed that human beings could have put -them together otherwise. The nurses of hospitals know well, as Dr. Lind -tells us, that there is most danger of catching a fever when they pile -heaps of bed-clothes or body-linen together for a few days, before it -is carried to the wash-house. The washer-women at Haslar have also told -me the same thing. They know when a dangerous fever is in the hospital -by the bad smell of the clothes: this makes them air them abroad, till -the smell is gone, and then they can wash them with safety. But, if it -happened, from the hurry, that this could not be done, or if it was -neglected by design, many of them were seized with the sickness. The -porters and people employed in cleaning and fumigating the blankets and -beds at Haslar are well acquainted with this fact, and they measure -the danger by the badness of the smell. This ought to instruct every -body to stand to windward of these infected substances when they are -opened; as the current of air would then carry it the other way. In one -of the courts of justice, the people who stood between the prisoners -and a window, into which the wind blew, escaped the infection, while -those on the other side were sufferers. - -“In the summer of 1793, while the Orestes brig, commanded by Lord -Augustus Fitzroy, lay at Plymouth, she was anchored very near and to -leeward of an army transport, which had on board a very malignant -fever among the soldiers. While the soldiers were moved on deck, to -go on shore to the hospital, the crew of the Orestes, from curiosity, -walked on deck to look at them. Such was the concentrated state of -the contagion among the clothing and bedding of these troops, on -bringing them from below, that eighteen people belonging to the brig -were quickly seized with the same fever, the infection of which had -been conveyed by the current of wind. It did not, however, extend much -farther in the Orestes, from the attention of her commander. But this -ought to be a caution for ships to keep clear of those that have fevers -on board, as a _virulent_ CONTAGION _may be conveyed to a considerable -distance_. - -“Dr. Lind is inclined to think that washing the bed-linen in hot water, -even when first shifted, is attended with much risk; and that the -noxious matter may be volatilized by the heat of the water, and affect -the woman. For this purpose he has recourse to his favourite process, -of _fumigation_, to insure the washer-woman. The heat of his fumigating -furnace would no doubt dry the linen, and exhale any moisture; but our -practice in the Charon (the hospital ship) was, to plunge everything as -it came from the bed into a tub of hot water kept ready on purpose. The -linen was washed and dried immediately after. We had in that hospital -many malignant cases of typhus, and some deaths, yet no infection was -ever spread there.” - -Our author next proceeds to inquire into the cause of this excessive -concentration of the infectious matter in _fomites_, or clothes, -bed-clothes, bale-goods, &c. The most plausible reason, he says, -that could for some time be assigned for this, “was, the generation -of animalcula; the cotton or woollen clothing was said to serve as -a nest for the corpuscles to multiply; and thus the contagion was -thought to increase seven fold.” This theory had an effect on the -practice of physicians, both as to the prevention and cure of fevers -supposed to proceed from thence. Our author looks upon the hypothesis -to be chimerical, because none of these animalcules have ever been -made visible by the best microscopes. But there is no necessity for -supposing the animalcules to be invisible to the naked eye. They may -creep on the ground, or fly in the air, without being observed by us. -Mr. Baker’s discovery of the insect which not only poisoned _eleven -hundred thousand_ times its bulk of water, but infected a much greater -bulk of air, with its effluvia,[129] shows that such a thing may be -_possible_; and in dubious matters bare possibility ought always to -produce inquiry. If the perspiration of human bodies when confined -becomes noxious, why may not that of a multitude of insects be so too? -There is no necessity for supposing that an insect must be swallowed, -or inhaled by the breath, before it can do hurt. What Dr. Trotter says -of the variolous contagion emitted from the human body will apply -equally to insects. “What has been called the insensible perspiration -(says he) which arises from the surface and the lungs, we have a right -to believe carries with it in solution a portion of the variolous -matter which charges the atmosphere with the contagion of small-pox, -even in such quantities as to impregnate the clothing of attendants and -visitors; by which means it has been frequently carried to families and -villages many miles distant from its source.” The smallness of size of -insects can be little objection here. A skunk is but a small animal, -yet it spreads its odour farther than an hundred diseased human bodies -could propagate the plague.[130] - - [129] P. 189. - - [130] Here, I hope, it will not be thought unreasonable to digress a - little in favour of the sensations of humanity which on all occasions - ought to predominate in our minds. Birds are the natural enemies of - that hateful class of beings we call _insects_, and which in general - are the natural enemies of man. In proportion to the havock we - make among the former, the latter will multiply upon us whether we - will or not. The wanton, indiscriminate, and I may add _provoking_ - destruction exercised among this useful as well as beautiful and - agreeable part of the creation, must certainly be sometimes attended - with bad consequences. Though birds feed on many different kinds of - insects, yet there are exceptions. If then we totally exterminate - a species of birds, is it not probable that a species of insects - might appear, the mischief done by which we could not be able to - counteract? _Quere._ Is it not possible that the _Hessian fly_ may - have made its appearance from this cause? - -On this subject, however, we may remark, that though the nurses and -attendants on hospitals measure the degree of infection by the smell, -yet people are by no means safe in approaching patients about whom no -smell can be perceived. We have already seen, from Dr. Fordyce, that -what may be called the _pure_ infection of fevers is not perceptible -by any of our senses; and there are examples of very offensive smells -issuing from diseased bodies without any contagion ensuing. Dr. Trotter -tells us, that “a patient in typhus was sent from the Venerable to the -hospital ship, with a fœtor about him, that exceeded any thing of the -kind that ever came within the Doctor’s knowledge. After being washed -and shifted, it still continued, and was perceived at a considerable -distance. He died in a few days, yet nobody was infected from him, -either in his own ship, or in our hospital. There was probably some -peculiarity of constitution here.” In M. Deidier’s experiments, above -related, the dog which eat the dressings of the plague sores, after -being infected with the disease, emitted a very disagreeable odour, -but we do not find that the odour was in any way infectious. In the -Encycloped. Britan, art. Med. _Hydrophobia_, we find an account of an -hydrophobic patient (and a patient who recovered) in whom the blood -drawn from a vein was as black as ink, and stunk abominably, yet -this stench was attended with no bad consequence. There is therefore -no essential connexion between offensive smells and contagion; yet, -as they are sometimes united, the absence of the smell ought not to -encourage us rashly to go into suspicious places, neither ought the -presence of it to deter us from venturing where we have otherwise good -reason to do so. - -Having given up the doctrine of animalcula, the Doctor goes on to -explain the doctrine of concentrated contagion in a manner very -similar to that given in this treatise, viz. from the decomposition -of some kind of gas. “The fœtor of the breath (says he) perspirable -matter, &c. evidently demonstrate that they differ from the healthy -state. The smell, to our senses, comes very near what is called -_sulphurated-hydrogenous gas_. Some of the fluids within the body would -seem to be in some degree in a state of actual decomposition; unless -we can suppose the mucous glands of the lungs secreting a fluid that -taints the expired air in this manner. The decomposition of the fat, -which sometimes disappears very suddenly in fevers, may give some -ground for the supposition that a large portion of these exhalations -are composed of hydrogenous gas. But, whether we can go thus far or -not, what is separated from the body, it is plain, is more disposed -to decomposition than when the body is in health. Now this process -will still go on, whether exposed to the atmosphere or not, with -this difference, that, by exposing substances which have imbibed the -exhalations of the diseased to a free air, the noxious gases will be -dissipated as quickly as they are evolved; while, on the other hand, by -laying the clothes in a heap, packing them firm in a chest, or making -up cloth into small bales, the gases are concentrated into a small -space; and woe to the man who first inspires them.... Now this does not -hold out an idea that the powers of contagion are multiplied, as by -generation; for that would be to say, that these gases are _themselves_ -what we call the matter of infection. I would only go so far as to -assert that they are the vehicles of it, till more certain experience -shall determine farther.” - -With respect to fumigations with nitrous acid, our author repeatedly -declares that he has no confidence in them; nay, he brings instances -where they seemed to have bad effects. But as the dispute about -fumigation has no connexion with the true plague, nitrous acid having -never been used as a preventive for it, we shall defer any farther -consideration of it to the second part of this treatise, to which it -naturally belongs. - -We come now to the fourth and last mode of prevention, viz. a -consideration of those means by which an individual, without separating -himself from society, and who is daily obliged to have communication -with the sick, may yet secure himself against infection. Here the -means recommended are extremely various, and some of them so opposite, -that we can scarce avoid suspecting them all. The misfortune is, that -though a person should go, without fear, among the sick, though he -should constantly take a medicine, and should never have the distemper, -yet we cannot say whether the medicine did preserve him or not. Were -it possible to know the particular constitution of the body which -disposed some to resist the attack of the disease, attempts might be -made to bring the constitutions of others to the same standard, but -unfortunately our ignorance here is so great, that any attempt to -alter the constitution of the body has generally proved unfortunate -even in other diseases. Dr. Lind informs us, that the first Portuguese -adventurers in Africa, having observed, that “such as had the good -fortune to escape a fit of sickness or death, soon after their arrival, -enjoyed afterwards a pretty good state of health, thence concluded, -that the blood of such persons had been entirely changed by the diet -of the country. Upon this erroneous principle they adopted a most -fatal method of seasoning people to these unhealthy climates. They, -by small quantities, frequently repeated, took away as much blood -as they supposed to be contained in the body, and thus they reduced -the patient to a state of extreme weakness.” From its being observed -that people of delicate constitutions are less liable to the plague -than others, such a mistake probably has also been made with regard -to this distemper, but with equally bad success. Allen tells us from -Diemerbroeck, “_Phlebotomy_, though mightily cried up by many of the -ancient and modern physicians, yet we reject it altogether, _as very -dangerous and detrimental_; for it appeared by experience that those -who made use of it for prevention’s sake were seized with the plague -soon after bleeding, wherefore we forbad it to all.” This may seem -surprising, as we find bleeding so much recommended by Sydenham as a -remedy; but by others it is equally reprobated; nay, Dr. Hodges tells -us that he never knew but one who recovered from the disease after the -use of it. Issues seem more likely, if not to prevent, at least to -render the disease more mild if it should attack. They are recommended -by Diemerbroeck, and Russel speaks of them as, “by some authors, -represented as almost infallible.” He cannot, however, recommend them -from his own experience, having never seen them opened for the purpose -of preventing the plague; and he justly observes, that when habitual -on any other account, they may perhaps lose their effect in this. -“Multitudes (says he) of both sexes at Aleppo had issues in their arms, -it being there a very common remedy in a variety of chronic disorders: -but, notwithstanding those outlets, numbers perished; and I did not -remark that those who had them were in any degree less liable than -others to be infected.” - -Tobacco has been recommended as an excellent preservative, particularly -by Diemerbroeck, who writes with a kind of enthusiasm in its favour. -“Being called (said he) to visit a patient afflicted with the plague, -as soon as I entered his chamber I felt a most offensive smell of -excrements (for he had a diarrhœa) with which I was greatly affected. -Leaving the house after a very short visit, I instantly found myself -seized with giddiness, nausea, and uneasiness at the heart; so that I -had no doubt of my having caught the pestilential contagion. Laying -aside all business, therefore, I immediately returned home, and smoked -five or six pipes of the best tobacco; by the use of which all the -above-mentioned symptoms so totally vanished, that I felt not the -least uneasiness any more. Then, being again desirous to go abroad -and visit other sick people, I took a drachm of theriaca, and from -thence-forward was in perfect health. The same thing happened to me -three or four times during the time of this pestilence; and without -loss of time, according to the quantity of infection I supposed that -I had taken in, I had recourse to the more plentiful use of tobacco, -by which my health was restored. I always looked upon tobacco to be -an excellent preventive remedy, and its smoke I have sometimes found -useful to myself even in an incipient attack of the disease.[131]” He -then proceeds to inform us of a report that in a violent plague at -London all the dealers in tobacco were exempted. At Nimeguen, however, -they were not so fortunate; yet of the family of the principal tobacco -merchant (Thomas Peters, an Englishman) which was very large, none were -infected, excepting only one servant maid, and she quickly recovered. - - [131] Diemerbroeck, Hist. 17, lib. 4. - -On this remedy Dr. Russel makes the same remark as on the issues. “The -custom of smoking (says he), is universal among both men and women at -Aleppo. This too, from its being habitually practised, might perhaps -lose part of its prophylactic virtue: at the same time those who use it -as a preservative must always be supposed in some degree accustomed to -it, otherwise the violence of its operation on most persons, on their -first beginning to smoke, might prove hurtful. It should further be -observed, that the tobacco commonly used in Syria is much milder than -the American, and that the oriental smokers seldom or never spit.” - -It hath been observed that the plague is stopped either by great heat -or great cold, but more readily by the former than the latter. “It has -generally been supposed (says Dr. Canestrinus) that the cold of winter -was destructive of contagious matter; but various instances of the -contrary may be collected. The plague in Transylvania continued through -the very severe frost in 1709. On the contrary it has been found, that -excessive heat has extinguished, or at least diminished, pestilential -diseases. During the plague at Aleppo the weather was unusually hot in -the beginning of July, and it was remarked that the disease declined -considerably; and in general Dr. Russel observed, that the plague -ceased at the hottest season of the year. The plague at Ockzacow, -which raged in the years 1738 and 1739, began in the month of April, -and continued with violence till July, when it declined considerably, -and entirely ceased in the month of September; in February of the year -following it re-appeared, and totally ceased in July.” - -From these facts we might be led to suppose that a warm regimen, or -occasionally exposing the body to great heat, might be advantageously -used by way of prevention; but Dr. Russel justly observes, that the -human frame, “could it support such an application of fire and smoke as -is necessary to expel or destroy contagion from infected substances, -would probably receive little benefit from it, if infected; nor could -those in health sustain, without prejudice, the heat and dense smoke -which is probably required for the perfect extinction of the infectious -effluvia floating in the confined atmosphere of a morbid body.” He is -of opinion, however, that some kinds of fumigations may be of use, -and he mentions some of these, but says that the perfumes ordered by -the college are perhaps as proper as any, though their forms might be -rendered more simple. Heat alone can scarce be thought very proper -for prevention, and, when the disease is once begun, is said to be -detrimental. Dr. Guthrie quotes Baron Ash saying, that “in heated -rooms the disease is ungovernable: it is only in free air that it is -to be treated.” But of late a discovery has been made of a surprising -power in heated oil of removing this disease, insomuch that, if we -can believe what has been published of it, we must suppose it to be -little less than a specific. So great indeed has been the confidence -put in this method, that, by order of the Academy of Sciences at -Lisbon, it has been translated into Arabic, French and Portuguese.[132] -“The method was first proposed by George Baldwin esq. agent for his -Britannic Majesty, and consul-general at Alexandria. He communicated -his method to Lewis de Pavia, chaplain and agent to St. Anthony’s -Hospital at Smyrna; who, after five years experience, pronounces it to -be the most effectual remedy hitherto made use of in the hospital of -which he has had the management for twenty-seven years. Immediately -after a person is perceived to be infected with the plague, he must -be taken into a close room; and, over a brazier of hot coals, with a -clean sponge, dipped in warm olive oil, his body must be very briskly -rubbed all over; for the purpose of producing a profuse sweat. During -the friction, sugar and juniper berries must be burned in the fire, -which raise a dense and hot smoke, that contributes to the effect. The -friction ought not to be continued more than four minutes, and a pint -of oil is enough to be used at each time. In general the first rubbing -is attended by a very copious perspiration; but, should it fail of this -effect, the operation may be repeated, first wiping the body with a -warm, dry cloth; and, in order to promote perspiration still farther, -the patient may take any warm sudorific drink, such as elder-flower -water, tea, &c. It is not necessary to touch the eyes; and other tender -parts of the body must be touched gently. Every possible precaution -must be made use of to prevent the patient from taking cold, nor must -the linen be changed till the perspiration has entirely subsided. The -operation should be repeated once a day, until evident symptoms of -recovery begin to appear. If there are already tumours on the body, -they should be gently and more frequently rubbed, till they appear to -be in a state of suppuration, when they may be dressed with the usual -plasters. The operation ought to be begun on the first appearance of -the symptoms of disease; if neglected till the nerves and the mass of -blood are affected, or a diarrhœa has commenced, little hopes can be -entertained of a cure; but still the patient should not be despaired -of, as, by an assiduous application of the means proposed, some few -have recovered, even after diarrhœa had commenced. During the first -four or five days the patient must observe a very abstemious diet; the -author allows only a small quantity of vermicelli, simply boiled in -water. Nor must any thing be taken for thirty or forty days, except -very light food, as, he says, an indigestion in any state of the -disorder might be dangerous. He does not allow the use of wine till -forty days. There is no instance of the person rubbing a patient having -taken the infection. He should previously anoint himself all over with -oil, and must avoid receiving the infected person’s breath into his -mouth or nostrils. The precaution to be used in all circumstances is -that of carefully anointing the body, and living upon light and easily -digestible food. Mr. Baldwin observes, that among upwards of a million -of people carried off by the plague in Upper and Lower Egypt, in the -space of four years, he could not discover a single oilman, or dealer -in oil.” _Lisbon, July, 1797. By Royal Permission._ - - [132] Annals of Medicine for 1797, p. 373. - -With regard to diet, and the use of spiritous liquors, opinions, as may -well be imagined, have been very discordant. Allen quotes Diemerbroeck -advising _poor people_ to take two or three spoonfuls of the best -white wine vinegar every morning, which he looked upon to be one of -the best preservatives: he recommends also the frequent application to -the nostrils of a spunge dipped in _treacle vinegar_. With regard to -himself he says that his principal care was to avoid uneasy passions of -the mind; and that when he found himself any way disturbed by these, he -cheered his heart by three or four glasses of wine: his common drink -was beer, and also white wine, small, or moderately strong, which -sometimes he drank to cheerfulness, but never to drunkenness. Dr. -Patrick Russel also says, that “a glass of generous wine, or any other -cordial more agreeable to the choice, may be taken before dinner, in -case of languor, or oppression at the stomach, from fatigue, fœtor, -or apprehension. _I found a rummer of old hock very agreeable on such -occasions._” Allen goes on to inform us from Diemerbroeck, that, -“as to diet, it is advisable in a pestilential disposition to use -temperance, which very much contributes to the preservation of health; -but all sudden changes are dangerous; wherefore it is most dangerous -suddenly to alter the usual rule of diet. It is very ill in the plague -to go abroad with an empty stomach: hog’s flesh is looked upon to be -very pernicious: all sweet things are to be avoided: wine moderately -made use of is good, but the abuse of it very dangerous.--Mercurialis -testifies, that among the Patavians and Venetians, most of the tipplers -died, who thought to drive out the plague with strong wines.” Mr. -Howard informs us, that a person in high station at Constantinople, -attributed his recovery entirely to the use of _green tea_, others to -_brandy_. He also mentions a Mr. Hare, master of a merchant vessel at -Senegal, who, during the prevalence of a malignant fever there, was -very much exposed to the infection, and who out of humanity waited -upon a negro, whom nobody would go near. He took no medicines, neither -did he taste either spiritous or fermented liquors, and was the _only_ -European that entirely escaped the contagion.[133] - - [133] The opinion of those physicians whom Mr. Howard consulted upon - this subject are given at large in the APPENDIX. - -These accounts seem to evince that little or nothing is to be expected -from a change of diet. This is an attempt to change the constitution -of the body, and cannot be expected to succeed any more than bleeding. -There is a certain quantity, and a certain species, both of food and -drink, different in different persons, necessary to preserve health, -and those who require both in larger quantity or better quality than -others, are no more to be charged with intemperance than those who are -supported by the smallest quantity of the coarsest fare. In times of -danger, therefore, those who have been accustomed to spiritous liquors -ought not to give them over; neither ought those to begin the use of -them who have not used them before. From the account formerly given -of the structure of the human body, it appears to be furnished with -an apparatus for _exhaling_ or throwing out a perspirable matter as -well as for _inhaling_ or taking in one equally subtile. How far the -skin may be able to _inhale_ or rather _imbibe_ surrounding effluvia, -may be doubted; but with the lungs there cannot be any doubt; and -the effluvia taken into them must unquestionably affect the blood, -and of consequence the vital principle, almost without any medium. -To deprive the body of its due portion of nourishment therefore is -to _throw a temptation in its way_ (if I may use the expression) to -absorb _any thing_; and the same effect must ensue from any other mode -of debilitating it, either by intemperance, terror, or the like; and -hence to visit infected places while under any such debility must be -very imprudent. Dr. Russel agrees that it is a general and rational -precept, never to go abroad fasting. For those who cannot easily bear -fatigue without eating between breakfast and dinner, some light food -may be proper, at an intermediate hour, in order to avoid going into -the chambers of the sick with an empty stomach in the forenoon. “In -such circumstances (says he) after a long and fatiguing morning, I -have often found myself disagreeably affected in my latter visits, and -have been sensible of slight giddiness, and of the appetite flagging -at dinner, as if something lay on the stomach. I have known others -much more strongly affected in this manner, and consequently much -more alarmed. In such cases much no doubt may depend on the fancy; -but in those times the power of the imagination requires management. -So intimately is it connected with the accidental state of the body, -that the same risk, from which a man shrinks in a state of languor and -fatigue, he will encounter undauntedly after a temperate meal: the -strange, unusual sensations, which amount almost to a persuasion of -having caught the infection, will often, like the phantoms of a vision, -vanish after a few glasses of wine.[134] Whether any slight degree -of real infection can be thus dissipated, I shall not take upon me to -determine; it is sufficient for the present purpose to indicate the -means of restraining those alarming sensations which, when aggravated -by imagination, are apt to depress the spirits, and, according to the -general opinion, to reduce the human body to that _relaxed_, _inhaling_ -state peculiarly susceptible of contagion.” - - [134] This _doctrine_ of _fancy_, or _imagination_, ought - undoubtedly, as Dr. Russel says of the imagination itself, to be - under some management. The indiscriminate use of the word has been - carried to such a length as in a manner to supersede all evidence, - testimony, argumentation or reason. With some it is sufficient to - discredit the most positive testimony (even upon oath) if they take - it into their heads that such a thing _cannot be_: which by the - bye is as strong an evidence of _ignorance_ as any man can give. - If imagination is given as a _cause_, the extent and nature of - its powers ought to be ascertained; but who has done this? On the - contrary I may say that not one in five hundred who makes use of - the word would be able to define it. But the most curious mode of - reasoning used by these _imaginary_ gentlemen is, if they are asked, - “How do you prove that such a thing is the effect of imagination?” - they are ready to answer, “I can indeed bring no proof that it is so, - but how do you prove that it is not?” Here the _imaginaries_ have - not _reason_ sufficient to show them that _they_ ought to bring a - proof, and not those who say they saw or felt any thing. But, waving - this, _sense_ is the highest faculty in our nature; _imagination_ as - well as _reason_ are inferior to it; because neither the one nor the - other can be conversant except about the objects of sense. If any - person therefore says that he _sees_ or that he _feels_ any thing, - nobody can, with any shadow of reason, say that he neither _saw_ nor - _felt_ any thing. If one man sees what another cannot see, while the - supposed object is easily within reach of the eyes of either, then - the one who cannot see it has a right to suspect that the object - is imaginary; but, if the person himself feels any slight pain or - uneasiness, and that should go off in a short time, after drinking - a glass of wine, there is as little reason to suppose that the pain - was imaginary, as that the drinking of the wine was imaginary. In - Dr. Russel’s case, though his strength was in general sufficient - to resist the contagion in which he was immersed, yet, when that - strength began to decay, it was no wonder that he found the contagion - beginning to invade: a few glasses of wine gave vigour to the system, - and enabled it to repel the attack. Had he been much fatigued with - bodily labour, and found himself greatly relieved by a few glasses of - wine, surely he would not suppose that his former fatigue was merely - imaginary. Just so must it be in the former case; the one has no more - to do with imagination than the other. - -As to other modes of precaution, the Doctor advises that such as are -about the sick “should guard the mouth and nostrils with vinegar, avoid -drawing in the breath while close to the bed side, or swallowing their -spittle while in the infected chamber. Before they approach the bed in -order to examine the eruptions, the bed-clothes ought to be removed, -to give time for the dispersion of a confined steam which immediately -discovers itself to the senses; and it will be advisable to dip the -hands in vinegar before examining the parts. On coming out of the -chamber it will also be proper to rinse the mouth, and wash the hands, -with vinegar, plain or camphorated.” He advises also to fumigate the -clothes with nitre, sulphur, and juniper berries, burnt on a red-hot -iron. - -“Upon returning home it may be advisable to shift clothes immediately, -hanging those taken off upon lines in a small chamber, to be again -smoked, and afterwards aired. The mouth and hands ought once more to be -well washed, and the hair might be fumigated with a little nitre and -sulphur, by means of a pipe, so as not to incommode the lungs.” - -One other mode of prevention, not of the disease, but of incurring -danger from it, is inoculation. This is greatly recommended by Baron -Ash above mentioned, and not only for the plague among the human -species, but for that among cattle, which frequently destroys great -numbers of those necessary animals. The case of Mathias Degio related -p. 272, shows the practicability and the safety of it. The only solid -objection that can be made to it is, that those who have once had the -plague are not secure from having it a second time, or oftener. Yet, if -we consider the extreme fatality of the disease when it attacks in the -natural way, and that the number of those who have the plague only once -is much greater than of those who relapse, this practice will certainly -be found to merit consideration, and, unless some objection to it be -discovered greater than any that has yet appeared, seems likely to be -advantageous to the human race in general. - - - - -SECTION V. - -_Of the Cure of the Plague._ - - -From what has already been laid down in a former section concerning -the nature of this distemper, it appears, in its worst and most -deadly form, to consist in the sudden breaking forth of a kind of -hard mortifications, or rather eschars, like those made by fire, in -different parts of the body. When these happen to fall upon any of -the vital parts, it is evident that no cure can be applied. When such -eschars discover themselves in abundance on the external parts, it is -likewise observed that the patient certainly dies; whether from the -same taking place inwardly, or from nature not being able to bear the -loss of substance, and to separate so many deep eschars, is uncertain: -but this kind, which attacks without fever, has always been reckoned -absolutely incurable. When the tendency to internal mortification -is less, and the fiery blasts, if we may so call them, approach the -surface, so that buboes or carbuncles begin to appear, there is -then some hope that the patient may recover. Even here, however, -the case must be considered as very doubtful, and we have seen that -in Dr. Russel’s three first classes of patients not one recovered; -nevertheless, as we are not always able to distinguish with certainty -whether the patient is altogether beyond the power of medicine or not, -excepting where the _tokens_ formerly mentioned appear, this kind only -is here distinguished by the name of the _fatal_ or inevitably mortal -kind of plague. In all cases, where there is time allowed, medicine -ought to be employed; but, as in other diseases, different theories -have bred such a contradiction of opinions, that it is with no small -difficulty we can judge which has any _probability_ of success. In -this uncertainty, however, we must look upon those who have recently -had an opportunity of seeing the disease as superior not only to those -who have only _read_ of it, but even to the most celebrated ancient -physicians who have written upon the subject. Those who have had -the best and latest opportunities of seeing the distemper are Drs. -Alexander and Patrick Russel at Aleppo, and the physicians to the -Russian army when the plague raged in it in 1770, &c. - -Dr. Alexander Russel begins with observing that “the discordant -opinions of medical writers concerning the method of treating the -plague are innumerable. In regard to bleeding and other evacuations, -they maintain opinions diametrically opposite; some recommending -them as indispensably requisite, others decrying them as invariably -pernicious; while both parties, with equal confidence, appeal to -experience. But, in a disease wherein reason is often perplexed, and -experience itself fallacious, it is greatly to be lamented that nature -is not more, and opinion less, consulted. - -“No traces of any satisfactory method of cure are to be met with among -the natives at Aleppo. The Mahommedans, holding the plague to be a -penal curse inflicted by Almighty God on a sinful people, have less -faith in the efficacy of medicine in that disease than any other: and, -as the chief of those who practise physic are either Christians or -Jews, not armed with the doctrine of predestination, and consequently -apprehensive of contracting the infection, they (the physicians) -endeavour to confirm the vulgar notion of the inutility of their art -in the plague, with a prudential view of evading the danger of being -forced to visit the sick. Hence the greatest part of the infected are -either left to struggle with the disease without any assistance from -medicine, or are under the necessity of submitting to the direction of -the meanest and most ignorant of mankind.” - -The whole practice of the native physicians consists in bleeding, let -the stage of the distemper be what it will, and afterwards attempting -to raise a sweat with the insignificant remedy of a few grains of -bezoar mixed with the distilled water of scorzonera. On the subject of -evacuations our author remarks, that bleeding, even very plentifully, -was always useful in the beginning, but as constantly prejudicial after -the first day. Vomiting was equally useful at the same period; with -mere warm water, if that would answer the purpose, but if not, small -drops of ipecucuanha or sal vitrioli might be added. Violent cathartics -were hurtful, but an emollient clyster or laxative of manna and cream -of tartar were not only safe but serviceable. “On the second day of -the disease (says the Doctor) where the remissions of the symptoms -were tolerably distinct, I have frequently and successfully given an -infusion of senna with manna and cream of tartar; and it is a fact -confirmed to me by repeated experience, that a purgative of this -lenient kind, given after the critical sweat, was the most effectual -means of promoting the suppuration of the buboes. - -“The natural crisis of the disease was always by the skin. When a -copious sweat could be procured by art, it was likewise of service; -but the attempt, if made the first day, was attended with two material -inconveniences: the first, that the common diaphoretic medicines, if -given in the usual dose, if they failed in their operation, threw -the patient into a flame, and greatly augmented all their symptoms; -the second, that, though they produced the desired effect, it was -necessary to keep up the sweat a much longer time than most people -of that country could be persuaded to endure; and, if the sweat was -prematurely checked by exposure to the air, all the symptoms were -either exasperated, or (what was often the case) a diarrhœa was -induced, which, though at first it might seem to relieve, yet generally -proved fatal in the end.” - -Contrayerva and valerian, saffron, the compound powder of contrayerva -of the Edinburgh College, are recommended as sudorifics; given in -small doses every four hours, with acidulated diluent drinks. These -medicines were occasionally joined with anodynes, among which syrup of -poppies was reckoned preferable to opium. In cases of diarrhœa, Venice -treacle or diascordium were joined with the diaphoretics. Neither bark -nor snakeroot could have a fair trial, on account of the prejudices -of the people: and on this occasion our author observes, that “the -physician who would obtain a ready compliance with his directions, in -that country, must as seldom as possible offend the palates of his -patients with nauseous remedies; for, whatever may be the consequence, -they will often rather choose to incur distant though great risks, than -avoid them by submitting to present inconveniences.” Nitrous medicines -were found ineligible on various accounts: 1. They did not, as in other -diseases, allay heat. 2. The sick could not bear them in ordinary -doses without languor and dejection. 3. They were apt to bring on a -diarrhœa.--The following is an epitome of our author’s practice: - -1. Bleeding from ten to twenty ounces as soon as possible after the -seizure. The quantity seldom exceeded sixteen ounces, and even this is -greatly above what is taken in any other disease in that country. - -2. After bleeding, where the nausea was considerable, the stomach was -cleansed with warm water; or, if that failed, with ipecucuanha or salt -of vitriol. It was of such importance to have both these evacuations -performed early, that our author instructed most of his acquaintance -how to act if they should be infected. - -3. A gentle anodyne succeeded the vomit. If by it the stomach was not -quieted, an ounce of diascordium, or 15 drops of laudanum, were added -to the saline draught of Riverius. - -4. Small doses of cordial and diaphoretic medicines, with a very small -quantity of antimoniated nitre, were exhibited every four hours; the -sick were encouraged to drink freely of a decoction of scorzonera -roots and barley, or spring water moderately acidulated with spirit of -vitriol. A mixture of the acid with syrup of violets was kept ready to -be added to plain water. All the drink was given warm if the patient -would be prevailed upon to take it so. - -5. In the winter the sick were removed into more airy lodgings than -those in which they usually slept, and the air of the room was warmed -or corrected by a moderate fire. In summer only the windows opposite to -the patient’s bed were ordered to be shut; but even this restriction -was not universally complied with; many insisting upon setting all the -windows open in the day time, and sleeping on the house top at night. - -6. In case of faintness and uneasiness, a cordial, composed of some -of the simple distilled waters, tinctures of saffron and valerian, -alkermes, and spirit of vitriol, was used with advantage and great -refreshment to the sick. This with plenty of acidulated drinks was the -chief prescription for infected children. - -Under the above treatment, a sweat often broke out on the second or -beginning of the third day; after which the sick were covered up, and -the sweat encouraged as long as they could be persuaded to bear it. -By this first sweat, especially if it happened on the second day, the -patient was never freed from the fever, though greatly relieved. It -was therefore necessary to continue the same medicines, in order, by -a more plentiful sweat, to procure a perfect crisis. Where the sweat -was supposed to be sufficiently copious, and had greatly mitigated the -symptoms, a mild cathartic was given in the morning, though some degree -of fever still remained; the other medicines not being intermitted -during its operation. An anodyne was given in the evening. - -In case of an exacerbation of the symptoms or the depression of the -buboes, as sometimes happened on the second or third day, it was useful -to apply a blister just below the tumour. A blister to the head was -useful in cases of coma and debility of the tongue. The natives were -exceedingly averse to the use of blisters; but, having observed that -some who had been judged past recovery had nevertheless struggled -through, apparently from the use of blisters, they at last came into -some degree of credit. Cataplasms, composed of garlic, bread and -vinegar, were advantageously applied to the soles of the feet. These, -as well as blisters, were useful in cases of coma; also emollient -laxative clysters. The dose of the alexipharmics was increased, and -acidulated drinks, in small quantities at a time, given frequently. - -To the buboes it was customary to apply suppurative cataplasms; but, as -these could not, where the patient was desirous of walking, be easily -kept on, a diachylon gum plaster was substituted, with the addition -of few cantharides, or a little euphorbium, if a greater stimulus -was judged necessary. In most cases the buboes were left to open of -themselves; the natives being afraid of the lancet or caustic, and -sometimes operators being wanting. No bad consequence ensued on their -being left to open of themselves, nor was any particular treatment -necessary. Where they mortified, the treatment was the same as in -carbuncles, and though, after the separation of the gangrened parts, -the ulcer often remained wide and deep, yet they healed kindly and in a -short time. - -Sometimes the carbuncles were scarified, but oftener not. The best -dressings were pledgits of yellow basilicon, with a small proportion of -oil of turpentine, or sometimes tincture of myrrh, with an emollient -cataplasm over all. - -Dr. Patrick Russel complains that, in Turky, physicians are laid under -such restraints, by popular prejudices, that they are sometimes obliged -to remain almost passive spectators of the disease. The natives are -fond of bleeding, and will at any time let blood in the hot stages, -when the febrile symptoms run high. About two thirds of the infected -were bled at the arm; but from the rapid progress of the disease, and -the quick transition to the low, languid state, few were bled more -than once, and that usually within the first forty hours. The time of -bleeding was usually the first night, or some time on the second day; -but sometimes not till the third. Where the operation was repeated, -it was usually on the third, sometimes on the fifth, and even on the -sixth; he has even met with instances wherein the patient was three -or four times bled, the last being as late as the seventh day. In his -own practice he usually advised one bleeding at the beginning, except -in the very young, aged, or infirm. On the first day, if not forbid by -circumstances, bleeding was ordered by way of precaution; but on the -succeeding days it was regulated by the state of the pulse, and other -symptoms. Where the infection was slight, and the febrile symptoms -moderate, or did not come on till some days after the eruptions, it -was wholly omitted. The quantity of blood taken away seldom exceeded -eight or ten ounces. Cupping was used by the natives, but never ordered -by Dr. Russel. Children were scarified in the legs. He seldom had an -opportunity of examining the blood drawn from a vein; but, in such -cases as occurred, the general appearance was little different from -that of healthy blood; the crassamentum was sometimes of a darkish -colour, but never sizy or resolved. - -With regard to the propriety or impropriety of bleeding, or at least -the success attending it, we can best judge from the histories of -cases given by Dr. Russel at the end of his work. Of these there are -an hundred and twenty, with some supernumeraries, giving an account of -the cases of the attendants, &c. Of these, sixty-five were bled; forty -died, and twenty-five recovered. - -Of these hundred and twenty cases at large, fifty-seven recovered, as -many died, and the event of six was unknown. This would tend to give -us some considerable idea of the Doctor’s success; but, when we take -into account the time of the year in which these cases were treated, -the matter will appear in a quite different light. Twenty-seven took -place mostly in the earlier part of the season, and were of consequence -more violent than the others; and, of these, twenty-one died, five -recovered, and the event of the other case was uncertain. Of the rest -only thirty-six died, and fifty-four recovered. Such an excessive -disproportion cannot be ascribed to the medical treatment, but to the -nature of the disease itself, growing milder as it extended wider. In -many of these cases it is not mentioned whether the patients took any -medicines or not; nevertheless, as it must always be supposed that a -physician would prescribe something for his patient, it must also be -supposed that all took medicines, excepting where we are expressly -told that they did not. The cases in which he mentions the medicines -employed were the following: - -1. A young man of 20, suddenly seized, was bled largely; had a vomit of -ipecacuanha, which brought off a quantity of bile, but without putting -a stop to the natural retchings. Some diaphoretic medicines were given, -which did not remain on his stomach, and he did not sweat. These were -stopped by a draught of juice of lemons and alkaline salt taken in the -act of effervescence. Sinapisms were applied to the feet, and he died -the third night at midnight. - -2. A widow lady about 40, of a thin, delicate habit, in whom the -disease came on gradually, was bled on the third day, and took -diaphoretic medicines and acidulated cordials till the 9th. She died on -the 11th. - -3. A Jewish rabbi, between 30 and 40, of a thin, spare habit, was bled -on the 2d day, and died early on the morning of the 4th. - -4. A Jewish boy, between seven and eight years old, of a pale, -unhealthy complexion, was repeatedly purged, and had suppurative -cataplasms applied to the buboes without effect. He recovered slowly. -Dr. Russel was not called till the seventh day of the disease, and we -are not informed when the purgatives were administered. - -5. A Jewish lad of 14, healthy and florid, was visited on the third -day. He had already been scarified in the legs, and bleeding was -ordered; but, as he became faint, only a small tea-cupful could be -taken away. The blood, after two hours, was found to have a soft and -loose texture, somewhat blackish on the surface; but the quantity of -serum was not greater than usual. It had appeared of a blackish colour -at first. He had a vomit, draughts with spiritus mindereri; afterwards -a diaphoretic mixture and acidulated cordial, and sinapisms to the -feet. On the seventh day he sweated copiously, and was much relieved, -but soon relapsed. On the 10th he sweated early in the morning, and had -a temporary relief, but soon became worse than ever. On the eleventh he -had three stools of black blood. One of these, kept for the Doctor’s -inspection, consisted of about three tea-cupfuls, without any fœtor; -the others were “inconsiderably small.” Some tincture of bark was now -added to his usual mixture. On the 15th he had a purging potion which -operated five times, had an opiate at night, and tincture of bark with -elixir of vitriol was ordered twice a day. Next day he was quite free -of fever, and quickly recovered. - -6. A Jew of a thin, spare habit, who took no medicines, died on the -sixth day. His wife, of a delicate frame, and six months gone with -child, was bled in the arm, had “proper drinks” directed for her, -brought forth a child in the agonies of death, and expired on the -sixth day. They were extremely poor, and Dr. Russel says of the house -they inhabited, that it “was one of those miserable dwellings which he -had always considered as one of the receptacles of contagion.” It did -not, however, appear to be so; for, though there were other six in the -family, only one of them was infected, who died in ten days. - -7. A youth of a delicate constitution, a French native of Aleppo, was -visited on the morning of the third day. He had a carbuncle on his -neck, which had been mistaken for an ordinary inflammation, and a -physician who had previously visited him applied a galbanum plaster, -ordering also some nitrous medicines; but the plaster giving much pain, -it was changed for a common poultice. Live pigeons were applied to the -feet. On the fourth he had a diaphoretic medicine, and his drinks were -acidulated with spirit of vitriol. The symptoms increasing, sinapisms -were applied to the feet, but without effect. Cataplasms of garlic were -applied next night; he had two copious black stools, not very fœtid, -and two bilious ones in the morning of the sixth. By these stools he -was greatly weakened, and was ordered a cordial with diascordium. He -had another stool, and became much worse. Cataplasms were applied -without effect, and he died on the seventh day. This patient had -a great number of eruptions; but, though six people attended him -constantly, none of them were infected. - -8. A Jewish girl of nine years old, of a delicate frame, and sprightly -disposition, was visited on the 4th day. The usual regimen and -medicines were ordered, but she could not be prevailed on to take any -thing besides an acidulated cordial. Palm-oil was externally applied -to a carbuncle near the corner of the mouth, about an inch long, and -the third of an inch broad. This seemed to ease the pain, but did not -prevent it from spreading. The face was also strangely disfigured by -three or four streaks of a pale red colour, shooting up on each side -from the cheeks towards the temples. The gangrene spread rapidly, and -she died on the evening of the tenth day. - -9. A stout, healthy Armenian youth, about 20, was visited on the first -day, and took a vomit of ipecacuanha, which brought up a good deal of -bile. An anodyne was given at night, but without effect. He took no -medicines afterwards but an acidulated cordial. On the third he eat a -quantity of cherries, and drank some iced water. He died on the fourth. -Here the infection spread violently, only one out of six in the same -house escaping the disease. Three died. - -10. An Armenian woman in the seventh month of her pregnancy. She was -bled the first day, had afterwards diaphoretic boluses, but did not -sweat. On the third day she was delivered of a dead child, and seemed -much better, but died at night. After death the body was entirely -covered with purple marks. - -11. A boy was bled and had an alexipharmic mixture the first day. A -diarrhœa came on, and diascordium was added to the mixture without -success. He died the third night. The infection was violent, only one -in the house escaping. - -12. A Jew of middle age and gross habit of body was bled on the -second day. He was visited on the fifth, had diaphoretic powders, and -sinapisms were ordered without success. He died on the 6th. - -13. A Christian youth of 17, taken suddenly, was visited on the second -day. A cataplasm was applied to the groin; he had a vomit of ipecacuan, -and a diaphoretic draught with nitre and diascordium at night, but did -not sweat. Next day he had acidulated drinks, a mixture with sweet -spirit of nitre, and a small proportion of nitre itself. On the fourth, -he had two stools, of a reddish colour like blood, after which he -became much worse. In the night he had two other stools, which seemed -to lower him. Throughout the day a larger portion of nitre had been -added to his mixture, and three tea-cupfuls of blood were taken away, -without the Doctor’s knowledge, by cupping. On the fifth the nitre -was omitted; he was ordered an astringent cordial, but it was not -given; however, the diaphoretic medicines were continued, and he had -three loose stools, which sunk him greatly. Next day he seemed past -recovery; lying motionless, insensible, his breathing quick, laborious -and interrupted; the skin not cold, but the feverish heat gone, and -his countenance ghastly. From this lethargic state the women attempted -frequently to rouse him, by applying vinegar to his nostrils, calling -him loudly by his name, and such like means, by which they sometimes -succeeded; but, though he opened his eyes, and gave signs of sense, he -could not be prevailed on to drink; and he remained silent. He would -then, for some time, writhe his body as in mortal agony, and again -relapse into lethargy. This dreadful paroxysm, however, began to wear -off about noon; and at night he was less disturbed than usual. On the -seventh day he was manifestly better; he had a looseness, with gripes, -for which the white decoction was ordered; and he had tincture of -bark thrice in twenty-four hours. On the sixteenth day the fever was -entirely gone. The Doctor observes that this patient sweated much less -than was usual with those who recovered. - -14. A Christian boy about 17 was visited on the 4th day, having taken -some absorbent powders on the 2d from another physician. The family -would allow no other medicines to be given, except a few grains of -bezoar, and he died next day. - -15. An Italian, a man about 40, of a gross habit of body, and addicted -to drinking, but who, finding himself somewhat indisposed, had for two -or three days lived temperately, was visited on the second day of his -illness, had a diaphoretic mixture, and a laxative medicine, without -relief. In the night between the 5th and 6th he had some retchings to -vomit. Next day he complained of a pain at the pit of the stomach, had -a vomit of ipecacuanha, which brought off a considerable quantity of -bile by vomit and stool, but without any apparent relief. He had two -fœtid stools, and was ordered a cordial with volatiles. On the 7th -his pulse was exceedingly sunk, and his extremities had been as cold -as ice, but with very little alteration in the eyes or countenance. -The patient did not know that these parts had lost their heat; and, -notwithstanding this change, the sensation still remained in them. He -died on the afternoon of the 8th day. This patient had no eruptions. - -16. A Christian merchant about 50, of an atrabilious habit, and subject -to the hæmorrhoids, on being taken ill drank immoderately of cold -water. He was visited next day. In the afternoon about ten ounces of -blood were taken away, and, as his pulse rose after the operation, -he lost, by Dr. Russel’s order, six ounces more. Three ounces -were afterwards taken away by cupping, and about as much more was -accidentally lost by the loosening of the bandage of the arm; so that -about 24 ounces were taken away in all. Next day he got a few drops of -Carmelite water, a kind of spiritous cordial, which he vomited, had a -blister and sinapisms applied, and died between 10 and 11 at night. He -had no eruptions. - -17. An Armenian youth was visited on the morning of the third day, was -bled, and had a saline draught every four or five hours. On the fifth -he was removed into a more airy chamber, and had Huxham’s tincture of -the bark. He died on the ninth day. - -18. A young lady of French extraction, of a thin, slender make, -was visited on the morning of the second day. On the third she had -diaphoretic powders, and lost a few ounces of blood by cupping, without -the Doctor’s knowledge; she had a diaphoretic mixture, and died on the -sixth day. - -From these accounts it is easy to see, that, in violent cases of the -plague, medicine can do little or nothing. Such cases generally occur -in the earlier months of the season, though they may take place, and -do take place in great numbers, at any time. In the beginning of the -season the patients are almost all attacked in this violent manner, and -very seldom recover, whether they take medicines or not. It being then -an established fact, that as the epidemic season advances the disease -grows milder, and many more continue to recover of themselves than -did so at first, we are naturally led to suppose that a multitude of -those who recovered after taking the medicines would have done the same -without them. Little therefore needs be said of the immense number of -prescriptions found in authors who have written upon the plague, as it -may generally be supposed that at certain times these would have been -ineffectual, and at others they were useless.--The following is an -epitome of Dr. Patrick Russel’s practice: - -1. Bleeding as early as possible, seldom repeated, except where -manifestly indicated by circumstances. - -2. Vomiting, if spontaneous, was encouraged by warm water. If the -patient was affected by nausea, vomiting was provoked by warm water or -camomile tea, assisted by a feather. If a bitter taste in the mouth was -complained of, ten or fifteen grains of ipecacuanha were given. The -times of remission were laid hold of for those remedies. - -3. Where spontaneous vomiting continued too long, a saline mixture was -given, sometimes with opiates and external applications. - -4. The stomach being settled, mild sudorifics were given in small -doses, every five or six hours. In the beginning, nitre was joined -with contrayerva, but where it occasioned loose stools, was left off. -Spiritus mindereri and saline mixture were also given as sudorifics. - -5. In case of diarrhœa, dilution was first prescribed and then the -white decoction. Laxative medicines were seldom admitted by the friends -of the patient. Diascordium and opiates were used in cases of obstinate -diarrhœa. - -6. In the advance of the distemper it was found more eligible to give -the sudorifics at shorter intervals, when occasion required, than to -augment the dose, which was apt to occasion disgust, and a rejection -of medicine entirely; consequences which also attended an attempt to -heighten the power of the medicines themselves. The general design was -to make their operation coincide with the periodical determination to -the skin naturally occurring in the disease. - -7. The sudorifics exhibited having but small power by themselves, it -was found necessary to assist them by dilution, as well as in every -other method which could be attempted. If the patient was not naturally -inclined to drink, he was encouraged to it by offering agreeable -liquids, either hot or cold at the person’s option. - -8. The diet was the same as in other acute distempers. No animal -food stronger than chicken broth was allowed; the rest confided of -farinacea and leguminous vegetables. “It was certainly necessary (says -our author) to a certain degree, to support nature by proper food; but -to force it upon a nauseating stomach seems to have been irrationally -recommended; and, where attempted, which the over care of the nurses -frequently did, usually excited vomiting. I sometimes wished to -give wine, but a religious bar lay in the way of Mahommedans, and a -prejudice against it, in all fevers, rendered it equally inadmissible -among the Christians and Jews.” - -9. For oppression at the præcordia, mild cordials, acidulated drinks -and cool air were found useful. Throughout the disease access of cool -air to the chamber was constantly allowed, and, where the chamber -itself was not sufficiently airy, the bed was removed to the house top. -Towards the height of the exacerbations, however, when there happened -to be the least appearance of moisture on the skin, the sick were kept -moderately covered up from the chin downward. - -10. After the height, and through the decline of the disease, the bark -in substance, or Huxham’s tincture, were given instead of the ordinary -sudorifics. - -In the plague which took place in the Russian army, the greatest -confidence seems to have been put in vomits. The disease commonly began -with a dull pain in the head, resembling that produced by the fumes -of charcoal, accompanied with shivering, universal weakness, &c.[135] -On the first appearance of these a vomit was given, working it off -with acid drinks. “If the nausea and bitter taste in the mouth was not -removed by the first, they gave a second, and sometimes a third or -fourth; nay, they sometimes, if the symptoms were very urgent, gave -two or three in the space of twelve hours, as there is no time to be -lost in this disease; for they did not find this species of evacuation -subject to the same inconvenience with purges, which a man in the -plague is unable to support; nay, they are even dangerous, though he -bears brisk vomits, and a repetition of them, when the nature of the -case requires it. - - [135] Duncan’s Med. Comment. vol. viii, p. 352. - -“The stomach being thus cleansed, they gave every morning a powder -composed of twenty grains of rhubarb, mixed with as much flower of -brimstone, and three grains of ipecacuanha, exhibiting also, every -hour, five grains of pure nitre mixed with two grains of camphor; and, -if costive, a laxative clyster was given every evening, composed of -decoction of camomile, wine vinegar, with or without soap, according to -circumstances. - -“The head, temples and buboes were frequently washed with warm vinegar, -and the last urged to suppuration with emollient cataplasms; but, in -case they were found to baffle all attempts to bring them forward, -they were then scarified or extirpated, and the patient ordered to -drink plentifully of _lime-water_. Bark was given after evacuation, -joined to the flower of brimstone in the proportion of one ounce of -the former to a drachm of the latter, divided into sixteen powders, -and taken in twenty-four hours. When delirium came on, blisters were -applied to the legs and arms, and camphor given largely. Vegetable and -mineral acids were given indiscriminately; but they found the vegetable -kind sometimes remain on the stomach when the other was thrown up; and -of the latter they preferred the vitriolic. Acidulated drinks were -given in quantity through the whole disease, and the food consisted of -acidulated water-gruel, and fruit when they could procure any. The air -of the room was kept charged with acetous vapours, as much as possible, -and it was remarked, that, while the bitter taste remained, there was -little hope of the disease abating.” - -According to Baron Ash, “the plague does not depend upon any -constitution of the air, but is communicated only by contact, and they -had repeatedly succeeded in suppressing it in different divisions -of the army, by the immediate separation of the infected with their -attendants, and burning every thing belonging to them, or that they -had touched. They found the greatest advantage in keeping the soldiers -ignorant of its existence till suppressed; for by this means they -preserved their peace of mind, and health of body; and they found an -exact military discipline the best preservative against the disease. -For the cure of those infected they found the cold regimen, a free -circulation of air, vegetable and mineral acids, ipecacuanha, rhubarb -and bark, to be the properest remedies. That, to purify the air in -hospitals appropriated for their reception, gun-powder was found most -efficacious, probably from the commotion given to the air in explosion, -over and above its action in common with other fumes. To resist -infection, courage and fortitude of mind is necessary, as consternation -and terror seem to prepare the body for the reception of the disease.” - -Dr. Sydenham seemed to have as great an opinion of bleeding, as -the Russian physicians of vomits. Considering the plague as merely -inflammatory, he lays the whole strength of the cure upon bleeding, -which he greatly prefers to any other remedy. The quantities he took -away were very considerable; and he gives an instance of a patient -who died from not having enough taken away. He also informs us, that, -during the civil wars in England, the plague raged in several places. -Being accidentally brought to Dunstar castle in Somersetshire, a -surgeon, who had travelled much in foreign parts, applied for leave -to give the garrison what assistance he could. This being granted, he -bled them, every man as he stood, without distinction, till ready to -drop down; the blood was suffered to flow down upon the ground, so -that no account could be taken of the quantity. They were then ordered -to lie in their tents; and, though no kind of remedy was given after -bleeding, every one recovered.[136] Notwithstanding his opinion of -bleeding, however, this celebrated physician was obliged to attempt the -cure by sweating, which he says he preferred to bleeding on account of -its not weakening the patient so much, nor hazarding the reputation of -the physician; yet he says it is prejudicial in young people where the -powers of life are strong. His improved method therefore was, first -to bleed moderately, if no swelling had appeared, by which means a -sweat would be more safely and easily raised. The bleeding is to be -performed in bed, after which the patient must be covered up with the -bed-clothes, and a piece of flanel applied to the forehead. This last -expedient, he says, contributes more to the raising of a sweat than -one would imagine. If no vomiting ensued, he administered sudorific -medicines internally. But, if the stomach cannot retain any thing, he -proposes to begin the sweating merely by the weight of the clothes, -and now and then throwing part of the sheet over the face. The sweat -being thus begun, the vomiting, however violent, generally stops, and -the medicines will be retained, so that as plentiful a perspiration as -we can desire may be excited. An instance of his success in this way -he gives in an apothecary who applied to him in behalf of his brother. -A sweat being proposed, the apothecary told him that he had given -him several strong sudorifics, all of which had been thrown up; but -the Doctor, having first sweated him moderately by the bed-clothes, -afterwards gave him a large dose of Venice treacle; which operating -powerfully, he recovered from the disease. He advises the sweat to be -kept up without intermission for twenty-four hours; a smaller time -being insufficient to remove the disease, and a stoppage of the -perspiration certainly attended with a return of the bad symptoms. On -this occasion he censures Diemerbroeck and others for advising to stop -the sweat on every slight occasion. The linen is to be allowed to dry -on the patient’s body, he must take all his liquids warm, and continue -the use of a diluting fluid. Sage posset drink is what he recommends. -Next morning the cure was finished by a purge of senna, tamarinds, -&c. Where a swelling appears, he directs to forbear bleeding even in -such as are not apt to sweat, least the patient should die suddenly -from a return of the morbific matter into the vessels. Bleeding, -however, might be used with safety even in this case, provided a sweat -was instantly to be raised; and thus he thinks the swelling might be -dispersed perhaps with more safety than by waiting for its suppuration. - - [136] Dr. Dover, who wrote, in 1732, the _Ancient - Physician’s Legacy_, had lodged his soldiers in a church in which - those who died of a plague had been buried. An hundred and eighty of - the soldiers were seized either with petechiæ or buboes. He ordered - them all to be bled in such quick succession, that the arm of the - first was not bound up till the blood flowed from the last. Thus - every one lost about an hundred ounces (upwards of three quarts.) He - then ordered them water acidulated with spirit of vitriol for their - drink; and by this treatment all recovered excepting eight, who would - not refrain from spiritous liquors. This was transacted in Peru: - but in Europe the plague will scarce bear bleeding to a few ounces. - (Sauvages.) - -This may be accounted an epitome of the most approved modern practice -in pestilential cases. The Russian physicians above quoted seem to -speak with most confidence of their success. They, however, “lay -great stress upon distinguishing the plague from the worst kind of -malignant fever in hot countries; and it is not without reason, as bad -consequences have attended the confounding of them on the breaking -out of the plague. I am credibly informed that the great havock made -in Moscow was principally owing to this circumstance; for it obtained -some time before it was discovered by gentlemen unacquainted with the -disease, and before they would acknowledge its existence, although -some veteran army practitioners recognised its appearance under one of -its forms, and endeavoured to alarm their brethren, but in vain, for a -time.”[137] - - [137] Duncan’s Med. Comment. vol. viii, p. 359. - -From this it is natural to conclude, that, when the disease was once -fairly discovered and attacked by the powers of medicine, it could -not make much resistance; yet Dr. Mertens, speaking of this very -plague, says, that owing to the rapidity of the distemper, and many -inducements to conceal it, _little can be said of remedies_ in the -plague. He divides the distemper into two kinds, the nervous and -putrid; the former “comprehending merely that degree of confusion and -disturbance given to the nervous system on the first introduction of -the miasma, and the latter commencing at the time the miasma begins to -operate upon the blood and other fluids by assimilating them to their -own putrid nature.” In the nervous state the miasma has sometimes been -carried off by sweat, gentle diaphoretics, camphorated emulsions, -juleps of camphor and musk. Gentle emetics, particularly ipecacuanha, -were found useful; but James’s powder (which was imported from England -in great quantity) did not answer any good purpose. In the putrid -state, the bark and mineral acids were useful; purgatives were hurtful, -blood-letting inadvisable, and scarifying the carbuncles, recommended -by almost every writer, attended with no good effect. - -Few of the modern travellers who have visited the countries in which -the plague is frequent, being versed in medicine, have said much about -the cure of it. Mariti only says, that, in the island of Cyprus, -infected patients were allowed no other diet than pure water, panada, -rice, tea, &c. Some thought to ward off the disease by drinking strong -liquors, but these _almost always_ fell victims to it. Whatever their -methods were, indeed, they must certainly have been very ineffectual, -since the same author informs us that, in the plague of 1759, in many -parts of that island there were not a sufficiency of inhabitants left -to cultivate the ground. - -Diemerbroeck, whose name justly ranks high among those who have -written on the plague, trusts mostly to sudorific medicines. Bleeding, -according to him, is absolutely to be avoided, as well as purging -and vomiting. He directed first that the chambers of the sick should -be kept clean, and the air purified three or four times a day by -fumigations, and that the sick should take (in the beginning, the -first, second, or third day) a _sweating draught_, and being well -covered with blankets plentiful sweats were promoted for two or three -hours or more (always having a regard to the patient’s strength.) If -the patient did not sweat easily, bags filled with hot, dry sand were -applied to the feet, armpits and groin. If the sick were not eased by -the first sweat, it was repeated in a few hours; but if, after the -second sweat, the fever and other symptoms still increased, it was the -worst sign. After ten or twelve hours, and on the following days, they -were repeated four or five times as occasion required. Besides this he -directed apozems, antidotes, &c. which, as it is most probable they had -no effect in removing the disease, it is needless to trouble the reader -with.[138] - - [138] As it might by some be deemed an affront offered to the wisdom - of antiquity, should we pass over in silence the opinions of the more - ancient physicians, I shall in this note give a short account of some - of their most remarkable modes of practice, as they are recorded in - Burnet’s _Thesaurus_. - - 1. Forestus, in many respects a respectable author, recommends an - _antidote_ composed of equal parts of rue, figs and almonds, beat - into a pulp in a stone mortar with a wooden pestle till united - (which is not very easily done) into an uniform mass, adding as - much syrup of citrons with vinegar as would render it soft, with a - little powdered salt put in last. The efficacy of this he tells us - he experienced in himself as well as all his family as a preventive; - himself taking in the morning the bigness of a small nutmeg of this, - made up into a confection with the ancient theriac, mithridate, - Armenian bole, terrasigillata, &c. - - In his regular practice (for the above must be accounted quackery) - he advises bleeding within the first twelve, or at most twenty-four, - hours; such as were bled afterwards he says died. If performed in - seven or eight hours after the commencement of the disease the - cure went on the better. Where bleeding was inadvisable he used - cupping with scarifications, finishing the cure with sweating and - cordials. He remarks that where black tumours or eschars, lentil - shaped, appeared, the disease always proved mortal, without a single - exception. These were small, like a grain of black pepper, and - therefore called by the vulgar _peppercorn_; undoubtedly the _tokens_ - of Dr. Hodges. - - 2. Hildanus, also a respectable writer, has an high opinion of issues - as a preventive. He says he never knew but one or two (and those of - a very bad habit of body) who had issues in their legs and arms that - perished in the plague, and says that he has known its efficacy as - a preventive not only in himself but many others. He says he kept - two issues in his own body, one in the left arm, the other in the - right leg. (See above p. 339) To the same purpose Mercurialis relates - that he never knew but one, and he was a _priest_, who died of the - plague having an issue. He says also that he had inquired of many - other physicians, who all gave a similar testimony. According to - him, in the plague at Lausanne, all who were attacked by vomiting or - looseness, and almost all who were bled, fell victims to the disease. - - As preventives he advises amulets made up of arsenic, powder of - _toads_, and _other things_. These are to be hanged round the neck in - times of plague, and are _undoubtedly_ of great virtue (_maximam_ ad - _præservationem vim habere, non est quod dubites!_) This remedy he - says he had from his preceptor _Cosmas Slotanus_, a very celebrated - surgeon. - - Brine of pork is another preventive, which he never tried himself, - but asks Sennerius about it. It was recommended to Hildanus by a - lawyer of his acquaintance. The brine is first to be boiled in a - kettle, and well skimmed, till it becomes clear, poured into earthen - vessels. and kept shut up from the air for a twelvemonth; after which - it was fit for use. A draught of this was given to people infected - with plague, and operated by sweat, stool or vomit, or perhaps both - by vomit and stool. The patient was to abstain from drink for some - hours after. The brine of _anchovies_ is recommended by Sam. Formius, - as useful in the plague at Montpelier in 1630. - - 3. The same author (Formius) tells us of a man and his wife and - wife’s sister, in Montpelier, who, being taken with the plague, - swallowed a solution of their own excrements in urine, _strained - through a linen cloth_, and thus got clear of the distemper. It - produced excessive vomiting and purging. Dr. Russel mentions one of - his patients, who, he suspected, had got a dose of bezoar in urine. - - 4. Johannes Helmontius says, that _to his certain knowledge_ (me - conscio) _Hibernus Butlerus_ cured some thousands of the plague, at - London; though unhappily our author got only part of the secret, - and which is to the following purpose. “He ordered me to suspend - by the legs before the fire, a large _toad_ taken in the afternoon - in the month of June; putting below him a cake of yellow wax. At - length, after three days suspension, the toad vomited earth, and some - _walking insects_ (insectas ambulantes) viz. _flies_ with shining - wings of a greenish colour, as if gilt: the toad died immediately - after this evacuation, nor did it take place, notwithstanding his - suspension till the third day. He (Butlerus) then told me that I had - medicine enough for curing _forty thousand_ people infected with - the plague, and promised to show me the mystery of the matter (rei - cardinem) but being suddenly sent into banishment he departed.” The - best part of the secret being thus lost, it is needless to trouble - the reader with any further account of experiments made with other - toads roasted alive, powdered and made up into troches,&c. presuming - that these could not equal the value of the original receipt. I - proceed therefore, - - 5. To the antidote of the celebrated Avenzoar, who drove away the - plague by the smell of the _urine_ of an _he goat_; and Mercurialis - says that in the house of a most reverend canon in Hungary, he saw a - large he goat kept for this purpose. - - 6. From such horribly disgusting remedies we certainly turn with - pleasure to the elegant tablets prepared for the Emperor Maximilian - II. These were composed of Armenian bole, prepared pearl, prepared - coral, prepared emeralds, prepared jacinct, gold-leaves (ingredients - in a medical view equally efficacious with chalk or oyster shells) - along with a little ambergrease and some other ingredients of - little value, as medicines, and made into tablets with conserve - of roses----It is needless to spend time in commenting on such - ridiculous remedies; suffice it to say, that the intention of all - rational practice both ancient and modern has been to effect a cure - by sweating. From the instance related by Sydenham, as well as that - of Dr. Power above mentioned, it seems, that if the exact time in - which the disease begins could be known, it might be carried off - by profuse blood-letting; but as this for the most part cannot be - discovered, it is certainly better to wait, even though the event - should not prove favourable, than to run the risk of killing, the - patient instantly by an ignorant effort to save him. - -That a free perspiration is the natural cure of the plague, seems -to be allowed by almost all writers of credit. Dr. Russel says, -“Of all excretions, _that_ by the skin would seem to be the most -materially important in the plague. Where the skin remains perpetually -dry, or where short and precipitate sweats are attended with no -favourable alteration, danger is always to be apprehended. On the -other hand, sweats, at certain periods of the disease, appeared -clearly critical in a greater or less degree. They were followed by a -manifest alteration for the better, and by their repetition the fever -was carried entirely off, or reduced to symptomatic exacerbations, -seemingly dependent on the eruptions.” He adds, that he never observed -blood exude through the pores, nor did he observe the sweat to be -remarkably offensive; or in any degree so remarkable as in some -eruptive fevers, particularly in the small-pox before eruption. -Dr. Hodges, however, says that in the plague of London sweats were -sometimes extremely acrid and fœtid; and that they were met with of -various colours, such as purple, green, black, or blood-coloured. -Sometimes it was cold, though the patient was tormented with -intolerable inward heat and drought; and would continue even after -death; but he was of opinion that sweat is the natural crisis of the -distemper. - -Besides those symptoms of the plague which have been enumerated, there -are others, particularly hæmorrhages and convulsions, with which it is -sometimes attended. These it has in common with the yellow fever, and -therefore are considered in the second part of the work. I now conclude -this part with a short retrospect of the principal facts which to me -seem to be the result of the investigation. 1. That the plague is of an -unknown (I believe it of _divine_) original. 2. That in the countries -on which it first was sent, it still remains, and from them has always -been propagated to others, without a single well attested instance to -the contrary. 3. That the means by which the distemper usually has been -propagated are _war_ and _commerce_. 4. That the disease differs from -all others in having a more violent tendency to inflammation, insomuch -that it approaches to actual accension; nay, that the extraordinary -instances of spontaneous burning we read of are to be accounted only -the highest degree of this disease. 5. That the immediate or proximate -cause of the plague is a tendency in the blood and other fluids to -discharge upon certain parts the latent heat they contain, in such -quantity as to destroy these parts entirely, and to convert them -into a kind of coaly substance. 6. That this tendency depends on a -certain inexplicable action of the external atmosphere, particularly -of the elementary fire contained in it, and of which it principally -consists.[139] 7. The approach of a plague cannot be foretold, either -from the constitution of the atmosphere, earthquakes, storms, or any -other natural phenomena. 8. The plague is an eruptive disease, and it -is known to be so by the _certain death_ of all in whom eruptions do -not appear; a tendency to eruption being _always_ observed where life -remained long enough. 9. The contagion of the plague diffuses itself -from a small space all around, lessening in violence the farther it -is diffused. In its most concentrated state it hath proved invincible -by medicine; in its mild state it requires none;[140] so that in the -plague the medical powers are found of less avail than in any other -acute distemper. 10. The natural cure of the plague is by perspiration -or sweat, and this perhaps is the only evacuation which ought to be -kept in view, as having a salutary tendency, by those who attend the -sick.[141] - - [139] These two last conclusions (though I believe them myself) are - proposed only as probable conjectures, which as yet I see nothing to - contradict. - - [140] See p. 282. - - [141] The operation of oil so much recommended by Mr. Baldwin is said - to be by producing sweat. (See above p. 341.) - - -END OF THE FIRST PART. - - - - -A TREATISE ON THE Plague and Yellow Fever. - - - - -PART SECOND. - -_Of the Yellow Fever._ - - - We now come to treat of a disease, less fatal indeed than the Asiatic - plague, but yet so deadly in its nature in the Western World, that - it has of late been confounded with the former, and attempts made - to prove that they are both to be considered only as degrees of - the same disease, and that both have been recorded by historians - indiscriminately under the common appellation of _plague_ or - pestilence. To investigate this matter candidly, and to show that - there is a real and essential difference between the two, as far as - we can credit testimonies drawn from the most respectable writers, - shall be the work of the following part of this treatise. - - - - -SECTION I. - -_History of the Yellow Fever._ - - -The distemper now under consideration has been commonly distinguished -by two different names; one of which is the _Yellow Fever_, the other -the _Black Vomit_. Both of these are taken from symptoms so remarkable -(though not occurring in every case) that, had the disease existed -in ancient times, we can scarce think but some of the historians of -antiquity would have taken notice that in such a plague those who died -generally became yellow, or that they had a continual vomiting of black -matter, which could not be stopped. Black or bilious vomitings are -indeed mentioned, though not as the principal symptom, but the yellow -colour is not once taken notice of. Dr. Hodges indeed mentions a single -instance of a patient who became all over of a _green_ colour; but as -a change of colour is not taken notice of in the plague as a general -symptom, either by him or by any other writer, we must conclude that -this distemper (the yellow fever) has been observed only in modern -times. - -When Columbus first visited the West India islands, we hear nothing of -his having found such a disease existing there; nor does it appear that -it was known among the many Spanish adventurers who succeeded him, and -who subdued such immense tracts on the Southern Continent. Soon after -the settlement of some of the West India islands, however, by other -European nations, this disease began to make its appearance, though -at what time is still uncertain. Dr. Hillary says, that, “as we have -no accounts of this disease in the ancients, nor even in the Arabian -writers, who lived and practised in the hot climate, we must give it -_some name_;” and he calls it the _putrid bilious fever_. “From the -best and most authentic account (adds he) that I can obtain, as also -from the nature and symptoms of the disease, it appears to be a disease -that is indigenous[142] to the West India islands and the continent of -America which is situated between the tropics, and most probably to all -other countries within the torrid zone. But I cannot conceive what were -the motives which induced Dr. Warren to think that this fever was first -brought from Palestine to Marseilles, and from thence to Martinique, -and so to Barbadoes, about thirty-seven years since (1721 or 1722.) A -better inquiry would have informed him, that this fever had frequently -appeared, in this and the other West India islands, many years before: -for several judicious practitioners, who were then, and are now, living -here, whose business was, visiting the sick the greatest part of their -life time, some of them almost eighty years of age, remember to have -seen this fever frequently in this island, not only many years before -that time, but many years before that learned gentleman came to it.” - - [142] Naturally belonging to the climate. - -To the same purpose Dr. Mosely says, “Warren, though he lived at -Barbadoes in 1739, supposes it never appeared in that island till about -the year 1721, and that it was then brought from Martinique in the Lynn -man of war. He says the second appearance of it there was in 1733, -and that it then came also from Martinique. He undertakes to show, -that it is a disease of Asiatic extract; and says, that a _Provencale_ -fleet arrived at Port St. Pierre in Martinique, from Marseilles, on -board which were several bales of Levant goods which were taken in at -Marseilles from a ship just arrived from St. Jean D’Acre (probably -the Ptolemais of the ancients.) Upon opening these bales of goods at -Port St. Pierre, this distemper immediately shewed itself; many of -the people were instantly seized, some died almost suddenly, others -in a few days, and some lingered longer; and the contagion, still -spreading, made great havock at the beginning. He says he had this -account from Mr. Nelson, an English surgeon, who was seized with the -disease at Martinique, and died of it a few days after his arrival at -Barbadoes. He says, it is very probable that the same fever, or one of -very near resemblance and affinity, may first have been carried among -the American Spaniards (among whom it is now endemic) in somewhat a -like manner; and that possibly some peculiar qualities in the air and -climate might have fostered and maintained it there ever since.” - -Dr. Mosely at once concludes the whole of this account to be -_fabulous_, but whether fabricated by Dr. Warren or the surgeon, he -does not say. He then appeals to Dr. Towne, who wrote before Warren, -in 1776, but takes no notice of this _chimerical_ origin of the yellow -fever, but considers it as an endemical disease in the West Indies. -Hillary’s opinion already given is also quoted. - -The next evidence is that of Mr. Hughes, who, though not a medical man, -has written on the first appearance of the yellow fever in Barbadoes -in the following terms: Dr. _Gamble_ remembers that it was very -“fatal here in the year 1691, and that it was then called the _new -distemper_, and afterwards _Kendal’s fever_, the _pestilential fever_, -and the _bilious fever_. The same symptoms did not always appear in -all patients, nor alike in every year when it visited us. It is most -commonly rife and fatal in May, June, July and August, and then mostly -among strangers; though a great many of the inhabitants, in the year -1696, died of it; and a great many at different periods since.” - -As to the first appearance of the disease in the West India islands -we have no accounts which have been deemed sufficiently authentic, -though indeed it must be confessed that the doubts seem to be derived -as much from an attachment to theory as to the investigation of truth. -“The _endemial causus_, or _yellow fever_, (says Dr. Mosely) which is -the terror of Europeans newly arrived in the West Indies, is called -by the French _la maladie de Siam_. Monsieur Pouppe Desportes, who -practised physic at _St. Dominique_ from 1732 to 1748, and who had more -experience, and has written from better information on the diseases of -that colony, than any of his countrymen, says that this fever was so -called from its being first taken notice of in the island of Martinique -at a time when some vessels were there from Siam. This account, though -probably true enough as to the time of its being first observed in -the French colonies, is extremely incorrect in other respects: for -M. Desportes has not only admitted a supposition that the disease -originated among these East Indian mariners, but calls it pestilential, -and says that the Europeans are almost the only victims to it. - -“The generality of the French writers say that it was brought directly -from Siam, in a merchant ship, and communicated to the people of -Martinique, whence the contagion was carried to St. Dominique, but that -sailors were the only people attacked by it, whence it was called _la -fievre matelotte_.” - -This account seems to carry no improbability in it; nevertheless -Dr. Mosely rejects it upon grounds that are very far from being -indisputable. “The French writers (says he) have not been at the -trouble to consider that a disease brought from Siam in the East -Indies, in a similar latitude to the West India islands, would be most -likely to affect the natives, living in a climate similar to that in -which the disease originated, rather than the Europeans of so different -a temperament of body.” But this argument would prove too much; for if -the disease would be most likely to affect the natives in a climate -_similar_ to that in which the disease originated, surely it would -be still more likely to attack the natives in _that very climate_ in -which the disease did originate, and that Europeans would be free. But -the very reverse is the case. The disease, according to Dr. Moseley -himself, originates in the West Indies; and yet Europeans, especially -those newly arrived, are particularly objects of its vengeance. - -“But (adds our author) the fact is, that this disease never attacks -either white or black natives of hot climates; neither was it brought -from Siam; and though it is possible, from the heat of the climate, -that it may frequently appear there, or in any other tropical -country (though BARRERE says it is unknown at _Cayenne_) no history -of that country that I have yet met with mentions such a disease; -notwithstanding what many writers have boldly advanced to the contrary.” - -Here it is evident we have no argument, but a parcel of assertions, -the first of which contradicts what he had just before quoted from Mr. -Hughes. For the latter informs us that in 1696 a great many of the -_inhabitants_ died of it as well as strangers. His not meeting with -it in any history of Siam is not a proof of its non-existence in the -country, neither indeed does he himself think that it is so, as he -tells us that it may possibly appear there, or in any other tropical -country. - -In Sauvages’s Nosology we find the plague distinguished into a number -of different species, among which there is one called the _plague -of Siam_. This, he says, was in the year 1685 brought from Siam to -Martinico, in the ship called the _Oriflame_. This seems to have been -the _yellow fever_, and the symptoms are considered in the following -section. This date agrees exactly with what Mr. Hughes says in the -place above quoted, that it was violent in Barbadoes in the year 1691, -when it went by the names of the _new fever_, and _Kendal’s fever_. -Both these names imply that the disease had been but lately known, and -that it was by no means a native of the climate. It must either have -been _imported_ therefore from some other country, or it must have -_originated_ in consequence of the settlement of some Europeans in a -climate so dissimilar to their own, while some of them still continued -to ramble from one country to another, occasionally visiting all, -without taking up their residence in any. - -Martinique seems to have been the first place where this distemper -made its appearance; and from thence it seems quickly to have extended -itself to St. Domingo and Barbadoes. Its farther progress, however, -cannot be traced, nor can we tell exactly what time it first entered -the continent. Whether the true plague was ever imported into the -Western Continent cannot at present be ascertained, neither can we -tell what diseases the Indians were subject to before the arrival of -the Europeans. The Spaniards, who first arrived, are allowed to have -been less subject to the plague than other nations,[143] but they were -quickly followed by those who had no such exemption. Sebastian Cabot -discovered the North American Continent for Henry VII of England, very -soon after, if not before Columbus discovered the Southern Continent -for the king of Spain. This was a very suspicious time; for Henry -VII himself had introduced the sweating sickness into England only -thirteen years before;[144] and in those days the plague seems never to -have been eradicated; so that it is by no means impossible that these -first adventurers might have communicated to the Indians with whom they -had any communication, the seeds of diseases totally unknown to them -before. Certain it is, that the North American Indians were subject to -epidemics before the settlement of any English colonies among them. -Hutchinson in his History of Massachusetts takes notice of the Indians -having been greatly weakened by an epidemic, which was attributed to -an unfavourable season, in consequence of which they were obliged to -feed upon unripe squashes, fruits, &c. We know not the nature of the -distemper, though, from the circumstance just mentioned, we may not -unreasonably conjecture it to have been of the pestilential kind. -That epidemics still continue among these people we also know from -the testimony of Capt. Carver, who found one of their towns deserted, -and the inhabitants fled into the woods, on account of an epidemic -disorder; but what the nature of it was he does not inform us.[145] - - [143] See p. 319. - - [144] See p. 17. - - [145] In Belknap’s Biography we have a more particular account of - this _pestilence_, as it is called, and which, if the relations - there given are to be credited, certainly determines the disease - in question to have been the yellow fever. The account is to the - following purpose: Lord Arundel, of Wardour, had employed a captain - Weymouth to search for a N. W. passage to India. In this he failed, - but falling in with a river, supposed to be either the Kennebeck or - Penobscot, he brought from thence five of the natives, with whom he - landed at Plymouth in July 1605. Three of the Indians were taken into - the family of Sir Ferdinando Gorges; and from these many particulars - were obtained respecting their country, which being eagerly attended - to by Gorges, he formed a plan of advancing his fortune by a thorough - discovery of the country. Two vessels were accordingly fitted out; - one of which failed, but the other brought such information as gave - encouragement to attempt the founding of a colony. Two of the natives - who had been brought to England were sent back, and 45 persons were - left on the continent to begin the settlement; but these, having - undergone great hardships, quitted the place in 1608. Gorges, - however was not discouraged. He sent out one of his servants, by - name _Richard Vines_, and some others, whom he hired to stay in the - country all winter. - - “Mr. Vines and his companions were received by the Indians with - great hospitality, though their residence among them was rendered - hazardous; both by a war which raged among them, and by a pestilence - which accompanied or succeeded it. - - “This war and pestilence are frequently spoken of by the historians - of New England, as remarkable events, in the course of Providence, - which prepared the way for the establishment of an European colony. - Concerning the war, we know nothing more than this, that it was begun - by the Tarratenes, a nation who resided eastward of Penobscot. These - formidable people surprised the bashaba, or chief sachem, at his head - quarters, and destroyed him with all his family; upon which all the - other sachems who were subordinate to him quarrelled among themselves - for the sovereignty; and in these dissensions many of them as well - as of their unhappy people perished. Of what particular kind the - pestilence was, we have no certain[146] information, but it seems to - have been a disorder peculiar to the Indians, for Mr. Vines and his - companions, who were intimately conversant with them, and frequently - lodged in their wigwams, were not in the least degree affected by it, - though it swept off the Indians at such a prodigious rate that the - living were not able to bury the dead, and their bones were found - several years after, lying about the villages where they had resided. - The extent of this pestilence was between Penobscot in the east, - and Narraganset in the west. These two tribes escaped, whilst the - intermediate people were wasted and destroyed.” - - This distemper appears to have raged among the Indians in the year - 1616. The following particulars are further given in Belknap’s - Biography, vol. ii, p. 208: “Hitherto they (the English colonists) - had not seen any of the natives at this place. The mortal pestilence - which raged through the country, four years before, had almost - depopulated it. One remarkable circumstance attending this pestilence - was not known till after this settlement was made. A French ship had - been wrecked on Cape Cod. The men were saved, with their provisions - and goods. The natives kept their eye on them, till they found an - opportunity to kill all but three or four, and divide their goods. - The captives were sent from one tribe to another, as slaves. One of - them learned so much of their language, as to tell them that God was - angry with them for their cruelty, and would destroy them, and give - their country to another people. They answered that they were too - many for God to kill. He replied, that if they were ever so many, - God had many ways to kill them, of which they were then ignorant. - When the pestilence came among them (a _new disease_, probably the - _yellow fever_) they remembered the Frenchman’s words; and when the - Plymouth settlers arrived at Cape Cod, the few survivors imagined - that the other part of his prediction would soon be accomplished. - Soon after their arrival, the Indian priests or powows convened, and - performed their incantations in a dark swamp three days successively, - with a view to curse and destroy the new comers. Had they known the - mortality which raged among them, they would doubtless have rejoiced - in the success of their endeavours, and might very easily have taken - advantage of their weakness to exterminate them. But none of them - were seen till after the sickness had abated; though some tools, - which had been left in the woods, were missing, which they had stolen - in the night.” - - [146] “The Pawkunnawkutts were a great people heretofore. They - lived to the east and northeast of the Narragansitts, and their - chief sachem held dominion over divers other petty sagamores; as - the sagamores upon the island of Nantuckett, and Nope, or Martha’s - Vineyard, of Nawsett, of Mannamoyk, of Sawkattukett, Nobsquasitt, - Matakees, and several others, and some of the Nipmucks. Their - country, for the most part, falls within the jurisdiction of New - Plymouth colony. This people were a potent nation in former times, - and could raise, as the most credible and ancient Indians affirm, - about three thousand men. They held war with the Narragansitts, and - often joined the Massachusetts as friends and confederates against - the Narragansitts. This nation, a very great number of them, were - swept away by an epidemical and unwonted sickness, an. 1612 and 1613, - about seven or eight years before the English first arrived in those - parts to settle the colony of New Plymouth. Thereby Divine Providence - made way for the quiet and peaceable settlement of the English in - those nations. What this disease was, that so generally and mortally - swept away, not only these but other Indians, their neighbours, I - cannot well learn. Doubtless it was some pestilential disease. I have - discoursed with some old Indians, that were then youths, who say, - that the bodies all over were exceeding _yellow_ (describing it by a - yellow garment they showed me) both before they died, and afterward. - - “The Massachusetts, being the next great people northward, inhabited - principally about that place in Massachusetts bay, where the body - of the English now dwell. These were a numerous and great people. - Their chief sachem held dominion over many other petty governors; - as those of Weechagaskas, Neponsitt, Punkapaog, Nonantum, Nashaway, - some of the Nipmuck people, as far as Pocomtacuke, as the old men of - Massachusetts affirmed. This people could, in former times, arm for - war about three thousand men, as the old Indians declare. They were - in hostility very often with the Narragansitts, but held amity for - the most part with the Pawkunnawcutts, who lived on the south border, - and with the Pawtucketts, who inhabited on their north and northeast - limits. In an. 1612 and 1613 these people were also sorely smitten - by the hand of God with the same disease before mentioned; which - destroyed the most of them, and made room for the English people of - Massachusetts colony, which people this country, and the next called - Pawtuckett. There are not of this people left at this day above three - hundred men, besides women and children. - - “Pawtuckett is the fifth and last great sachemship of Indians. Their - country lieth north and northeast from the Massachusetts, whose - dominion reacheth so far as the English jurisdiction, or colony - of the Massachusetts, doth now extend, and had under them several - other smaller sagamores; as the Pennakoaks, Agawomes, Naamkeeks, - Pascatawayes, Accomintas, and others. They were also a considerable - people heretofore, about three thousand men, and held amity with the - people of Massachusetts. But these also were almost totally destroyed - by the great sickness before mentioned; so that at this day they are - not above two hundred and fifty men, besides women and children. - This country is now inhabited by the English under the government of - Massachusetts.” (Gookin’s Historical Collections of the Indians in - New England.) - - The following was communicated to Benjamin Basset, esq. of Chilmark, - by Thomas Cooper, a half blooded Indian, of Gay Head, aged about - sixty years; and which, he says, he obtained of his grandmother, who, - to use his own expression, was a stout girl when the English came to - the island: “Before the English came among the Indians, there were - two disorders of which they generally died, viz. the consumption and - the yellow fever. The latter they could always _lay_ in the following - manner: After it had raged and swept off a number, those who were - well, met to lay it. The rich, that is, such as had a canoe, skins, - axes, &c. brought them; They took their seat in a circle, and all the - poor sat around without. The richest then proposed to begin to lay - the sickness; and, having in his hand something in shape resembling - his canoe, skin, or whatever his riches were, he threw it up in the - air; and whoever of the poor without could take it, the property it - was intended to resemble became for ever transferred to him or her. - After the rich had thus given away all their moveable property to - the poor, they looked out the handsomest and most sprightly young - man in the assembly, and put him into an entire new wigwam, built of - every thing new for that purpose. They then formed into two files - at a small distance from each other; one standing in the space at - each end put fire to the bottom of the wigwam on all parts, and fell - to singing and dancing. Presently the youth would leap out of the - flames, and fall down to appearance dead. Him they committed to the - care of five virgins, prepared for that purpose, to restore to life - again. The term required for this would be uncertain, from six to - forty-eight hours, during which time the dance must be kept up. When - he was restored he would tell, that he had been carried in a large - thing high up in the air, where he came to a great company of white - people, with whom he had interceded hard to have the distemper laid, - and generally, after much persuasion, would obtain a promise, or - answer of peace, which never failed of laying the distemper.” - - The following is extracted from Prince’s Chronological History of - New England, p. 46: “This winter (1617) and the spring ensuing, a - great plague befals the natives in New England, which wasteth them - exceedingly; and so many thousands of them die, that the living are - not able to bury them, and their skulls and bones remain above ground - at the places of their habitations for several years after. - - “By Capt. Dermer’s letter of Dec. 27, 1619, in Purchas, and of - June 30, 1620, in Gov. Bradford, compared with Gov. Bradford’s own - account, it seems that the Narragansitts in the west, and Penobscots - in the east, escaped this plague, or that it raged only in the - countries lying between them, and prepared the way for another - people.” - -Mr. Webster, in his eighth letter to Dr. Currie on the subject of -pestilential diseases, quotes from the Doctor’s letter to Mr. Wynkoop, -of October 5th, 1797, the following passages: “Thomas Story and Joseph -Gough relate, that a malignant fever prevailed in Philadelphia in 1699, -introduced from the West India islands.... Dr. Mitchill ascribes the -yellow fever as it appeared in Virginia in 1741 and 47 to specific -contagion, and mentions that it had been twice imported into Virginia -by his Majesty’s ships of war. Dr. _Leamy_ (_Lining_) in the Physical -Essays in Edinburgh, informs us, that the yellow fever which has -prevailed at different periods at Charleston, South Carolina, was -always traced to some infected person recently from the West Indies. -In 1741 it was introduced by a chest of wearing apparel which had -belonged to a person who died of it from Barbadoes.” These quotations -are made by Mr. Webster with a view to dispute the contagious nature of -the disease. Here they are introduced only to show if possible the time -that the disease first entered the United States; and the introduction -of it into Philadelphia in 1699 (though we are not sure if even this -was its first appearance), still corresponds extremely well with the -date of its introduction into Martinique mentioned by Sauvages. Dr. -Lining says it had been four times epidemic in Charleston before the -time that he wrote; viz. in 1732, 1739, 1745, and 1748. Hence we may -conclude, that this fever, on the northern part of the continent of -America, has been nearly coeval with the settlement of the British -colonies there; for we cannot suppose that we have accounts of the -very first time that it made its appearance any where. Numbers of -individuals would probably be affected with it, and their cases pass -unnoticed, till the general malady attracted the public attention. - -In the Spanish dominions it seems to have been otherwise. Dr. Moseley -quotes Don Ulloa saying that “the _vomito prieto_, or black vomit, was -unknown at Carthagena, and all along the coast, till the years 1729 and -1730. In 1729 Don Domingo Justiniani, commodore of the guarda costas, -lost so considerable a part of his ships’ companies at _Santa Martha_, -that the survivors were struck with astonishment and horror at the -havock made among their comrades. In 1730, when the galleons under Don -Manuel Lopez Pintado came to Carthagena, the seamen were seized with -the same dreadful mortality, and so sudden were the attacks of the -disease, that persons, walking about one day, were the next carried to -their graves. Unhappily, after all the experiments of the surgeons of -the galleons, and physicians of the country, no good method of treating -the disease has been discovered; no specific for curing it.” - -This fatal disease, however common in the southern and warm part of the -continent of America, seems not to have exerted its power in the more -northern and temperate climates till the year 1793. Since that time -its ravages have been too well known to require an enumeration here. -To describe the symptoms, inquire into the causes, and the means of -prevention and cure, is a work of more importance, and to this we must -now proceed. - - - - -SECTION. II. - - _Symptoms of the Yellow Fever, as described by various - authors.--Comparison between them and those of the Plague, with an - inquiry into the Causes.--History of the Distemper as it has appeared - in various parts of the United States since the year 1793.--A - discussion of the question Whether the Yellow Fever is Contagious or - not._ - - -Of all those who have attempted to give an account of this fatal -disease, none appear to have exceeded Dr. Moseley, either in his -accuracy in enumeration, or perspicuity in description, of the -symptoms. According to him the yellow fever is a species of the -_kausos_ of Hippocrates, Aretœus and Galen; that is, the _febris -ardens_ or _causus_, aggravated by climate, incidental only to the -gross, inflammatory and plethoric at any season of the year, totally -different from the remitting bilious fever to which all habits of body -are subject in hot climates, particularly after rains, and in the fall -of the year. The causus, seldom seen in the temperate climates of -Europe, never appears there with the violent symptoms which attend it -in hot climates. “Whether in the latitudes (says he) so mild as those -of Spain, Greece, Italy and the Archipelagan islands, the causus has -ever been attended with black vomiting, as in the West-Indies, I cannot -tell. Lommius mentions the vomiting of blood, and voiding black liquid -stools and black urine. Critical and symptomatical yellowness of the -skin in the causus are enumerated by Hippocrates among its symptoms, -and Lommius mentions the danger of that appearance before the seventh -day. The affinity of the symptoms, progress and termination of a causus -in Europe to those of the yellow fever in the West-Indies, excepting -the black vomiting, leaves no room to doubt that the difference of -climate constitutes all the difference that is found between them.” - -For these reasons Dr. Moseley adopts the name of _endemial causus_; -and he takes notice that many difficulties have arisen to young -practitioners, and to strangers in the West-Indies, from the various -names improperly given to it from its ultimate and not from its primary -symptoms. Some call it a _burning_ bilious fever; Warren, a _putrid_ -bilious fever; but, though they have disputed about their terms, Dr. -Moseley thinks that neither of them have proved whether bile be the -cause or the effect of the disease. To call it the black vomit or the -yellow fever, he thinks also improper, as a stranger would not know -the disease until some of these symptoms appear; both of which are -generally fatal, and neither of them constant. - -The West-India causus he says is no more putrid than the small-pox, -or any other acute disease; which may, after it has passed its -inflammatory state, change to putrefaction, and end in death with an -extraordinary dissolution of the fluids. The disease is in truth an -inflammatory one in the highest degree possible; accompanied with such -symptoms in a greater extent as attend all inflammatory fevers, and -most strikingly the reverse of any disease that is putrid, or of one -exacerbation. It obeys no season of the year, and attacks such people, -and under such circumstances, as are seldom the objects of putrid -diseases, viz. all who are of an inflammatory diathesis, and do not -perspire freely. - -This distemper attacks sailors in the West-Indies more than any other -set of men, even of new comers. For this the Dr. assigns as a reason, -that they eat, drink, and sleep, so much at sea, use no exercise, -and are always of gross habit of body. To this he adds the heat and -dampness of harbours, generally in the neighbourhood of marshes, and -their exposure to land winds at night; the labour they endure on board -vessels in port, and the carelessness and excesses frequently committed -by these people after long voyages. - -When a stranger newly arrived feels a sudden loss of strength, with -a continual desire of changing his position without finding rest in -any, we may expert a causus. If he has exposed himself to any of the -causes just mentioned, the probable consequences would be, that on the -morrow he would feel an heaviness, lassitude, oppression and loss of -appetite.[147] Next day, or perhaps within twelve hours from the first -indisposition, the violence of the disease commences with faintness, -generally giddiness of the head, with a small degree of chillness and -horror, but never any rigor. These symptoms are succeeded by a high -fever, great heat, and strong beatings of the arteries, particularly -those of the temples and carotids; flushings of the face, gasping for -cool air; tongue white tinged with yellow, after the retchings have -commenced; excessive thirst; redness, heaviness, and sensations of -burning in the eyes; heaviness and darting pains in the head, small -of the back, and often down the thighs; the pulse generally full and -strong, but sometimes quick, low, and vacillating; the skin hot and -dry, though sometimes it has a partial and momentary moisture. There is -a sickness of stomach from the beginning; retchings succeed immediately -after any liquid is swallowed, which bring up bilious matter. There -is an anxiety with stricture, soreness, and intense heat about the -præcordia; great restlessness, heavy respiration, sighing, urine deep -coloured and in small quantity. - - [147] “This (says the Doctor) is the time to extinguish the disease; - but Europeans and North Americans generally neglect it, as they are - not accustomed at home to have recourse to medicine on the first - moment of indisposition.” - -Thus the fever goes on during its first stage, which constitutes the -inflammatory period, and continues from twenty-four to sixty hours. -The second, which our author calls the _metaptosis_, is comparatively -mild, and is an intermediate state between the inflammatory and -gangrenous stages. In this there is an abatement of many of the former -symptoms, and a kind of deceitful tranquillity, accompanied, however, -with a perturbation, if the patient should happen to sleep. There now -appears a yellow tinge in the eyes, neck and breast; the heat subsides, -sometimes accompanied with chillness, but never with that kind of -rigor, which, when it happens, terminates the disease by sweat, or -by copious bilious evacuations, upwards or downwards. The retchings -increase and become porraceous: the pulse flags, but is sometimes -high, and sometimes soft; the skin moist and clammy; urine of a dark -saffron colour, and in small quantity; the tongue in some cases is -dry, hard, and discoloured, in others furred and moist; the head is -confused, sometimes with delirium, with a glossiness of the eyes. This -stage of the disease continues sometimes only for a few hours, at -others from twelve to forty-eight, seldom longer, and too frequently -the disease hurries on rapidly from the first to the third stage, which -is the gangrenous or fatal state. Now the pulse sinks, intermits, and -becomes unequal, sometimes very quick; the vomiting becomes frequent -with great straining and noise. The matter discharged is now in greater -quantity, appearing like the grounds of coffee, or of a slate colour, -and the stomach can retain nothing: the breathing is difficult, the -tongue black, the sweats cold and clammy, the eyes yellow and sunk; -there is a yellowness round the mouth and temples, and soon after -over the whole body. The deepening of the yellow colour, with an -aggravation of the other symptoms, is a forerunner of death. There is -a deep respiration, subsultus tendinum, a convulsive kind of sighing; -the urine is quite black, and sometimes totally suppressed. There is a -death-like coldness of the hands, feet and legs, while the heat still -remains about the stomach; the patient is delirious, and struggles to -get up in bed; he trembles, his speech falters; blood oozes from the -mouth and nostrils, sometimes from the corners of the eyes and ears; a -black bloody cruor is discharged both by vomit and stool: livid spots -appear on different parts of the body, particularly the præcordia; -hiccup, muttering, coma, and death, follow in quick succession. - -The affecting case of capt. Mawhood, who died on the fourth day of -the disease, at Port-Royal in Jamaica, in the year 1780, exhibits a -dreadful picture of this disease in its last stage. “When I entered -the room, (says Dr. Moseley) he was vomiting a black, bloody cruor, -and he was bleeding at the nose. A bloody ichor was oozing from -the corners of his eyes, and from his mouth and gums. His face was -besmeared with blood, and with the dullness of his eyes it presented -a most distressing contrast to his natural visage. His abdomen was -swelled and inflated most prodigiously. His body was all over of a deep -yellow, interspersed with livid spots. His hands and feet were of a -livid hue. Every part of him was cold, excepting about his heart. He -had a deep, strong hiccup, but neither delirium nor coma; and was, at -my first seeing him, as I thought, in his perfect senses. He looked -at the changed appearance of his skin, and expressed, though he could -not speak, by his sad countenance, that he knew life was soon to yield -up her citadel, now abandoning the rest of his body. Exhausted with -vomiting, he was at last suffocated with the blood he was endeavouring -to bring up, and expired.” - -The symptoms just now enumerated generally take place in those who -die from the third to the seventh day of the disease. But in this, -as in other fevers, the symptoms vary considerably according to the -constitution of the patient, and habit of the body. In some it begins -neither with chillness, faintness, nor flushings of the face. Sometimes -the pulse is much depressed and not quick; and in sultry weather, -and damp situations, where the inflammatory state has been only of -a few hours duration, the _metaptosis_ has been so rapid, that the -black vomiting and the mortified state have unexpectedly appeared, -and have ended the patient in 24, 36 or 48 hours. But our author says -that he never saw or heard of an instance of what Lind says, that the -black vomit may attack a man when newly arrived, without any previous -complaint; or of that mentioned by the same author, viz. “an uneasy -itching sensation, commonly in the legs; and upon pulling down the -stockings, streams of thin-dissolved blood followed, and a ghastly -yellow colour quickly diffused itself all over the body.” - -In some cases the disease is much more mild. There are instances where -it has been protracted to the eighth, ninth or tenth day; and others -where it has never passed from the inflammatory stage; but being -checked, though not extinguished, it has been lengthened out, and at -last converted into a remittent of great duration, most difficult of -cure, and tedious of recovery. - -According to our author, the stomach seems to bear the principal burden -of the disease, and accordingly, after death, appears to have been -principally affected. Great heat is perceived near the præcordia during -all the stages of the disease, and pain and uneasiness are complained -of when those parts are pressed with the hand. After death, livid -spots appear over the whole body, particularly about the præcordia. -On dissection, the stomach, in some part or other, is generally found -mortified, especially if the black vomiting has continued long, and the -livid spots have appeared before death. Frequently the upper part of -the duodenum is in a gangrenous state, and always bears the marks of -inflammation, lest the disease have been of ever so short a duration. - -Though both liver and gall-bladder must be very much affected in this -disease, yet Dr. Moseley is of opinion that nothing can be depended -upon from an inspection of them after death. Some symptoms there are -in common with inflammations of the liver, but none of those which -distinguish it from other diseases. It never terminates in suppuration -of the liver as the hepatitis sometimes does, though it is frequently -carried off by an enormous secretion of bile. “Dissections (says the -Doctor) have never discovered any certain and uniform appearance in the -liver of those who have died of this disease. In hot climates a sound -state of the liver is never to be expected after death, whether the -disease has been acute or chronical. Of the latter class of diseases it -is almost always either the seat, or the origin.” - -Dr. Lining, in a letter to Dr. Whytt at Edinburgh, published in the -Physical and Literary Essays, defines the disease, to be “that fever, -which continues two or three days, and terminates without any critical -discharge by sweat, urine, stool, &c. leaving the patient excessively -weak, with a small pulse, easily depressible by very little motion, or -by an erect posture; and _which_ is soon succeeded by an icteritious -(jaundice) colour in the white of the eyes and the skin; vomiting, -hæmorrhages, &c. and those without being accompanied with any degree of -a febrile pulse and heat.” - -In the four times in which he mentions it to have been epidemic at -Charleston, our author says, that none of the years (excepting 1739, -the summer and autumn of which had been remarkably rainy) were either -warmer or more rainy (and some of them less so) than the summers and -autumns were in several other years in which there was not one instance -of any one being seized with it. The subjects were whites of both -sexes, especially strangers lately arrived from cold climates, Indians, -Mistees, Mulattoes of all ages, excepting young children, and of those -only such as had formerly escaped the infection. Negroes were not -liable to it. - -Those affected with the fever, for a day or two previous to the attack -generally complained of head-ach, pain in the loins and extremities, -but principally in the knees and legs, debility and lassitude; but -some were taken ill suddenly without any warning. The symptoms were, -shivering; frequent, full, hard and strong pulse; though sometimes -small and hard, and in others soft and small; but towards the end of -the fever it became smaller, harder, and less frequent. Sometimes there -was a remarkable throbbing in the hypochondria and carotids, the former -causing in some a tremulous motion of the whole abdomen. The heat was -about 102 of Fahrenheit, and nearly equal over the whole body; some had -frequent returns of chilliness without any diminution of temperature of -the body. “In a few there happened so great a remission of the heat for -some hours, when at the same time the pulse was soft and less frequent, -and the skin moist, that one from these circumstances might reasonably -have hoped that the fever would only prove a remittent or intermittent. -About the end of the second day the heat began to abate.” Here Dr. -Moseley takes notice that when the fever abates, some, who have -mistaken the _bilious remittent_ for the _causus_, speak of remissions -which do not happen in this fever. “This circumstance of the endemial -causus (says he) I believe, has never been mentioned before.” - -Dr. Lining goes on to inform us, that the skin was rarely dry in this -disease, there being generally a propensity to sweat. “On the first day -the sweating was commonly profuse and general, on the second it was -more moderate; but on both those, there happened frequent and short -remissions of the sweatings, at which times the febrile heat increased, -and the patient became more uneasy. On the third day the disposition -to sweat was so much abated that the skin was generally dry; only the -forehead and backs of the hands continued moist.” A great despondency -and prostration of strength took place from the first attack. On the -first day they generally dozed much, but were afterwards very watchful. -On the second day the pains in the head, loins, &c. of which they had -complained before the attack, and which were sometimes very acute in -the forehead, generally went off. Many on the first day were a little -delirious, but afterwards not until the recess of the fever. - -The blood had no inflammatory crust; in warm weather it was florid -like arterial blood, and continued in one soft homogeneous like mass, -without any separation of the serum after it was cold. When there was -any separation, the crassamentum was of too loose a texture. - -This disease was not attended with any remarkable thirst; but, on the -third day, as the fever began to lessen, or rather, says the Doctor, -as the fulness of the pulse, heat and disposition to sweat, began to -abate, a nausea, vomiting, or frequent reachings to vomit, came on -especially after the exhibition of either medicines or food. A very few -had a vomiting, either bilious or phlegmatic, on the first day. The -whole febrile state was attended with an obstinate costiveness. - -These were the principal symptoms with which the febrile state was -attended, and which generally went off on the third day, or in -seventy-two hours from the first attack, without any salutary crisis, -and was soon succeeded by the second _stadium_, as our author calls it; -a state, though without a fever, much more terrible than the former. -The symptoms now were, - -1. The pulse, though hard and small, became less frequent; very little -more so than in health. Soon after it became much slower, and very -soft; this softness remaining while any pulse could be felt. In many it -gradually subsided, till it became scarce perceptible; neither could -it be supported by any of the ordinary means used for that purpose. -After this the yellow suffusion, the vomiting, delirium, restlessness, -&c. increased to a great degree. Sometimes the pulse would recover its -strength, but only for a short time. - -2. The heat did not exceed the natural, and was still farther -diminished as the pulse sunk; the skin became cold, and the face, -breast and extremities acquired something of a livid colour. There was -no great thirst, though the sick had a great inclination for strong -liquors. - -3. The vomiting or reaching to vomit increased, and in some were so -constant, that neither medicines nor aliment of any kind could be -retained. Some vomited blood, others only what was last exhibited, -mixed with phlegm, while others had what is called the _black vomit_. -But this, though its general appearance is black, appears not to be -entirely so, but owes its colour to a great number of black flakey -substances. These are by our author supposed to be the bile mixed with -the mucus of the stomach, or adhering to it. He founds his opinion upon -observations from dissection, where the mucus of the stomach was always -found abraded, and the bile in its cystis black, and sometimes very -viscid. This change in the state of the bile he has always observed -in such as died of this disease, and likewise that the blood was very -fluid, and the vessels of the viscera much distended. In one case he -found the bile of the consistence of turpentine, and carbuncles or -gangrenous specks on the stomach. - -The reaching to vomit continued a longer or shorter time, according -to the state of the pulse; an increase of fulness of the pulse being -attended with an abatement of the reaching, and the contrary. - -In this state the patients were extremely unquiet, even their sleep -being frequently attended with dejection of spirits and debility. This -last symptom was so excessive that if the patient was only raised -up in bed, or sometimes if the head was only raised from the pillow, -while a little drink was given, the pulse sunk immediately, and became -sometimes so small, that it could scarce be felt: they became cold, -the skin became clammy, the delirium increased, their lips and skin, -especially about the neck, face and extremities, as well as the nails, -acquired a livid colour. The restlessness and tossing were so great, -that it was sometimes scarce possible to keep the sick in bed, though, -even in this state, they made no particular complaint, and if asked how -they did, the reply was, _Very well_. - -A yellowness in the eyes became now very observable, and this was -soon diffused all over the body; but in some, this colour did not -appear until a little before death, when it spread surprisingly quick, -especially about the breast and neck. Along with this were a number -of small spots of a scarlet, purple or livid colour. These appeared -principally about the neck and breast. - -Some were obstinately costive, others the contrary, with large, liquid -and black stools, but others were relieved by moderate stools, even -though black. In some they resembled tar, in smoothness, tenacity, -colour and consistence. - -In this disease there was such a putrid dissolution of the blood that -hæmorrhages took place from almost all parts of the body. In women -the menstrua flowed, sometimes in great quantity, even at irregular -periods. Blood flowed also from the eyes, nose, mouth and ears, and -from those parts where blisters had been laid on. “Nay, (says our -author) in the year 1739 or 1745, there were one or two instances of an -hæmorrhage from the skin, without any apparent puncture, or any loss of -the scarf-skin.” The urine was pale while the patient was not yellow, -but a deep saffron colour when the yellowness had come on. Sometimes it -was turbid, at others bloody, and the quantity of blood was always in -proportion to the state of the pulse; diminishing as the pulse became -more full, and increasing as it became weaker. - -In the third stage, which always terminated in death, the pulse was -exceedingly small and unequal, though soft; the extremities were cold, -clammy and livid; the face and lips in some flushed, in others they -were of a livid colour; the livid specks increased so fast, that in -some the whole breast and neck appeared livid; the heart palpitated -strongly; the heat about the præcordia was greatly increased, -respiration became difficult, with frequent sighing; the patient became -anxious and extremely restless, the sweat flowed from the face, neck -and breast, blood from the mouth or nose or ears, and in some from -all together; the deglutition became difficult, hiccup and subsultus -tendinum came on, the patient picked the bed-clothes, was comatous or -constantly delirious. In this terrible state some continued eight, ten -or twelve hours before they died, even after they had been so long -speechless, and without any perceptible pulsation of the arteries and -wrists; whereas in all other acute diseases, death follows immediately -after the pulse in the wrists ceases. When the disease was very acute, -violent convulsions seized the unhappy patient, and quickly brought -this stadium to its fatal end. After death the livid blotches increased -fast, especially about the face, neck and breast, and the putrefaction -began very early, or rather increased very quickly. In hot weather, -and when the symptoms at first were very violent, there was little -difference to be observed between the stadia, the whole tragedy being -completed in less than forty-eight hours. - -On this disease in general Dr. Lining remarks, that the infection was -increased by warm, and lessened by cold, weather. In hot days the -violence of the symptoms were augmented to such a degree as sometimes -to become fatal to those who, in moderate weather, seemed to be in no -danger; while, on the other hand, in cold days, some who had been in -great danger were apparently saved from the jaws of death. The disease -was also more fatal to those who lay in small chambers without a -proper ventilation, to such as were of an athletic and full habit, to -strangers, natives of a cold climate, and to such as were most afraid -of it, as well as to those who had previously overheated themselves -by exercise in the sun, or by excessive drinking of strong liquors. It -proved also most certainly fatal to valetudinarians, or to such as had -been previously weakened by any disease. - -Dr. Lind observes that “a yellow colour of the skin is observed not -only in common agues, but likewise in other fevers; sometimes denoting, -as in contagious fevers, their malignant nature, at other times, as -in some West Indian fevers, an universal dissolution of the blood and -humours; and frequently this symptom accompanies gentle discharges of -the bile, and a diseased liver.” In speaking of the disease in the West -Indies, he mentions some fevers, which he derives from stagnated air, -“of such a malignant nature, that the people after being there a few -days are suddenly seized with violent vomitings, head-achs, deliriums, -&c. and in two or three days more the whole body putrefies, and the -dissolved mass of blood issues from every pore.... On considering -the yellow fever particularly he is of opinion that the remarkable -dissolution of the blood, together with the tendency to putrefaction in -the whole body, the black vomit, and other characteristic symptoms, are -often accidental though fatal appearances in fevers of the West Indies. -They proceed, according to him, in such as are newly arrived, sometimes -from a gross habit of body, excessive drinking of spiritous liquors, -and from being afterwards overheated in the sun; but the intense heat -and unhealthfulness of the air does much more frequently produce -all those symptoms. This fever was once supposed to have been first -carried into the West Indies by a ship from Siam: _an opinion truly -chimerical_; as similar diseases have made their appearance, not only -in the East Indies, but in some of the southern parts of Europe, during -a season when the air was intensely hot and unwholesome. This happened -in the months of September and October 1764, when excessive heat and -want of rain for some months gave rise to violent epidemic bilious -diseases, resembling those of the West Indies, in the city of Cadiz in -Spain, of which an hundred persons often died in a day. At this time -the winds blew mostly from the south, and after sunset there fell an -unusual and very heavy dew. The disease began with alternate heats and -chills, nausea, pains of the head, back, and loins, and at the pit of -the stomach, These symptoms were often followed, in less than 24 hours, -with violent reachings, and a vomiting of green and yellow bile, the -smell of which was very offensive. Some threw up an humour as black as -ink, and died soon after, in violent convulsions and in a cold sweat. -The pulse was sometimes sunk, sometimes quick, but often varying. After -the first day, the surface of the body was generally either cold, or -dry and parched. The head-ach and stupor often ended in a furious -delirium, which quickly proved fatal. The dead bodies having been -examined by order of the court of Madrid, the stomach, mesentery and -intestines were found covered with gangrenous spots. The orifice of the -stomach appeared to have been greatly affected, the spots upon it being -ulcerated. The liver and lungs were both of a putrid colour and texture. - -“The stomach contained a quantity of an atrabilious liquor, which, when -poured on the ground, produced a sensible effervescence; but, when -mixed with spirit of vitriol, a violent ebullition ensued. The dead -bodies turned so quickly putrid, that at the end of six hours their -stench was intolerable, and in some of them worms were already found -lodged in the stomach. His Majesty’s ship the Tweed being at that time -in Cadiz bay, several of her men were taken ill when on shore, but, by -being carried on board, all of them recovered. Neither did the black -vomit or any other deadly symptom of that fever make its appearance -in any of the ships. The dread of this distemper forced many people -of fashion to retire into the country, where they remained in perfect -safety.” - -Dr. Lind further remarks, that in the yellow fever it is a bad sign if -the skin is very dry and rough; “and the longer it continues in this -state, the greater is the danger, as such patients seldom recover, -though the pulse may give hopes, and the other symptoms also be -fluttering; for many have a good pulse in this fever a little before -death.” He also quotes Dr. Bruce, an eminent physician of Barbadoes, -whose account of the disease is to the same purpose. He says it may -come on at any season of the year, but that the symptoms are most -severe when there is great heat joined with moisture. The blood, even -in the beginning of the disease, is of a florid red colour, and as -it were rarefied; the crassamentum scarcely cohering; the serum of a -clay-coloured yellow. It sometimes finishes its course in 24 hours. - -The account given by Dr. Hillary corresponds also very much with that -already given. The subjects of the disease are the same with those -already mentioned. He has seen it at all seasons of the year, but it -is worst in a hot season, especially if it was preceded by moist and -warm weather. “Blood, taken even at the beginning of the disease, is -often of an exceeding florid red colour, much rarefied and thin, and -without the least appearance of fiziness; and the crassamentum, when -it has stood till it is cold, will scarce cohere, but fluctuates; the -serum is very yellow.... On the second or third day the blood is much -more dissolved, the serum more yellow, and the crassamentum loose, -scarcely cohering, but undulates like sizy water when shaken, and -sometimes has dark, blackish spots on its surface, showing a strong -gangrenescent diathesis.... In the latter stage of this fever the blood -is so attenuated and dissolved, that we frequently see it flowing not -only out of the nose and mouth, but from the eyes, and even through the -very pores of the skin; also great quantities of black, half-baked, -half-mortified blood is frequently voided, both by vomiting and -stool, with great quantities of yellow and blackish putrid bile, by -the same ways; and the urine, which was before of a high icteritious -colour, is now almost black, and is frequently mixed with a quantity -of half-dissolved blood.... Soon after death the body appears much -fuller of livid, large, blackish, mortified spots, particularly about -the præcordia and hypocondres, especially the right; which parts seem -to be, even from the first seizure, the principal seat of this terrible -disease. And upon opening the bodies of those who die of it, we -generally find the gall-bladder and biliary ducts filled with a putrid -blackish bile, and the liver and stomach, and adjoining parts, full -of blackish and mortified spots, and sometimes gangrenes, in those, -as also in several other parts of the body. And the whole corpse soon -putrefies after death, and can be kept but a few hours above ground.” - -Dr. Jackson, in describing the yellow fever of Jamaica, acknowledges -the difficulty of characterising the disease, even though he is of -opinion that it “possesses some characteristics of its own, different -from those of any other.” In a note at the end of his work, he -observes the impropriety of calling it the _yellow_ fever; because -that yellowness sometimes does not appear at all; and in no one case -does it ordinarily show itself till the latter stages. “I know also -(says he) that most of the practitioners of Jamaica consider it only -as an aggravated species of the remittent, the common endemic of hot -climates. It appeared to me, I must confess, in a different light.... -It may not, however, be improper here to take notice of the opinion of -Dr. Moseley, who has endeavoured to persuade us that it is no other -than the _kausos_, or ardent fever, of the ancients. But the yellow -fever of the West Indies is, by Dr. Moseley’s own confession, in some -measure peculiar to strangers newly arrived in tropical climates. -The _kausos_, we are informed, made its appearance in the islands -of the Archipelago, and on the coasts of the contiguous continents, -indiscriminately among men and women, natives and foreigners: in fact -it has not, as far as I can perceive, any claim to be considered -as a distinct disease. If I rightly understand Hippocrates, or the -description of the still more accurate Aretæus, _kausos_ in reality is -only an accidental condition of the common endemic of the country, -where the force of the fever is chiefly exerted upon the stomach and -alimentary canal. In this manner it appears frequently in Jamaica, and -in the southern provinces of America. In the hot months of summer, -it appears occasionally in every climate; and is not necessarily -accompanied with, nor does it depend upon, a general inflammatory -diathesis of the system for its existence.” - -The Doctor divides this disease into three species: 1. Where “signs -of putrefaction are evident at a very early stage, which is generally -rapid in its course, and which casually terminates in black vomiting. -Yellowness seldom or never fails to make its appearance in the present -instance; and perhaps it is the only one which, strictly speaking, -can be called the yellow fever. 2. A form of fever which has either -no remissions, or remissions which are scarcely perceptible; in -which signs of nervous affection are more obvious than symptoms of -putrescency; and in which yellowness and black vomiting are rare -occurrences. 3. Another form, in which regular paroxysms and remissions -cannot be traced, but in which there are marks of violent irritation, -and appearances of inflammatory diathesis in the earlier stage, -which give way, after a short continuance, to signs of debility and -putrescency, to which yellowness frequently succeeds, or even sometimes -the so much dreaded vomiting of matter of a dark colour. The disease -in these three forms appears to be in reality one and the same. The -difference of the symptoms probably arises from very trivial or very -accidental causes. It is in some measure peculiar to strangers from -colder regions soon after their arrival in the West Indies, and may -generally be distinguished from the common endemic of the country, not -only by a total want of paroxysms and remissions, but likewise by a -certain expression of the eye and countenance, with something unusually -disagreeable in the feelings, of which words convey only an imperfect -idea.” - -The symptoms enumerated by Dr. Jackson are in general the same with -those already taken notice of. He mentions likewise a degree of -confusion frequently joined with _grimness_, difficult to be described -in words, but which a person acquainted with the appearances of the -disease immediately recognises as one of its distinguishing marks. In -the second stage he says, that no sweat or moisture was now observable -on any part of the body: the state of the skin impressed the idea as if -it were not pervious to any degree of perspiration, and heat gradually -forsook the surface and extremities: the tongue became moist, and at -the same time frequently clean about the edges: the gums became redder, -more spongy, and showed a greater disposition to bleed: vomiting -was troublesome: the matter thrown up was ropy, in large quantity, -and abounding with villous or mucous flakes of a darker colour. The -circulation in the extreme vessels became gradually more languid; the -natural heat retired from the surface of the body, which was now dry -and impervious; the pulse returned nearly to its ordinary state, or -became slow, full and regular; the yellowness increased fast, so that -the whole body was frequently yellow as an orange, or of as deep a -colour as the skin of an American savage: anxiety was inexpressible; -vomiting was irrestrainable, and the vomiting of a matter like the -grounds of coffee at last made its appearance. This matter was often as -black as soot, where the progress of the disease had been rapid; while -it was not only less intensely black, but often tinged with green, -where the disease had been more slow and gradual. The number of villous -or mucous flakes, in the matter discharged by vomit, increased as the -disease advanced, and with them were joined streaks of blood, which -seemed principally to come from the throat and gums. As the disease -advanced, the vomiting became more frequent, but was seldom accompanied -with any violent retching. Quantities of liquor were discharged, so -enormous that it was often difficult to imagine whence they came; after -which the patient enjoyed some respite, till a similar collection was -made. As soon as the matter discharged by vomit acquired this dark -and sooty colour, the belly generally became loose, the stools being -black, smooth, and not unlike tar or molasses; the tongue became -clean, the gums putrid; hæmorrhages, or rather _oozings of blood_, were -sometimes observed in different parts of the body, while livid blotches -made their appearance on the belly and insides of the thighs. The -pulse, which during the latter stages of the distemper could scarcely -be distinguished from that of a person in health, became at last -irregular, quick, or intermitting; soon after which coma or convulsions -closed the scene. Sometimes the yellowness succeeded the black -vomiting. In these the vomiting began unexpectedly, or without much -previous affection of the stomach: the colour was commonly intensely -black; the patient turned yellow almost in an instant, and died in a -very short time. When any one recovered from this deplorable situation, -of which there were some few instances, the termination was not by any -regular crisis. The black vomiting ceased, sometimes apparently in -consequence of treatment, sometimes evidently of its own accord: but a -vomiting of a ropy, glutinous matter continued for a great length of -time, together with an extreme irritability of the stomach, and a very -peculiar state of the skin; which sometimes did not recover its natural -smoothness and unctuosity for several weeks. - -The disposition to faint, so common in the yellow fever, is supposed -by Dr. Jackson to arise from a kind of torpor in the nervous system, -rather than the usual causes of fainting. For this opinion he assigns -as a reason, that “the patient was often able to stand upright for -some time, and even to walk to a considerable distance; and, when at -last overcome, was observed to fall down in a torpid, rather than a -fainting, state.” - -In dissections our author observed that the omentum and all its -appendages were in a dry and parched state, and of an uncommon dark -grey colour. But, along with this dark grey colour, and want of -unctuosity and moisture, usually met with in the abdomen, the stomach -and intestines had a dirty yellow appearance, were highly putrefied, -and much distended with wind. The liver and spleen were generally -enlarged in size; the former of a deeper yellow than any of the other -abdominal viscera; while the texture of the spleen was often less -firm than natural. The bile was usually black and thick, like tar or -molasses; the blood-vessels of the liver bearing marks of uncommon -distension. A quantity of black fluid, similar to that ejected by -vomit, was found in the stomach, which fluid our author says positively -derived its blackness from the bile, the flakes observed to float in -it being parts of the villous coat of the stomach abraded. He denies -that the black colour of the matter vomited is owing to blood, as many -authors have supposed. He says that the passage of the bile might be -easily traced from the gall-duct into the pylorus. - -This being in the Doctor’s opinion the only true kind of yellow -fever, we shall not follow him through the description of the other -two species, but proceed to consider that remarkable and excessively -fatal distemper which appeared in the year 1793, first in the West -India islands, and then on the American continent. Dr. Chisholm, who -has described the distemper very particularly, derives it from the -coast of Africa, and gives the following account of its origin on the -authority of a Mr. J. Paiba, “one of the adventurers in the Boullam -scheme; and who, despairing of success, left the coast of Africa in -a vessel called the _Hankey_. This vessel sailed from England in -April 1792 with stores and adventurers for the intended colony at -Boullam. The people were all in good health: that part of the coast -of Africa on which they touched is remarkable for its healthiness; -only it is destitute of water except what can be procured by digging -temporary wells on the beach, and which is brackish, and consequently -unwholesome. The ferocity of the negroes who inhabit that part of the -continent prevented them from being accommodated on shore, so that they -found themselves obliged to remain on board the Hankey for nine months. -As the rainy season came on almost immediately after their arrival on -the African coast, they attempted to shelter themselves by raising the -sides of the vessel several feet, and covering it with a wooden roof.” -Thus were upwards of two hundred persons, among whom were many women -and children, confined in such a manner as must be supposed capable -of producing fevers of a bad kind, if they could be produced by such -causes. Accordingly a malignant fever did break out; the vessel was not -ventilated, nor were the bed-clothes, &c. of the sick destroyed; from -whence Dr. Chisholm concludes that the infection remained on board the -vessel. The Doctor then proceeds to give the following account of the -vessel after her departure from Boullam:[148] “Capt. Coxe, finding the -water at Boullam unwholesome, proceeded with his ship to Bissao, where -there is a Portuguese settlement, for a supply. The ship was navigated -by about twelve seamen, most of whom had not experienced sickness, and -had probably been procured from Sierra Leone: at any rate they were -then taken on board for the first time. Of these, before the return of -the Hankey to Boullam, nine died; and the remainder, with the captain, -were reduced to a deplorable state. The time for which the Hankey was -chartered being expired, Mr. Paiba, with his family, intended to return -to England in her; but as no seamen could be procured they put to sea, -having on board the captain, sick, and only the mate, Mr. Paiba and -two seamen to navigate the ship. With much difficulty they arrived at -St. Jago, where they fortunately found the Charon and Scorpion ships -of war. Capt. Dodd of the former, humanely rendered them every service -in his power, and on leaving them put two men of each ship on board -the Hankey. With this aid they proceeded to the West Indies; a voyage -to England being impracticable in their wretched state. On the third -day after leaving St. Jago, the men they procured from the ships of -war were seized with the fever, which had carried off three fourths -of those on board the Hankey at Boullam; and, having no assistance, -two of the four died: the remaining two were put on board here in the -most wretched state possible. Capt. Dodd, on his arrival at Barbadoes -from the coast of Africa, was ordered to convoy the homeward-bound -fleet of merchantmen. In the execution of his orders he came to Grenada -on the 27th of May, and, hearing of the mischief which the Hankey -had been the cause of, mentioned that several of the Charon’s and -Scorpion’s people were sent on board the Hankey at St. Jago, to repair -her rigging, &c. that from this circumstance, and the communication -which his barge’s crew had with that ship, the pestilence was brought -on board both ships; and that of the Charon’s crew thirty died, and of -the Scorpion’s, about fifteen. The Hankey arrived at the port of St. -George’s (in Grenada) on the 19th of February, in the most distressed -situation, and for a few days lay in the bay, but was afterwards -brought into the careenage. From this period are we to date the -commencement of a disease before, I believe, unknown in this country, -and certainly unequalled in its destructive nature.” - - [148] Chisholm’s Essay on the Malignant Pestilential Fever, p. 86. - -This account of the introduction of the fever (which however is -by Dr. Chisholm accounted very different from the yellow fever -above described) is so clear and distinct, that, at first reading, -it commands our belief. It hath not, however, met with universal -approbation; and even the _facts_, for which both parties appeal to Mr. -Paiba and capt. Dodd, vary from one another in a surprising manner. Dr. -Trotter, in his Medicina Nautica, p. 328, gives the following account: -“Dr. Chisholm tells us, that the ships of war on the African station, -having sent men to assist the Hankey, after numbers had perished from -the fever, received the infection by means of this communication, -and that in the Charon thirty died, and fifteen in the Scorpion. -Capt. Dodd, who at that time had his broad pendant in the Charon, now -commands the Atlas of 98 guns in the fleet; Mr. Smithers, the surgeon, -is at present in the Formidable, a second rate, also in the fleet; -_from them_ I have copied the following narrative of their transactions -with the Hankey: - -“When the squadron under commodore Dodd came to St. Jago in 1793, the -Hankey lay there in great distress for want of hands; having buried -above one hundred persons, men, women and children, from the time she -had been at Bulam. _The fever was now overcome_: Mr. Smithers saw two -men that had lately recovered. He left a quantity of bark. The Charon -and Scorpion sent two men each to assist in navigating her to the West -Indies. The Hankey at this port was cleaned, washed with vinegar, -and fumigated. _No fever appeared in either of the men of war_, in -consequence of this communication; they arrived at Grenada in perfect -health, but did not go into the same part of the island to which the -Hankey went. The Charon, at this harbour received some seamen from the -merchant ships then taking in cargoes for England; she had afterwards -_fourteen_ cases of yellow fever, of which one died; but it is -remarkable that the Scorpion did not bury a single man during the whole -voyage.[149] It is probable from these facts, that the Hankey _did not_ -import the infection that produced the Grenada fever; for, _after the -disease was worn out_, she had a passage to make to the West indies of -many hundred leagues. It is also doubtful how the effects left in the -Hankey could produce the fever, for the _bedding was thrown away_, and -what clothing remained had been aired, and probably had scarcely been -in contact with the body after being sick.” - - [149] To this is subjoined the attestation of Mr. Smithers with - respect to the Charon. - -The discordance between this and the foregoing account is abundantly -evident. Dr. Chisholm’s account of the bedding, &c. is also very -different. “Our lieutenant governor, Ninian Home, esq. some time after -the disease became epidemic, informed me, that, in consequence of the -information he had received of the clothes, &c. of the victims of the -fever at Boullam being still on board the Hankey, he ordered Capt. Coxe -to be brought before him and some gentlemen of the council. He then -acknowledged, that _all the effects_ of those who had died were then -on board his ship, and said that he _would not_ destroy them, unless -he was indemnified for the loss he might sustain, should the heirs of -the deceased call on him for those effects. Every argument was used to -induce him to destroy the articles, but the only one which influences -a man of this description, _indemnification_; and he of course carried -the seminium of the disease to England.” It was this consideration -which induced the governor to write to the secretary of state, and in -consequence of his representation the vessel was obliged to perform -quarantine in England, a circumstance which Dr. Trotter mentions -without approbation. - -Thus far the matter of _fact_ seems to be very much obscured; and -the more we investigate, the more we are involved in darkness. In -the Medical Repository, vol. i, p. 484, we find the following severe -censure passed upon Dr. Chisholm by the late Dr. Smith of New York: “It -belongs to another part of this paper to assign the probable motives of -Dr. Chisholm for maintaining that the fever was imported into Grenada: -certain it is that he avowed a different opinion to Mr. Paiba, to whom -he freely declared, that he could by no means trace the disease to the -_Hankey_; and that he believed it to be of local origin, owing to the -unhealthy condition of the careenage, and the particular prevailing -winds: and, to confirm this notion, he informed Mr. Paiba that a -similar disease, from the same cause, though in a less degree, had -existed in St. George’s some years before.” - -This was plainly giving Dr. Chisholm _the lie_; which, whatever -might have been the consequence between the two parties, absolutely -supersedes, to any impartial and unconcerned person, the evidence of -_both_, at least as far as regards the origin of this disease. It -is not, however, to be supposed that Dr. Chisholm would pass such a -censure unnoticed. He did accordingly reply in a letter to Dr. Smith, -who had sent him a copy of the Repository, with a letter inviting -him to defend what he had said. Dr. Smith died before this letter -reached him, but the principal part has appeared in the Medical -Repository, vol. ii, p. 285. In this Dr. Chisholm retracts what he -had said concerning the mortality on board the Charon and Scorpion -ships of war. “I have lately received (says he) from a gentleman of -the navy here, a log-book of the Charon, kept by one of her officers -during the voyage in question. In this I find, that no sickness took -place in either of these ships in consequence of this interview. A -log-book is unquestionable evidence, and I therefore admit it.” As -to the more serious part of the charge, viz. that Dr. Chisholm had -wilfully misrepresented matters, the Doctor replies, that the narrative -published by him was in general such as he had from Mr. Paiba; not -indeed in manuscript, as Dr. Smith stated his to have been, but in -conversation; and that this conversation took place expressly with -a view to elucidate the cause of the fever, which he (Dr. Chisholm) -could not account for by any reasoning from local causes, but heard it -very generally ascribed to infection from the Hankey. Mr. Paiba was -introduced to Dr. Chisholm at the request of the latter by the Hon. -Samuel Mitchill _now_ (the letter is dated Sept. 6th 1768 probably -1798) the senior member of the council of Grenada. “Mr. Mitchill (says -the Doctor) brought Mr. Paiba to my house, and was present during the -greatest part of the time the conversation continued. I found Mr. Paiba -very willing to give me every information in his power relative to the -state of the Bulama or Boulam colony, and of the ship Hankey; but I -found him strongly disinclined to fall in with the universally received -opinion, that that ship introduced the disease. The particulars I have -given, are those Mr. Paiba related to me in this conversation; and, in -order to be correct, I immediately, after Mr. Paiba left me, committed -them to paper. Mr. Paiba promised to favour me with a written account; -and in order to direct that gentleman’s attention to the points I -considered as of most importance, I drew up a set of queries, and Mr. -Mitchill charged himself with the delivery of it. A copy of these I -have now in my possession, and a slight attention will exhibit my -view in framing them, and show the doubts respecting the nature of -the epidemic which suggested them. Although I repeatedly, through Mr. -Mitchill and Mr. Palmer, the gentlemen with whom Mr. Paiba resided -in the country, renewed my request to have this promise fulfilled, -Mr. Paiba left the Island without gratifying it. If no other strong -proof existed of something peculiar in the fever which at that time -prevailed, the circumstance of my formally applying to Mr. Paiba for -information relative to the state of the Hankey, and of taking the -trouble to obtain an interview with him, presents an evidence as -conclusive as can well be required by reasonable men. But the belief -of the infection of the Hankey was _universal_, nor was it by any -means confined to those whose interest might have been affected by the -prosperity of an infant colony on the coast of Africa.” - -Another charge against Dr. Chisholm is, that he falsifies the date -of the Hankey’s arrival at Grenada; and which in Dr. Smith’s paper -is brought forward in the following words: “In p. 91 the Doctor -remarks, that, ‘in the short space of time from the beginning of March -to the end of May, 200 of about 500 sailors, who manned the ships -in the regular trade, died of this fever.’ By this it appears that -the fever in question broke out as early as the beginning of March. -The disingenuousness of this author is particularly evident from -this quotation, if the period of the commencement of the disease be -correctly assigned: and that it is so is probable from the difficulty -of concealing the fact; as there must have been thousands of witnesses -to the progress of the fever. When therefore it was thought proper to -fix the odium of introducing the disease upon the Hankey (a project -of which Dr. Chisholm seems originally to have had no idea) it became -necessary for him to fix an earlier date to her arrival. Now, that the -Hankey did not arrive till towards the latter end of March, is verified -by the concurring testimony of Mr. and Mrs. Paiba, and of Mr. Bell, of -this city (New York) who happened to be in Grenada about that time, -and was personally acquainted with Mr. and Mrs. Paiba in that island.” - -In answer to this Dr. Chisholm repeats his declaration that the Hankey -arrived at Grenada on the 18th of _February_, and not on the 19th -of March, as Dr. Smith (supposed on the authority of Mr. Paiba) had -stated. In proof of this he produces an incontestible evidence, viz. -an extract from the St. George’s Gazette in Grenada, of date 19th of -February, which begins thus: “By the ship Hankey of London, arrived -here _yesterday_ from the island of Boulam on the coast of Africa, we -are informed,” &c. The remainder of the extract contains an account of -the excessive mortality on board the ships; which, as it may perhaps be -exaggerated, it is needless to transcribe. - -The next thing of consequence is the destruction of the bed-clothes -and effects of the deceased; of which Dr. Smith says, “Before the -Hankey put to sea, all the bedding of the sick was thrown overboard -or destroyed; the ship was washed from stem to stern, both above -and below, with salt water; and the purification was completed by -fumigating her with tar, pitch and gun-powder. In this clean condition -they bade farewel to Bulama on the 22d of November, 1792; but, in -attempting to pass through the channel near to the entrance into the -open sea, in a dark and foggy night, they got aground on a sand-bank, -upon the north side of the island of Formosa or Warang, belonging to -the Bijugas, who are represented as cannibals. The extreme terror -excited by this accident was not calculated to improve the health of -the people on board the Hankey; so that, when it became necessary to -take measures for their security and deliverance, only four men were -found in a condition to do duty, and all of these had intermittents. -With them, however, and his lady, Mr. Paiba set off, in an open boat, -for Bissao, to obtain assistance from the Portuguese settlement. -Thither he arrived, rowing through rains and fogs, in a leaky boat, -after being out two nights and a day; and having obtained such help -as he could, returned to the Hankey, got her off, and carried her to -Bissao. On the passage there _eight_ persons died who belonged to -this ship. At Bissao they refitted, and the Hankey _was a second time -purified as completely as she had been before leaving Bulama_.” - -In answer to all this Dr. Chisholm _again declares_, “that the bedding -and effects of the deceased _were preserved_ on board the Hankey, and -constituted the seminium of the infection. Capt. William Liddle, of the -ship General Mathew, saw them on board; and it was in consequence of -that gentleman’s representation that the lieutenant governor, Mr. Home, -entered into a strict investigation of the matter; the general result -of which I have given; and the authenticity of it may be depended on. -Capt. Liddle is now resident in London, and Mr. Byles, the governor’s -secretary, is now resident commissary at Grenada; and these gentlemen -will readily testify to the truth of my statement. The destructive -articles I have mentioned _were not thrown overboard_ till the Hankey -arrived in Grenville Bay, when they were destroyed at the request of -Mr. Prendfoot, the gentleman who chartered the ship for England.” - -Dr. Chisholm is likewise charged with having mis-stated the case of -a Capt. Remington, said to be the first who suffered by the fever in -Grenada. The words in Dr. Chisholm’s Essay are, “A Capt. Remington, an -intimate acquaintance of Capt. Coxe’s, was the first person who visited -the Hankey after her arrival in St. George’s bay. This person went on -board of her in the evening after she anchored, and remained three -days; at the end of which time he left St. George’s, and proceeded in -a drogher (a coasting vessel) to Grenville bay, where his ship, the -Adventure lay. He was seized with the malignant pestilential fever on -the passage; and the violence of the symptoms increased so rapidly, as, -on the third day, to put an end to his existence.” In opposition to -this Dr. Smith gives the following statement from Mr. Paiba: “He (Capt. -Remington) had been all day and all night coming from Grenville bay, -and had been wet through. He slept on board in his clothes; and went in -an open boat _the next day_ back to his ship: enough to kill any one -in that climate.” Dr. Chisholm replies “that the above statement is -not correct, nor founded on fact; Dr. Chisholm’s evidence for what he -said was founded on the information of captains of vessels, who knew -all the circumstances of his visit to the Hankey; and of Dr. Stewart, -an eminent practitioner, who attended him at Grenville bay, when he -landed there. Lastly, that the idea of his having returned to Grenville -bay in an open boat, is absurd; nothing of the kind having been ever -attempted.” - -From this tedious account it is plain that the evidence relative to -the importation of the fever into Grenada by the Hankey is quite -contradictory, and subversive of itself, because we are unable to judge -between the two disputants. A further consideration of it would lead -us entirely from the subject of this treatise, into an endless dispute -about which of the two parties had spoken the truth. Setting aside -therefore _the whole_ of the evidence on both sides as insufficient, we -shall now proceed to give an account of the symptoms of the distemper -as described by Dr. Chisholm, and to which description there has never -been any objection made. - -In the most violent kind of this fever, according to our author, “the -patient, without any previous complaint, suddenly becomes giddy; -he loses his eye-sight; every thing seems to move round him with -inconceivable velocity; he falls down almost insensible, and in that -state remains near half an hour, or upwards. During this paroxysm the -body feels cold, and is over-spread with cold sweat, which issues from -every pore in astonishing abundance. On his recovery the cold goes -off, and is instantly succeeded by intense heat, and quick, small, -hard pulse; the head achs dreadfully, particularly the fore part; -generally accompanied with pain in the right side and at the præcordia. -The last, however, has never been acute, and may rather be called -oppression than pain. The eyes are much inflamed, watery, protruded, -and wildly rolling; the face much flushed; much heat is felt at the -pit of the stomach, and that organ seems to be considerably affected -by the frequent retching and vomiting which then come on. The patient -soon after complains of intolerable pains in the small of his back and -in the calves of his legs; but the latter appears to be most violent. -During twelve, eighteen, twenty-four or thirty-six hours, these -symptoms continue increasing, except the quickness and hardness of the -pulse, which does not change materially during that time; and are then -succeeded by general coldness, cold sweat, a greater or less degree -of coma and delirium, or a state very much resembling intoxication. -Life in this state is lengthened out to sixty or ninety hours from -the first attack. A short interval of reason then takes place; the -patient considers himself better, and is, for a moment, flattered with -the prospect of recovery: but a fit as sudden and unexpected as the -first comes on, during which he foams at the mouth, rolls his eyes -dreadfully, and throws out and pulls back his extremities in quick -succession. In general the patient expires in this fit; but some have -recovered from it, and continued rational for a few hours longer, when -a second fit has carried them off.” - -This, without much deviation, was the general progress of the worst -kind of the fever. In some, however, a comatose disposition showed -itself from the very first; in others the disease began with short -convulsive fits in frequent succession, followed by constant delirium -and cold clammy sweat, without any intervening heat. In a few cases the -first symptoms were coldness and shivering, as in other fevers. - -The distinguishing symptoms were the uncommonly sudden attack, the -remarkably acute pain in the loins and calves of the legs, the watery, -inflamed and rolling eye, flushing of the face, tendency to coma, the -pain generally confined to the forehead, and the peculiar cast of the -delirium, during which the looks and actions of the patient very much -resembled those of a person intoxicated. It was never furious in any -other way than by making efforts to get out of bed; and these in a few -instances rose so high that the patients got up, dressed themselves, -and walked out a considerable way before they could be overpowered. -“The strength during the delirium is to appearance surprisingly great, -for it is frequently necessary to use the united efforts of two or -three men to keep the patient in bed. This is, however, no more than a -spasmodic affection of the muscles; for in reality the powers of the -sick in this disease are reduced to the extreme of debility, as is seen -in the convalescent state.” - -The most unequivocal characteristic of this disease, however, according -to our author, is the appearance of a kind of petechiæ, but which look -rather like red or livid patches than what is commonly understood by -that word. They were _always_ the forerunners of death. In a few very -violent cases the body was almost of a livid or black colour, but they -were generally seated on the neck, shoulders and breast. _Vibices_ -also, like those in the plague, described p. 258, sometimes made their -appearance, and were also a fatal presage. - -Hæmorrhage occurred much more frequent and profuse in this than in any -other acute distemper our author had met with. “In several instances, -the immensity of blood discharged has evidently been the more immediate -cause of death. The robust, plethoric and gross habits have been the -most subject to it. It has taken place from the nostrils, mouth, anus, -and urethra; sometimes from the canthi (corners) of the eyes; but -never, I believe, from the ears or pores of the skin. The most profuse -discharge has been from the nostrils and anus, and has frequently, -amounted to three or four pounds at a time; the stools having been on -those occasions entirely composed of pure blood. Towards the close of -life, the blood thus discharged has appeared granulous, or like ichor, -with a sediment of a black gritty substance, and has been so extremely -offensive as to oblige all the attendants to keep at a considerable -distance till the hæmorrhage ceased. Hæmorrhage, however, has never -been critical, nor has it in any instance permanently relieved the -head-ach or pain in the breast or side.... Nearly about the period that -these profuse discharges came on, a rawness was felt on the whole of -the interior surface of the nose, and on several parts of it little -ulcers formed; on others, small eschars, which were remarkably itchy, -but on being touched, or an attempt made to detach them from the -membrane of the nose, were very painful, and bled. These disappeared -in proportion to the patient’s recovery; and I have reason to suspect, -that, when the issue of the disease was fatal, these little eschars -became gangrenous.” - -In this distemper there was always a tendency to coma after the first -two days; and after the third, it certainly came on. On examining -the heads of two who died convulsed after having been comatose for -some time, a great quantity of serum was found in the brain; and, on -narrowly inspecting the eyes of those who were afterwards seized with -coma, the pupil was found manifestly dilated. - -A remarkable symptom unnoticed in any other fever is taken notice of -by our author; viz. an affection of the testicles. “About the end of -the second day the patient began to complain of a violent pain in these -parts, accompanied with a contraction of the spermatic cord, and a -drawing up of the testicles towards the abdominal ring. On examination -they appear very much lessened in size, are drawn up considerably -towards the abdomen, and the scrotum appears at the same time -remarkably flaccid and empty. The surface of the scrotum becomes soon -after very painful, and an excoriation takes place, chiefly at the most -descending part, from which a considerable quantity of very offensive -purulent matter issues: at the same time a similar discharge from the -urethra takes place, which ceases with the disease when the event is -favourable, or becomes ichorous and bloody, and insufferably fœtid -when death is the consequence. In cases which terminate favourably, -the whole of the scrotum, in a few days, is covered with a crust of -hardened pus, which in the convalescent state, comes away very easily -by means of a warm bath. The thickness of this coat may be about the -fourth of a line; and, when separated, it much resembles moistened -parchment. In fatal cases, this affection of the scrotum always -terminates in gangrene a few hours before death.” - -Another remarkable symptom is the change of voice to a shrill, soft -and low sound when compared with the natural tone, at the same time -that the syllables are more distinguished, and the words are strangely -lengthened out in a drawling and whining manner. This change of voice -affords a pretty certain prognostic; every alteration towards the -natural tone being an almost certain sign of a favourable change, and -the contrary if the voice becomes farther removed from it. - -The pains felt in this fever were in a great measure peculiar to it, -and seem to have been of a spasmodic nature. In the head the pain shot -from the forehead, to which it was confined, invariably towards the -bottom of the orbits, where it was generally exquisite. Sometimes it -extended to the temples, where there was always a throbbing; but in -no case did it extend to the back part, or over the whole head. This -pain extended also to the balls of the eyes, which were protruded, -and seemed ready to start from their orbits, with an inflammation -externally, and a sensation of pain internally, rendering the admission -of light intolerable. In the legs the pain had its seat at the top of -the great tendon, immediately below the calf, and in the point where it -was seated a gnawing sensation was felt, occasioning exquisite torture, -with an involuntary contraction of the limb; so that, on the whole, our -author concludes that this pain much resembles the cramp, differing -only in being more permanent. - -With regard to the pulse, our author observes, that in this disease “it -never intermits. Even at the approach of death it has not intermitted, -but has generally been remarkably tremulous, and so slow as to beat no -more than thirty times in a minute. On the whole, it has not been found -quicker than 130, or slower than 30, in a minute.” In violent cases the -pulse was hard, quick and small, but sometimes full; and when it was -so it was a good sign. It was however subject to excessive variations; -and it frequently happened, “especially in the robust, that, after the -first stage, flushing and chillness have often alternated in less than -a minute; and that, although the skin felt considerably warm, the pulse -has been no more than 52; but that, even when the low state came on, -in which there was always a disagreeable coldness of the surface, it -has been as quick, and nearly as full, as during the preceding febrile -stage, although unaccompanied with thirst, or any other evident symptom -of the existence of fever.” - -In the state of delirium, Dr. Chisholm observes, that, whatever was -the subject of the patient’s raving thoughts, he was always strongly -under the impression of fear; and a word from the physician always -reduced him to implicit obedience, however restless he might have been -before. During this state he complained of no pain, even from blisters, -nor was he sensible of the operation of laxative medicines. On being -asked about his situation, he always answered that he was very well, -and sensible of no pain, as in the yellow fever already described. It -is observable, however, that the yellow colour, so remarkable in the -former, seldom took place in the Boulam fever; but indeed this symptom, -as has formerly been noticed, is by no means a characteristic either of -the one disease or the other; but Dr. Chisholm observes “that in some -protracted cases on shore, and in some among the sailors, which might -have been a combination of the pestilential and yellow fevers, this -symptom appeared about the 5th, 7th or 9th day.” - -Besides the petechiæ and vibices, already mentioned, Dr. Chisholm takes -notice of two other sorts of eruptions, which appeared about the lips: -the one was such as frequently appears at the termination of the common -remittents, and was favourable; the other resembling spots made by the -fine black pencil of a painter, all round the mouth, but especially the -upper lip, and certainly affording a fatal prognostic. - -This disease was attended with a suppression of urine, a violent pain -above the os pubis, a scalding in the urethra, a sense of fulness, -without any visible swelling, a contraction and distortion of the -penis; the urine generally of a deep red, sometimes brownish, green, -very often bloody, and in a few cases much inclining to black, and of -an oily consistence. Its smell was generally very offensive. All the -excretions were exceedingly offensive, but the fæces most remarkably -so towards the latter end of the disease; for in the beginning they -had no remarkable fœtor. The sick were almost universally costive, -which our author supposes to have arisen from a suspension of tone -in the intestinal canal; for by exciting action in the fibres a -large evacuation generally ensued. The colour of the fæces varied -from yellow, or a yellowish white, to black; and from a considerable -degree of thickness, to the exact appearance of coffee-grounds. The -matter discharged by vomit also varied from porraceous to black, and -resembling coffee badly boiled. - -In this disease, as in the plague described by Thucydides, most other -diseases degenerated into it, or partook of its nature. Dysenteries -suddenly stopped, and were immediately succeeded by the symptoms -of pestilential fever. A remarkable instance of this is given in -twenty-seven recruits, who had been seized with dysentery, in -consequence of being exposed to rain, receiving the infection in the -hospital to which they were carried. The medicines exhibited with -a view to cure the dysentery seemed to be attended with surprising -effect; but in a short time symptoms of pestilential fever came -on, even in a few hours after those of dysentery had disappeared. -In like manner catarrhal complaints soon changed their nature. -Convalescents from other diseases, such as laboured under chronical -complaints, particularly rheumatism and inflammation of the liver, were -particularly subject to it. “The puerperal fever became malignant, -and of course fatal; and even among pregnant negro women, who might -otherwise have had it in the usual mild degree peculiar to that -description of people, many were reduced to a very dangerous situation -by it. In short, every disease in which the patient was liable to -infection, sooner or later assumed the appearance, and acquired the -danger, of the pestilential fever.” - -This fever was said to be propagated from Grenada to others of the -West India islands, and to the United States, where in the same year, -1793, it raged with great violence in Philadelphia. Without entering -into any inquiry at present concerning the truth of this report, or -the origin of the fever itself, let us see whether from the symptoms -enumerated by Dr. Rush, who hath written a very lengthy dissertation -upon the disease, it was the same with the Boulam fever already -described. According to him the fever in 1793 was frequently preceded -by “costiveness, a dull pain in the right side, defect of appetite, -flatulence, perverted taste, heat in the stomach, giddiness or pain -in the head, a dull, watery, brilliant, yellow or red eye, dim and -imperfect vision, hoarseness, or slight sore throat, low spirits, or -unusual vivacity, a moisture on the hands, a disposition to sweat at -nights, or after moderate exercise, or a sudden suppression of night -sweats.... On entering a sick room the physician was first struck by -the _countenance_ of the patient. It was as much unlike that which is -exhibited in the common bilious fever, as the face of a wild animal -is unlike that of a domestic one. The eyes were sad, watery, and so -inflamed in some cases as to resemble two balls of fire. Sometimes they -had a most brilliant or ferocious appearance. The face was suffused -with blood, or of a dusky colour, and the whole countenance was dusky -and clouded. After the 10th of September, when the determination -of blood to the brain became universal, there was a preternatural -dilation of the pupil. Sighing attended in almost every case. The -skin was dry, and frequently of its natural temperature.... The pulse -at the beginning of the attack was sometimes full, tense and quick, -but frequently weak; sometimes so low that it could not be perceived -without pressing the wrists; and sometimes it had no preternatural -quickness. In many it intermitted after the fourth or fifth, and -sometimes after the fourteenth stroke. In some it was extremely slow; -even as low as thirty strokes in a minute. The pulse was also _tense_ -and _chorded_. The slow intermitting pulse was observed more frequently -in children than adults, and supposed to proceed from a collection of -water in the brain. Impressed with this idea, I requested Mr. Coxe, one -of my pupils, to assist me in examining the state of the eye. For two -days we discovered no change in it; but on the third day after we began -to inspect the eyes, we both perceived a preternatural dilatation of -the pupils in different patients; and we seldom afterwards saw an eye -in which it was wanting. In Dr. Say it was attended with squinting, a -symptom which marks a high degree of a morbid affection of the brain. -Had this slowness or intermission of the pulse occurred only after -signs of inflammation or congestion had appeared in the brain, I should -have supposed that it had been derived wholly from that cause; but I -well recollect having felt it several days before I could discover -the least change in the pupil of the eye. I am forced therefore to -call in the operation of another cause, to assist in accounting for -this state of the pulse, and this I take to be a spasmodic affection, -accompanied with preternatural dilatation or contraction of the heart. -Lieutaud mentions this species of pulse in several places, as occurring -with an undue enlargement of this muscle. Dr. Ferriar describes a -case, in which a low, irregular, intermitting and hardly perceptible -pulse attended a morbid dilatation of the heart.... After the 10th of -September this undescribable or _sulky_ pulse became less observable, -and, in proportion as the weather cooled, it disappeared. It was -gradually succeeded by a pulse full, tense, quick, and as frequent -as in pleurisy or rheumatism. It differed, however, from a pleuritic -or rheumatic pulse, in imparting a very different sensation to the -fingers. No two strokes seemed to be exactly alike. Its action was of -a hobbling nature.... It was an alarming symptom.... The pulse most -frequently lessened in its fulness, and became gradually weak, frequent -and imperceptible before death; but I met with several cases in which -it was full, active, and even tense, in the last hours of life. - -“Hæmorrhages occurred in the beginning of the disorder, chiefly from -the nose and uterus. Sometimes only a few drops of blood distilled -from the nose. As the disease advanced, the discharges of blood became -universal. They occurred from the gums, ears, stomach, bowels, and -urinary passages. Drops of blood issued from the inner canthus of the -left eye of Mr. Josiah Coates. Dr. Woodhouse attended a lady who bled -from the holes of her ears which had been made for ear-rings. Many -bled from the orifices which had been made in performing venesection, -several days after they appeared to have been healed; and some from -wounds in veins made in unsuccessful attempts to draw blood. These last -were very troublesome, and in some cases precipitated death.... - -“I was surprised to find so few marks of hepatic affection. I met with -but two cases in which the patient could lie only on the right side. -Many complained of a dull pain in the region of the liver, but very few -complained of that soreness to the touch, about the pit of the stomach, -which is taken notice of by authors, and which was universal in the -yellow fever of 1762. In proportion as the cool weather advanced, a -preternatural determination of the blood took place to the brain and -lungs. Many were affected with pneumonic symptoms, and some appeared -to die of sudden effusions of blood or serum in the lungs.... The -disease seldom appeared without nausea or vomiting. In some cases -they both occured for several days, or a week, before any fever took -place. This was more frequently the case where the disease _was taken -by exhalation from the putrid coffee, than by contagion_. The stomach -was so extremely irritable as to reject drinks of every kind. Sometimes -green or yellow bile was rejected on the first day of the disorder; but -I much oftener saw it continue for two days without discharging any -thing from the stomach, but the drinks which the patient had taken. -If the fever in any case came on without vomiting, or if it had been -checked by remedies that were ineffectual to remove it altogether, it -generally appeared or returned on the 4th or 5th day of the disorder. -I dreaded this symptom on those days; for, though it was not always -the forerunner of death, yet it generally rendered the recovery more -difficult and tedious. In some cases the vomiting was more or less -constant from the beginning to the end of the disorder, whether it -terminated in life or death. The vomiting which came on about the 4th -or 5th day was accompanied with a burning pain in the region of the -stomach. It produced great anxiety and tossing of the body from one -part of the bed to another. In some cases this painful burning occured -before any vomiting took place. Drinks were now rejected so suddenly -as often to be discharged over the hand that lifted them to the head -of the patient. The contents of the stomach were sometimes thrown up -with a convulsive motion which propelled them in a stream to a great -distance, and in some cases all over the clothes of the by-standers.... -On the first and second days many puked from half a pint to nearly a -quart of yellow or green bile. In four (three of whom recovered) the -bile, even at this time, was black. On the 4th or 5th day a matter -resembling coffee-grounds was discharged.... Many recovered in whom -this symptom appeared. Towards the close of the disease there was -a discharge of a deep or pale-coloured black matter, with flakey -substances frequently swimming on the top of it.” - -A quantity of grumous blood, dark coloured on the outside, was -frequently discharged by vomit towards the end of the disease; and, -along with all the discharges from the stomach, there was occasionally -a large worm, and frequently large quantities of mucus and tough -phlegm. Our author supposes the black blood and coffee-coloured matter -to be different from that which constitutes the true _black vomit_. -This last he supposes to arise in some cases from matter formed in -consequence of a mortification of the stomach. - -The bowels were generally costive, sometimes with extreme pain, -tenesmus, and mucous and bloody discharges. Sometimes the disease came -on with diarrhœa, principally in those who had weak bowels. Sometimes -there was a tension of the abdomen, with pain in the lower part of -it. Flatulency, chiefly in the stomach, was almost universal in the -disorder throughout all its stages. - -The colour and consistence of the fæces was various according to -the mode of treatment the patient had undergone. Where they were -spontaneous, or brought away only by gentle purgatives, their -appearance was natural; but when the patient was strongly purged, -they were dark-coloured, fœtid, and in large quantity. The colour was -sometimes green, sometimes olive. Their fœtor was proportioned to the -time they had been detained in the bowels. In one case, where tonics -had been used, and the patient had no stool for several days, a purge -produced such an excessively fœtid discharge, that the smell produced -fainting in an old woman who attended. Their acrimony was so great that -the rectum was excoriated, and an extensive inflammation sometimes -produced round its extremity. In some cases the stools were as white as -in the jaundice. Large round worms were frequently discharged with them. - -The urine in this disease was sometimes plentiful and high-coloured, -sometimes clear, and sometimes turbid; sometimes discharged with a -burning pain, as in a gonorrhœa; sometimes it was suppressed; and in -one case the patient voided several quarts of limpid urine just before -he died. - -Many were relieved on the first day by sweats, sometimes spontaneous, -and sometimes produced by diluting drinks, or strong purges; sometimes -of a yellow colour, and offensive smell. Sometimes they were cold, -though the pulse was full at the same time. In general, however, -the skin was dry, and there were but few instances of the disease -terminating by sweat after the third day. In some there was a great -discharge of mucus from the throat, occasioning an almost constant -hawking and spitting; and those always recovered. - -In this fever, as in that of Boullam, and in the true plague, people -sometimes fell down suddenly in apoplexy, syncope or universal -convulsions. Some had numbness and immobility of their limbs. Some had -a coma (a continual sleepiness) or an obstinate wakefulness; the latter -chiefly attended a state of convalescence. In some the distemper began -with a violent cramp in the legs or arms. The last stage was attended -with a strong hiccup, which was a very dangerous symptom, as indeed it -is in all fevers. In some cases there was a deficiency of sensibility, -in others too much, so that the mere motion of the limbs was attended -with pain. - -In this, as in the Boullam fever, the patient often manifested a -considerable degree of strength, even without any delirium. One of Dr. -Rush’s patients stood up before a looking-glass, and shaved himself, -the day on which he died. A delirium, however, was common, alternating -in some cases with the _exacerbations and remissions_ of the fever, but -in some continuing without intermission to a few hours before death. -Some had maniacal symptoms, without any appearance of fever; but in -many the understanding was not impaired throughout the whole course of -the disease. - -In this disease the pains in almost every part of the body were very -distressing. In those cases, however, “where the system sunk under the -violent impression of the contagion, there was little or no pain.” In -other cases the patients were distressed with pains in their head, -particularly affecting the eyeballs. Sometimes it extended from the -back down the neck. A pain was felt in the ears, as if they were drawn -together by strings. The sides, stomach, liver and bowels were all -affected. A burning pain in the stomach was sometimes so excessive -that the patient shrieked out violently. The back was often the seat -of violent pain, which sometimes extended from the back to the thighs; -and the arms and legs were sometimes affected in such a manner that one -patient said his limbs felt as if scraped with a sharp instrument. - -The thirst was generally moderate, but sometimes otherwise; and, when -excessive thirst came on in the last stage of the disorder, it was -a dangerous symptom. Water was preferred to all other drinks. The -appetite for food returned much sooner in this than in other fevers, -and was excessively keen. Coffee was relished in the remissions, in -every stage of the disorder. Wine was disliked, but malt-liquors -were agreeable. In some cases the recovery was attended with a great -propensity to venery, as in the true plague, but in an inferior degree. - -In some cases the disease was attended with buboes and glandular -swellings. “I met with three cases (says our author) of swellings in -the inguinal, two in the parotid, and one in the cervical glands: -all these patients recovered without any suppuration of their -swellings. They were extremely painful in one case, in which no -redness or inflammation appeared. In the others there was considerable -inflammation, and but little pain. - -“Several cases of carbuncles, such as occur in the plague, came under -my notice. They were large, hard swellings on the limbs, with a black -apex, which, upon being opened, discharged a thin, dark-coloured, -bloody matter. From one of these malignant sores an hæmorrhage took -place, which precipitated the death of an amiable lady. A large and -painful anthrax on the back succeeded a favourable issue of the fever -in another patient. I met with a woman who showed me the marks of a -number of small boils on her face and neck, which accompanied her -fever.... Notwithstanding the disposition to cutaneous eruptions in -this disorder, it was remarkable that blisters were much less disposed -to mortify than in the common nervous fever. Such was the insensibility -of the skin in some people, that blisters made no impression upon -it.... In every case of this disorder which came under my notice, -there were evident remissions or intermissions of the fever, or such -symptoms as were substituted for fever.” - -The yellow colour rarely appeared before the third day, and generally -about the fifth or seventh day. The eyes were not always affected with -this colour. Sometimes it appeared first on the neck and breast; and -in one case it appeared behind the ears and on the crown of the head, -which had been bald for some years. It varied in the deepness of the -tint, and sometimes disappeared altogether; but, though some cases of -great malignity and danger appeared without any yellowness, it was -always a dangerous symptom when it appeared early. The cause of this -yellowness is by our author supposed to be an absorption and mixture of -the bile with the blood. - -After death the body appeared of a deep yellow colour, sometimes a -few minutes after death; sometimes it was purple or black; and in one -case yellow above, and black below, the middle. In some it was pale, -as in common diseases, and many died with a placid countenance as in -natural sleep. In some the body grew cold soon after death, in others -not till six hours afterwards, and in like manner stiffness occurred -sometimes in one hour, in others not till six. Where evacuations had -been procured, symptoms of putrescence were longer in making their -appearance than in those who had used no medicines for that purpose. -Many discharged large quantities of black matter from the bowels, -others, of blood from the nose, mouth and bowels. - -“The morbid appearances of the internal parts of the body (says the -Doctor) as they appear by dissection after death, from the yellow -fever, are different in different countries and in different years.” -Dr. Mitchill, in his history of the yellow fever in Virginia, in -1737 and 1741, informs us, that, in a female slave of forty, the -gall-bladder was outwardly of a deep yellow, but within, full of a -black, ropy, coagulated _atrabilis_ (black bile) obstructing the -biliary ducts. It was so thick, that it retained its figure when the -gall-bladder was opened. It more resembled bruised and mortified -blood than bile, though it would stain a knife or probe of a yellow -colour. Two thirds of the liver on its concave surface were of a deep -black colour, and round the gall-bladder it seemed to be mortified -and corrupted. A viscid bile, like that just described, was found in -the duodenum near the gall-bladder. The villous coat being taken off, -the other parts were found red and inflamed. The whole was lined with -a thick fur or slime. The omentum was so much wasted, that nothing -but its blood-vessels could be perceived. The stomach appeared to be -distended or swelled, lined like the duodenum, containing a quantity -of bile even blacker than that in the bladder. It was inflamed both on -the outside and inside. The lungs were inflated and all full of black -or livid spots; and on these spots were small blisters like those of an -erysipelas or gangrene, containing a yellow humour. The blood-vessels -in general were empty; only the vena portarum seemed full and distended -as usual. On cutting the sound part of the liver, the lungs or the -spleen, blood issued freely. - -Dr. Mackittrick found the liver sphacelated, the gall-bladder full of -black bile, and the veins tinged with a black _fluid_ blood. In all -cases the stomach, duodenum and ilium were remarkably inflamed. The -pericardium contained a viscid yellow serum, and in larger quantity -than usual. The urinary bladder a little inflamed; the lungs sound. - -Dr. Hume, of Jamaica, found the liver enlarged and turgid with bile, -and of a pale yellow colour; the stomach and duodenum sometimes -inflamed; and, in one case, the former had black spots of the size of a -crown-piece. He had seen some bodies in which there was no appearance -of inflammation of the stomach, though the patients had been afflicted -with excessive vomiting. - -Dr. Lind’s account is given on p. 394. - -Drs. Physic and Carthrall, of Philadelphia, found the brain in a -natural state; the viscera of the thorax perfectly sound; the blood in -the heart and veins fluid, similar in its consistence to the blood of -persons who have been hanged, or destroyed by electricity. “The stomach -and beginning of the duodenum are the parts that are most diseased. -In two persons, who died of the disease on the 5th day, the villous -membrane of the stomach, especially about its smaller end, was found -highly inflamed; and this inflammation extended through the pylorus -into the duodenum some way. The inflammation here was extremely similar -to that induced in the stomach by acrid poisons, as by arsenic, which -we have once had an opportunity of seeing in a person destroyed by it. -The bile was of its natural colour, but very viscid.” - -In others the stomach was spotted with extravasated blood; and it -contained, as well as the intestines, a black liquor like that which -had been vomited and purged before death. The gentlemen were of opinion -that this must have been a secretion from the liver, as a fluid of the -same kind was found in the gall-bladder, of such an acrid nature that -it inflamed the operator’s hands, and the inflammation lasted some -days. The liver was of its natural appearance, or nearly so. These -dissections were made early in the season; and at that time Dr. Rush -is of opinion that the disease was not attended with any congestion in -the brain, though it was so afterwards; and accordingly we are informed -that Dr. Annan attended a dissection at Bush-hill, in which the vessels -of the brain were remarkably turgid. Dr. Rush, however, is likewise -of opinion, that the morbid appearances in the brain may cease after -death, as well as the suffusion of blood in the face disappears after -the retreat of the blood from the extremities of the vessels in the -last moments of life. “It is no new thing for morbid affections of the -brain to leave either slender or no marks of disease after death. Dr. -Quin has given a dissection of a child that died with all the symptoms -of hydrocephalus internus, and yet nothing was distinguished in the -brain but a slight turgescence of the blood-vessels. Dr. Girdlestone -says, that no injury appeared in the brains of those persons who died -of the symptomatic apoplexy which occurred in a spasmodic disease -which he describes in the East Indies; and Mr. Clark informs us that -the brain was in a natural state in every case of death from puerperal -fever, notwithstanding it seemed to be affected in many cases soon -after the attack of the disorder.” - -With regard to the state of the blood in this distemper, Dr. Rush -says, that when drawn from a vein, it was, “1. In the greatest number -of cases, dense, and of a scarlet colour, without any separation -into crassamentum and serum. 2. In many cases it did separate into -crassamentum and yellow serum. 3. In a few cases the serum was of a -natural colour. 4. There were many cases in which the blood was as -sizy as in pneumony and rheumatism. 5. In some instances the blood was -covered with a blue pellicle of sizy lymph, while the part which lay in -the bottom of the bowl was dissolved. In two cases the lymph was mixed -with green streaks. 6. It was in a few instances of a dark colour, and -as fluid as _molasses_. Both this and the 5th kind of blood occurred -chiefly where bleeding had been omitted altogether, or used too -sparingly, in the beginning of the disorder. 7. In some patients the -blood in the course of the disease exhibited nearly all the appearances -which have been mentioned. They were varied by the time in which the -blood was drawn, and by the nature and force of the remedies which had -been used in the disorder.” - -From this account of the different appearances of the blood, it appears -to have varied at the very first attack from an healthy state, and to -have gradually deviated from that state more and more, as the disease -advanced. Dr. Rush says,[150] from Dr. Mitchill’s History of the Yellow -Fever in Virginia, in 1741, that “blood drawn from a vein was always -dissolved. The same state of the blood was observed in many persons who -had been exposed to the contagion, who discovered no other symptom of -the disease.” In p. 70 Dr. Rush gives his own opinion in the following -words: “I shall say, hereafter, that the blood was seldom dissolved in -this fever;” and p. 73, speaking particularly of the blood, he enters -into an argumentation against the putrescency of that fluid. “It” (the -blood) says he, “has been supposed to undergo a change from a healthy -to a putrid state; and many of the symptoms which have been described, -particularly the hæmorrhages and eruptions on the skin, have been -ascribed to this supposed putrefaction of the blood. It would be easy -to multiply arguments to prove that no such thing as putrefaction can -take place in the blood; and that the symptoms which have been supposed -to prove its existence are all effects of a sudden, violent and rapid -inflammatory action, or pressure upon the blood-vessels; and hence -the external and internal hæmorrhages. The petechiæ on the surface of -the skin depend on the same cause. They are nothing but effusions of -serum or red blood, from a rupture or preternatural dilatation of the -capillary vessels. The smell emitted from persons affected with this -disease was far from being of a putrid nature; and, if this had been -the case, it would not have proved the existence of putrefaction in -the blood; for a putrid smell is often discharged from the lungs, and -from the pores in sweat, which is wholly unconnected with a putrid, -or perhaps any other morbid, state of the blood. There are plants -which discharge an odour which conveys to the nose a sensation like -that of putrefaction; and yet these plants exist at the same time in a -state of most healthy vegetation: nor does the early putrid smell of -a body which perishes with this fever prove a putrid change to have -taken place in the blood before death. All animals which die suddenly, -and without loss of blood, are disposed to a speedy putrefaction. -This has long been remarked in animals that have been killed after -a chace, or by lightning. The poisonous air called _samiel_, which -is described by Chardin, produces, when it destroys life, instant -putrefaction. The bodies of men who die of violent passions, or after -strong convulsions, or even after great muscular exertion, putrefy in -a few hours after death. The healthy state of the body depends upon -a certain state of arrangement in the fluids. A derangement of these -fluids is the natural consequence of the violent and rapid motions, -or of the undue pressure upon the solids, which have been mentioned. -It occurs in every case of death from indirect debility, whether it -be induced by the excessive stimulus of contagion, by the volatile -vitriolic acid which is supposed to constitute the destructive _samiel_ -wind,[151] or by violent commotions excited in the body by external -or internal causes. The practice among fishermen in some countries of -breaking the heads of their fish as soon as they are taken out of the -water, in order to retard their putrefaction, proves the truth of the -explanation I have given of its cause soon after death. The sudden -extinction of life in the fish prevents those convulsive or violent -motions which induce sudden _disorganization_ in their bodies. It was -remarkable that putrefaction took place most speedily after death from -the yellow fever, where the commotions of the system were not relieved -by evacuations. In those cases where purges and bleeding had been used -it was much slower. There is a fact mentioned by Dr. Ferriar, from -Dr. Hamilton, late professor of anatomy at Glasgow, which may seem at -first to militate against the facts I have mentioned. He says that he -had observed that bodies which were brought into the dissecting room -that had petechiæ on them were longer in putrefying than any others. -The fevers of which the poor (the common subjects of dissection) die, -are generally of the low nervous kind. Great _direct_ debility is the -characteristic of those fevers. The petechiæ which occur in them appear -in the last stage of this direct debility. They are the effect, not of -too much impetus in the blood, as in the yellow fever, but of a defect -or total absence of it in the last hours of life. The slow progress of -the body to putrefaction after death, in the instances mentioned by -Dr. Hamilton, seems to depend upon the same cause as that to which I -have ascribed it in those cases of death from the yellow fever in which -evacuations had been used, viz. direct debility. In the former cases -this slowness of putrefaction is induced by nature, in the latter by -art. The effects of debility from both causes are, notwithstanding, the -same.” - - [150] Account of the Bilious Remitting Fever, &c. p. 106. - - [151] See p. 126, n. where an account is given of the samiel, and - another hypothesis concerning its nature. - -From this long detail, in which the author’s meaning seems rather -involved in obscurity, we may gather that in the fever of 1793 the -blood had no determinate appearance, but that, according to the action -of the vascular system, it was sizy or otherwise. This position, which -in my opinion is the meaning of the passage just now quoted, is not -supported by any facts. It is mentioned indeed that the blood in some -was sizy, in others quite fluid, but as the cases in which it was so -are not particularly related, we do not know whether the action of the -vessels was stronger in those where the blood was fluid than where it -was not. Certain it is, that the blood may be made fluid by certain -substances mixed with it, without any action of the vessels at all. The -poison of the ticunas, as well as all other animal poisons, renders the -blood fluid, yet this will kill instantaneously when injected into a -vein, before the vessels have time to act in such a manner as could be -supposed to change the texture of any of the fluids.[152] Or if this -still will not satisfy, we are assured that the poison of serpents, as -well as many other substances, which are not poisons, when mixed with -the blood taken out of the body, will prevent it from coagulating. -Granting, therefore, what hath not been proved, that the greater -the action of the vessels, the more fluid the blood will be, yet we -cannot know whether this fluidity be occasioned by the action of the -vessels, or the action of the vessels by the tendency to fluidity in -the blood. But it matters not which of the two is cause or effect: the -question is, Whether in the yellow fever does the ultimate effort of -the disease tend to produce any alteration in the texture of the blood -to fluidity, or otherwise? This can be known only from considering -the symptoms which take place in the last stage of the disorder, and -from dissections. Now, from the concurrent testimonies of all the -writers quoted in this treatise, it appears that towards the end of -the disease there is such a tendency to dissolution, that the whole -body seems ready to fall down into a putrid mass; or at least into -what is commonly called so, whether with strict propriety of language -or not, signifies little. In short, the difference between the plague -and yellow fever seems to be entirely of the same kind with that taken -notice of in this treatise, p. p. 269, 270, where the bile of a person -dying of a malignant fever was injected into the veins of a dog. Here -the blood was very fluid. In capt. Mawhood’s case (p. 385) the blood -flowed from his nose, eyes and gums, besides what he discharged by -vomit. Dr. Lining (p. 389) attests a similar tendency to dissolution in -the blood in a most remarkable manner. See also Dr. Lind’s opinion to -the same purpose, p. 393, Dr. Hillary’s, p. 395, Dr. Jackson’s account, -p. 399, Dr. Chisholm’s, p. 411; and lastly, Dr. Rush’s own testimony -concerning the hæmorrhages from all parts, lately quoted. - - [152] See p. 221–223. - -As we have formerly seen, that in the plague there was no such tendency -to dissolution, but rather to coagulation, in the blood, it was thence -concluded that the immediate cause of the symptoms of plague is a -tendency in the blood to throw out the latent heat it contains, by -which means the parts on which these discharges fall, are burnt up to a -kind of cinder. In the yellow fever the reverse takes place. The blood -has a tendency to absorb heat, and if it does so it must of course -become thinner, for this is the nature of all fluids, and indeed it -is abundantly manifest that fluidity in all cases is an effect of the -absorption of heat.[153] In consequence of this absorption, the body -towards the latter end feels cold, the heat seems to retire from the -extremities towards the vital parts, and the vessels contracting and -losing their power by reason of the abstraction of sensible heat, the -pulse ceases entirely some time before death. Dr. Huxham takes notice -of this excessive coldness in the limbs taking place in a lady who -died of a malignant fever, and likewise that an intolerable stench -issued from her body for some time before her death, though kept clean -with all possible care. As the plague therefore is the highest of all -inflammatory diseases, so the yellow fever seems to be the highest of -the malignant class. - - [153] See p. 150. - -It may be objected, however, that as hæmorrhages, petechiæ, black -vomiting, and convulsions, sometimes take place in the plague, we -cannot from the existence of similar symptoms in the yellow fever, -conclude that they are different diseases. But, with regard to the -first, it must be observed, that an hæmorrhage may ensue from a rupture -of vessels as well as from an oozing of blood in consequence of an -acrimonious thinness of blood. It is indeed to be questioned, except -in cases where blood is discharged by the pores of the skin, whether -any hæmorrhage takes place but by a rupture of vessels. In an healthy -subject, hæmorrhages very frequently take place from the nose where -the blood is of a very proper consistence; and Dr. Russel says that -he had occasion to see hæmorrhages from the nose and uterus only; -that in the advanced stages of the disease though the blood was paler -and of a _thinner_ consistence, the hæmorrhage was seldom profuse. It -was, however, of very bad omen; most of the cases in which it appeared -having terminated fatally. - -That towards the end of this disease the blood should begin to absorb -the heat which it had before thrown out, is not wonderful. A tendency -to dissolution very probably does in all cases take place in a greater -or lesser degree; but we have not any reason to suppose that in the -true plague hæmorrhages ever are as frequent, violent, or attended with -such an apparent tendency to putrefaction, as in the yellow fever, and -consequently we must suppose that there is some _specific_ difference -between the state of the blood in the one disease and in the other. - -Convulsions, though very frequent in the yellow fever, yet, according -to Dr. Russel, were very rare attendants on the access of the -pestilential fever. Even hiccup was seldom observed, and sneezing -not once. However, he says that convulsive motions of the limbs were -frequently observed in the course of the disease; but this is far -from what Dr. Chisholm says of the Boullam fever, where the patient -expired in a violent convulsive fit; or what Dr. Rush says of the -fever of 1793, in which the patient sometimes fell down in universal -convulsions. In short, the absence, or much less frequency, of nervous -symptoms in the plague, seems to constitute another _specific_ -difference between the two. - -With regard to black vomiting, it is neither peculiar to the plague -nor yellow fever. Dr. Miller[154] has shown that it may be occasioned -by almost any kind of acrid poison taken into the stomach. In proof of -this he quotes from Sauvages the case of a man who died in consequence -of taking a drachm of white arsenic instead of cream of tartar, in -whose stomach was found, on dissection, a black liquor which deposited -a sediment like powdered charcoal. The villous coat of the stomach -was likewise abraded. For other cases of the same kind he refers to -Wepfer de cicuta aquatica, Morgagni, &c. Another case of poison by -arsenic occurred in New-York hospital, in which the patient had a black -vomiting. In another case in which corrosive mercury was swallowed -by mistake, the patient, after being to appearance in a fair way of -recovery, began to vomit a dark-coloured matter, and died in a day or -two. The agaricus clypeatus, a kind of poisonous mushroom, brought -on bilious stools, locked jaw, vomiting, delirium, oppression of the -breast, sighing, anxiety, great prostration of strength, yellowness on -some parts of the skin, and death on the sixth day. On dissection the -stomach was found to be inflamed, the duodenum distended with flatus, -and the gall-bladder full of green and black bile. - - [154] Med. Repository, vol. ii, p. 412. - -But the principal distinctions between the plague and yellow fever -seem to be the eruptive nature of the former, and the propensity in -the latter to attack strangers newly arrived from colder climates; -also in being more easily checked by cold than the plague. It has -already been remarked from Dr. Russel, that of _two thousand seven -hundred_ patients, whose cases he noted, every one had buboes. These, -however, were not all the cases he saw; for he mentions some that had -no eruptions; but from this it is impossible to avoid drawing the -conclusion, that eruptions are the true characteristics of the plague. -Of these two thousand seven hundred, eighteen hundred and forty-one had -buboes in one or both groins; five hundred and sixty-nine had them in -the arm-pit; two hundred and thirty-one had parotids; four hundred and -ninety, carbuncles; and seventy-four, spurious buboes. Now, in all the -number of cases of fever which Dr. Rush attended in 1793, he had only -two with buboes, and one parotid; and as to the carbuncles they do not -answer the description of those in the former part of this work.[155] -It is impossible therefore that any more clear line of distinction can -be drawn between the plague and yellow fever. The following table, -however, exhibiting at one view the symptoms of the plague, the yellow -fever, fever of Boullam, and fever of 1793, will perhaps set this -matter in a still clearer light. - - [155] See p. 257. - -From a mere inspection of the detail of symptoms in this table, the -difference between the several distempers is obvious. It is evident -that none of them can with any kind of propriety be called higher and -lower degrees of the rest. The plague is _essentially_ different from -the other three, which seem indeed to be nearly allied; the Boullam -fever being only attended with more violent and malignant symptoms. We -ought now to enter into a particular inquiry concerning the origin and -nature of these fevers; but, as a knowledge of this is in some measure -dependent on the question, whether or not they are contagious, we shall -in the first place present the reader with the following extract from -a French treatise, in which the question seems to be handled in an -agreeable and judicious manner, and then make another attempt, by an -investigation of matter of fact, to determine whether the disease has -ever been excited by imported contagion or not: - -“A very important question is--whether this disease is contagious. -The greater part of the American physicians are of opinion that it -is, and are persuaded that it is brought from the West Indies, by -the ships which arrive here in the beginning of every summer. It is -even from that opinion, and on their vigorous representations, that -quarantines have been established, which every vessel from the West -Indies is obliged to perform during 10 and sometimes 20 days at Fort -Mifflin, several miles distance from Philadelphia. This formality, so -troublesome to navigation, was observed this year (1798) with more -severity than ever it was; but without answering any good purpose for -the vessels; for very few ships’ companies appeared taken with the -_yellow_ or _putrid fever_. Nevertheless the epidemic, whatever name it -assumes, raged this year in Philadelphia with more fury than even in -1793. Besides, if the quarantine was a sure preservative, if almost all -the ships’ crews coming from the West Indies brought the _yellow fever_ -with them, why should not CHARLESTON, NORFOLK, ALEXANDRIA, BALTIMORE, -BOSTON and SALEM, where no quarantines are performed, be affected with -the contagion, as well as New York and Philadelphia? The American -physicians are so convinced that the _yellow fever_ is contagious, that -they scrupulously prohibit persons in health from all communications -with those diseased; they order frequent _waterings_ in the streets and -about the houses where the fever has manifested itself, and aromatic -fumigations. They even order the clothes of those who have fallen by it -to be burned, as is practised with respect to those who die with the -plague. It must be confessed that their precautions, in this respect, -have in some sort been justified, on seeing all the individuals of one -family successively taken with it, and often at the same time, their -neighbours, and so on, to a number of people who might be authorised -to attribute their misfortunes only to their vicinage with the first -victims. - - -_Characters and most remarkable Symptoms_ - -OF THE - -Plague, Yellow Fever, Fever of Boullam, and of Philadelphia in 1793. - -(_In this table the mark Do. refers to the column immediately preceding._) - - -_General Characters._ - - FEVER OF FEVER OF - PLAGUE. YELLOW FEVER. BOULLAM. PHILADELPHIA - IN 1793. - - Known and Not known to Supposed by Various opinions - described exist before the Dr. Chisholm concerning it. - by ancient last century. to be a kind - historians. of new disease - originating in - foul vessels on - the coast of - Africa in 1793. - - Attacks Attacks Do. Attacks more - indiscriminately principally generally than - people of all those who change the common yellow - nations. their climates, fever. - especially from - cold to hot. - - Not brought on Brought on Do. Do. - by intemperance. not only by - At least Dr. P. intemperance, but - Russel never saw by slight errors - an instance. in regimen. - - Sometimes seems Attacks the Attacks the As in the yellow - to spare the robust much intemperate and fever. - weakly and more violently robust. - delicate, and to than those of - attack the robust. a contrary - description. - - People sometimes Not observed. Those attacked by Patient sometimes - struck dead as the disease fall falls down in - by a stroke down giddy and apoplexy, syncope - of lightning. almost insensible or universal - Sometimes fall with a profuse convulsions. - down suddenly, cold sweat. - but revive, - and by proper - management regain - their health in a - short time. - - Death sometimes Death sometimes Do. Do. - takes place within - without any fever twenty-four - or complaint; hours, but - preceded only not without - by momentary some previous - sickness, by complaints. - eruptions of - purple spots, or - the breaking out - of hard eschars - in different - parts of the body. - - Irregular No remission, Do. Remissions and - remissions and but a cessation exacerbations. - exacerbations. of one set of - symptoms to make - way for another. - - Venereal appetite Not observed. Do. Venereal appetite - monstrously increased but - increased on less than in the - recovery. plague. - - -_Symptoms of the Disease in various parts of the Body, or over the -whole System._ - - FEVER OF FEVER OF - PLAGUE. YELLOW FEVER. BOULLAM. PHILADELPHIA - IN 1793. - - Infection Not commonly Do. Do. - sometimes begins observed. - with apparent - intoxication. - - Sometimes is felt Not observed. Infection felt at Do. - like an electric the commencement - stroke. of the disease, - occasioning a - nausea and rigor. - - Fainting very Do. Do. Do. - frequent. - - Convulsions rare Not commonly Convulsions Tremors of the - at the beginning. observed. sometimes very limbs uncommon. - Convulsive violent: the - motions of patient often - the limbs not expiring in a - unfrequent fit. - throughout the - disease. - - Hiccup uncommon. Hiccup extremely Do. Do. - common. - - Sudden loss of Do. Excessive A surprising - strength. strength during degree of - the delirium. strength - sometimes only a - few hours before - death. - - Delirium at times. Do. Do. Sometimes Do. - constant. - - Loss of speech, Not observed. Do. Do. - faltering and - trembling of the - tongue. - - Coma very general. Do. Do. Do. - - Muddiness of the Grimness of Eyes inflamed, Eyes watery, - eyes, scarce to countenance. Eyes watery, rolling inflamed, or like - be described. red and heavy. and protruded. balls of fire. - Countenance wild - and ferocious. - - A solitary A deep yellow The yellow colour Yellow colour - instance of the colour all over scarcely metvery frequent. - patient becoming the body so with. - green all over. common that the - disease has one - of its names from - it. - - Eruptions of Never observed. A kind of small The carbuncles - the nature eschars in the do not answer to - of eschars, nose. Small any description - sometimes black spots on of those in the - small, and the upper lip, plague. - called tokens, but neither - pepper-corns, &c. resembling - sometimes larger, the tokens or - and called carbuncles in - carbuncles, on the plague. - many different Carbuncles - parts of the body. mentioned, but - not described. - - Buboes in the Very rarely Sometimes A very few - inguinal, observed. observed, but - instances. - axillary and only in fatal - parotid glands cases. - exceedingly - common. - - Pulse extremely Pulse sometimes Pulse Pulse disappeared - variable; indistinguishable disappearing on as in the plague - disappearing from that of a pressure. Did not and Boullam - entirely on healthy person, intermit even at fever; otherwise - pressure; often even a short time the approach of as in the yellow - intermitting. before death. death. fever. - Otherwise of - all possible - varieties. - Sometimes - entirely gone a - considerable time - before death. - - Excessive Not observed. Do. Do. - uneasiness at the In the last - heart. One person stage the heart - died with violent palpitates - palpitation. strongly. - - Violent pain at Universal in the Very frequently Disease sometimes - the pit of the yellow fever of observed. began with a pain - stomach, which 1762. in the stomach. - could not bear A burning pain - the touch. frequently - accompanied the - vomiting. - - Hæmorrhages not Hæmorrhages Do. Do. - very common, and excessively - only from the common from every - nose and uterus. part of the body. - - Vomiting of Vomiting of Do. Do. - yellow, green and matters of the - black matter. same kind; - also of matter - resembling coffee - grounds with - flaky substances - floating in it. - - Stools less Stools Do. Immense Stools extremely - fœtid than in a excessively quantities of fœtid when - common tertian. fœtid, and in excessively fœtid strong evacuants - Dark coloured great quantity. blood discharged. had been used, - blood sometimes otherwise the - discharged. fœtor was less. - - Sweats of various Not observed. Not observed. Yellow and fœtid - colours, and sweats. - fœtid. - - Sweat the natural No natural Do. Seldom terminated - crisis of the crisis. by sweat after - distemper. the third day. - - -_Appearances on Dissection._ - - FEVER OF FEVER OF - PLAGUE. YELLOW FEVER. BOULLAM. PHILADELPHIA - IN 1793. - - Bile of a black Bile of a black Intestines Bile very viscid. - and greenish colour, and very mortified. - colour; turning viscid. Congestion of - quite black by Effusions of blood in the - the addition Stomach affected blood and serum brain. - of spirit of by gangrenous in the brain. - nitre; a lasting spots called Blood in a fluid - grass green by carbuncles by Dr. Liver sometimes state. Stomach - adding spirit Lining. shrunk up into and intestines - of vitriol; and half its natural inflamed. - of a yellow by Blood very fluid, size. - the addition of and the vessels Liver sometimes - alkalies. of the viscera of its natural - much distended. appearance. - Heart of an - extraordinary Duodenum and - bigness; in seven other parts of - cases stuffed the intestines - with thick, black mortified. - blood; in one, - filled with a Worms from - large polypus; putrefaction - in another the found in the - contents not stomach in six - mentioned. hours. - - Lungs in five Omentum and its - cases either appendages of a - purple, livid, dark grey colour, - or covered with and uncommonly - spots of these dry. - colours. - Liver and spleen - Liver greatly enlarged. - enlarged, with - mortified spots - in five cases. - Stuffed also with - thick blood. - - Mortifications - in the brain, - intestines, &c. - - Abscesses in - two cases; one - in the muscular - integuments of - the thorax, the - other in the - aorta. - - -Fever of 1798. - -_Doctors_ RAND _and_ WARREN’s _Dissections_. - - CASE I. Patient died CASE II. Death on the CASE III. Death on - on the 6th day. Lungs 12th day. Patient the fourth day. Lungs - filled with dark had been delirious inflamed on the fore - blood. Air vessels since the 6th. Blood part, and exceedingly - not distended. Large vessels of the brain stuffed with blood - extravasation of greatly distended. in the back parts. - firmly coagulated An effusion of serum Liver inflamed, and - blood in the thorax. between the dura of a very dense - Fluid blood in the and pia mater. A consistence. Gall - pericardium. Coronary band of coagulated bladder entirely - veins extremely lymph producing an obliterated; its coats - distended. Liver adhesion between the forming a confused - inflamed on both two coverings of the membranous substance - sides, and indurated brain, under the by coalescence with - as if boiled. Gall sagittal suture. Lungs the neighbouring - bladder contracted, adhered firmly to parts. Stomach covered - and containing only the pleura, and had in the inside with the - about a quarter of an several indurations black vomit. Colon and - ounce of a substance of the size of a part of the omentum - resembling pitch. pigeon’s egg. Left inflamed. - The secretion of lobe extremely - bile had apparently diseased, and in a * * * * - ceased for some time. state of suppuration. - Stomach and intestines Liver much enlarged In the two cases where - inflamed, and their and inflamed, the the gall bladder had - veins distended. inside of the great been diseased, and - Omentum thickened lobe near the gall the liver did not - and dark coloured bladder appearing as perform its functions, - from the swelling of if contused. Stomach the patients became - its vessels. Spleen covered on the inside yellow; but not in the - enlarged but without with the matter of other, where the bile - inflammation. the black vomit, was in due quantity. - though the patient In the second case the - had no evacuation of patient had previously - that kind. Duodenum had a pulmonary - and small intestines complaint. - much inflamed. Gall - bladder full of bile, - and ducts pervious. - Bladder contracted to - the size of a pullet’s - egg, with a quantity - of blood effused in - it. - -“Nevertheless, if this distemper was as contagious as certain -physicians pretend, why should they not be the first to be taken with -it; they who see, examine and touch many patients every day? Why should -not those who nurse them day and night, who continually breathe those -putrid miasmata; why should not those who attend the hospitals, those -who daily carry 30 or 40 coffins to the grave, be taken with it? We do -not hear, however, that the physicians, surgeons, nurses and sextons -have enlarged the funeral list more than any other class of citizens. -Some doubtless have fallen, and perhaps they owed their death to their -frequent communications with the sick; but would the epidemic have -spared them in any other condition, more than a number of unfortunate -people who are neither physicians nor nurses? - -“Another particular not less remarkable is, that the _yellow fever_ -seems hitherto to have spared the Frenchmen who have resided in the -West India colonies, the greatest part of whom have nevertheless -staid in New York and Philadelphia during the _yellow fever_, and -have lived in the midst of the contagious air which proves so fatal -to the Americans. The result of all this is, that, notwithstanding -four years’ experience, notwithstanding the public and private -researches and discussions which took place between the physicians and -philosophers of the American continent, there is still much uncertainty -on the nature of the distemper which so rapidly depopulates New York -and Philadelphia. Every opinion, every system, presents palpable -contradictions, and is liable to objections which it is difficult, not -to say impossible, to answer in a satisfactory manner. If the disease -be contagious, why are not the physicians, the nurses, the servants -of the hospitals, taken sooner than persons who have no sort of -communication with the sick? - -“If it be not contagious, how happens it that the natives of every age -and sex, many of which, the women and children especially, live in a -pretty sober manner, and seldom drink any of those liquors so liable to -inflame the blood, are taken with it, and fall, in spite of all the -efforts of medicine? How happens it that the Europeans and Frenchmen -who have never been in the colonies are attacked like the Americans, -whilst the planters in the West Indies are spared? - -“On the other hand, if, as the French physicians pretend, this is -nothing else than the malignant putrid fever, often prevalent in -Hispaniola, how happens it that those medicines and that mode of -treatment which were so frequently successful in the colonies have -no sort of success when administered to Americans, and seldom with -Europeans? Why is this fever attended, in its very first stage, with -vomitings of blood, bile, black spots, _purples_ and other alarming -symptoms, which they frequently have at Hispaniola? How comes it that -the West India planters, who, while they resided in the colonies, -had frequent attacks of putrid and often inflammatory fevers, -enjoy the most blooming health ever since they have been on the -American continent? And why are they not taken with those putrid and -inflammatory fevers, at a time when those who have given them an asylum -are the daily victims of it? Finally, if we must attribute the epidemic -to no other cause than the immoderate heat of the summer, which is -really greater here for two or three months than at Hispaniola, where -a land and sea breeze tempers its violence, why does it not stop its -ravages when the heat moderates? We have observed in the epidemics -of New York and Philadelphia, that they were less destructive in the -burning dog-days than in the months of September and October, when the -mornings, evenings and nights begin to be cool, and even cold enough to -allow people to go clothed as warmly as in winter. - -“We have now a recent and striking example that it is not heat only -which causes the epidemics; since there were only, in the month of -September, three or four days of great heat. The rest were very cool. -It may even be said that from the 22d it was cold, especially on the -28th and 29th, when a violent north wind obliged many people to have a -fire. The number of deaths never were, however, so numerous as they -have been since the 20th of September. The funeral list, which in July -and August amounted to 40 per day, reached on the 20th of September to -78, the 22d, 68, the 23d, 71, the 24th, 63, the 25th, 80, the 26th, 77, -the 27th, 96, the 28th, 106, the 29th, 76, and from the 29th at twelve -o’clock, to the 1st of October, same hour, the number was 170; a number -as prodigious as it is frightful: we could not therefore even flatter -ourselves that the severest frosts of the end of October would dispel -the epidemic, did not experience afford us that comforting hope. - -“What then is the physical cause of this scourge, which all human -prudence and science are unable to avert? The ministers of religion -will not fail to ascribe it to celestial wrath, and to advise prayers, -fast and charity to appease it. Those pious practices cannot assuredly -do harm; but the philosophical observer, who does not conceive that -Philadelphia and New York should have excited the Heavenly wrath more -than those of other cities of the continent, will seek for more natural -causes, and will examine whether they should not be attributed to some -local and peculiar vice of those two unfortunate cities, and perhaps -to the temperament, the diet, the mode of life, of their inhabitants. -Respecting this, we do not find, in the _localities_ of New York and -Philadelphia sufficient reasons, nor in the constitutions or mode of -life of their inhabitants sufficient variations, to mark them as the -victims of the _yellow fever_, while the inhabitants [of other places] -are free from it. - -“I am however inclined to think that New York and Philadelphia, more -than any other cities, contain causes of corruption or putridity, -occasioned by their size and the extent of their commerce, which, added -to the high mode of life of the Americans, may be the source of the -calamity which now affects them. - -“In effect, we observe that in these two cities the epidemic has -constantly manifested itself in those parts which are not only the most -commercial, but also where the _common_ sinks of the city meet; where -the houses, inhabited by the poorer class of people, being smaller, -and more crowded together; where the stores contain most provisions -liable to fermentation and putridity; where the shipping crowded in the -_wharfs_ render the water stagnant; where immense quantities of dirt -and litter are brought from every quarter for the purpose of filling -up new wharves and other places designed to be taken from the sea, to -enlarge lands to build upon; finally, where the water used to drink -does not reach the pumps of the lower part of the city until it has -filtrated through the burying-grounds and privy-houses of the upper -parts, most of which have no walls, and are never emptied. - -“Let us add to all those causes of infection the dead dogs, cats, pigs, -and rats, which are thrown into the common sinks and docks, the rotten -fish, and the privies, which in several houses, especially at New York, -are nothing but _tubs_, which are emptied weekly on the sea shore, and -we shall have less reason to wonder at the putrid exhalations which -issue on the eastern part of New York, and at Philadelphia on that part -contiguous to the Delaware, and which are capable of infecting the -whole atmosphere, and to impair the health of those who live in it. If -the people who dwell in those parts are not scrupulously sober, if they -frequently indulge in the use of spiritous liquors, if they feed on -such food as is generally known to be unhealthy, is it to be wondered -that, with such a mode of life, their blood should be more disposed to -inflammation and to be dissolved and corrupted, in the midst of an air -already corrupted and loaded with destructive miasmata? - -“Now every man knows that those who live contiguous to the river at New -York, and the Delaware at Philadelphia, mostly sailors, shipwrights, -truckmen, labourers, tavernkeepers, &c. seldom trouble themselves about -the quantity of their foods and drinks, but indulge copiously in the -use of strong liquors, of which an astonishing consumption is made -in those parts. They are not in other respects more careful as to -cleanliness in their narrow and low houses. There, in a _hole_ called -a _bedroom_, and on a feather-bed half rotted, in a heap of rags half -devoured by insects still more disgusting, two and sometimes three -individuals, covered with sweat, often drunk, sleep, and still increase -the filth by their shameful and dirty mode of life. Shall we find it -strange that those infected haunts should shed forth in the morning -a mephitic air, capable of suffocating the most robust and vigorous -men? Shall we wonder that those who breathe this pestilential gaz are -suddenly seized with a fever? in itself perhaps not very dangerous, -if it were treated in a suitable manner. But what is their method of -treating it? They do not even know the name of _ptisan_, still less the -use of _anodynes_, nor that of _salt of nitre_, nor of _camphor_, so -proper to prevent putridity. Punch, made with rum; water mixed with gin -and molasses; a sort of soup made with Madeira wine; fish; raw oysters, -&c. these are their first medicines. If their wives or friends go to -consult the apothecary, he advises the _castor-oil_, or the famous -calomel pills or powders, whose virtues the quacks extol for every -disease. Finally, if the fever increases, the doctor is called, who -administers a light puke of 12 or 15 grains of tartar emetic, a plenty -of laudanum to procure sleep, and who, seeing the case desperate, -withdraws, saying that he was called too late![156] - - [156] In Dr. Rush’s account of the fever of 1793, we find the - following remarks on the French mode of practice to which it seems - remarkable that our author has given no answer: “I proceed with - reluctance to inquire into the comparative success of the French - practice. It would not be difficult to decide upon it from many - facts that came under my notice in the city; but I shall rest its - merit wholly upon the returns of the number of deaths at Bush-hill. - This hospital, after the 22d of September, was put under the care - of a French physician, who was assisted by one of the physicians of - the city. The hospital was in a pleasant and airy situation; it was - provided with all the necessaries and comforts for sick people that - humanity could invent, or liberality supply. The attendants were - devoted to their duty, and cleanliness and order pervaded every room - in the house. The reputation of this hospital, and of the French - physician, drew patients to it in the early stage of the disorder. - Of this I have been assured in a letter from Dr. Annan, who was - appointed to examine and give orders of admission into the hospital - to such of the poor of the district of Southwark, as could not be - taken care of in their own houses. Mr. Olden has likewise informed - me, that most of the patients who were sent to the hospital by the - city committee (of which he was a member) were in the first stage - of the fever. With all these advantages, the deaths between the 22d - of September and the 6th of November, amounted to 448 out of 807 - patients who were admitted into the hospital within that time. Three - fourths of all the blacks (nearly 20) who were patients in this - hospital died. A list of the medicines prescribed there may be seen - in the minutes of the proceedings of the city committee. Calomel and - jalap are not among them. Moderate bleeding and purging with glauber - salts, I have been informed were used in some cases by the physicians - of this hospital. The proportion of deaths to the recoveries, as it - appears in the minutes of the committee from whence the report is - taken, is truly melancholy!” - -“Although the inhabitants of the other parts of the city who are in -better circumstances follow a mode of life more regular, feed on more -wholesome aliment, and are much more cleanly in their houses (except -however _feather-beds_ and _lower bedrooms_) it is nevertheless a -fact that they are much inclined, the men especially, to eat salt -meat, meat half cooked, green fruit, and still more to drink spiritous -wines. Several of them allow themselves an immoderate use of the latter -between dinner and tea-time, the strength of which, added to that of -the high-spiced food, and liquors, must necessarily increase in their -blood that fermentation already excited by the heat of the season. Now, -shall we not concede that bodies thus predisposed ought to be more -susceptible than others of the impression of the corrupted _miasmata_ -which are constantly exhaled from every thing that surrounds them; from -the common sewers, the wharves or the docks; from the dirt and litter -of the alleys and lanes; from the sulphureous bilge-water of ships; -from the cellars and from the stores; in short, from those houses which -contain sick, dying and dead persons?” - -Here the author, after stating objections on both sides, seems at last -to determine that the disease is produced by putrid effluvia. The -dispute on this subject, however, hath continued so long, that we can -by no means expect to settle it in this treatise. At first view one -would think that nothing could be more easy than to determine whether -the disease arose soon after the arrival of foreign vessels, or in -places which had no connexion with maritime affairs. But when we come -to particulars there is such a strange disagreement and contradiction -concerning facts, that we are in every instance driven back into the -wide field of theory and argumentation. One instance of this we have -already had in the case of the Boullam fever said to be imported by -the _Hankey_. Let us now try another. Dr. Currie of Philadelphia, in a -letter to Mr. Wynkoop of date October 10th, 1797, says that the fever -at New-York, of 1795, was proved “by unquestionable facts,” to have -been introduced from Port au Prince by the brig Zephyr; and for a proof -of this he refers to a letter of the health committee of New York to -the governor, dated September 8th of that year. From this letter it -appears that Dr. Treat visited this vessel on the 28th of July, where -he found three men ill of what he called a bilious _remitting fever_, -and the body of one who died that morning. Two days after, the Doctor -was taken ill, and died in eight days, with unequivocal symptoms of -yellow fever. On the 25th, four persons from on board the ship William, -from Liverpool, which arrived several weeks before (the crew of which -till this time had been healthy) were taken ill of fever, and died with -similar symptoms in seven days. Nothing can be more direct than this -evidence, yet it did not give satisfaction. - -The fact was impugned by the late Dr. E. Smith, in a letter to Dr. -Buel,[157] who produces such evidence as, in his opinion, “establishes -it beyond a 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.” - - [157] Webster’s Collection, p. 98. - -The evidence brought forward is the declaration and deposition of capt. -Bird. In a letter to Dr. Dingley, the captain “thinks it his duty to -contradict the report” that Dr. Treat “caught the disease of which he -died on board the Zephyr.” He contradicts it by a deposition, that “the -mate and one mariner had the _fever and ague_ seventeen days on shore, -and came on board with the same disease; and the captain himself had a -dysentery on his arrival in New York; and John Wheeler, aged 16 years, -died on the day of the arrival of the brig in New York, by _worms -crawling up into his throat, and choking him_. He was sewed up in a -piece of canvass, and ready to be committed to the deep, when Dr. Treat -came on board, who desired the captain to have the canvass opened, that -he might inspect the body; and he only cut the canvass over the face, -but did not make any other examination of the body.” - -How far this proves captain Bird’s assertion, that Dr. Treat _did not_ -catch the disease on board the Zephyr, the reader will judge. It is, -however, inconsistent with the plan of this treatise to enter into -an examination of contradictory evidence concerning matters of fact. -Accounting as _nothing_, therefore, all that has been said, _by either -party_, concerning the brig Zephyr, let us proceed to other testimonies. - -In a collection of _facts_ and _observations_ by the College of -Physicians, published last year, we find the following remarkable -accounts tending to prove that the disease was introduced by the ship -Deborah, from Port au Prince and Jeremie in St. Domingo: 1. In a letter -from Dr. Stevens to Dr. Griffiths it is stated, that “the yellow -fever prevailed in almost all the sea-port towns in the French part -of Hispaniola, particularly at Cape Nichola Mole, where it raged so -violently that it obliged the British to abandon the post sooner than -they intended. About the same time it appeared in the harbour of St. -Thomas, and was so destructive to foreigners, that it obtained the name -of _the plague_.” The Doctor saw several cases of it in St. Domingo, -during the months of August and September, 1798, and “these were -entirely confined to _American seamen_, while the native inhabitants of -the city were totally exempt from it.” 2. From this very sickly coast -arrived the Deborah on the eighth of July. 3. On the 12th of August -John Lewis, mate of the Deborah, informed Dr. Currie, that the vessel -had lost _seven_ persons with fever on board during her passage, and -one by accident; _and that she had been employed as a transport in the -British service_ previous _to her taking in her cargo at Jeremie._ -4. Mr. Thomas Town informed Dr. Wistar, that, on the first of August, -1798, he was told by Alexander Philips, of Water-street, that he (Mr. -Philips) had brought up two or three sick people from the Deborah, in -one or two boats. Some of them he had brought to his own house; and one -was dead. Philips himself was sick at the same time, and died a day -or two after. 5. Mr. Purdon informed Dr. Currie that he had a similar -account from Mr. Philips, whom he saw on the first or second of August -in apparent good health, and that he died on the Saturday following. - -All this, and further evidence seemingly equally strong, was set aside -with the greatest facility by bringing counter-evidence, particularly -that of Mrs. Philips, who denied that there were any sick people in -the house; and by bringing instances of the fever existing in town -before the vessel arrived. It is needless therefore to trouble the -reader with any further discussion of this evidence more than the rest. -As the ancient Britons, in their letter to Aetius, lamented that the -_barbarians_ drove them to the sea, and the _sea_ drove them back to -the barbarians, so may we lament, in the present investigation, that -the uncertainty of theory drives us to _facts_, and the uncertainty -of supposed facts drives us to _theory_. Still, however, we shall not -despair. The introduction of a disease into a large city is much more -difficult to be traced than in a smaller one. In the year 1794 the -disease appeared in the town of New Haven in Connecticut. Dr. Monson of -that place informs us, that it appeared on the 10th of June, when Mrs. -Gorham, residing on the _Long wharf_, was visited by Dr. Hotchkiss, who -found her affected with symptoms of the yellow fever. In three days -her complaints suddenly vanished, and she was supposed to be in a fair -way of recovery, but the same evening she vomited matter resembling -coffee-grounds, and died next day. On the same day that Mrs. Gorham -died, Dr. Monson visited her niece, a girl of eight years of age, who -had staid a week with her aunt, and was taken ill three days before. -The day after the Doctor saw her she was suddenly relieved as her aunt -had been, but in a few hours vomited matter like coffee-grounds, and -died next day. These and some other similar cases having alarmed the -select men, inquiry was made, when “it appeared, that, in the beginning -of June, capt. Truman arrived from Martinico, in a sloop that was -infected with the contagion of the yellow fever; that this vessel lay -at the _wharf_, within a few rods of Mrs. Gorham’s residence; that she -had on board a chest of clothes which had belonged to a mariner who -died of the yellow fever in Martinico; and that his chest was carried -into Mr. Austin’s store, and opened in presence of Capt. Truman, Mr. -Austin, Henry Hubbard, and Polly Gorham: the three last died in a short -time after their exposure to the contents of the chest. Hence it is -highly probable that Mrs. Gorham caught the disease from the infected -sloop or clothing. Mr. Austin’s store stands within three or four rods -of Mr. Gorham’s house; and no person in town was known to have the -yellow fever previous to capt. Truman’s arrival.” - -In his further account of this fever Dr. Monson shows that it was -contagious in the highest degree, and that Mr. Gorham’s house proved a -kind of seminary from whence the disease spread itself. “June 26 (says -he) Isaac Gorham lost an infant child with the yellow fever; and soon -after his son and daughter were affected with it: the former died. -Solomon Mudge died on the 30th; Jacob Thomson’s negro woman on the 1st -of July; Archibald McNeil on the 9th; Polly Brown on the 3d of August; -John Storer, jun. and John Hide, on the 8th; and widow Thomson on the -10th. Jacob Thomson’s negro woman, Solomon Mudge, John Storer, jun. -and John Hide, had visited Mr. Gorham’s house a few days before their -illness; Polly Brown and Mrs. Thomson nursed in Mr. Gorham’s family; -and Archibald McNeil nursed Solomon Mudge. Elias Gill died on the 12th -of August, and Samuel Griswold’s wife on the 7th: the former visited -Mr. Gorham’s house, the latter nursed in his family. - -“There were a number of persons who caught the disease at Mr. Gorham’s -house, and recovered. - -“Mrs. Thomson, on the first day of her illness, was moved half a -mile from Mr. Gorham’s, into George-street. Luther Fitch caught the -disease from Mrs. Thomson, and communicated it to his servant maid. -Both recovered. Mr. Fitch lives in College-street, nearly three -quarters of a mile distant from Mr. Gorham’s house. I could trace the -disease throughout the town. No person had the yellow fever unless -in consequence of attending the sick, or of being exposed by nurses, -infected houses, clothing, or furniture. - -“I have inquired of several aged persons in this town relative to the -yellow fever, whether they knew of its having ever been here previous -to June 1794, and there is but a single instance; the facts relating to -which are these: In the year 1743 a transient person, by the name of -Nevins, who came from the West Indies, lodged at the house of Nathaniel -Brown, an inn-keeper in this city. The man was taken very sick in the -night, and died shortly afterwards; and his body was very yellow after -death. Mr. Brown’s wife sickened in a short time, and died of the same -complaint, which was at that time supposed to be the yellow fever. - -“I am credibly informed that several persons at Mill-river, in -Fairfield county, and also at New London, died with the yellow fever in -August and September, 1795. It was propagated there by infected persons -from New York. - -“Capt. John Smith died in this town, the 20th of August, 1795. He -caught the disease in New York, and communicated it to one of his negro -servants.” - -On the whole, Dr. Monson concludes, “that the yellow fever is seldom -or never generated in this country, and that it is always imported -from abroad. An objection to the idea of its being generated in this -country is, that it was never known in the interior of this state, or -of the United States, so far as I can learn. Had it ever appeared in -Connecticut before the year 1743, and June 1794, we should undoubtedly -have had some record of the fact. There is no such record, and no -person remembers to have heard of such a disease, but at these periods, -prevailing in any part of the state. There are numbers of aged persons -in New Haven who remember the putrid ulcerous sore throat, small pox, -measles, dysentery, &c. raging here with great mortality, but have no -recollection of any yellow fever. Hence we may rationally conclude that -it never did appear in this state but in the years 1743 and 1794. - -“It is evident, from facts before mentioned in this letter, that the -yellow fever was propagated in no other way than by contagion, and -that this is a _specific contagion_, and no more diversified, in its -operation on the human system, than that of the small pox and measles. - -“If the citizens of large commercial cities were attentive in tracing -the origin of the yellow fever, on its first appearing among them, -they would often find that the disease was imported. In some instances -it would be extremely difficult to discover the origin. But the -mischief lies in this; that the inhabitants of such cities, whenever -a contagious disease makes its appearance among them, endeavour to -suppress all rumour of it, from an apprehension of alarming the -country, and injuring their commerce; unwilling to believe that there -is evil in the city, till the disease spreads in every direction. Then, -indeed, when it is too late, they are solicitous in the use of means to -arrest its progress. As it extends itself slowly at first, seasonable -exertion might both detect its source, and prevent its increase; but -when it is diffused through a city, it spreads with rapidity, and it -is no longer possible to discover where it began. But as, whenever the -yellow fever has appeared in the United States, it has always been in -sea-port towns, and originated near wharves, docks, and warehouses, -there seems to be high probability that the disease is imported.” - -The evidence here seems so strong, that no counter-evidence that -can be brought appears likely to invalidate it. The coincidence of -the commencement of the fever with the arrival of the ship hath not -been denied, as in other cases; and, though it has been attempted to -prove that a fever might have arisen from the quantity of putrid or -putrescent matters at that time in the town, yet the circumstances of -those who were present at the opening of the chest of clothes being -taken with the fever, and those who were sick of it in so many cases -infecting one another, cannot by any means be overthrown. But the fact -is, that even those who contend most violently against importation, do -yet allow that it may in some cases be so; but they contend that if -proper care be taken it will not spread. Dr. Smith in his letter to Dr. -Buel says, “that infection may be brought into any place from abroad; -that, under certain circumstances of the place where it is introduced, -it becomes very 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 its merited insignificance.” But, with -due respect to the memory of Dr. Smith, this must surely be accounted -a very inconsiderate mode of reasoning. In the instance he speaks of, -that of the Zephyr lately mentioned, he allows that Dr. Treat _might_ -have caught the disease on board the vessel,[158] “but (says he) 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 the concession.” Surely we must -look upon the life of Dr. Treat himself to have been a matter not -entirely insignificant, and if he caught the fever by going on board, -a number of others who went in full confidence of the _impossibility_ -of importation, might have done the same. As far therefore as the -prevention of such accidents can be accounted a matter of importance, -it is also of importance to believe the doctrine of imported -contagion. It is true, Dr. Smith, in the passage just quoted, adds -immediately after, that “no such concession (with regard to Dr. Treat) -is necessary;” but, in p. 104, he does make an ample concession, as we -have seen, viz. that the contagion may not only be imported, but, under -certain circumstances, _be very active and destructive_. The question -therefore rests here: Can we at all times promise that, with the utmost -care that can be taken, the circumstances of a place may not be such as -to give activity to an imported contagion? In the nature of things it -is impossible that the docks, wharves, streets and alleys of a large -town can be absolutely clean. It is equally impossible that _all_ men -can be advised to be temperate, cleanly, and neat in their lodgings; -and we are unable to determine how far people may deviate from the -_rule of right_ in those respects without danger. Before any theory -of this kind could be supported, it would be absolutely necessary to -bring an unequivocal proof that yellow fever had been in _one_ instance -at least produced by local causes; but this cannot be done. Among the -Hottentots, the dirtiest people in the world, no such disease exists. -Among the peasants of Poland, who likewise live in a very dirty manner, -their mode of life is said to produce not a fever, but a disease of -the hair, called the _plica Polonica_. In the Medical Repository, -vol. i, p. 276, Dr. Mitchill of New York describes a disease called -_elephantiasis, liktraa, or scurvy_, occasioned by loathsome, -putrefying diet, such as rotten fish, fish-livers and roe, fat and -train of whales and sea-dogs, congealed sour milk, with little or no -vegetable provisions, and by exposure to wet and cold. This disease -prevails in Iceland, in the Ferro islands, in two districts of Sweden, -and in _Madeira_; yet this disease is not the yellow fever, though it -is said to make the person afflicted with it more like “a putrefying -corpse than a living man.” The _cold_ seems to be assigned as a reason -why the disease does not assume a febrile form; but, however this may -hold with Iceland, it cannot with Sweden, where the summer is so hot, -that the sun has been said to set forests on fire. This is probably a -fable; but we are assured by Pontoppiddan, in his Natural History of -Norway, a country to the full as cold as Sweden, that in summer the -heat is very great. His expression is, that it is enough to “make a -raven gape.” As to _Madeira_, where the climate is warm, there can be -no such objection. But a particularity of this disease is, that it is -infectious. Supposing then that by any means it should be exalted into -a fever, have we any reason to imagine that in such a case it would lay -aside its infectious property? Surely not. If this then is the case -with a disease produced by the same causes with the yellow fever, we -have the very same reason to suppose that the latter is infectious, as -that the former would be so if it could lay aside its present form, -and assume that of fever. Another proof that mere dirtiness cannot at -all times produce a distemper, or even propagate its infection, may be -deduced from the sixth case quoted p. 355 from Dr. Russel, where he -says that a poor Jewish family lived in a place such as he had always -considered as one of the receptacles of contagion, yet only one in six -of those who remained in it was taken with the plague. In all cases of -plague, or of violent epidemic disorders, it has indeed been observed -that the poor were more subject to an attack than the rich. This was so -remarkable in the plague of London in 1665 that Dr. Hodges says it was -called the _poor’s plague_; and Dr. Ferriar tells us from Diemerbroeck, -that in some parts of Italy it was customary in the beginning of -a pestilence to drive out the poor; and likewise that this cruel -expedient was used at Marseilles. The bad success of the experiment at -this last place, however, shows that people of any description, and in -any circumstances, may be attacked. A very probable cause, entirely -distinct from any mode of living, may be assigned in this case, viz. -that the poor are more exposed to infection than others, both from -their circumstances and their rashness; for it will be evident to -those who converse with the most uninformed people of any country, -that the Turkish notion of predestination is far from being confined -to Mahometans. It is not, however, denied, that dirtiness, as well as -other local causes, may do much hurt, and occasion the spreading of a -disease which otherwise would not spread; because uncleanness of all -kinds seems to be the proper vehicle of infection, in which it appears -to delight to take up its abode. In the Medical Extracts, vol. ii, -p. 174, we have from Goldsmith the following anecdote concerning the -concentration of pestilential infection in the plague of London: - - [158] Webster’s Collection, p. 98. - -“A pious and learned schoolmaster, who ventured to stay in the city -during the plague, and took upon himself the humane office of visiting -the sick and dying who had been deserted by better physicians, averred, -that, being once called to a poor woman, who had buried her children -of the plague, he found the room where she lay so little, that it -could scarce hold the bed on which she was stretched. However, in this -wretched abode, beside her, in an open coffin, her husband lay, who had -some time before died of the distemper, and whom she soon followed. -What shewed the peculiar _malignity_ of the air, thus suffering from -human miasmata or effluvia, was, that the contagious steams had -produced spots on the very _wall_ of their wretched apartment. And -Mr. Boyle’s own study, which was contiguous to a pest-house, was also -spotted in the same frightful manner.” This shows not how infection -may be _produced_, but how it may be concentrated in such miserable -apartments. The appearance on the walls brings to remembrance what is -said in the book of Leviticus concerning the appearance of the leprosy -in walls and clothes. - -But, supposing we should allow that dirtiness may bring on a yellow -fever (and it is plain that this cannot be proved) we have, in the case -of the Busbridge Indiaman, a _demonstration_ that cleanliness cannot -keep it off.[159] This vessel sailed from England for the East Indies, -in the year 1792, much about the same time that the Hankey sailed for -the coast of Africa. She had on board 264 people in all, viz. 109 -belonging to the ship’s company, 130 recruits, and 25 passengers. She -had very boisterous weather at first setting out, but crossed the -equator on the 26th of May, where the weather was sultry, with heavy -showers of rain. The disease now made its appearance first among the -recruits, and in a fortnight spread among the ship’s company. It -was common for six or seven to be attacked with it daily from the -commencement; “and in the space of twelve weeks almost every person in -the ship not only had laboured under it, but many had suffered repeated -relapses.” For several weeks the weather was hot and sultry; but, when -in the vicinity of the Cape of Good Hope, they experienced a reverse, -and were driven by a storm as high as S. lat. 42. Here the thermometer -indicated a temperature only 13° above frost, but no material change -in the disease took place. Afterwards, when returning into the warm -latitudes, they experienced the sultry heats of the Atlantic without -any change either for the better or the worse, and this for no less a -space than three months. - - [159] Annals of Medicine, vol. i, p. 166. - -As to the origin of the disease, Mr. Bryce the surgeon, though -inclined to ascribe it to contagion, could not trace it to any origin -of that kind, as the vessel had been six weeks at sea before it -appeared. It “could not be ascribed to want of air or cleanliness, -as _every possible_ attention had been used to preserve these: the -different apartments were thoroughly cleaned and fumigated with wetted -gun-powder; the decks were sprinkled with boiling vinegar; and the -windsails were attentively kept in order at each hatchway. Mr. Bryce is -inclined to conjecture that a peculiar combination in the circumstances -of diet, situation, and state of the atmosphere, may have given rise to -this calamity. But the same combination of circumstances so frequently -takes place _without any fever_, that it appears much more probable -the disease had its origin either from an _imported fomes_, or from a -_fomes generated in some individual in_ the ship, from whence it was -afterwards propagated to others by _contagion_.” The disease produced -on board the ship was not contagious to the people on board another -vessel with whom they had communication, nor to the people ashore -among whom the convalescents were put, nor to new passengers taken on -board the vessel in the East Indies; circumstances certainly not a -little surprising. - -It doth not therefore appear, that, without the intervention of some -other cause, mere dirtiness can produce the yellow fever. Let us -next see what can be done by confinement, want of air, or, as it has -been lately called, abstraction of oxygen. On this, however, we must -observe, that in all cases where people are allowed to breathe, their -lungs must be filled with the due quantity of _some_ elastic fluid. If -the fluid they breathe contains a smaller quantity of oxygen, it must -contain a greater quantity of something else. If a disease therefore is -produced, it must be occasioned by the _presence_ of that other fluid, -as well as by the absence of oxygen. Now, in confined air, we know that -not only the oxygen is diminished, and consequently a larger proportion -of azote or septon mixed with it, but in addition to this increased -proportion of azote, there is also a positive augmentation of the -deleterious part of the atmosphere by the effluvia from the bodies of -those who are confined. These effluvia, as we have seen, p. 90, contain -a great quantity of fixed air. Others have shown that they contain -also azote; and it may be so; but still we are sure that the fixed -air predominates. Besides this, from the breath we know that a great -quantity of aqueous moisture proceeds. Experiments on the action of -these different kinds of fluids are yet in an imperfect state, yet some -important facts relating to them are known. 1. Oxygen breathed in great -proportion produces an augmentation of heat, and proves an universal -stimulant. See p. 118. By itself it quickens the pulse.[160] 2. Pure -fixed air breathed by itself destroys life with the circumstances of -increased heat, rarefaction of the blood, and rupture of the vessels. -See p. 206. 3. The circumstances attending death by breathing azote -are not particularly recorded; but we know that by breathing an -atmosphere lowered by it the consumptive fever is not increased, -but diminished; and there is an account in the Medical Annals of a -person who was perfectly cured of a consumption by the smell of the -bilge-water of a ship. 4. It has formerly been shown, from Dr. Black’s -experiments, that, when the vapour of water is condensed in the body, -a great quantity of heat must be thus communicated to it. In confined -air therefore there is a diminution of the oxygen which produces heat; -but there is an augmentation of the fixed air and of the aqueous -moisture which increases it; so that, on the whole, the balance must -be considered as in favour of the augmentation of heat in the human -body; not to mention the quantity of sensible heat continually added to -the atmosphere by that which evaporates from the body. This position, -however, doth not stand upon the uncertain ground of theory; it is -confirmed by the following remarkable fact: Commodore Billings, who -commanded a Russian expedition fitted out by the late empress, found, -in his travels through the northeastern part of Asia, that the cold of -the atmosphere exceeded not only what was known in other climates, but -even what most people had been able to produce by freezing mixtures. -Dr. Guthrie informs us that he was unable to produce a greater degree -of cold than 36 below 0 of _Reaumur_, though assisted by 20 below 0 of -natural cold, and the power of all the freezing mixtures he knew. “How -much then (says he) was I surprised to hear Mr. Billings assert, that -some spirit thermometers which he had with him, graduated according to -_Reaumur’s_ scale, were often as low as 40° below the freezing point -of water, that is, 8 deg. below the freezing point of mercury. And -once or twice he observed them at 42 deg. below the _freezing point of -quicksilver_.[161] - - [160] In the Medical Extracts we find it recorded, that a young - gentleman having breathed pure oxygen for several minutes, his pulse, - which was before 64, soon beat 120, in a minute. - - [161] This account is taken from the Annals of Medicine for 1798, - and appears in a letter from Dr. Guthrie at Petersburg to Dr. Duncan - at Edinburgh. It is drawn up with such _astonishing_ inaccuracy, - that we may well be surprised how the one physician should write, - and the other print it. There seems in the first place to have been - a mistake of Reaumur’s thermometer for Fahrenheit’s. But even this - will not rectify the account. The _zero_ or (0) on Reaumur’s scale - is the freezing point of water; on Fahrenheit’s it is the cold - produced by a mixture of salt and snow, 32 degrees below the freezing - point of water. The freezing point of quicksilver has been fixed at - 39, 39-1/2 or 40 degrees below the cold produced by salt and snow. - When the thermometer therefore fell to 40 deg. below the freezing - point of water, it was only eight degrees below the cold of salt - and snow, and not equal to the congelation of mercury by more than - thirty degrees. The difference between this and _forty-two_ degrees - below the freezing point of quicksilver is enormous and incredible. - It indicates a degree of cold hitherto unobserved on the face of - the earth, and scarcely equalled by the latest experiments made - at Hudson’s bay, where, by means of vitriolic acid and snow, the - thermometer was made to indicate a degree of cold 40 degrees below - the freezing point of quicksilver. The inaccuracy and confusion of - this account, however, does not affect the subsequent part relative - to Mr. Billings’s journey. - -“During this severe cold (probably 42 below 0 of Fahrenheit) the -Nomade Tchutski (a wandering nation on the northeastern extremity -of the Asiatic continent) who were conducting him along the coast -of the Frozen ocean, in sledges drawn by rein-deer, encamped every -night on the frozen snow in low tents, which they quickly formed with -the skins of rein-deer, spreading some of them on the surface of the -snow, on which they all slept; and he assured me, that, so far from -suffering from cold during the night, the heat was so excessive in -these fur tents, where from ten to fifteen slept together, according -to its dimensions, that no one could bear even a shirt; but all lay -in a violent perspiration, naked as they were born, till dawn of day, -without the aid of fire, excepting a train-oil lamp, which lighted each -tent.” - -From this account it seems pretty evident, that, by the accumulation of -animal effluvia, a heat may be communicated to the atmosphere greater -than that of the human body. We cannot suppose the heat of the tent -which put the people in a violent perspiration to have been less than -90° of Fahrenheit; and, supposing the temperature of the external -atmosphere to have been at a medium 30° below 0, there must have been -a generation of 120 degrees of heat; but the heat of the human body -does not exceed 97 degrees, and it cannot communicate more heat than -it has. But we must suppose the tents to have been capable, had they -been filled to the top, of containing twice the number who did sleep in -them. They could communicate to the air therefore only one half of 97 -degrees, or 48-1/2°; the remaining 71-1/2° therefore must been derived -from the breath and perspiration of the body.[162] - - [162] Here no account is made of the heat that the very cold snow - upon which they lay must have absorbed, which we know must have been - very considerable, though it cannot be calculated. - -Let us now attend to the consequences which must naturally and -undeniably follow from this fact. If, in such a violently cold climate, -the effluvia of fifteen human bodies could produce a heat sufficient to -induce a violent perspiration, what would they not have done had they -been in a climate where the heat of the atmosphere was upwards of an -hundred degrees greater, or between 70 and 80 above 0 of Fahrenheit? -Perhaps this was never thoroughly tried except in the black hole at -Calcutta. Here an hundred and forty-six men and one woman were enclosed -in a dungeon only 18 feet square, and consequently affording scarce -eighteen inches square to each. This happened in a very hot climate, in -the month of June; so that we cannot suppose the temperature to have -been less than 80° of Fahrenheit. - -On being confined in this manner, the vital powers endeavoured, by -a most profuse perspiration, to send off the superfluous quantity -of heat thrown into the body. This was exactly what took place with -Dr. Guthrie; but, in the case of the black hole, there was, besides -the quantity of heat produced by the warmth and perspiration of the -body, _an hundred and ten_ degrees more to be added, on account of -the natural heat of the atmosphere. For we cannot suppose the heat at -Calcutta, in a sultry evening in the month of June, to have been less -than 80, which added to –30, supposed to be the temperature among the -Tchutski, makes 110°. The perspiration was extremely profuse, and was -soon accompanied with excessive thirst; nature being unable to supply -such a quantity of liquid, or this liquid to carry off the heat from -the body. The want of pure air began then to be felt by a difficulty of -breathing; and Mr. Holwell, having in despair retired from the window, -found the difficulty of breathing increase, attended by a palpitation -of the heart. Aroused by his sufferings, he returned and was relieved -by drinking some water, and having air at the window. The difficulty -of breathing diminished, and the palpitation ceased; but, finding the -thirst not to be quenched by water, he sucked his shirt-sleeves, which -were wet with sweat, and endeavoured as much as possible to catch all -of it that he could. The taste was soft and agreeable. A pungent steam -was now felt like spirit of hartshorn. A number had died, and Mr. -Holwell, once more rendered desperate, retired from the window, and -lay down upon a bench, where he soon lost all sense. Next morning only -23 survived, of whom Mr. Holwell was one. He revived on being brought -out to the fresh air, but was instantly seized with a putrid fever, -as well as all the rest of the survivors. In this situation they were -obliged to walk, loaded with fetters, to the Indian camp; at night they -were exposed to a severe rain, and the day following to a sultry sun; -yet, notwithstanding this ill treatment, they all recovered; having an -eruption of large and painful _boils_ all over the body. Mr. Holwell, -however, said that he never afterwards enjoyed good health. - -Another melancholy proof of the bad consequences resulting from a want -of fresh air we have in the evidence given by Dr. Trotter, when the -question concerning the slave trade was agitated before the British -House of Commons. He deposed that the slaves were confined 16 hours out -of 24, and permitted no exercise while on deck. They were kept in rooms -from 5 to 6 feet high, imperfectly aired by gratings above, and small -scuttles in the sides of the ship, which could be of no use at sea. -The temperature of these rooms was often above 96 of Fahrenheit, and -the Doctor says that he never could breathe in them, unless just under -the hatch-way. “I have often (says he) observed the slaves drawing -their breath with all the laborious and anxious efforts for life which -are observed in expiring animals subjected by experiment to foul air, -or in the exhausted receiver of an air-pump. I have often seen them, -when the tarpaulings have been inadvertently thrown over the gratings, -attempting to heave them up, crying out, in their own language, ‘We -are suffocated!’ Many I have seen dead, who, the night before, had -shown no signs of indisposition; some also in a dying state, and, if -not brought up quickly on the deck, irrecoverably lost. Hence, in one -ship, before her arrival in the West Indies, out of 650 slaves, more -than 50 had died, and about 300 were tainted with the sea scurvy.” - -A third example of the effects of want of air, though conjoined with -other causes, may be reckoned the case of the Hankey, formerly related. -The people there were not indeed confined as much as in the black -hole, but it is impossible to suppose that there could be a proper -circulation of air, and the length of time the passengers were confined -might be equivalent to the violence of the cause in the case of the -black hole. In the latter, however, the disease produced was not the -yellow fever, but seems to have been a kind of non-descript eruptive -one, more resembling the small pox, or rather _Job’s disease_, than -any other. From Dr. Chisholm’s account of the Boullam fever also, it -seems to have been more of an eruptive nature than the common yellow -fever; so much, that Dr. Chisholm is of opinion that it partook “in -no small degree of the nature of the true plague.” He says that in it -he “did not observe _carbuncles_ on any who died; but that in many -who recovered they were numerous, large, and very troublesome.” He -considered them also as a critical discharge, and the only one in this -fever; but in the plague they certainly are not; neither is it at -all probable that they were of the same nature with the pestilential -carbuncles. - -In p. 207 of this treatise it is inferred, from some experiments of Dr. -Davidson and Dr. Chisholm, that the fevers in warm climates _are not_ -owing to a deficiency of oxygen in the atmosphere; but in a treatise on -the yellow fever in Dominica by Dr. Clarke, we have other experiments, -which, if they can be depended upon, certainly overthrow that doctrine, -or at least render it very dubious. Dr. Clarke endeavoured to ascertain -the purity of the air by Mr. Scheele’s apparatus, and which was -likewise used by Dr. Davidson, viz. filling gallipots with flowers of -sulphur and iron filings well mixed and moistened, and putting these -upon a stand under a glass vessel, which was placed on a stool in a -pail of water. The glass vessel was marked and divided on the outside, -and, allowance being made for the space occupied by the gallipot, -the water rose only one fifth in the glass vessel, after standing 24 -hours. When the disease abated, it rose near one fourth; and upon many -trials afterwards it never rose above one fourth. When the emigrants -fled towards the mountains, where the air is very pure, they always -avoided an attack of fever, or soon recovered if in a convalescent -state. This is similar to what is stated by Van Swieten concerning the -plague at Oczakow, viz. that the atmosphere was so loaded with some -kind of vapour, that in certain parts of the town polished sword-blades -were turned black. This seems to have indicated a great prevalence -of inflammable or hepatic air, or both, in the atmosphere; but it is -extremely doubtful whether this could produce a _fever_, much less the -true _plague_. In Dr. Clarke’s experiments it were to be wished that he -had examined the nature of that part of the atmosphere which was left -after the absorption of the oxygen. It is by no means probable that -at any rate the addition of a fifth part of azote could have rendered -the air so unwholesome; and besides, we are entirely at a loss whence -to derive such an immense quantity; for certainly the quantity of air -which surrounds us, even for a few miles extent, is so great, that -any considerable alteration in its composition could not take place -without a very evident cause. The probability therefore is, that the -experiments did not give an accurate statement of the quantity of -oxygen contained in the atmosphere. Experiments on this subject must -always be uncertain; and of all the modes of trying the qualities of -the air, perhaps that with sulphur and iron filings is most liable to -variation. It may vary, from the nature of the sulphur,[163] from the -cleanness or the impurity of the iron filings, or lastly from the -accuracy of the mixture. It is also a misfortune in this case, that -though a great absorption proves the existence of a large quantity of -oxygen in the atmosphere, yet a small one does not prove the contrary; -for it is more reasonable to suppose that we have failed in our -experiment, than that the constitution of the atmosphere has changed. -Dr. Clarke’s experiments therefore cannot prove any thing, until more -accurate methods of investigating these things be found out. - - [163] If sulphur be a _simple_ substance, as the new chemists - pretend, there ought never to be any variation in its properties, - except what arises from mere impurity; but the following is a - remarkable instance to the contrary: Dr. Crawford (brother to the - celebrated Adair Crawford) informed me, that for his oil of vitriol - works at Lisburn, in Ireland, he had purchased _five tons_ of - sulphur produced from copper mines in the island of Anglesey. The - sulphur looked well, and was not more impure than what he commonly - used; but, on trial, the produce of acid fell so much short of - what he had been accustomed to receive, that it would not afford - the expense of manufacturing. An experiment on such a large scale - could not be erroneous. If sulphur is a simple substance, the fact - is unaccountable: if it is composed of phlogiston and acid, an over - proportion of the former will easily account for it. - -We must now proceed to investigate a third cause assigned for the -production of fever, and that is the putrefaction of animal and -vegetable substances. This hath been very much insisted on. Dr. Rush -ascribes the fever of 1793 to the exhalations of putrid coffee, but -allows also the distemper to have been contagious, and says, that “for -several weeks there were two sources of infection, viz. exhalation and -contagion. The exhalation infected at the distance of three or four -hundred yards, while the contagion infected only across the streets. -The more narrow the street, the more certainly the contagion infected. -Few escaped it in alleys. After the 15th of September the atmosphere -of every street was loaded with contagion; and there were few citizens -in apparent good health, who did not exhibit one or more of the -following marks of it in their bodies: 1. Yellowness in the eyes, and -sallow colour on the skin. 2. Preternatural quickness in the pulse. -3. Frequent and copious discharges by the skin of yellow sweats. 4. -A scanty discharge of high-coloured or turbid urine. 5. A deficiency -of appetite, or a preternatural increase of it. 6. Costiveness. 7. -Wakefulness. 8, Head-Ach. 9. A preternatural dilatation of the -pupils.... Many country people who spent but a few hours in the streets -in the day, in attending the markets, caught the disease, and sickened -and died after they returned home; and many others, whom business -compelled to spend a day or two in the city during the prevalence of -the fever, but who escaped an attack of it, declared that they were -indisposed during the whole time with languor or head-ach.” - -Thus, according to our author, the fever of 1793 _began_ from putrid -effluvia, and _was continued_ by contagion. But many attempts have been -made to prove that putrid effluvia _alone_ both begin and continue -it. The limits of this treatise would not allow (even were it but -beginning) of a particular account of all that has been said upon the -subject; neither indeed is it needful. A single well attested instance -would decide the matter; but we have already seen the difficulty of -procuring that instance on either side. Certain it is, that we have -instances of the yellow fever arising where it is not pretended that -there was any considerable collection of putrid matters. In the Medical -Repository, vol. ii, p. 149, we find an account of the yellow fever -appearing “in a country village, near a fresh river, _on low marshy -ground_, seven miles from Portland, so that no suspicion could arise -of the disease being imported. _Several other cases of yellow fever_ -occurred _in different parts of the country_.” This stands on the -authority of Dr. Jeremiah Barker of Portland, so that there can be no -doubt of its authenticity; and though it cannot prove that the yellow -fever _may not_ arise from putrid effluvia, yet it certainly shows that -it _may_ arise without them. It does the same with marsh effluvia; for -though we may, in the case of the village, suppose that the marshy -ground on which it stands occasioned the disease there, yet what shall -we assign as the cause of its being dispersed in different parts of -the country, where there were neither marshes nor rotten beef? The -proofs indeed of animal effluvia being the cause of yellow fever are so -equivocal, that Dr. Davidson[164] supposes putrid _vegetable_ matters -to be more active in this way than the former. For this supposition -he gives as a reason, that Dr. Rush has observed, that butchers, and -those who lived in the neighbourhood of shambles, scavengers, grave -diggers, and others of similar employments, escaped the yellow fever -in Philadelphia. These, the Doctor justly observes, were more exposed -to what he calls the _gazeous oxyd_ of azote, than any other class; -and he likewise takes notice, that sailors, who during long voyages -feed on putrescent food, which might be supposed to produce a great -quantity of this acid, are thence subject to scurvy, a disease not -only different from fever, but entirely opposite to it. This exemption -of people conversant among the dead has been also taken notice of by -Dr. Mitchill,[165] who brings as an argument against the contagious -nature of the disease, that “seven men belonging to the alms-house of -New York were employed, during the whole of the sickly season of 1798, -in putting the persons dead of the plague (yellow fever) into coffins, -and though they handled in the course of their service upwards of _five -hundred_ corpses, in different stages of putrefaction, and though they -were much incommoded with the pestilential quality of the air in the -rooms they entered, and frequently were obliged to vomit, not one of -them was so much indisposed, during the whole season, as to discontinue -his employment.” This is no doubt a very remarkable fact, but in the -present instance it proves too much; for if, from it, we conclude that -the disease is not contagious, we must also conclude that it cannot be -produced by putrid animal substances. Yet in the very next sentence Dr. -Mitchill assures Dr. Currie, “that exhalations from corrupting _beef_ -and _fish_ have excited sickness as malignant, and as deadly, as any -which has occurred.” If exhalations from putrefying beef and fish have -produced this sickness, why did not exhalations from putrefying _human -bodies_ do the same? and if we are assured that the latter _did not_, -we have as little reason to suppose that the former _did_; unless we -establish a difference between the corrupting flesh of one animal and -of another, which no experience hath countenanced in the least. - - [164] Medical Repos. vol. i, p. 170. - - [165] Medical Repos. vol. ii, p. 313. - -The exemption of those employed in burying the dead, even in the true -plague, is observable. Dr. Canestrinus supposed it might be owing to -the use of garlic, which they were wont to bruise and rub their hands, -face and breast with, and likewise to chew, before they entered into an -infected house; but this cannot be supposed a very powerful antidote. -Dr. Rush is of opinion that grave diggers escaped in Philadelphia by -the circumstance of their digging in the earth; and he says also that -scarce an instance was heard of those employed in digging cellars -being attacked with the disease. “There seems to be something (says -he) in the fresh earth, which attracts, or destroys, by mixture, -contagion of every kind. Clothes infected by the small pox are more -certainly purified by being buried underground than in any other way. -Even poisons, are rendered inert by the action of the earth upon them. -Dogs have long ago established this fact, by scratching a hole in the -ground and burying their limbs or noses in it, when bitten by poisonous -snakes. The practice, I am told, has been imitated with success by the -settlers upon new lands in several parts of the United States.” - -This reason is very plausible for the exemption, of such as work in the -ground, from contagion; but it cannot do for scavengers and butchers, -who by the nature of their employment are frequently exposed to steams -from the vilest matters. We may, on the contrary, derive from thence -a very strong argument that these steams are by no means essentially -connected with contagion. We have already seen from Dr. Fordyce (p. -169 of this treatise) that contagion or infection is not the object of -sense. Dr. Rush, though he doth not absolutely say that the contagion -of the yellow fever hath no smell, yet informs us, that “the smell of -the contagion, as emitted from a patient in a clean room, was like -that of the small pox,[166] but in most cases of a less disagreeable -nature. Putrid smells in sick rooms were the effects of a mixture of -the contagion with some filthy matters. In small rooms, crowded in some -instances with four or five sick people, there was an effluvium that -produced giddiness, sickness at the stomach, a weakness of the limbs, -faintness, and, in some cases, a diarrhœa. The contagion adhered to -_all kinds of clothing_. It was in no instance communicated by paper.” -From so great authority we may certainly conclude that, _according -to the best observation_, there is an _essential difference_ between -the contagion of a disease and the effluvia of a putrefying carcase; -and that, though the latter may be the vehicle of the former, and may -increase its virulence, either by being partly assimilated to its -nature, or by affording it a proper _nidus_ for concentrating itself; -yet that originally the one is not the other; and, though contagion may -bring on a fever without putrid effluvia, yet putrid effluvia cannot do -so without contagion. With regard to pure contagion, I shall here, to -the evidences already produced, subjoin the testimony of Dr. Davidson, -formerly quoted. “I must declare[167] (says he) I have seen the disease -evidently propagated in this way (by contagion;) but in many instances -it could not be traced. I have known three cases of the fever brought -on by persons bathing in the sea along side the vessel, some distance -from the shore, and neglecting to dry themselves properly afterwards. -The seminia of the disease were here present, and, like the electrical -jar charged, required only the approach of a conductor.” This shows an -amazing subtilty and diffusibility in the contagion, scarcely indeed -credible, if it were not known to be equally subtile in other cases. -In the correspondence between Dr. Haygarth, of Chester in England, and -Dr. Waterhouse, professor of medicine at Cambridge near Boston, the -latter informs us, from Dr. Rand, that by burning, in a field near -Charlestown, the bedding, furniture, &c. belonging to a person who had -been ill of the small pox, the people who lived in the wake of the -smoke proceeding from it were attacked with the small pox, and the -disease spread. This is similar to an observation formerly quoted from -Huxham; but the following are much more remarkable: “A vessel arrived -at Charlestown from Lisbon, laden with salt, and lemons in boxes.[168] -A person had the small pox on board, and the small pox officers would -not suffer the lemons to be sold, without being first unpacked and -the paper surrounding each lemon taken off. These papers were kept -by themselves in a storehouse for several weeks; and after this, by -order of the overseers, they were brought out and burnt; when, of two -children playing round the fire, one, named Manning, took the disorder, -and broke out at the usual time.... - - [166] Account of the Bilious Yellow Fever, p. 107. - - [167] Med. Repos. vol. i, p. 171. - - [168] Haygarth’s Sketch of a Plan to exterminate Casual Small Pox, - vol. ii, p. 270. - -“Dr. Rand was called to a lady, whom he found hot and feverish with -a violent pain in her head and back; but he had no suspicion of the -small pox. He bled her, and a Mrs. Brandon held the vessel to receive -the blood, some of which spirted on her hand and arm. Next day the -small pox appeared on the lady who was bled; and she was of course -immediately separated from Mrs. Brandon; notwithstanding, in twelve or -fourteen days, Mrs. Brandon was seized with the small pox, and died. -Several other persons present were also liable to the infection, yet -no one took the disease but this woman, who stood over the blood while -it was running, and received some on her arm, except Mrs. Benjamins, -to whom the bason of blood was handed over the bed, who also took -the small pox from the effluvia of the blood. The same physician was -called to the child of Manning (who was supposed to have taken the -small pox from the burning of lemon-papers as aforesaid;) he found the -child bleeding at the nose in its mother’s lap, who was then in the -ninth month of her pregnancy. The next day the small pox appeared on -the child, and it was of course immediately separated from its mother -and all the family; nevertheless, in about fourteen days the mother -was seized with the disorder, and not long after delivered of a dead -child, which child _had distinct eruptions over its whole body_.” - -These facts are of the utmost importance in determining the nature of -contagious diseases. In conjunction with others, they show that such -diseases originate in the blood, and from thence are communicated to -the rest of the body. They show also, that the contagion is in all -cases truly _specific_, and _immutable_. Thus the contagion of the -small pox, whether existing in the matter of a pustule, in the smoke of -burning clothes or paper, or in the effluvia of blood, is invariably -the same, and never produces any other disease. It is the same whether -applied to the human body, or to that of a brute animal; of which -we have a remarkable instance in the Medical Repository, vol. i, p. -258. “A peasant of the county of Essex, in England, seeing a great -many children carried off by the natural small pox, was desirous of -inoculating his two boys; one nine, and the other twelve years old. -Not being able to employ a surgeon, he collected the scabs of a child -then sick of the disease, powdered them, and sprinkled the powder upon -slices of bread and butter. The two sons ate them, and gave a bit to -the house-dog. They had a mild small pox, and got well without any -remarkable accident. The dog remained sick for two or three days, drank -a great deal, and refused to eat: on the fourth he had a very decided -variolous eruption: on the ninth the pustules were full ripe, and dried -up and fell off like those of the two children. An English author says -he has seen the same epidemic in a flock of sheep, the greater part -of which were infected, and communicated it to two cows, one of which -died. The symptoms that manifested themselves in these animals in the -course of the disease were in every respect the same as in the human -species.” - -This instance, partly quoted in the former part of this treatise, -likewise is a strong proof of the contagion of small pox being first -communicated to the blood; for, by swallowing it along with the -aliment, it would, in the common course of digestion, be absorbed by -the lacteals, and enter the blood with the chyle. The experiments -with dogs made by M. Deidier, of which an account is given p. 268, -show that the contagion of the plague is equally specific with that of -the small pox; and we see that it acted in all cases in which it was -tried by being mixed with the blood. Being thus first mixed with the -blood, it is plain that the contagion must have passed from this fluid -to all the other parts of the body; and, if diseased blood is capable -of communicating its disease to all the sound parts of the body in -which it circulates, we must own that this strongly corroborates Dr. -Waterhouse’s suspicion, “that the blood is capable of producing the -infection before the disease is so far advanced as to be apparent on -the surface.” If the disease originates in the blood, the latter should -indeed seem more capable of communicating it at first than afterwards; -because we must suppose that the diseased parts would be thrown off to -the surface, and so pass off altogether. On this subject Dr. Waterhouse -also quotes the opinion of Dr. Holyoke of Salem, “who, for his -learning, professional abilities and integrity, is justly esteemed one -of the first physicians in this country, and whose extensive practice -has afforded him ample experience in the small pox.” He writes to Dr. -Waterhouse, “that, although he has reason to believe that an infected -person seldom gives the disease till after the eruption is considerably -advanced, yet there are facts which make it probable that it is -sometimes communicated earlier.” - -In the same letter Dr. Waterhouse gives other instances of the -inconceivable subtilty of variolous contagion, no less remarkable than -those already mentioned. One is of Dr. Brattle, who, having visited -patients infected with the small pox, “used the common precaution of -covering his clothes with a loose gown, &c. but neglected his _wig_. In -consequence of this small neglect, after riding six miles on horseback, -he gave the disease to a person in a room through which he passed, -where he did not stay to sit down.” Another is, if possible, still more -remarkable: “David Anthony, esq. one of the overseers of the small pox -in Rhode Island, after going into the hospital, and using the common -precautions, neglected to _smoke his wig_. In his way home, two miles -from the hospital, he called at the house of his daughter. He did not -dismount, but sat on his horse, and talked to her through an open -window; and, at the common period (by which we usually understand about -fourteen days) she took the disease and died. Many such instances, adds -the Doctor, could I relate, where wigs have given the infection, after -being exposed to the open air during the passage of several miles.” - -From all this it appears how difficult a task they undertake who -contend for the domestic origin of the yellow fever, without contagion. -In all cases they must have recourse to something visible and obvious -to the senses. Thus putrid beef, putrid fish, ponds of water, marshes, -&c. are all easily seen, and we are able to prove their absence as -well as their presence. But we certainly know that the yellow fever -has arisen where none of those supposed causes have existed, as in the -Busbridge Indiaman; and, on the other hand, all the supposed causes -have existed without the production of any fever. Of this last Dr. -Chisholm, in the conclusion of his defence against Dr. Smith, gives the -following remarkable instance:[169] “During a considerable part of the -years 1776 and 1778 my duty led me very much to reside in New York; and -during my residence, particularly in the summer and autumn of 1778, -which were remarkably hot, and insufferably so in the lower streets of -New York, no disease of a very alarming nature, and none which assumed -the form of an epidemic, appeared among the troops or inhabitants. -The smell from all the ships, and from those in particular delineated -by Dr. Seaman (who has written a treatise on the subject) was in the -highest degree offensive. The police at that time was by no means -strict: putrid substances of every description were accumulated in the -ships, and in many parts of the city unconnected with wharves, and yet -no disease was the consequence.” - - [169] Med. Repos. vol. ii, p. 291. - -Some particulars above related may perhaps appear, to those who deny -the existence of contagion, in rather a ludicrous point of view. It -is indeed too common for people to laugh at what they cannot answer; -but if we consider the instantaneous and inexplicable action of the -poison of serpents, and in how little time they produce a mortal -disorder, or even death itself; when we consider that contagion is -only a volatile poison, and that it for the most part takes up an -incomparably longer time to bring on death than the bites of some -venomous animals; we cannot be surprised that a quantity of this -volatile matter inconceivably less than that of animal poison should -be capable of bringing on the disorder; for the length of time may -be supposed to make up for the deficiency of quantity. Yet, if we -consider the extreme activity of some animal poisons, the wonder at the -small quantity of contagion necessary to produce a deleterious effect -will in a great measure cease. In the former part of this treatise it -has been observed, from Dr. Mead, that the whole quantity of poison -emitted by a viper, when it bites, does not exceed the bulk of a _good -drop_. An ordinary drop from a vial weighs half a grain, so that we -cannot suppose a large drop to be more than a whole grain. But there -are instances in which effects equally deleterious are occasioned by -the bites of animals the whole bulk of which is scarcely equivalent -to that of the poison of the viper. In the northern climates of the -Old World, _spiders_ do not grow to any remarkable bulk, yet the -bite of the poisonous spider of Russia is as mortal as that of the -rattlesnake.[170] The effect of the _furia infernalis_ of Linnæus is -still more to our purpose. It is an insect found in the forests of Kemi -in Lapland, and likewise in Sweden and Russia; and, if we can give -credit to Mr. Pennant, in some of the Western Islands of Scotland. This -insect falls down out of the air, and, if it happens to light upon any -uncovered part of the human body, it almost instantly penetrates down -to the bone, occasioning the most excruciating pain, and death in a -_quarter of an hour_.[171] Now, should we suppose the whole body of -this insect to be poison, as it is probable that it is not, it is so -minute, that though the whole were volatilized into contagion, it might -be well supposed to adhere to a _wig_, or even a more diminutive part -of the clothing; and, considering the virulent effects of even this -small quantity of contagion when concentrated, it would easily follow -by fair calculation, that a very _minute proportion_ of even this -_small quantity_ might bring on a dangerous disease. - - [170] See Medical Annals, vol. iii, p 400. - - [171] The following account of the poisonous insects of Russia, - extracted from Dr. Guthrie’s letter to Dr. Duncan (Med. Annals vol. - iii, p. 396) may be not unacceptable to the reader: “I have lately - seen (says Dr. Guthrie) a woman with her hand and arm in a most - violent state of irritation from the lodgement of the lumbricus - melitensis, a worm not much thicker than a horse-hair which had - entered her thumb whilst at work in a marshy spot, and was, when - I saw her, a day after the accident, on its way up the arm, with - excruciating pain. I must own that I should not have known the nature - of the disease, if a fellow-peasant had not immediately declared - that it was produced by the dangerous worm; which many of these - people are acquainted with to their cost, as an inhabitant of the - stagnant pools and marshes in that district, about sixty versts to - the southwest of Petersburgh. I must farther acknowledge, that I was - happy to hear the patient was to be instantly transported to another - village, where a famous operator lived, well skilled in the art of - extracting the venomous insect; as I should certainly have gone very - awkwardly to work if I had been obliged to operate; though the simple - peasants perform it with success and safety, gradually winding the - worm round a quill, till the whole animal be extracted; a work of - much patience and perseverance. I was very sorry that duty obliged - me to be in town the same evening, a drive of sixty versts. It was - therefore impossible for me to accompany the patient, though I was - very desirous of witnessing this village-operation. - - “But Russia is pestered with a still more dangerous worm; the furia - infernalis. It is still smaller than the former, not being thicker - than a human hair. This infernal insect, from its extreme lightness, - is often carried up into the air, with the dust, by whirlwinds; and, - if it unfortunately falls on the uncovered part of a man or beast, it - enters the flesh in an instant, and soon proves mortal, if a remedy - be not quickly applied. - - “Our new vice-governor of Petersburg lately came down from Siberia, - where he was commandant of a fort. He tells me, that in the district - of Nerchinsk, where he commanded, the peasants, as well as their - cattle, are often destroyed by an insect falling upon them. To - prevent this accident from proving fatal, the part is instantly - scarified, and rubbed with a mixture of snuff and sal ammoniac. - - “This I am convinced must be the furia infernalis; more especially as - he assured me, that the insect was so very minute, that none of the - peasants had ever seen it when it fell upon them, and that they had - no idea of its nature and form. But one circumstance of his, recited, - almost staggered my belief; that the carcase of an animal killed - by this insect is almost as dangerous as the insect itself. This - phenomenon I cannot account for in any other way but by supposing, - as the accident always happens in the hot months of the year, that a - high degree of putridity is produced by the venomous worm, when the - case proves fatal. - - “I informed the vice-governor of the manner in which the Dalecarlian - peasants in Sweden treat the accident, in order that he might - communicate their mode of cure to his Siberian acquaintance, which - is merely applying to the part affected a piece of sweet curd. The - insect possibly prefers this to flesh, and leaves the one for the - other. I am, however, much afraid that this simple remedy will seldom - be at hand in Russia, as the peasants are unacquainted with the use - of rennet, but prepare a sour curd by means of heat, throughout the - whole empire; evidently taking its origin in the Tartar Koumis, and - shewing them to be a people of Scythian extraction. They likewise - separate butter from milk by heat, instead of the churn; a curious - circumstance probably unknown to you before. - - “These two dangerous insects are, however, not all which threaten - the life of man in this empire: the southern provinces are infected - with a third, the bite of which is as mortal as that of the deadly - rattlesnake, if the part be not instantly scarified, and rubbed - with fresh butter. This is a species of crab-spider, the phalangium - acaroides, resembling the tarantula, but rather thinner and smaller. - It however kills and devours that formidable spider in a few minutes, - which, when compared with it, is an innocent animal. - - “Your acquaintance, Mrs. Guthrie, lately returned from a tour on - account of health, along the north shore of the Black Sea. Among - much important and curious information, she gave me some account - of the cure employed for the bite of this mortal spider, which - finds many lurking-places among the ruined buildings of the ancient - Chersonesus Taurica, or Crimea, laid waste in the last Turkish war. - It is a curious fact, that animal oil counteracts the venom of the - spider tribes, as vegetable oils do the venom of serpents. I suspect, - however, that either of them would counteract both poisons; indeed, I - think we have a proof of animal oil acting wonderfully on serpents, - in the anecdote related by Bruce, when the deadly cerastes, or viper - of the Nile, turned away its head from the oily breast of the prime - minister of Fenaar, when he carelessly took it up in his hand, and - applied it to his naked bosom, to show Mr. Bruce how innocent it was - to men of his colour, whose very skin sickened the animal, and made - it avoid all contact.” - -Lastly, it may be urged on the side of contagion that, when a vessel -arrives from a sickly country, it is no proof that she has not brought -a disease with her, that the people aboard are in health. There is -abundance of evidence that very dangerous maladies may be communicated -by those who do not labour under the same. The prisoners at the -Oxford assizes were not sick at the time they communicated a dreadful -distemper to those around them. Dr. Brattle and Mr. Anthony were in -perfect health when they communicated the contagion of the small pox, -yet the effect was not less fatal. In short, _contagion_ being a -power certainly known to exist, though invisible and imperceptible, -it is impossible ever to prove that it is absent; neither after the -contagion of any disease has once got into a country can we be assured -that it may not revive. The experience, we may say, of the whole world -testifies that it does adhere particularly to clothing. Dr. Lind thinks -it may adhere to the timbers of ships; and there is the greatest -reason to believe that it may also adhere to the walls of apartments in -houses. The appearance of fever therefore without any new importation -cannot prove that it has not arisen from contagion. But it is now time -to state the evidence on the opposite side. - -In Webster’s Collection we find the domestic origin of yellow fever -supported by Drs. Valentine Seaman, and E. H. Smith of New York; and -by Drs. Taylor and Hansford, and Dr. Ramsay of Norfolk. Dr. W. Buel of -Sheffield has also given an account of a fever, but so unlike that of -which we treat, that what is said of the one cannot be applicable to -the other. - -The arguments used by Dr. Seaman are, 1. Several persons were infected, -who had taken the utmost care to avoid all communication with the sick, -who had not been for several weeks out of their houses, or within -_eighty_ feet of an infected person. 2. The nurses and attendants in -some places were infected, but in others generally escaped. Neither did -the disease spread into the country, as was reported; the Doctor having -inquired into these reports, and found them groundless. 3. Dr. Lining -says in his letter to Dr. Whytt,[172] “If any person from the country -received it in town, and sickened on his return home, the infection -spread no further, not even to one in the same house.”[173] - - [172] See p. 387. - - [173] The same physician, in the very letter quoted by Dr. Seaman, - says that all the times this fever had appeared in Carolina, the - origin of it was evidently traced to some vessel arrived from the - West Indies. - -Several other arguments of the same negative kind are adduced, which, -being not essentially different from those already quoted, it is -needless to detail. The following are rather of a different nature: 4. -Some contagions are propagated by contact only, others at a distance; -but at any rate we may suppose that contact will propagate contagion -more readily and more powerfully than any other mode that can be -imagined. Yet multitudes of dissections have been made, and those who -made them are still alive. 5. “Specific and acknowledged contagions -all seem to arise from themselves only: hence it would be almost as -hard for me to believe that the siphylis, small pox, or measles, could -be produced from any other cause than their own proper virus, obtained -from persons affected with the like disease, as it would be for me -to conceive of the formation of a plant without its having received -its seed, or _radical_, from one of the same nature.[174] Contagions -seem to fix in the soil of our bodies, and there seed, as naturally -and regularly as vegetables do on the earth. But the yellow fever has -been produced from _other causes than contagion_.[175] Does it not -then admit of a doubt, whether it _can possess_ a power of propagating -itself?” 7. Contagions respect no persons, but all of every clime and -colour are equally attacked with them; but the yellow fever is known -to attack some much more readily than others. 8. Contagious diseases -generally have a determined time of invasion after an exposure to their -cause: but the advocates for contagion in the yellow fever cannot -be confined in this manner. “Their doctrine requires that it (the -contagion of yellow fever) be permitted to act at any time between that -of the exposure and the sixteenth day; otherwise it would not embrace -cases enough to give it a currency.”[176] 9. “Contagions act more or -less at all places and seasons, simply of themselves, without the aid -of any particular circumstance of air or climate; but the supporters -of the yellow fever being contagious are obliged, _by the force of the -foregoing observations_, to acknowledge their _imaginary fondling_ to -be but a _half-formed monster_, and perfectly inactive without being -assisted by the concurrence of a predisposing constitution of the -air. (Rush on yellow fever.) This fever exists only in warm weather: -hence its cause in this city (New York) was perfectly extinguished -by the frosty nights in the 10th month. It is confined mostly to low -situations in thick-settled places; otherwise our almshouse and the -surrounding country would have sadly experienced its deleterious -effects.” - - [174] Arguments of this kind involve us in an endless dispute - similar to that relative to the _equivocal generation_ of plants - and animals; that is, the production of plants without a seed, and - animals without parents. As some diseases are confessed to arise - from some kind of seed, we are puzzled to account for the origin of - the _first_ disease of that kind. Nevertheless, as these diseases do - exist, the difficulty arising from a consideration of their origin is - overlooked. In the yellow fever, which is not of so long standing, - the origin is more disputed. But it is likewise undeniable, that some - contagious distempers (the itch particularly) though capable of being - propagated by contagion, may yet arise from want of cleanliness, and - living on particular kinds of food. May not this also be the case - with the yellow fever? And is it not the safe and rational way to act - as though it might not only be produced at home, but imported from - abroad? - - [175] This is the very point in question; but our author, instead of - enumerating the facts by which his position may be supported, refers - to Dr. Lind, whose evidence shall be afterwards considered. - - [176] No greater latitude, or very little more, is required by - the advocates for the contagious nature of the yellow fever than - Dr. Seaman must allow in a distemper which he himself owns to be - contagious. It is well known, on the eastern continent at least, - that a gonorrhœa will come on at any time between the first and - _fifteenth_ day after the infection is received. Dr. Guthrie supposes - the time intervening between the reception of pestilential contagion - and the appearance of the symptoms to be four days; and Dr. Chisholm - thinks that in the Boullam fever it is somewhat short of two days: - but it is plain that much must depend on the quantity of contagion, - and the predisposition of the body to receive it. - -This argument merits a particular consideration, as involving a -question of very great importance, namely, concerning the constitution -of the atmosphere, which we have had occasion formerly to speak -of, and which is by some thought to be sufficient of itself to -produce epidemics, without the intervention of any other cause. This -constitution of the atmosphere is, it is true, something _unknown_; -and, when people appeal to it, it is only in other words owning their -ignorance; but the necessity of recurring to some cause imperceptible -by our senses has in all ages been obvious. So much indeed has been -said in this treatise on the causes of plague (which may apply also to -yellow fever)[177] that more would be superfluous, even if our limits -would admit of it. The dilemma (and it is equally insoluble let us -say what we will) stands thus: If the yellow fever is produced by the -effluvia of marshes, by putrid streams, or by any thing else, how comes -it to pass that it has been so frequent in the United States since the -year 1792 in comparison of what it was for 30 years before? Have the -American cities all at once become sinks of filth and nastiness? Have -the seasons been changed, or have the inhabitants given themselves -up at once to swinish intemperance and gluttony, devouring, like -savages, their meat half-rotten, half-roasted or half-boiled? From -some declamatory publications indeed one might be apt to think that -the authors certainly meant to bring such accusations against them. -But it undoubtedly will be found an hard matter to prove that the -general cleanliness of the country is inferior to what it was, or that -the people are less virtuous than they were before. Besides, has not -the vigilance of the magistrate, ever since 1793, been exerted to the -utmost to procure a removal of those nuisances from which the disease -might be supposed to arise? Yet their efforts have not availed; for -it is confessed that the attack in 1798 was the most severe ever -experienced. If cold could have exterminated the disease, certainly the -three last winters have been abundantly sufficient to do so; yet it -is certain that cases of the fever did appear in the end of December -last, when the cold must certainly have been deemed sufficiently -intense to put a stop to putrefaction of every kind. No wonder then -that people, unable to see the causes of these things, should have -recourse to something invisible, which they called the _constitution -of the atmosphere_. On this subject Dr. Haygarth of Chester makes the -following objections to the commonly received opinions concerning -epidemic constitutions of the atmosphere:[178] - - [177] See p. 166, & seq. - - [178] Sketch of a Plan to exterminate Casual Small Pox. - -“1. Dr. Odier of Geneva, in a letter to Dr. Haygarth, writes thus: -‘I believe it would not be difficult to prove that the state of the -atmosphere is in no respect the cause (of the regular epidemics of that -city;) for the villages and towns which surround it do not experience -the same epidemic all years as Geneva, although they are situated under -the same heavens, and exposed to the same vicissitudes of atmosphere.’ -2. Sydenham conjectures that some effluvia, issuing from the bowels of -the earth, produce epidemics. Were this true, it might advance one step -towards a solution of the difficulty by discovering a local difference -in the atmosphere. But it has never yet been pretended that any such -vapour was perceived. Yet every part of the earth must be capable of -furnishing it; as no portion of the whole habitable globe has been -discovered where the air could not propagate the small pox.... 3. Hence -we may safely conclude, that the slight variations of the same climate, -and the same season, must be altogether insignificant and nugatory. -What important difference of atmosphere can be supposed to exist for -weeks or months together in two neighbouring villages, or in the -adjacent streets of the same town? This remark is plainly applicable -to the propagation of the plague and other infectious distempers. Yet -the latest and most respectable authors continue to be misled by this -groundless hypothesis.” - -Objections of this kind do not solve the difficulty. The excessive -disparity of seasons with respect to the spreading of epidemic -diseases, the long cessation of them at some times, and their sudden -revival, as if with redoubled fury, at others, indicate the operation -of some cause invisible to us; but whether that cause resides in the -earth or in the air, cannot easily be known. As contagious matter seems -to operate by being received with the air into the lungs, it would -seem rather probable that the ultimate cause of epidemics resides also -in the air. Dr. Haygarth complains that the _vapour_ arising from -the earth, supposed to produce epidemics, should be invisible; but -the contagion of the small pox, or of any other infectious disorder, -is equally so. It must, he says, be diffused all over the earth. The -electric fluid is so; it issues from the earth in every part of its -surface, as is demonstrated by the common experiments of electric -machines; and there are the strongest reasons to believe that it issues -at some times and in some places in much greater abundance than others. -But enough has been said on this subject; we must now consider matters -a little more obvious. - -Though it is not easily seen in what manner the proportion of the -ingredients which compose the atmosphere can be changed, and we are -unable to discover the operation of the more subtile fluid contained -in it, yet we are certain that its constitution must be different in -different parts of the world. Islands, from their being surrounded -on all sides by the sea, must of consequence have an atmosphere -considerably different from that of the internal parts of continents, -where the air always passes over large tracts of land. Hence the -continent of America, being situated between the two vast oceans -called the _Atlantic_ and _Pacific_, must possess a constitution -of atmosphere considerably different from that of the Eastern. Of -consequence, the diseases of Europe and Asia, when transplanted to -America, or to the American islands, will probably, sooner or later, -assume a type different from that which they had in their own country. -Dr. Waterhouse has taken notice of this in his letter to Dr. Haygarth, -and thinks that it may hold good even in the small pox. “May not the -small pox (says he) operate differently in the two countries? It has -certainly had a different appearance, and required a somewhat different -treatment, almost every time it has come among us. That the difference -in the virulency of the small pox, observed at different periods, when -epidemic here, may be attributed to a peculiar constitution of the -atmosphere, no one seems to doubt; and why may not the difference, so -reasonably to be expected between the atmosphere of your island and -this continent, allow us to suppose that there is some difference in -the facility of receiving the infection?” This is also an important -consideration, and may throw some light on the cause, as well as the -mode of prevention, of this disease. - -Lastly, Dr. Seaman attempts to disprove the authenticity of some cases -which have been brought as positive proofs of the disease having -been received by infection. These belong not to us to consider; it -being impossible, by reason of the invisible nature of contagion, to -determine from a simple consideration of any patient’s case whether -it was infectious or not. Dr. Fordyce has laid down the proper rule -for judging in such cases.[179] One only of the instances brought -by Dr. Seaman therefore we shall mention, and that, not because it -proves any thing, but on account of its singularity. “Daniel Phœnix, -city-treasurer of New York, is supposed without doubt to have taken -his complaints from contagion: the corporation, some time past, having -issued into circulation, for the accommodation of the inhabitants, a -great number of paper penny bills, it has been concluded that he must -have received contagion through the medium of some bundles of these -bills, which he opened, that had been nearly worn out, to be exchanged, -and which he opened and examined to ascertain their amount some days -after he had received them.” The Doctor allows that he might have been -infected by the bills, but ascribes it to putrid effluvia.[180] - - [179] See p. 169. - - [180] Dr. Seaman, having at last, as he thinks, completely overthrown - his adversaries, and ranked himself with the _more considerate_ and - _reasonable_ part of the community, likens those who differ from him - to such as believe in the _power of imagination_ to mark the child - in the womb; and which he is of opinion that the women of America - would not disbelieve, though all the physicians on the continent - were to unite in persuading them to the contrary. On this subject - the writer of this treatise is happy at having it in his power to - declare himself of the same opinion with the ladies, and to offer, - in support of their opinion and his, the following fact. A pregnant - woman, having been employed in dyeing some cotton yarn, and rinsed - it, after it had got the colour, in cold water, threw it, while wet - and cold, about her neck. It touched the skin on the back part of the - neck, and part of her arm. The woman started, shivered, and instantly - said that her child would be _marked_. It happened exactly according - to her prediction. The back part of the neck, and corresponding part - of the arm to that which the cotton touched, being covered with - purple spots in the child, exactly similar to what might have been - made by drops of the purple liquid in which the yarn was dyed falling - upon the skin. Of this fact I am as certain as of my own existence; - having been present when the cotton was dyed, having heard the woman - call out as above related, and seen the child after it was born, and - particularly inspected the marks. - -Dr. Smith, in his letters to Dr. Buel, insists much on the vitiated -state of the atmosphere, and is at some pains to describe the persons -who were most subject to it. These, in 1795, were for the most part -_foreigners_; under which denomination the Doctor comprehends those -who came from other states, from the West Indies, and from Europe, or -who had not been many months or years settled in the city. The number -of citizens who suffered he does not suppose to have exceeded one in -seven; but he remarks, that, both among foreigners and citizens, the -severity of the disease fell chiefly on the poor. This mixture of -different nations he accounts, and with great probability, one of the -causes of the distemper. In confirmation of it he quotes Dr. Blane, -on the diseases of seamen, remarking, “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.” The same observation is made by Dr. Rush, -who, besides a general reference to the history of diseases, adds the -following remarkable fact: “While the American army at Cambridge, in -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, southern and middle 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.” - -This confirms the observation made in the former part of this treatise, -when speaking of the English embassy to China. It may likewise with -probability be assigned as one reason why large manufactories are -generally so unhealthy. In them there always is a collection of people -from many different and distant parts; and what holds good on a large -scale must also do so on a smaller one. But this does not disprove the -doctrine of contagion, but rather confirms it; for, if the discordant -effluvia rising from healthy bodies of different _constitutions_ can -_generate_ a disease, much more may we suppose the effluvia from sick -persons capable of continuing and propagating it. - -Now, let us consider the account, imperfect as it is, which we have -been able to collect concerning the appearance of the yellow fever on -the Western Continent. We have seen (p. 377, n.) that, at the time -the plague was in England, five of the Americans were transported to -that country; two of whom, after staying some time in England, were -sent back, with other strangers, to America. This first colony having -failed, another was sent; the Indians went to war among themselves, -and the yellow fever is supposed to have made its appearance. Here a -suspicion naturally arises, that a slight pestilential taint had been -imported by some of these strangers, and that what would have been the -_true plague_ in Europe or Asia, by reason of the peculiar constitution -of the atmosphere in the New World, there became the _yellow fever_. -The same may be said of the original importation of it into Martinico. -Sauvages expressly says it was the _plague_ which was imported. Moseley -and others deny that any such disease as the yellow fever exists in -Siam; and indeed it seems at any rate to be a new disease. It seems -_possible_ that diseases may change their nature; and Dr. Ferriar has -given a dissertation on the conversion of diseases. As therefore the -true plague never made its appearance in America or the West Indies, it -seems not unreasonable to suppose that these countries are incapable -of receiving it, but that the pestilential poison, when transported to -the Western Continent, may assume a different, and in many respects -an opposite, nature; the two diseases being thus like the opposite -poles of a magnet, scarce agreeing in any thing but the common work of -destruction. - -It is needless to spend time in attempting to investigate the cause -of this disease appearing at different periods. That of 1793 has been -the most remarkable and the most destructive; the disease having never -since that time ceased its ravages. Previous to its appearance at -Philadelphia that year, Dr. Rush observes, that, “during the latter -part of July, and the beginning of August, a number of the distressed -inhabitants of St. Domingo, who had escaped the destruction of fire -and sword, arrived in the city. Soon after their arrival the influenza -made its appearance, and spread rapidly among the citizens.” The -yellow fever quickly followed; for on the 5th of August the Doctor -mentions his being called to his first patient. To the same purpose -we are informed by Dr. Clarke that “the fever made its appearance in -Dominica about the 15th of June, 1793, a few days after the arrival of -a great number of French emigrants. They were not sick, and the fever -had not made its appearance in Martinique when they left it. From the -1st of July to the 1st of October it was computed that eight hundred -emigrants, including their servants and slaves, were cut off by this -fever; and about two hundred English, including new comers, sailors, -soldiers and negroes, all fell victims to it in the same space of time. -Few new comers escaped an attack, and few recovered. It spared neither -age nor sex among the Europeans and emigrants; and not only the people -of colour from the other islands, but the new negroes who had been -lately imported, were all attacked. Such as had been long on the island -escaped.”[181] - - [181] Medical Review, vol. iv. - -These facts seem to point out one of the causes, and very probably a -principal cause, of this dreadful distemper. They show very evidently -that there is a connexion between war and diseases. It has formerly -been attempted to point out a natural connexion between the horrid -practices of men, on these occasions, and the production of disease. -These investigations, however chimerical they may be reckoned, are yet -supported by many facts, which undoubtedly prove that mankind cannot -always maltreat and torment one another with impunity. The affair of -the Black assizes, and Old Bailey session, in 1750, shows, that by -confinement and bad usage the human body, without being apparently -deprived even of health, may become poisonous to those around it, -and produce dreadful diseases. In like manner the inhabitants of St. -Domingo, having been put to the most dreadful distress, became properly -fitted for spreading destruction wherever they went.[182] It is even -probable that, in proportion to the degree of distress suffered by -these people, the disease communicated by them will be malignant; nay, -that new diseases may spring up, which cannot be treated with success -by any method yet known to physicians. With regard to the disease in -question, it seems plainly to have from some cause or other received an -additional malignity. Dr. Chisholm says that what he calls the Boullam -fever was supposed in Grenada to have been the common yellow fever of -the West Indies engrafted on the jail fever. Dr. Lind, Dr. Jackson, and -even Dr. Chisholm himself, agree that the former is not infectious: -but from what has been already said the evidence seems to prevail in -favour of the opinion that the latter is so. Should we then allow that -two kinds of this fever might exist at the same time, in one city, the -difficulty would be at once removed. But this has been reckoned by -many, particularly by Dr. Rush, as totally inadmissible; and indeed it -is a maxim consonant to general experience, that two epidemics cannot -exist in one place at the same time, or that two diseases can scarcely -exist at once in the human body. This however must be understood, -principally at least, of acute diseases, or such as affect the whole -system; for if any disease of a particular part shall take place, it -does not seem impossible that a fever may be superadded to such local -disease. The following considerations may perhaps throw some light on -the subject: - - [182] Dr. Moseley who has written at some length on the interruption - given to military operations by diseases, gives an account of general - Dalling’s expedition in 1780, where the English troops, confined - in the castle of St. Juan, in an unhealthy situation on the river - Nicaragua, were cut off by diseases; but these were fluxes and - intermittents. He doth not mention the yellow fever among them. He - tells us indeed that the troops under general Garth brought the jail - fever along with them, and that those who returned to Jamaica were - harassed with obstinate intermittents, with diarrhœa, dysentery, or - painful enlargements of the liver and spleen. - -It appears from the experiments of Dr. Adair Crawford, that, when -animals are immersed in hot water, the blood drawn from a vein is of -a florid red colour. In summer it is likewise observed to be of a -more florid colour than in winter. If heat thus gives a more bright -red to the blood, it undoubtedly also makes it more fluid, and in -proportion to its fluidity it will likewise become acrimonious; though -this acrimony is not necessarily connected with a florid colour, as -the blood of the arteries is not more so than that in the veins. -In the yellow fever, however, the blood sometimes, towards the end -of the disease, becomes endowed with extreme acrimony. Dr. Smith, -in one of his letters to Dr. Buel, observes, that “blood drawn in -the fever of 1795 was remarkably _wanting_ in floridity; especially -what was evacuated towards 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 -discolouration and inequality on its surface.” He observes also, -nay, considers it as _demonstrated_, that the yellow fever _is not_ -a disease of vascular debility, and he says that it is attended with -an astonishing _fluidity_, or, as it is called, _dissolution_ of the -blood. Every one therefore who comes from a cold to a warm climate must -in some degree or other have his blood liquefied, and in a certain -proportion rendered more acrimonious than before. This acrimony may -be undoubtedly augmented by certain causes, and by none more probably -than immoderate drinking of spiritous liquors. Every one therefore -who comes from a cold country to a warm one, especially where the air -is also moist, may consider himself as already diseased, at least in -comparison with what he was when at home. For the blood is now exposed -to a greater degree of heat, and consequently is about to absorb, -or rather may be considered as in the act of absorbing, more, and -consequently of changing from a thicker to a thinner or more fluid -state; the latter being the natural situation of the blood in warm -countries. Dr. Rush, in his inquiry into the proximate cause of fever, -has accounted for the dissolved appearance of the blood in malignant -fevers to a tendency in the blood-vessels to paralytic affection. He -says that “it (the dissolution of the blood) begins in the veins, in -which muscular action is more feeble than in the arteries. This has -been proved by Dr. Mitchill in his account of the yellow fever in -Virginia in 1741. He found the blood to be dissolved when drawn from -the veins, which, when drawn from the arteries of the same persons, -exhibited no marks of dissolution.” This, as the Doctor observes, “is -a fact of great importance;” only we must remember, that, in every -thing relative to the human body, when we find two phenomena constantly -accompanying each other, it is extremely difficult for us to determine -which is cause or effect. Instances of this often occur; and in the -present case the dilemma is as great as any other. Though, from the -testimony of Dr. Mitchill, we cannot doubt that in yellow fever the -dissolution begins in the veins; and though it is likewise extremely -probable that this dissolution is attended with a paralytic tendency, -we cannot know whether the dissolution is the cause of the paralytic -tendency, or the paralytic tendency the cause of the dissolution. The -point, however, is of no importance. We see that in warm climates the -blood of a person newly arrived has a natural tendency to dissolution, -and of course the veins to the paralytic affection just mentioned. -The liver therefore, which is supplied with blood by a large vein -branched out like an artery, and terminating in other veins to carry -back the blood from the former,[183] must be much more affected than -any other part of the body; and this indeed seems a very probable -reason why all those who come to warm countries become much more -inclined to bilious complaints, which denote an affection of the liver, -than they were before. This hepatic affection may very probably be -greatly augmented, in new comers, by various causes. One of these is -hard labour under a greater heat than they have been accustomed to; a -second, that in the West India islands they have not access to that -plentiful supply of fermented liquor, abounding in fixed air, which -they had at home. This, though not generally taken notice of, is far -from being a matter of little consequence; for, though emigrants from -Britain and Ireland have been for the most part accustomed to drink -spiritous liquors, yet fermented malt liquors certainly constitute -the principal part of their drink. The total want of these, and the -substitution of ardent spirit and water, must certainly be detrimental, -even though they keep within the bounds of moderation, and much more -if they do not. Dr. Moseley relates,[184] from Dr. Irving, that, in a -bad kind of intermittent which broke out among the troops in service -on the Spanish main in 1780, “nothing was so grateful as _London -bottled porter_. Wine was neither so much desired by the sick, nor -so serviceable in corroborating and keeping up the powers of the -stomach; which, like the rest of the body, was soon reduced, from the -slightest indisposition, to the lowest state of debility.” A third -cause is no doubt their frequently drinking too freely of spiritous -liquors, perhaps not of the best quality; and which, as they are -neither conjoined with the fixed air nor with the mucilage which as it -were inviscate and blunt their force in malt liquors, cannot fail of -exerting their deleterious properties in a very remarkable manner. - - [183] See p. 94. - - [184] Treatise on Tropical Diseases, p. 173. - -From these and other causes there must necessarily arise a -predisposition to hepatic diseases; and this predisposition cannot -be removed until the blood has assumed the state of fluidity proper -to the climate in which they are, and the body has acquiesced in the -change. They are then said to be _seasoned_ to the climate; and it is -seldom that this seasoning takes place without a disease; indeed so -seldom, that the first illness which happens to seize them after their -arrival is called the _seasoning_. Dr. Trotter indeed gives a very -different account of this seasoning. He considers those who come from -a cold to a warm climate as having a redundancy both of excitement -and excitability, and says that “to _wear out this accumulated -excitability_ by slow and gentle gradations is the grand explanation -of the word _seasoning_: it is the _secret_ which constitutes the only -difference between the inhabitants of England and Jamaica. The yellow -fever of the West Indies therefore, as it appears in the body of a raw -European, is a disease of the _utmost excitement_, in a constitution of -_accumulated excitability_; where a tense fibre and dense blood permit -it to be carried to the highest pitch of inflammatory tendency; which, -from the nature of the animal economy, speedily exhausts the powers of -life, even in a day or two, inducing putrefaction and death.” - -Explanations of this kind may edify those who understand them; -but, though we should declaim ever so much about excitement and -excitability, it is plain, that, in every one who comes from a cold -country to a warm one, the liver is affected in a manner that the rest -of the body is not. In some constitutions, or from exciting causes -in any constitution, this affection of the liver may be augmented, -and no doubt at last produce a bilious fever, which may be varied -in a number of ways, according to the nature or the energy of these -causes. The pure bilious fever, being of itself properly a local -affection, may not be contagious; and we find it generally agreed -among physicians that the common yellow fever of the West Indies is -not infectious. Nevertheless, it seems by no means improbable that -from certain circumstances contagion may be joined with it, and it may -then spread and infect, even as the most deadly plague. Dr. Crawford -relates, that, in the year 1770, a new kind of fever broke out in the -Middlesex Indiaman, of which many died. It is not said that the disease -was contagious; but, on opening the bodies of some who died, the liver -was found enlarged, and of a more florid colour than it ought to be. -It cannot be deemed impossible that contagion, even that of the true -plague, might be mixed with this fever, which (as the affection of the -liver was probably the original disease, might have been accounted -little other than symptomatic) would then have assumed very malignant -symptoms. - -We might now say that we have got to the end of our subject. Having -so amply discussed the question concerning contagion, and stated the -principal part of the evidence against it, it seems proper to conclude -the section with a short history of the disease in the malignant -form it has assumed in the United States since the year 1792. Still, -however, it is necessary to say something further of one or two of the -causes which have been commonly assigned as necessarily inducing this -disease. These are, 1. Extreme heat, and, 2. Marsh effluvia. The effect -of the former has already been partly considered as a predisponent -cause of yellow fever: but it doth not appear that merely from this -cause the disease has ever been produced. It hath indeed been observed -by very intelligent physicians, that in Virginia the remitting fever -has often been brought on by mere exposure to the sun. Dr. Oliver of -Salem hath obligingly informed me, that he has “in more than one -instance been seized with that disease after riding in the sun;” and -that an eminent practitioner in Virginia had informed him that he had -also more than once suffered in the same way. Drs. Taylor and Hansforth -observe, that, when the remitting fever proves mortal, it is generally -attended by sickness and perpetual vomiting; which is the termination -of the yellow fever. The above evidence is decisive with regard to -heat being able to produce a remittent, but cannot exactly apply to -the yellow fever, which has no remissions. Two sailors indeed, lately -brought from a coasting vessel to the Salem hospital, were attacked -with violent symptoms of yellow fever without having been, as is -said, exposed to any infection. But evidence of this kind cannot be -supposed to be incontrovertible. We have already seen the difficulty of -ascertaining _facts_; and if it is difficult to prove that contagion -_has_ been received, it must be still more so to prove that it _has -not_. The persons in question had both worked during a very hot day -in a vessel’s hold, they afterwards sat exposed in the damp air of -the evening on the deck until 10 o’clock at night, and then slept -in the vessel’s cabin with the windows open. One of them was seized -in the night with a most violent pain, and the other on the morning -succeeding. It is said that about 11 months since this vessel was at -New York, and that a person on board had the yellow fever; it is also -alleged that the vessel was not purified, and that the beds remained on -board. It has therefore been by some conjectured that the disease might -have been derived from this source. - -Dr. Ramsay, in a letter to Dr. Currie of Philadelphia, censures Dr. -Lining for saying that the yellow fever was imported into South -Carolina. “The greater yellowness of the skin (says he) appears to be -the only circumstance in which it differs from the bilious remittent -fevers of hot climates, or very hot seasons of any climate.” Our -author also censures Dr. Lind of Haslar,[185] who, he says, has been -misled by the _misrepresentations_ of Dr. Warren and others. He also -gives into the opinion that contagion acts only by contact, or at a -very little distance; but this subject we cannot enter farther into -at present. If we can believe Dr. Moseley, the sure criterion by -which the yellow fever may be distinguished from any other is, that -the former hath no remissions.[186] If solitary cases of it appear in -Carolina and the southern States every year, this will not prove that -the disease was generated in the country, any more than that the plague -was generated in London, because it appeared there for many years -successively. - - [185] If physicians censure one another at this rate, how is it to be - determined who gives a true state of the matter? - - [186] This position of Dr. Moseley is not universally received. The - meaning of the word _remission_ certainly is a temporary abatement, - and implies a recurrence, of the same symptoms which originally took - place. Dr. Moseley describes the yellow fever as beginning with one - kind of symptoms which suddenly cease and are succeeded after a - certain interval by others of a quite different kind; and he claims - the discovery as his own. If he be right in this description, the - yellow fever is certainly not a remittent; if otherwise, it must be - difficult to establish any true distinction between them. - -But, if the heat of the sun cannot produce the true yellow fever, it -can kill suddenly without any fever whatever. This is said by Dr. -Moseley to be less frequent in the West India islands than on the -eastern and western continents. He says that he has felt as great -inconvenience from the sun’s heat at Venice, Naples, Rome, Montpelier, -and in Virginia, as in the West Indies;[187] but he concludes that the -_transitions_ from heat to cold are more pernicious to the human body -than any continued heat, however violent. - - [187] At Strasburg, in Germany, our author says that he saw a man - who had been an idiot for more than a year from a stroke of the sun. - The 8th of July 1707 was so hot in England that many people died at - their work, and many horses and oxen were killed by the sun’s rays. - In 1743, _eleven thousand_ people perished from the 14th to the - 25th of July in the streets of Pekin in China. On the 30th of July, - 1705, the heat at Montpelier was so great, that eggs were roasted by - it. Chalmers, in his account of the weather and diseases of South - Carolina, says, that he has seen a beef-steak, laid on a cannon for - twenty minutes, deprived of its juices, and overdone by the excessive - force of the sun’s rays. - -With regard to the effluvia of marshes, it is not denied that they -produce fevers, but those fevers are of the intermittent or remittent -kind. Dr. Smith indeed, in the first volume of the Medical Repository, -labours to prove that the plague described by Thucydides was not -essentially different from the fevers which sometimes prevail in -North America, and that it had its origin from marsh effluvia and the -ravages of war. That this distemper was not the plague described by -Russel we may gather from a single circumstance: for Russel tells us -that _sneezing_ never occurred in the plague described by him,[188] -while Thucydides says that it was one of the common symptoms of his. -Neither does the description of it (Appendix No. 1) at all agree with -any of the accounts of the yellow fever we have. The climate of Attica -no doubt was variable, and may in this respect resemble that of North -America; but so is the climate of China, yet no such diseases are -there produced. The Doctor concludes that the distemper originated -from _local_ causes; but the difficulty we find in proving such origin -of diseases in our own days, and in the country where we reside, must -certainly make us look upon the proofs which can be brought for the -local origin of a disease which happened two thousand years ago, and in -a distant country, as very equivocal. The following extract from the -Paris Medical Memoirs may be adduced as a proof of the intrinsic power -of marsh mud to produce fevers. It is contained in a paper written by -Dr. Perkins of Boston. “A farmer was in the practice of spreading, -upon about thirty acres of land, some new marsh mud, from October to -April annually, to increase the fertility of the soil. In the summer -of the third year, those inhabitants who lived to the northward and -eastward of the place were attacked with a very malignant fever, which -generally proved mortal. What is a proof that the marsh mud was the -cause of the disease is, its extent, which was not more than a mile and -an half from the farmer’s house, in the direction of the southerly and -westerly winds. Perhaps had this marsh mud been washed by plentiful -rains, the danger would have been less. Something like it happened to -the inhabitants of the marshes _in East Sudbury_, (les marais situes -a l’est dans le Sudberg) where the passage for the waters was too -deep, and too confined. In regular seasons they were attacked with -simple intermittent fevers; but, after wet seasons, there prevailed -among them malignant fevers, and very obstinate remittents. Since the -marshes have been drained, the inhabitants are no longer subject to -fevers, and are as healthy as those of others places. We know that -there are local epidemics, which are produced by a low, wet and rich -soil; such are, probably, those which prevail in the lower part of New -York, which, according to the informations obtained by Mr. Perkins, is -more unhealthy towards the end of the summer than the other part of -the city, and whose inhabitants are subject to diseases of a putrid -_caractere_. - - [188] See the Table. - -“It appears, from several observations, that the most mortal epidemic -fevers are not commonly produced by causes operating immediately; the -cause often existing several months before the disease even appears.” - -The other arguments used by Dr. Smith in his letters to Dr. Buel -proceed upon the state of the city, the mode of living, &c. and the -condition of most of the emigrants, their bad accommodations, and -especially their abuse of spiritous liquors. The neglect of bathing -is also much complained of, and a comparison made with the conduct of -the French in this and other respects, greatly to the advantage of the -latter. - -Drs. Taylor and Hansforth consider the disease which took place in -Norfolk in Virginia as only an higher degree of the common remittent -fever which usually prevails, and ascribe it to the long-continued -heat, putrescence, &c. Some French ships were said to have brought the -disease, but these arrived “so long before the disease appeared, that -(the Doctors think) it would be absurd to suppose even a possibility -of its being derived from them.” Mr. Webster adds, in a note, that the -French corvettes, three of which squadron were taken by the Thetis, -capt. Cochran, “anchored in Hampton Roads, May 18th. The fever did -not appear in Norfolk till August. Captain Cochran’s crew, however, -_took the fever from the French prisoners_, and twelve of them died -before the Thetis reached Halifax.” This is certainly a suspicious -circumstance. - -Dr. Ramsay, in his letter to Dr. Mitchill concerning the same -distemper, observes that it was confined almost entirely to foreigners, -of whom he gives a very unfavourable account. The situation of the -town, putrescence, &c. are likewise brought in for a share, as well as -the season, which had been uncommonly warm. - -These are the principal evidences that have been brought for and -against the origin of the disease which since 1792 has raged with such -violence in the United States. Innumerable pieces have appeared in the -Newspapers on both sides of the question, the most remarkable of which -are the letters of Mr. Noah Webster to Dr. Currie. These, however, -we cannot now consider, as we cannot expect indeed that they should -contain any thing else than a fuller detail of what has already been -set forth. Mr. Webster besides, in his letters, owns that he is not a -medical man; nay, that he had not “read above three or four medical -books.” I hope therefore the reader will excuse the preference given in -this treatise to the writings and arguments of those who are acquainted -with medicine both by reading and practice. The dispute between the -College and Academy of medicine can be settled only by themselves; the -only safe line of conduct seems to be to admit both doctrines, and -to take every method of preventing the introduction of the disease, -whether supposed to be generated or imported. - -Whether the distemper which has so fatally prevailed since the year -1793 be naturally connected with the troubles in Europe and the West -Indies or not, it is certain that it has been cotemporary with them. -In New York the disease appeared in 1791, but we are not furnished -with any particular accounts of it at that time; nor does it appear to -have made any great ravages, either on the continent or the West India -islands, till 1793. At this time the war raged in Europe with fury; the -French royalists were every where driven out, and distressed in every -possible way. Desolation and slaughter prevailed at St. Domingo, while -an unbounded intercourse took place between the United States and all -those nations who were involved in the calamities resulting from the -unbridled passions of man excited to their utmost pitch of ferocity. -In the midst of this general commotion the fever broke out in the West -India islands, appearing first in the island of Grenada. We have seen, -that, according to Dr. Chisholm, this disease was brought to Grenada in -the Hankey, from the coast of Africa, on the 18th of February. About -the middle of April it began to appear on land. In the beginning of May -it reached a detachment of the royal artillery lying at a distance from -the focus of infection, “but (says Dr. Chisholm) by the communication -which the gunners in Fort George had with the 45th regiment, and the -predisposition of the men to receive the infection as far as that could -be induced by excesses in drinking, and other irregularities.” About -the first of June the disease began to appear among the negroes of -the estates in the neighbourhood of the town, but never attacked them -with the same violence that it did the white people. During the months -of May, June and July, it appeared in different parts of the country; -being, as our author supposes, carried thither by infected persons. -From Grenada, the Doctor says, the disease spread to the islands of -Jamaica and St. Domingo, and from the latter to Philadelphia, “by -vessels on which the infection was retained by the clothes, more -especially the woollen jackets, of the deceased sailors.” - -This account of the origin of the fever at Philadelphia, as we have -already seen, is inadmissible by those who deny the contagious nature -of the disease; but as the latter have never given any distinct account -of its rise, or shown why it should first appear in one island and then -in another, instead of beginning in them all at once, we must adhere to -that of Dr. Chisholm, till we are furnished with a better. - -In Philadelphia it has already been observed, that Dr. Rush was called -to his first patient on the 5th of August; but Mr. Carey mentions a -child of Dr. Hodges “as probably the first victim;” who was taken ill -on the 26th or 27th of July. This same month the unfortunate fugitives -had arrived from Cape Francois; and we have already seen, from Dr. -Clarke, that the arrival of some of their fellow-sufferers in Dominica -had the same dreadful attendant. Whether the disorder is to be ascribed -to the arrival of these people in either place, the reader will judge. -Other vessels are charged with having imported the same; but, facts -being disputed, we cannot enter into the controversy. - -The disease began in Water-street, to a particular part of which, near -to that where the suspected ships lay, it was for some time confined, -but did not excite public alarm till about the 19th of August. From -this time to the 25th of the month the attention of the citizens was so -much aroused, that they began to move into the country; and on the 22d, -the city commissioners were peremptorily ordered by the mayor to keep -the city clean. On the 26th the College met, and addressed the citizens -on the subject; recommending such means of preventing the spreading -of the sickness as to them seemed most proper. Among these were, to -avoid any intercourse with the infected, to live temperate, keep their -minds easy, and to avoid fatigue. Lighting of fires was particularly -disapproved of; but the burning of gunpowder, and the steams of vinegar -and camphor, were recommended for infected rooms, and for using on -handkerchiefs, and in smelling-bottles. - -In consequence of this address also the bells were stopped from -tolling, the constant noise of which had greatly contributed to -increase the public alarm. The people, who had been in use to light -large fires in the corners of the streets, being forbid on the 29th -by proclamation to do so, had recourse to firing of guns; which -was at last carried to such excess, that it also was prohibited by -proclamation on the 4th of September. - -Notwithstanding all these precautions, the distemper continued to -increase in such a manner as to produce the most dreadful terror and -dismay. “Indeed (says Mr. Carey) it is not probable that London, at -the last stage of the plague, exhibited stronger marks of terror than -were to be seen in Philadelphia, from the 26th or 27th of August, -till pretty late in September.” This produced scenes of distress -unparalleled till this time in the city, and of which many instances -are to be met with in Mr. Carey’s account. It cannot, however, be -doubted that the violence of the distemper, its contagious nature, -and the consequent danger of visiting the metropolis, were greatly -exaggerated. Thus terror was struck throughout all the adjacent states. -At Chester-town, in Maryland, a meeting was held, on the 10th of -September, in consequence of which the Eastern shore line of stages was -quickly stopped. On the 10th of the same month it was ordered by the -mayor of New York that the names of all such persons as had arrived or -should arrive from Philadelphia or other place, by land or water, that -were or _should be sick_, should be reported to him, that those who -were sick of infectious diseases might be removed out of the city. Next -day the governor proclaimed that all vessels from Philadelphia should -approach no nearer than Bedlow’s island, about two miles from the -town, till license was given. But these precautions not being deemed -sufficient, a night watch was established, and next day an address -was published by delegates, purporting the insufficiency of all that -had been done, and again calling upon their fellow-citizens to exert -their utmost vigilance in detecting the fugitives from Philadelphia. -Various other resolutions were passed in New York; and throughout the -whole continent such measures were taken as seemed most likely to -proscribe the unhappy Philadelphians, and to prevent their having any -place of refuge from the sickness they so much dreaded. On the 1st -of October, however, the inhabitants of Springfield, in New Jersey, -passed a resolve, offering their town as an asylum for the people -of Philadelphia, and directing an hospital to be provided for the -reception of such as might fall sick. Similar resolutions were passed -by the inhabitants of Elizabethtown, and Elkton in Maryland. - -The distemper in the mean time arrived at the most dreadful height -in Philadelphia, and almost all those who could take the charge and -burthen of public affairs were absent. An hospital had been established -at Bush Hill, but, for want of superintendence, had fallen into such -disorder, that the poor chose rather to deny their illness than to -be sent to it. On the 15th of September, however, Stephen Girard, a -native of France, and a wealthy merchant, together with Peter Helm, -a native of Pennsylvania, offered their services as superintendants. -By their exertions the credit of the hospital was soon retrieved, and -such numbers demanded admittance, that it became necessary for each -candidate to procure a certificate from a physician, that the patient -really laboured under a malignant fever. In a short time the affairs -of the city went on, in every respect, with as much regularity as -could be expected; but the mortality increased throughout the month -of September, and the three first weeks of October. Great hopes were -entertained from some cold and rainy weather in the end September; -but they proved illusive, and the disease became even more fatal than -before, till the 26th of October, when it suddenly ceased, as Mr. Carey -says, with hardly any rain, and a very moderate degree of cold. “That -day (adds he) was as warm as many of the most fatal ones in the early -part of the month. To account for this is perhaps above our power. In -fact, the whole of the disorder, from its first appearance to its final -close, has set human wisdom and calculation at defiance.” During the -time of this calamity Mr. Carey computes that _seventeen_ thousand left -the city, and _four_ thousand and thirty-one perished. - -This city suffered another attack in 1794 but far less severe than -before. In 1795 and 1796 the disease seems scarcely to have made -its appearance; but in 1797 it revived, and, in 1798, broke out -with greater fury than even in 1793. No particular history hath -been published of this last severe attack. We know only in general, -that, though a much greater number of the inhabitants fled out of -town in 1798 than in 1793, the number of deaths was almost as great; -being estimated at three thousand eight hundred and forty-one. Great -disputes, as has been observed, have taken place concerning the -origin of these diseases; on which we shall only further remark, that -if, after such repeated and dreadful experience of the bad effects -of allowing putrid matters to accumulate, such quantities could be -collected as to produce the very fatal sickness of last year, it argues -a most unaccountable, and indeed incredible, insensibility on the -part of the people, as well as remissness on that of the magistrates; -and this perhaps may be accounted as strong an argument in favour of -contagion as can be adduced. - -That such a violent distemper should cease all at once, is indeed not -to be expected; and we have already heard of its again appearing in the -city. Fear has been very justly excited, there and in other places; -but it is to be hoped that the remarkable coolness of the season will -operate favourably in preventing any very violent attack for this year. - -New York has also suffered very considerably from this disease. Here it -appeared in 1791, in the autumn, and in a part of the town remarkable -for its vicinity to a collection of filth. In 1792 it made no progress; -and in 1793, though some died of it who fled from Philadelphia, it -did not spread. In 1794 it returned with considerable violence, and -with still greater in 1795. In the history of this disease by Dr. -Seaman,[189] he takes notice that in July and August an unusual number -of persons suffered from drinking cold water, and some fell down and -died in the streets; but the Doctor supposes this to have happened -rather through the excessive heat of the sun than the drinking of -water. As the disease came on, all others gave way to it, even “_the -common remitting bilious fever_;”[190] and in the month of July some -cases occurred. We have already had occasion to take notice of the -death of Dr. Treat, who was taken ill on the 22d of July; but before -that time, on the 6th of the same month, Dr. Seaman says that, in -conjunction with this gentleman, he had visited a patient “affected -with all the full-marked and decided symptoms of an highly malignant -yellow fever.”[191] The disease continued to gain ground in August, -and became extremely violent in that and the following month; but, -according to our author, the low ground in the southeast part of the -city was the “grand centre of the calamity, diffusing its effects like -diverging rays, aiding, by its most powerful influence, different -secondary centres, already smoking hot, to flame out its pestiferous -_operations_.” In this part of the town five hundred died in three -months. - - [189] Med. Repos. vol. i, p. 316. - - [190] Webster’s Collection. - - [191] This proves that Dr. Treat _was not_ the first person who - suffered by this disease but it will not prove that the disease was - not imported by capt. Bird’s vessel; for the fever spread in the - vicinity of the vessel, not of the almshouse, where the first patient - was carried. - -The attack at this time did not arouse the people to a proper sense of -their danger. As formerly, the origin of the disease in 1795 had been -attributed to the filth of the city. Next year it was attributed to -the same, and so in 1797 and 1798. This last year, particularly, it is -said to have originated partly from great quantities of putrid beef -and fish, collected for exportation, and which could not be exported. -In Mr. Hardy’s account of this fever, it is calculated that there died -in 1798 two thousand and eighty-six; but that, if it were taken into -the account how many left the town and died in the country, the number -would amount to between two thousand four hundred, and two thousand -five hundred. - -It is not in Philadelphia and New York alone that this distemper -has prevailed. Boston, Newburyport, Portsmouth, Portland, and even -detached spots in the country, to which it is not possible to trace any -infection, have felt its ravages. At Salem also, where the disease was -never known before, twenty-one cases, including some doubtful ones, -appeared in 1798; and of these, eleven proved fatal. In 1796, when -it prevailed in Newburyport, it was supposed to have been introduced -by a vessel from the West Indies; and, according to Dr. Coffin, the -opinion would have been incontrovertible, had not a large quantity -of fish-garbage been collected at the place where the vessel landed; -so that, though the disease spread from that place, it could not be -known whether it proceeded from the vessel, or the fish, or both. -It seems now unfortunately to be the case, that where this disease -once gets footing it cannot easily be eradicated. If we suppose it -always to be imported, the continual intercourse with the West India -islands will account for this; but the extreme difficulty, or rather -impossibility, of procuring an account of facts or even a single fact -which cannot be controverted, renders every thing that can be said -upon the subject uncertain and precarious. In the case of New London -particularly, where 81 persons were destroyed by it last year, neither -importation nor collections of filth could be assigned as the cause; -nevertheless it began near a _wharf_; but Mr. Holt, in his account of -the disease, thinks it was most probably owing to the mere heat and -dryness of the season. On the other side of the question, however, we -must still insert Dr. Brackett’s account of the origin of the disease -at Portsmouth, in answer to a letter from Dr. Oliver of this place. - -“The yellow or pestilential fever made its first appearance at -Portsmouth, about the first of August last. Eight or ten days before -that time a vessel arrived here from Martinico, and brought a French -family (four or five in number.) This vessel, before she left the West -Indies, had two sailors taken sick (as the captain informed me) one of -whom died on the passage home; the other was on the recovery when the -vessel came into this port. - -“There was not, nor had not been for a long time before, any fever in -this town. Two or three days after, I heard that one or two men, who -were labourers (and probably had been on board, as they lived nigh -where the vessel lay at the wharf) died suddenly with fever, but am -uncertain whether with yellow fever, as I never saw them. The first -of August, the owner, whose house was about four or five rods distant -from the vessel, had a child of four or five years of age taken sick; -the next day I visited it, and two days after he died. The symptoms -appeared like a cholera morbus--sick stomach, and frequent puking of -black bile. The day before he died a brother of his, fifteen years -old, was taken ill, and had much the same symptoms, only greater -inflammation and distress. He was blooded freely, took calomel, bark, -&c. He died five days after sickened. Between the 8th and the 20th of -August, four or five of the other children and servants were taken with -the same symptoms, and recovered. On the sixteenth day, a daughter, -seventeen years of age, was taken down with the same disease: she was -treated in the same manner, with bleeding, mercury, warm bath, bark, -&c. and died on the 9th day. This patient had a great discharge of -blood from her mouth and gums for three days before she died. One or -two more of the family had it afterwards, and recovered. All these -patients took the infection, I believe, about the same time. Many -others in that neighbourhood had the fever during this time, about one -half of whom died: out of forty-six patients I lost fifteen. If I could -procure a soreness of the fauces, by administering calomel in small -doses, and rubbing it in the gums, or by frictions on the legs and arms -with mercurial ointment, the third or fourth day, I was sure of their -recovery. - -“How many died of this disease in the whole, I have forgotten; as, -through fatigue, and debility of body and mind, I kept no notes: I -think rather more than half of those who had it. The fever agreed in -every symptom, almost, with that described by Dr. Rush and others. The -contagion did not appear to be propagated, as the largest number who -had the disease were seized in the month of August, and lived in the -streets only which communicated with the wharf where the vessel lay, -and the beach where she was graved. These streets are in the highest -part of the town, and always esteemed the most healthy, and as free of -putrid substances as any in it. In the months of September and October -the fever was followed by dysentery, and spread through almost every -part of the town and its environs. There has been no case of fever -or dysentery since last fall: this place, during the winter, and -summer thus far, has been uncommonly healthy; and it appears likely -to continue so, if the committee of health should not be remiss in -their duty. Thus, without any comments, I have endeavoured to give -you a short history of the pestilential fever, as it appeared here -last summer. The ideas, you may communicate to the author of the book -intended to be published.” - -The following letter from Dr. Warren, which he obligingly sent to two -physicians in Salem, gives an accurate account of the distemper which -prevailed in Boston last year: - -“I should immediately have answered your favour of last month, but for -a wish to give you as complete an account of the causes and mortality -of the late epidemic as could be collected. - -“There were a number of suspected causes, which, though concealed -during the prevalence of the disease, it was hoped would be developed -after the agitation of the public mind had entirely subsided; and I -was in expectation that some regular returns would have been made of -the numbers who had passed through the disease, and of those who had -died with it, so that some estimate might be formed of its malignity -and mortality; but such returns have not yet been made, and it is -therefore impossible to obtain any satisfactory evidence on those -heads. I suppose the number of deaths to have been rather short of two -hundred; but this is only a rude guess, and should not be relied on in -forming any consequential deductions on the subject. I shall, however, -now offer such an account of the disorder as my present materials have -enabled me to prepare. - -“The first unequivocal appearance of the malignant fever, in the town -of Boston, was on the 20th of July 1798 (though one family had been -attacked with a fever, attended with unusual symptoms, as early as -the middle of June; but, as no other instances occurred for so long -a time, of an alarming nature, some doubts may perhaps be justly -entertained of the identity of the affection.) Three or four cases -only, I believe, happened between this and the latter end of the month. -The two first of these were young men employed in stores directly -opposite to each other, on Green’s wharf, near the Town-dock. A few -days after, three or four persons were seized with the same complaint, -whilst following their respective occupation in Market square, on the -east and south sides of Faneuil Hall, or the Market-house. In the -beginning of the month of August several persons were taken sick in -the same neighbourhood, chiefly young men between 16 and 24 years of -age, whilst employed in stores and counting houses there situated. The -stores in Merchant’s row, extending from the Market to State-street -were more especially visited with the disease, and, in the course of -the same month, a family at the bottom of State-street, and several -persons at Oliver’s dock, were taken sick. At this place a kind of -bason is formed between a point of the town projecting from Fort hill, -and the Long wharf, which is constantly receiving the offals of fish, -and other animal substances, which from its situation could not be -washed off by the waters contained in it. This spot is remarkable for -having been the residence of most of the persons first attacked with -the bilious remittent fever of 1796. To the latter end of this month -the number of sick continued to be increasing; but the attacks were -principally confined to the above-mentioned quarters, till at length -the disease appeared on the south side of Fort hill, at some distance -to the southward of Oliver’s dock, leaping, as it were, over the summit -of the hill, without lighting upon the inhabitants on the north of -that eminence. The fatality of the disease was here probably greater -than in any part of the town of equal population; and it was nearly -the last place in which it disappeared. Very few families who remained -in their own houses upon the hill escaped its attack; and the progress -of the disease, in all the places above mentioned, seemed to have been -arrested only by means of the evacuation of the buildings by the -people who inhabited them. In the latter end of August, and through -the month of September, many persons were taken sick in Fore-street, -which runs northerly from Market of Dock square, along the heads of the -wharves, on the eastern side of the town. - -“Through the whole period of the sickness scarcely a person was taken -ill who had not resided, or been in daily employment, in the vicinity -of these places. The subjects of the disease were generally natives of -the town, chiefly in the prime of life, and in the vigour of health. -I recollect no instance of any French inhabitants being assailed by -it, and have heard of only one or two instances of the blacks being -affected with it. - -“That the fever was in a degree contagious, I cannot entertain a doubt; -but that it was not so in a very high degree, I am as fully persuaded, -from the number of cases in which there was reason to believe it could -not have been taken in that way. In most instances, where contagion -might have been suspected, the subjects were so situated that they -might have received it from the same source as those with whom they had -communicated. I cannot learn that any evidence has been furnished of -infection from the sick who had been removed into the country, though -there were many instances of such removals, under the most malignant -forms which it assumed. - -“The fever was generally ushered in by a chill, but I think by no means -equal to that which commonly precedes fevers of the ardent kind, nor in -proportion to the violence of its subsequent periods. In a short time -the rigors were succeeded by excessive heat; the pulse, which had been -small and contracted, became hard and full; the respiration laborious -from violent oppression at the scrobiculus cordis; the tongue assumed -a whitish cast; the eyes became highly inflamed, while the pains in -the head, back, and legs, were intolerably severe. To these symptoms -succeeded nausea, and vomiting sometimes of a highly bilious matter, -seldom attended with diarrhœa, but often with a burning at the stomach, -tenderness of the abdomen, parcity of urine; and, in one instance, a -dysuria, with a great proportion of blood at each evacuation of that -fluid. - -“These appearances usually continued about 48 hours, after which they -often suddenly gave place to a very different train of symptoms. The -pulse sunk astonishingly, and became intermittent; the heat and pains -entirely subsided; and the patient supposed himself to be out of -danger. From a perfect possession of all his intellectual faculties, -with a serenity of mind, which in no other disease, I believe, is -so generally observed to accompany its last stages, on or about the -5th day from the accession of the fever, he fell into a state of -insensibility, and thence sunk gently into the arms of death. In others -this change was less rapid; the pulse became gradually smaller, the -distressing symptoms slowly abated, a coldness of the extremities took -place, and continued for several days before death, accompanied with -clammy sweats, often without any perceptible pulse in the wrists, for -several hours before the fatal termination. The tongue seldom became -much coated, to the last. Delirium was by no means generally attendant; -and a yellowness of the skin was far from being universal; sometimes, -however, this appearance was observed within the three first days; -often on the fourth and fifth; and I was induced to consider it as an -accident, rather than a constituent character of the disease. - -“The black vomit, as it has been usually called, though in my opinion -by no means to be considered as a pathognomic sign of the disease (as -I have frequently seen it take place in other acute fevers, especially -the puerperal) was very frequently attendant on the last stages of the -disorder; very few recovered after this circumstance had taken place; -in one person, however, who had it in the most alarming form, together -with an intermittent pulse, coldness of the extremities, singultus, and -every usual mark of immediate dissolution, a most unexpected recovery -happily disappointed the positive prognostics of his physicians. As -the cure advanced, the skin in this instance became extremely yellow, -and continued so for many weeks after the fever had subsided; the -biliary ducts having been completely obstructed, and consequently -the alvine evacuations of a clayey colour, and with much difficulty -procured. Frequent repetitions of rhubarb and calomel in large doses, -the continuance of the mercurial medicine in small doses, so as to keep -up a continual ptyalism, and a laxative diet, restored him to perfect -health. - -“For the discoveries which were made on dissecting the bodies of -some of those who died with the disease, I beg leave to refer you -to a publication in the Boston Centinel, made during the prevalence -of the disorder in this place, and subscribed by Dr. Isaac Rand, -sen. President of the M. Medical Society, and myself.” (For these -discoveries see the table, facing p. 434.) - -“We had heretofore treated our patients agreeably to the method -practised at Philadelphia in 1793, with bleeding in most instances, and -active purges of jalap and calomel, or Rochelle salts. The diseased -state of the liver, the known effects of mercury in hepatitis, and the -recollection of the suggestions contained in Dr. Rush’s publication -on the yellow fever, together with those of several other celebrated -writers on the same subject, induced us to enter immediately on the use -of calomel in small doses, as recommended in our paper above referred -to. - -“In my own practice I _now_ usually commenced the treatment by bleeding -from ten to sixteen ounces, and followed it by a dose of between ten -and fifteen grains of calomel with between twenty and twenty-five -grains of jalap, or an ounce of Rochelle salts, or more, according to -the constitution. Immediately after the operation of these medicines -I began with the use of calomel in small doses, in pills of a grain, -every hour, and sometimes of 3 grains every two hours. Within the -first twenty-four hours, but scarcely ever after, I found occasion -frequently to repeat the bleeding, and it is worthy of remark, that in -scarcely a single instance was this operation performed without almost -instantaneous relief; although in most cases, a few hours after, there -was a recurrence of the symptoms. The blood for the most part was dark. -In three cases there was no separation of serum from the coagulated -mass at the end of forty-eight hours. In two of these (and they were -the only cases in which I observed it) a firm buff was formed on its -surface; and all three died of the disease. - -“The calomel was often continued through the whole course of the -fever; and ptyalism was usually brought on within three or four days: -though sometimes upwards of 200 grains were given, at the rate of a -grain every hour, without any specific effect on the salivary glands. -In proportion as the soreness of the mouth advanced, the symptoms -universally gave way; and in every patient, two only excepted, this -effect of the remedy was a sure pledge of recovery. In this exception -were comprehended two persons of the same family, a father and -daughter, both of whom had survived the 14th day of the disease, had -copious hæmorrhages from the mouth (a circumstance which also attended -on many who recovered) and died in a state of apparent putrefaction. - -“The purgative medicines were generally repeated every second day; or -an enema of water gruel was administered occasionally, if the bowels -were constipated; but if otherwise, and the calomel passed off by -those emunctories, opium was combined with it in sufficient quantities -to restrain the discharge. The evacuations which took place from the -intestines, during the use of the mercury, were almost universally of a -remarkably dark colour, generally approaching to a deep green, but by -no means remarkably fœtid. When spontaneous, they were often observed -to be of the colour and consistence of water gruel. - -“In cases of very laborious respiration, which was frequently in an -extreme degree distressing, especially after the first 36 or 48 hours -had elapsed, blisters, applied either to the chest or extremities, -had a favourable effect; on the latter, they were most useful in the -advanced stages of the disease, by exciting to action the debilitated -vessels, and by restoring circulation and warmth to the parts. In the -same intention, wine, snake-root, and the bark, were sometimes used -with advantage. - -“The diet was generally of the lightest and most cooling nature; -barley-water, apple-water, and spruce-beer, were generally both -grateful and salutary. The warm bath was often exhibited with apparent -success, especially in the beginning of the disease, and when a copious -sweat had been induced by it. The cold bath was also resorted to by -some respectable practitioners, and perhaps, under some circumstances, -with good effects; but I have no reason to think it was generally -advantageous. - -“Upon the whole, I believe that the most efficacious remedy, and the -only one to be relied on, is mercury. It is certain that, as far as my -observation has extended, under no other method of treatment did so -many recover; and there were but few instances of a fatal termination, -when it had been administered from the commencement of the fever. - -“Various have been the causes assigned to this disease. That its origin -was domestic, I have not a single doubt. No instance of the arrival -of any vessel from the warmer latitudes, with this sickness on board, -has been discovered; and it is believed that the local causes are -sufficiently numerous to account for its existence. At most of the -places, where its ravages have been made, very large quantities of -putrid substances had been for some time accumulating. The offals from -the fish market, as well as damaged fresh and salted fish to an immense -amount, had been thrown into the dock. A very great number of raw hides -had been imported, and stored in places contiguous to those in which -business was constantly going on. The influence of a continued heat -through the summer, to a degree scarcely before known in this country, -had rendered these articles highly putrid; and from the same cause -several articles of provision, such as barrelled beef, &c. which had -been prepared for exportation, but, by reason of the restraints laid -on our commerce, retained in store, had become tainted. The effects -of these were in some instances incontestibly evinced; three lads, -who had been employed in repacking beef, were at about the same time -seized with the disease in its most fatal form; and a person, who had -purchased some of the hides at a low price, immediately after their -removal fell a sacrifice to his folly. - -“Two or three thousand of the inhabitants removed into the country, and -began to return about the middle of October, when the decline of the -disease justified the measure.”[192] - - [192] The following facts, in confirmation of the importation of - the yellow fever, were communicated in a letter from an eminent - practitioner in New Haven to a gentleman of the same profession in - this town. They came to hand too late to be inserted otherwise than - in a note, the sheet being already prepared for press: - - A child was reported to have died of worms, and the parents were - indulged in the common ceremonies of burial: but the truth was, that - the disease had been the black vomit. The consequence was, a very - extensive spread of the contagion. In less than a week six out of - eight of the bearers were taken with the fever, and these were young - persons from different parts of the town. “As to the suppositions - (says the gentleman) with respect to local causes originating the - disease, I conceive there is no occasion to seek for any other than - what was contained in the chest (p. 444) which was a blanket and - clothing taken off the corpse of one who had died of the fever in - the West Indies, and without the least formality of cleaning put - down into a close chest, and brought to New Haven, and lodged in - Austin’s store. Now it appears to me (these facts well ascertained) - as idle to inquire after other causes, as it would, suppose it were - the infection of the small pox brought in a chest, and a number - of persons who had inspected the chest to be taken down with it. - Would, in such a case, mankind have racked their inventions to have - investigated other inducing causes? Surely not.... As to local - putrefying substances, there was nothing but what has been common to - the place, where the fever made its first appearance, for many years - in dry summers. - - “I might revert to the introduction of the fever by importation at - Chatham on Connecticut river; at Providence, Rhode Island; in which - the importation was as evident as at New Haven. In short, there is - scarcely a place on the continent, where this fever has made its - appearance, but what it may be traced to an imported origin. There - have been but two or three exceptions which I have heard of.” - - The following particulars relative to the disease at Portsmouth - may likewise be deemed authentic, as communicated by a respectable - gentleman (though not of the medical profession) in that place; - “Most men of judgment and information on the subject suppose it - was imported last year in a ship of Mr. Sheafe, which arrived from - Martinico about the 20th of July. One man had died on board this ship - in the West Indies: all the rest arrived in health; but the disorder - made its appearance in a few days afterwards. Mr. Sheafe lost three - of his own family. He lived within a stone’s throw of the wharf where - his ship lay, and the fever spread in the neighbourhood. Mr. Plummer, - in the next house to Mr. Sheafe’s, died about the 10th of August; - Miss Parker, in the same house, four days afterwards; and Miss Smith, - who had lived nearly opposite, removed to Berwick, and was there - seized and died about the same time. It is worthy of remark, that - this was always thought the most healthy part of the town.” - - As a contrast to these evidences, we subjoin the following epitome - of part of Dr. Rush’s address to the citizens of Philadelphia on the - origin of the yellow fever, &c.[193] In this address, the Doctor - considers it as indisputable that the disease is, in all countries, - the offspring of putrid vegetable and animal exhalations; but it - prevails only in hot climates and in hot seasons. In Philadelphia it - arises, 1. From the docks; and hence, in New York, it has got the - name of the _dock fever_. 2. From the foul air of ships. 3. From the - common sewers. 4. From the gutters. 5. From dirty cellars and yards. - 6. Privies. 7. Putrefying masses of matter lying in the neighbouring - part of the city. 8. Impure pump water. - - The disease is considered by the Doctor as an higher degree of - bilious fever. He answers the objection by Dr. Chisholm (see p. 467.) - where he speaks of the fever not being produced in 1778, “when it - was left in a more filthy state by the British army than it has been - at any time since.” To this he answers that for the production of - the disease three things are necessary. 1. Putrid exhalations. 2. - An inflammatory constitution of the atmosphere, and, 3. An exciting - cause, such as great heat, cold, fatigue, or intemperance. The - constitution of the atmosphere, however, he looks upon to be the - principal cause; as without this constitution mild diseases would - be produced, but along with it they become very malignant. “The - pestilential constitution of the air in the United States began in - 1791. It prevailed in Charleston in 1792, and it has been epidemic - in one or more of the cities or country towns of the United States - every year since.... It has not been confined to the seaports. It - has prevailed since the year 1793 in many of the villages of New - England, and of the southern states. On the Genesee river it has - become so prevalent as to acquire the name of the Genesee fever. - The bilious fevers which prevailed in all the above places before - the year 1793 were of a mild nature, and seldom mortal. They have - lately disappeared, or are much diminished; and have been succeeded - by a fever which frequently terminates in death in five days, with a - yellow skin and black vomiting.” These circumstances are supported by - undeniable testimony. - - In answer to the question, “Can the yellow fever be imported?” - Our author answers as follows; “I once thought it might; but the - foregoing facts authorise me to assert, that it cannot, so as - to become _epidemic_ in any city or country. There are but two - authorities on which the belief of this disease being imported - rests. These are Dr. Lining’s and Dr. Lind’s. The former says it - was imported into Charleston in 1732, 1739, 1745 and 1748. The - latter says it was conveyed into Philadelphia, where it afterwards - became epidemic, by means of the clothes of a young man who died in - Barbadoes. No circumstances of ships or names are mentioned with - these assertions to entitle them to credit, and from the facility - with which vague reports of the foreign origin of this disease have - been admitted and propagated by physicians in other countries, - there is reason to believe the assertions of those two physicians - are altogether without foundation. The College of Physicians of - Philadelphia, after two weeks investigation, were unable to discover - any ships, clothes, or sick person, that could have introduced - the disease into Philadelphia in the year 1793. The Academy of - Medicine have clearly proved, by many documents, that the disease - was not imported in the years 1797 and 1798. The origin of a few - cases, reported by Dr. Griffitts and other members of the College - of Physicians, which have lately appeared in our city, has in vain - been sought for from a prize sloop of the Ganges. Two affidavits of - Messieurs Hill and Ingersol prove that she had been healthy in the - West Indies, and that no person had been sick on board of her during - her voyage, nor after her arrival in our port. Equally unsuccessful - have been the attempts to derive those cases from beds and blankets - infected by the fever of last year. In Boston, Connecticut, New - York, Baltimore, Norfolk and Charleston, both physicians and - citizens have long ago rejected the opinion of the importation of - the fever. Some physicians suppose it possible for the contagion of - this fever to adhere to the timbers of ships that have sailed from - West India ports, and that it may be propagated from them to a whole - neighbourhood, although houses, and even streets, interpose between - them. This opinion is too absurd to stand in need of refutation. - Indeed every thing that relates to the importation of this fever is - contrary to reason and facts--It is an error, substituted in the room - of a belief that all pestilential diseases were derived from the - planets.” - - [193] _Printed in 1799._ - - - - -SECTION III. - - _Methods of Prevention and Cure._ - - -In the yellow fever, as in the plague, where an attack is frequently -made with such violence as to bring on death in twenty-four hours, or -even a still shorter time, it is plain that much more dependence must -be placed on prevention than the efforts of the most skilful physician -after the disease has once begun; for, in such violent attacks, -medicines, though ever so powerful, have not time to act. In countries -therefore where this terrible disease exists, the first consideration -necessary for every individual is, whether he is one of those likely to -be attacked by it. Now, from the general testimony of those who have -seen this fever, it appears that such as are newly arrived, the young, -and in other respects the healthy and strong, the laborious, and the -intemperate, are most liable to be attacked. Dr. Nassy of Philadelphia -seems _alone_ to afford an exception to the general testimony. -Speaking of the cause of epidemics, after having ascribed them to some -constitution of the atmosphere, he says, “If the air is not infected, -diseases cannot be epidemic; and this is so, _indeed_, though it only -attacks the natives. What can be the cause of that corruption of the -air? For what reason are the natives, and those inured to the climate -of Philadelphia, _alone_ infected with the prevailing disease, while -_foreigners_ escape it?” Dr. Chisholm particularly points out those -who, in 1793, were most liable to the Boullam fever. These were, “1. -Sailors; more especially the robust and young; those least accustomed -to the climate; and those most given to drink new rum. 2. Soldiers; -more especially recruits from Europe; and the most intemperate. 3. -White males in general lately arrived; more especially young men from -Europe. 4. All other white males; more especially the lower classes; -and of them the most intemperate; those debilitated by recent sickness. -5. White, females, more especially those connected with the shipping; -and those lately from Europe. 6. People of colour, from _Mustees_ to -_Cabres_. 7. Negro men; more especially sailors and porters. 8. Negro -women; more especially house wenches. 9. Children; more especially -those of colour.” It is certain, however, that, when the distemper -rages with great violence, natives as well as foreigners are liable to -be attacked. We cannot suppose that all who perished at Philadelphia -in 1793 and 1798 were foreigners. Though the latter therefore have -the greatest occasion to fear, the natives must not think themselves -absolutely secure; neither are foreigners to be terrified in such a -manner as if they could not escape. With respect to the general modes -of prevention, then, to which it is the business of every individual to -attend, the following things are to be taken into consideration: - -1. Every one who comes from a cold to a warm climate may be assured -that on his arrival the temperature of his body is higher by three or -four degrees than that of the native inhabitants. - -2. In this situation he must consider himself as necessarily about -to undergo a change of constitution; and such change he may likewise -be assured will best be made by the gradual operations of nature; -concerning which we know so little, that it does not seem adviseable to -use any artificial method of promoting or accelerating it. - -3. As the voyage from the Eastern continent must have taken up a -considerable time, and as the mode of living on sea must have been -very different from that to which he was formerly accustomed, we must -consider the constitution as already in some degree altered from what -it was when the person first went on board. - -4. This alteration will be greater or less according to circumstances. -If the vessel has been much crowded with passengers; if the weather -has been stormy, so that he has been exposed to damp; if they have had -little water, or of bad quality; if their provisions have been bad, or -if there has not been a sufficient supply of fresh air in the place -where he slept; the body must be considered as already predisposed -to disease, which the new climate will scarcely fail of bringing to -maturity. - -5. Every one must consider that mode of living to which he has been -accustomed the greatest part of his life as _natural_ to him. Any -considerable deviation from it, especially if sudden, would be of -bad consequence, even in his own country; much more must it be so in -another. As much as possible therefore he ought to conform his mode of -life in the new country to what it was in the old, adhering only to the -rules of temperance. - -6. It has already been observed, that we must take into account the -time that the person has been at sea, and the difference between his -mode of life during his voyage, and that to which he was formerly -accustomed. This difference consists in one particular in having lived -for some weeks entirely upon salt provisions. To these he has been in -some measure accustomed; and therefore it must be reckoned injudicious -to give up the use of salted meat at once for such as is fresh. In -fact, this mode of abandoning salt meat for fresh has been reckoned by -the best physicians one of the causes by which the disease is brought -on. Drs. Taylor and Hansforth express themselves in the following -manner on this subject: “It has been noticed by several medical -writers, that fresh meats, and particularly beef, in southern climates, -apparently generate fluxes and other malignant diseases.” Dr. Ramsay, -also, says of those who were mostly affected with the yellow fever in -Norfolk, that, “being _foreigners_, they dealt lavishly in beef, fish, -and all kinds of fresh food. Observe, this beef was driven perhaps from -one to two hundred miles before killed, then exposed in a hot market to -vend; that, by one o’clock, their dining hour, I always did, and do, -believe it must have been tainted. Observe, the fish were all dead by -break of day, and brought by land from twenty to twelve miles--hard -drinkers of spirits mostly.... One or two natural born citizens were -the whole, out of upwards of two hundred and twenty, who, in the space -of six weeks, fell victims to this disease. The natives live chiefly -on salted meats and fowls, or other kinds of poultry, which are killed -but a little time before dressing.” It is unfortunate that among the -emigrants from cold countries there is a general prejudice against -salt, as highly inflammatory; and many diseases are imputed to the use -of it where it is undoubtedly entirely innocent. In very cold climates -indeed it has with great reason been supposed to produce the scurvy; -and the Tchutski, who conducted capt. Billings through their frozen -regions, informed him that salt was poison in their climate; throwing -away, with marks of abhorrence, a quantity he had brought with him from -his frigate. We cannot indeed argue from salt being pernicious in a -cold climate that it is medicinal in a warm one, but we shall soon see -that it has been recommended in the plague, and may not improbably be -useful in the yellow fever. At any rate the practice of the natives -ought in this respect to be a rule for emigrants, rather than any -theories they may have laid down previous to their leaving their own -country. - -7. In like manner those who newly arrive in a warm climate ought to -avoid as much as possible the using of violent exercise in a heat -greater than that to which they have been accustomed, and by all means -to avoid intemperance in spiritous liquors. We are not however to -imagine from this that such as have been accustomed to drink spiritous -liquors are all at once to give over the use of them, and live a life -of abstinence. On this subject Mr. Hardie, in his account of the -malignant fever of 1795, has the following judicious observation: “It -has often been said, that temperance was the best preservative against -infection. The observation, in general, is certainly just; but it may, -and during the late calamity has, been carried too far. For my part, -from what has come under my own knowledge, I have no hesitation in -asserting, that to persons who had been accustomed to live freely, -nothing could be more dangerous than to become remarkably abstemious -upon the appearance of this disorder. Persons of the above description -should, in my opinion, have continued to live in their usual manner; -by which means they would have been more likely to repel infection, or -if infected, they would have more strength to resist the attack. But, -whilst I consider abstinence in such a situation as highly improper, a -state of intemperance is certainly more so; for, were it necessary, I -could mention the names of several individuals, who whilst in a state -of intoxication were attacked with the fever, and in two days after -were tenants of the grave. The fate of such people might be pronounced -almost with certainty: they were seized with symptoms of a peculiarly -malignant nature, and their death seemed unavoidable.” - -On the subject of vegetables much declamation has been used. If we give -heed to some, it might almost be supposed that all diseases incident -to human nature are owing to the use of animal food. The following -paragraphs from Webster’s Collection may serve as a specimen: “We shall -not repeat the observations which we have heretofore made, upon the -averseness the Americans feel for soup and restorative broths, on their -eating their meat running with blood, with scarcely any bread, and -plenty of heavy potatoes, the only vegetables which are seen on their -tables; whilst the French always give the preference to vegetables, and -especially to those which are light and wholesome. But we cannot help -observing, that, in the months of May, June and July, the streets and -markets were seen in the morning furnished with an immense quantity -of fruits, the most part of which are either green or unripe. In the -evening all those fruits have disappeared and have been eaten; hence -bloody fluxes, dysenteries and bad chyles, which unwholsome food must -undoubtedly produce. - -“The city of Naples contains about four hundred thousand inhabitants; -of whom thirty or forty thousand are said to belong to the class of -beggars. In that climate the rains prevail, with little intermission, -for three months, from February to May. From May to September, a -drought, equally severe, and scarcely allayed in many years by a -single plentiful rain, renders the heat almost intolerable. The wages -of a labourer not exceeding eight pence this currency a day, and meat -being rarely had in their markets for less than four pence the pound, -and vinous liquors in the same proportion, the mass of population is -excluded from any share of these luxuries; of consequence they support -themselves on vegetables, roots, sallads, fruits, &c. and dilute their -food, and animate their spirits, with water and lemonade. Yet this city -has, for a great number of years, known no general disease. And for ten -years no febrile disease, of any sort, was common among them. They also -pay great attention to personal cleanliness. Facts of this sort are -very important, and form the best comment on the discordant opinions of -our physicians.” - -As a contrast to these the reader may take the following quotation from -the Medical Extracts: - -“One gentleman excepted, says Dr. Shebbeare, and I never saw a -gentleman or lady who wholly abstained from animal food look like -other people; nothing is so easy to distinguish as a _vegetable man_ -by his physiognomy, the fittest appellation by which they can be -distinguished; he neither moves, talks nor looks like other people; -his face conveys a declaration of his whole body being out of order, -by the lifeless insipidity which is in it, as his conversation does of -his mind being disturbed, his whole time being taken up in recounting -to the world his manner of living, his feelings, his weak stomach, -his disturbed sleep, &c.... If he pretends to have spirits, it is no -more than a certain equability of a lifeless, inanimate state, like -that of the dormouse among animals, or the yew tree in winter among -vegetables,” &c. (Medical Extracts, vol. x. p. 234.) - -On the subject of vegetable and animal food we find the following -observations in Willich’s Lectures on diet, &c. “In the primitive -ages, people subsisted chiefly on plants and fruits. Even to this -day many nations, the Bramins, for instance, abstain from the use of -animal food. The ancient Germans also, who were so renowned for their -bodily strength, lived upon acorns, wood-apples, sour milk, and other -productions of their then uncultivated soil. In the present mode of -life, here (in England) as well as on the continent, a great proportion -of the poorer class of country people almost entirely subsist on -vegetables. Although these people duly digest their vegetable aliment, -and become vigorous, yet it is certain that animal food would answer -these purposes much better. Hence, in countries where the labouring -class of people live principally upon animal food, they far excel in -strength and durability.” - -On the subject of diet we shall take notice only of one article more, -and that is, the use of warm diluting liquors. These are commonly three -in number, viz. tea, coffee and chocolate. Abundance of declamations -have been published against the use of these, particularly the -first; but the daily experience of multitudes shows that its use, in -moderation, is perfectly innocent. Indeed when people go to excess with -this, as well as any thing else, bad effects must certainly ensue. -Zimmerman[194] mentions a Dutch physician (Bontikoe) who maintained -that tea _ought_ to be drank in the quantity of _one_ or _two -hundred_ cups a day! But such ridiculous excesses must make any thing -destructive to health; and accordingly this practice, being opposed -by Boerhaave, soon fell into disuse. Coffee has the same exhilarating -virtue as tea, but must be considerably different in its qualities, as -having in it a portion of empyreumatic oil extracted by the toasting, -and therefore a change from tea to coffee in such as come into a warm -country seems to be improper. Chocolate differs considerably from -both, possessing no exhilarating virtue, or only in a small degree, -but is more nutritive, and in South America constitutes a considerable -part of the food. On coming into warm climates it is obvious that the -increased perspiration must be supplied by a considerable quantity -of diluting liquids; and such of these as the person has been most -accustomed to ought to be preferred. For the rest, diluted malt liquors -seem preferable to spirits and water. Cyder, though very agreeable when -fresh, is apt to become vapid, and even get a putrescent taint. Perhaps -a plain infusion of malt, of late found so useful at sea, might also -prove beneficial at land, where proper fermented liquors cannot be had. - - [194] This author relates the following curious anecdote concerning - tea-drinking: “We had a gentleman in Switzerland, who in every - respect knew how to assume the tone of majesty. He was told one day - that nothing elevated the dignity of a king so much as when every - thing around him had a pale look. This intimation was sufficient for - him. He directed all his servants to be blooded once a month, and - obliged each of them to swallow fifty dishes of tea every day.” Tea - is said to produce a cadaverous hue in the person who drinks it after - bloodletting. - -These modes of prevention are obviously derived from the circumstances -which attend every emigrant from a cold to a warm country. The -indication must be, to keep themselves as cool as possible, without -debilitating the body. It was formerly a custom to use bleeding and -purging when people arrived in warm latitudes; but this practice fell -into disuse, perhaps without sufficient reason. Dr. Rush attests the -efficacy of these remedies as preventives when signs of the disease -appeared. “During the existence of the premonitory symptoms (says he) -and before patients were confined to their rooms, a gentle purge, or -the loss of a few ounces of blood, in many hundred instances prevented -the formation of the fever. I did not meet with a single exception to -this remark.” As mercury is found to be one of the best remedies, if -not the only one, that can be depended upon for curing the disease -after it is once formed, it is natural to think that it would act as -a preventive; and accordingly we find, in Dr. Walker’s account of the -yellow fever in Jamaica, an instance to our purpose. When the fort of -Omoa was taken from the Spaniards, a great quantity of quicksilver -was carried off by the English. One ship was loaded with it, and, -the vessels containing it being broken by the shot of the ship which -captured her, a number of men were employed in collecting it with their -hands into buckets. Not one of these men was in the least affected -with sickness, though a most malignant fever raged among the rest. -Preventives of such a powerful nature, however, could not well be -adopted without the advice of a physician; it being evidently dangerous -for any person unacquainted with medicine to tamper with himself in -this way. - -When the disease happens to get into a town, it then becomes an -object for every person to avoid the danger; and for this Dr. -Chisholm has given such instructions as seem to be quite sufficient -for any individual, and may be very easily reduced to practice. His -observations may be summed up as follows: 1. To avoid going into -infected houses. 2. If this cannot be done, to avoid going into the -chamber of the sick. 3. If neither of these is practicable, to avoid a -near approach to the sick person. 4. To avoid drawing in his breath, -or that peculiar smell which issues from the bodies of the sick; and -not to touch the bed-clothes. By neglecting this the person becomes -affected with nausea: slight rigors and head-ach succeed in a few hours -by the disease. 5. Not to touch the patient’s body or his wearing -apparel, or suffer the effluvia from either to be blown upon the body. -The distance at which the contagion acts is by Dr. Chisholm supposed -not to exceed ten feet; but Dr. Lind thinks it may extend to fifty or -sixty feet; but this must depend very much upon circumstances. The -only thing that can be done in such cases is to keep at as great a -distance as possible. As to the preventives commonly recommended, such -as vinegar, camphor, garlic, &c. we have no accounts of their having -ever been efficacious in any case; and there is not the least reason to -think that they can be so. - -To purify rooms or ships from the infection they have received, it -has formerly been observed that fumigations with the acid of nitre -have been recommended. According to the theory of Dr. Mitchill of -New York, however, this mode of prevention must not only be useless -but pernicious. The reason is, that according to this gentleman the -disease is produced by the very acid in question. His reasoning is -shortly this: Putrid substances evolve various sorts of air, two of -which by combination form the acid of nitre. Neither of these by -themselves are capable of producing fever, though in conjunction they -are. Their combination is the acid of nitre, which the Doctor thinks -is always that which produces putrefaction. Dr. Girtanner has related -an experiment which seems to confirm this opinion, viz. that, having -injected some nitrous air into the jugular vein of a dog, the animal -died in a short time, and upon opening him his lungs were found of a -greenish colour and partly putrid. Dr. Beddoes adds, in a note, that -the green colour is a sign of the existence of nitrous acid, not of -putridity; but, notwithstanding this, Dr. Girtanner might still have -been in the right, as we cannot say that the existence of nitrous acid -is incompatible with putridity. But there is not any occasion to enter -into a discussion of the question, as the matter seems to be determined -by facts which cannot be overthrown. Dr. Carmichael Smyth, in a -treatise on the jail fever, considers the disease as proceeding from -putrefaction, and “particularly the putrefaction of the _perspirable -matter_,[195] when there is not a renewal of the application of air -to carry it off.” With regard to _specific_ contagions he thinks they -can neither be carried off nor blunted, but by exposure to the open -air or to a stream of water; but with _putrid_ contagions he believes -that they may be destroyed by the mineral acids in a state of vapour. -The pernicious qualities of the fumes of sulphur prevented him from -making any trials with that substance; but to nitre there was no such -objection, and he therefore proceeded in the following manner; the -subjects of his trial being the prison wards at Winchester, where the -Spanish prisoners were kept, and among whom a typhus fever was making -rapid progress: Having divided the wards into four parts, he removed -the prisoners into three of them, took out of the fourth division all -the hammocks and bedding, and had them thoroughly cleaned out. The -hammock posts were well washed with diluted spirit of salt. The wards, -when dry, were closely shut up, and pots placed in them at different -distances, containing from half a pound to a pound of nitre, which was -deflagrated by an iron heater put into each pot.[196] The wards were -then shut up for some hours, and when opened were exposed to a free -ventilation. The process was repeated twice or thrice, after which the -prisoners were likewise cleaned; their old clothes, bedding, &c. taken -away, were replaced by others, and none of these were afterwards seized -with the fever. - - [195] If this be chiefly composed of fixed air and azote, as has been - said in p. 146, it is difficult to see how putrefaction can take - place in it. - - [196] It is not easy to understand this. Nitre cannot deflagrate or - burn, unless it be mixed with charcoal, sulphur, or some inflammable - substance. The iron heater could only expel the water, with a small - proportion of acid. - -A much more decisive experiment was afterwards made at Sheerness on -board the Union hospital ship, where there were upwards of two hundred -people sick of a very malignant fever. Previous to the fumigation -all the ports and scuttles were shut up. “Sand which had been heated -in an iron pot was then scooped into earthen pipkins, into each of -which was put a small tea-cup containing about half an ounce of -vitriolic acid; to which after it had acquired a proper degree of heat -an equal quantity of nitre in powder was gradually added, and the -mixture stirred with a glass spatula, until vapour arose from it in -considerable quantity. The pipkins were then carried through the wards -by the nurses and convalescents who kept walking about with them in -their hands, occasionally putting them under the cradles of the sick, -and in every corner where any foul air was suspected to lodge. Thus the -fumigation was continued, until the whole space between decks, fore and -aft, was filled with the vapour, which appeared like a thick haze.” - -The first fumigation was performed in about three hours; the vapour -subsided in about an hour, when the ports and scuttles were thrown open -for the admission of fresh air. Mr. Menzies, the operator, perceived -that even by this first fumigation the air was considerably sweetened; -and on repeating the operation next day, which (now that the people -were more expert) took up only an hour, such a change was made as the -nurses and attendants were very sensible of, and, beginning to put -confidence in the remedy, approached the cradles of the sick with less -fear. The experiment was further carried on by Mr. Bassan, to whom Mr. -Menzies resigned the office of conducting it; and from repeated trials -it appeared that the fumigation effectually counteracted the influence -of the contagion, though numbers of patients, labouring under the most -malignant fevers, were received from the Russian ships of war. - -The good effects of nitrous vapour used in this way is also confirmed -by Mr. David Paterson, now surgeon in Montrose in Scotland. The trial -took place in the prison wards at Forton. The operation was performed -in the manner above related, and with such success, that a ward 57 -feet long, 10 feet and an half high, and 20 feet broad, was filled -in a quarter of an hour, only by means of three pipkins. The good -effects were extremely obvious, and Mr. Paterson observed that in the -wards which had been fumigated at night there was an agreeable smell -next morning; and by this smell he was able to discover whether the -operation had been properly performed or not. The same author gives -several cases in which the good effects of the pure acid vapour of -nitre in cleansing putrid ulcers was manifest. A third testimony of -the efficacy of this vapour is given in a letter to Dr. Garthshore of -London from Mr. James McGregor, surgeon to the 88th regiment, in the -island of Jersey. The disease was a typhus fever, which had formerly -proved very destructive; but, while the acid vapour was used, only -one out of _sixty-six_ cases proved fatal. Mr. McGregor is not only -of opinion that the nitrous fume prevented the contagion from acting -fatally, but that it destroyed it altogether, so that no more cases -appeared. Mr. Paterson made trial of different acids, but had not -completed his experiments: we are informed, however, in the Medical -Extracts, that in the year 1795, near about the time that the last -experiments were made upon the Union hospital ship, Morveau in France -had employed, for the same purpose, oxygenated muriatic acid[197] in -the form of air or vapour, with which he purified the infected hospital -at Dijon; and the same method was afterwards extended to the different -military hospitals by a decree of the National Assembly. - - [197] Perhaps this vapour may be as efficacious as the other in - destroying contagion, but its smell is so extremely offensive and - disagreeable to the lungs, that on this account nitrous vapour seems - much preferable. - -This mode of prevention seems to be established on as sure a testimony -as any thing can be; but what can be said that will not be disputed? -Dr. Trotter has argued in the most strenuous manner that such -fumigation is not only useless, but pernicious. “The whole preservative -means (says he) are comprised in the immediate removal of the sick; -cleanliness in person and in clothing; fires to keep the people -warm in the winter season; avoiding cold and moisture, fatigue and -intoxication; and keeping the ship dry and properly ventilated.” To -these he also thinks it would be expedient to add a band of music in -order to keep up the spirits of the people; but, with regard to any -thing else, he thinks that “a physician of a fleet, though armed with a -diploma, and with the chemistry of the elements at his fingers’ ends, -will find that very little has been left for him to do; whether his -doctrine of prophylactics (preventives) be the _vinegar of the four -thieves_, or the fumigations of modern physicians, under the scientific -appellations of sulphureous gas, muriatic acid gas, or nitrous gas.” -The Doctor was so zealous against these noxious fumigations, that he -wrote to Evan Nepean, esq. at the Admiralty upon the subject. His -argument was, that every possible method was taken on board of vessels -to expel _azote_ or _mephitic air_, by opening ports, scuttles, &c. -and putting down windsails, &c. “This azote is the base of the nitrous -acid: they only differ in the degrees of combination with oxygen, or -what was formerly called dephlogisticated air: and in proportion to -the quantity it attracts of this principle it is called azote, azotic -gas, nitrous gas, nitrous acid, nitric acid. In short, Dr. Smyth’s -preventive is the very substance that every intelligent officer is -hourly employed to drive from the decks of his Majesty’s ships.”[198] -This letter was transmitted to the commissioners for the sick and -wounded for their report. The answer of the commissioners was to -the full as learned as the Doctor’s letter; but they considered the -experiments of Dr. Smyth and others as quite decisive upon the subject, -so that Dr. Trotter was obliged to submit. The matter therefore being -determined by such high authority, we must take leave of the subject, -and proceed to consider the mode of preventing the disease from getting -entrance into any town, or of eradicating it when once it has got in. - - [198] Medicina Nautica, p. 229. - -Among these the enacting and strictly enforcing quarantine laws -certainly hold the first place. But these belonging entirely to the -magistracy and police of the place cannot be the subject of any -discussion here. The success of these has been so great in other -countries, that Dr. Willich informs us “that some of the most ingenious -practitioners of Italy and Germany are, at this moment, employed in a -serious attempt wholly to extirpate this contagion (the small pox) from -the continent of Europe; an object which has formerly been accomplished -in the cases of the plague and leprosy.”[199] Perhaps, then, it is no -improbable supposition, that, by a strict observance of quarantine -laws, and attention to cleanliness, the yellow fever may be eradicated -at least from the northern states, whose climates are less congenial to -it than the southern. - - [199] Willich, p. 13. - -Dr. Chisholm informs us that the general plan of prevention made use of -in Grenada consists in the destruction of all small wooden buildings; -obliging the inhabitants to build with stone or brick; to make spacious -streets; to have the rooms of the houses as large as possible; stables, -necessaries, &c. at a distance; and certain places appointed as -receptacles for filth, to which it must be carried every morning; -slaughter-houses at a distance from the town, &c. with a number of -other particulars relative to cleanliness which it is needless to -enumerate here; not forgetting the quarantines, lazarettos, &c. without -which he does not think any activity on the part of the people can -avail. - -Dr. Rush, who is an enemy to quarantines, recommends to the people -of Philadelphia the following particulars: “1. Let the docks be -immediately cleaned, and let the accumulation of filth in them be -prevented in future, by conveying water into them by a passage under -the wharves, or by paving them with large flag stones inclining in -such a manner towards the channel of the river as that the filth of -the streets shall descend from them (after it falls into the docks) -into the river. This method of paving docks has been used with -success in the city of Brest. 2. Let every ship that belongs to our -port be compelled by law to carry a ventilator. Let all such ships -as are discovered to contain foul air in their holds be compelled -to discharge their cargoes before they reach our city, and let the -ships in port be compelled to pump out their bilge water every day. -3. Let the common sewers be washed frequently with streams of water -from our pumps. Perhaps an advantage would arise from opening them, -and removing such foul matters as streams of water are unable to wash -away. 4. Let the gutters be washed every evening in warm weather. By -frequently washing the streets and pavements the heat of the city would -be lessened, and thereby one of the predisposing causes of the fever -would in some measure be obviated. 5. The utmost care should be taken -to remove the filth from the yards and cellars of every house in the -city. Hog-sties should be forbidden in yards, and the walls of cellars -should be whitewashed two or three times a year, and their floors -should be constantly covered with a thin layer of lime. Whitewashing -the outside of houses in sickly streets would probably be useful. 6. -Let the privies be emptied frequently; and let them be constructed -in such a manner as to prevent their contents from oozing through the -earth so as to contaminate the water of the pumps. 7. Let all the filth -be removed from the neighbourhood of the city, and let the brick kiln -and other ponds be filled up from time to time with the earth which is -obtained in digging cellars. 8. In the future improvements of our city, -let there be no more dwelling houses erected in alleys. They are often -the secret receptacles of every kind of filth. 9. The predisposition -of our citizens to be affected by the remote and exciting causes of -the yellow fever would be very much lessened by their living sparingly -upon fresh animal food, and chiefly upon broths and fresh vegetables, -rendered savoury by spices and a small quantity of salted meat, during -the summer and autumnal months. A constant attention should be paid at -the same time to bodily cleanliness.” - -These are the modes of prevention which seem to be the most obvious -and necessary, as well as approved by the best judges. It appears, -however, that in certain cases neither human skill nor care can prevent -or cure the disorder. The number of physicians who have fallen victims -to this disease are too manifest proofs of this.[200] Indeed, when -we consider that it is the nature of the distemper first of all to -attack the vital parts, and that this attack may commence with little -or no pain, it is evident that an attack may be begun before we think -of a preventive, and may, as it were in a moment, prevail in such a -manner as to be entirely beyond the reach of medicine, before even -a medicine is thought necessary. In every case therefore, where the -yellow fever prevails, an attention to health becomes as necessary as -procuring the means of subsistence. Every precaution must be used, and -when we have done so we are not even then secure. We are ignorant of -the natural causes which produce it; they are invisible to our senses, -and incomprehensible by our understandings. Safety then can only be -expected from the protection of that Being to whom all natural causes -are known, and to whom all must yield obedience. In short, we may sum -up the whole in the well known sentence, “_He that will love life, and -see good days, let him refrain his_ TONGUE _from_ EVIL, _and his_ LIPS -_that they speak no_ GUILE. _Let him eschew_ EVIL _and do_ GOOD; _let -him seek_ PEACE, _and ensue it_.” A very strange receipt indeed, we -will say; but how often have we tried it? - - [200] Dr. Rush pathetically laments the loss of Dr. Nicholas Way, - who had been his intimate friend. In a poem called the _Political - Greenhouse_ we find some account of the death of Drs. Smith, Cooper - and Scandella, who also perished; and the fates of Drs. Smith and - Scandella were connected with one another. Dr. Cooper of Philadelphia - was seized with the disease in that city. A friend who attended - him sickened during his attendance, and Dr. Cooper, before he had - thoroughly recovered, attended in his turn the friend who had taken - care of him. A relapse ensued, and the Doctor died. Dr. Smith was - intimate with Dr. Scandella of Venice, who had come from thence to - America, and was at New York during the time of the fever in 1798. - Intending to return to Europe, he waited there for the English packet - boat; but, being informed that a foreign lady in Philadelphia, for - whose daughter he had an attachment, was sick of the yellow fever, he - returned to that city; but could not save either mother or daughter - from the cruel disease. On Scandella’s coming to New York the second - time he could find no body that would receive him as a lodger. In - this forlorn situation he wrote to Dr. Smith, who instantly gave him - an invitation to his house. Here he was seized with the fever, and - was attended by Dr. Smith, until the latter also fell sick. A friend - who lived in the house attended first Dr. Scandella, and then Dr. - Smith, until both died. - -The cure of the yellow fever hath been attempted in various ways, -according to the theories laid down by different physicians concerning -its nature. Dr. Cullen considers it as of the nature of _typhus_ -fever,[201] and of consequence would have treated it with antimonials; -most probably with his favourite remedy, tartar emetic. Dr. Rush, -from his opinion that it is the highest degree of inflammatory fever, -recommends powerful evacuants, and large blood-letting, in 1793, and -1797, though he seems to have altered his sentiments in 1798. Dr. -Brown, who would have considered it as a disease of debility, would -of course have prescribed opium and other stimulants; and lastly, on -the theory of Dr. Mitchill, that the disease proceeds from an _acid_, -remedies of a nature directly opposite, viz. _alkalies_, ought to -be useful. It is not the design of this treatise to enter into any -consideration or comparison of the practice of different physicians, -but to point out at once, to those who are not physicians, the remedies -which have been, by general consent, accounted most efficacious; and -in this respect there is now a surprising unanimity among gentlemen of -the medical profession. Those which hold the first rank are, - - [201] Typhus Icteroides. - -1. _Mercury._ In the use of this medicine the physicians of the Western -world have certainly excelled those of the East. In a paper in the -Medical Repository, vol. i, p. 500, Dr. Holyoke of Salem says that -the practice of giving mercury was first introduced into New England -about 60 or 70 years ago,[202] by a physician from Scotland, a disciple -of the celebrated Pitcairn. In 1734 or 1735 it was used successfully -in a very malignant disease called the _throat distemper_, and which -he thinks was of the same genus with the _malignant ulcerous sore -throat_ treated of by Huxham. About 45 years ago it was commonly used -in pleurisies and other inflammatory disorders; and, ever since the -year 1751 or 1752, it has been used by Dr. Holyoke himself. In Europe, -however, the case was exceedingly different; mercury being there -generally reckoned pernicious in such disorders, from a notion of its -being inflammatory, or dissolving the blood. Thus, on the appearance of -the Boullam fever in Grenada, Dr. Chisholm found himself exceedingly at -a loss what to do, and he seems to have _invented_, rather than to have -been previously _instructed_ in, the mercurial practice. His success, -however, was very great, provided he could raise a salivation; but in -order to do this he was frequently obliged to give much larger doses -than he had ever done before, or had any notion of doing. In p. 159 he -mentions one patient who took 400 grains before the salivary glands -were affected. He tells us, however, p. 271, that, on the re-appearance -of the fever in 1794, he gave the medicine in much larger doses than -before; beginning with mercury without any previous evacuations which -he had used the year before, and with such success that he did not -lose a single patient; so that he professes himself almost ready to -pronounce it _infallible_ in curing the disease. The practice of -giving mercury is confirmed by Dr. Rush, and indeed by so many other -physicians, that it is superfluous to quote them. Dr. Nassy, formerly -mentioned, again stands almost singular in condemning the medicine, -because it dissolves the blood; but it is impossible that any theory, -however plausible, can stand against well attested facts. Dr. Rush is -indeed very much of opinion that it is easily practicable for people to -cure themselves of this disorder, dreadful as it is, provided they take -it in time. But by this we must understand, that the very moment the -person feels uneasiness he must apply a remedy, and not trust to nature -in any case whatever. When the yellow fever prevails, every one who -feels the slightest disorder may be assured that his disorder partakes -of its nature, and ought immediately to have recourse to a mercurial -purge. Dr. Rush says also that bleeding should be first performed. The -many disputes, however, concerning the efficacy of this last remedy, -must make any person hesitate at the application of it without medical -advice, especially as a mercurial purge may be safely taken without it. - - [202] The Doctor’s letter is dated December, 1797. - -2. _Blood-letting._ This was, by Dr. Rush, considered as the capital -remedy in 1793; but Dr. Chisholm, who made trial of it in the Boullam -fever, found that it could not be used with any degree of safety. Dr. -Jackson says it is frequently necessary in the Jamaica fever, but -it was seldom of use to repeat it. Dr. Walker says it increased the -debility in the same fever of 1793, 94 and 95. Dr. Moseley recommends -it in the yellow fever of the West Indies, but only in the first -stage, and says that the injudicious performance of this operation, -when the second stage has come on, has given occasion to the opinion -that a patient cannot bear two bleedings. Dr. Coffin found it useful -at Newburyport in 1796, in the beginning of the disease, and says it -may sometimes be repeated. Repeated bleedings are recommended by Dr. -Ouviere of Philadelphia, who says they are not to be omitted even in -fat and weak habits. This is confirmed by the editor of the Medical -Repository, vol. i, p. 92, who says it was used with success at the -hospital in New York in 1796, “at repeated times, to the amount of -from 24 to 175 ounces, and in some cases several times performed -after the sixth day of the disease, to the great relief of the sick.” -Dr. Bruce recommends it in the island of Barbadoes in the robust and -plethoric.[203] Dr. Hillary says that in the same island it is always -absolutely necessary, and that it may even be repeated once, but -that a third bleeding was seldom necessary. Dr, Wright, in the same -island, found the “lancet not only unnecessary but dangerous in the -extreme.” Dr. Clarke, in Dominica, found it generally very pernicious, -and assures us “that there was not a single instance of an emigrant -recovering who had been bled in this disease. In the first 24 hours -indeed it was admissible in the young and athletic seized a short time -after their arrival, but after that time, or at most after 36 hours, it -will always be found prejudicial, if not fatal.” It was not tried by -Dr. Bryce on board the Busbridge. It is recommended by Dr. Currie in -his treatise on bilious fevers. - - [203] Lind on hot climates. - -It is needless to take up time with a detail of more opinions. From -those already recited it is natural to conclude that the fever in some -places, and at some times, differs very much from others. This is -conformable to the opinion of Dr. Currie, who says, that the bilious -fever “is amazingly influenced in its aspect and symptoms by the -soil, situation, climate, season, and by the preceding and present -state of the atmosphere, and the customary mode of living of the -inhabitants.” The utility or even safety of blood letting then seems -to depend on circumstances which can be only known, and that perhaps -with difficulty, at the time; nor can its success in one season be a -sufficient argument for the general practice of it in another. - -3. _Vomits_ have generally been found dangerous. Dr. Moseley, Dr. Rush, -and indeed almost all who have practised in this disease, say, that -they cannot be ventured upon without extreme caution. Dr. Chisholm, -in imitation of the Russian practice in the true plague, attempted -the cure of the Boullam fever by vomits; but, as one half of those to -whom they were exhibited died of the disease, he did not think there -was any encouragement to proceed. Perhaps as preventives they might be -useful, as it seems probable indeed that any thing must be which tends -to cleanse the alimentary canal. - -4. _Purgatives_ are found extremely useful, both as preventives and -medicines. There are innumerable instances where an incipient attack -of the disease has been carried off by a brisk purge. Dr. Chisholm was -able to remove the slighter cases of Boullam fever by purgatives. He -used at first glauber salts with two grains of tartarised antimony, -which generally proved emetic as well as purgative; but he afterwards -used with advantage the better purging salts, rendering the solution -palatable by the addition of lime juice and sugar. But in all violent -cases he would depend on nothing but mercury. - -5. _Stimulating medicines._ The stimulants commonly used on the -Brunonian plan, viz. opium, bark, &c. are universally owned to be -pernicious. In a letter from Dr. Sayres to Dr. Currie,[204] the former -says, that “bark, wine, and a number of the common stimulants, were -given on the first appearance of debility taking place; but with little -success. Finding the common round of medicine ineffectual in the -advanced state of the disease, I determined (says Dr. Sayres) to use -a different mode of treatment. In three cases of adults, two of which -had the black vomiting, and the third was in a gore of putrid blood -from the mouth and nose, I forbid medicine, and directed very cold -water and brandy mixed strong, to be given as freely as possible. It -had the happy effect of checking the vomiting in two cases, when the -stomach had rejected every kind of mild drink, &c. and, by continuing -that practice almost so as to produce high intoxication, for two or -three days, these two cases were recovered almost from a state of -death. The third was apparently much benefited for three days; but, -being in a high putrescent state when I saw him, and having lost a very -considerable quantity of blood from the mouth, nose, &c. he died oil -the ninth day.” In the Boullam fever Dr. Chisholm used the Angustura -bark in twelve cases, eight of whom recovered; but, though it was -greatly superior to the Peruvian bark, he did hot think proper to trust -to it in violent cases. - - [204] Memoirs of Yellow Fever, p. 137. - -6. _Alkaline remedies._ These have been recommended on the supposition -that the yellow fever is occasioned by an acid. Their efficacy -is attested by Dr. Jeremiah Barker of Portland, who says that -they afforded more relief than any others, and that all the cases -accompanied with yellowness ended favourably, but one. The alkaline -remedies “would actually alleviate the distressing pain and anguish at -the stomach, which would not yield to opiates. The morbid excitement -too was _evidently_ under the controul of alkalies; the febrile -disturbance appeared to be in a direct ratio to the degree of virulence -in the deleterious cause.”[205] We have not any particular details of -cases, nor any form of exhibition pointed out. In a dysenteric fever -indeed he says that he used a mixture of a quarter of an ounce of -salt of wormwood with a pound of lime water; the dose from one to two -ounces every hour, once in some cases every half hour, or oftner, in an -infusion of camomile.[206] Calcined oyster shells were sometimes given -from 40 to 60 grains. - - [205] Medical Repof. vol. ii, p. 149. - - [206] In this mixture the fixed air in the alkaline salt would - instantly destroy the virtues of the lime water by precipitating the - lime. What is sold for salt of wormwood is neither more nor less than - common pearl ash. - -7. _Cooling medicines, external and internal._ The good effects of -cold water applied to the body in fevers has long been known. Dr. -Jackson observes that it was first introduced at Rome in the infancy -of the Methodic sect, and attained afterwards a high degree of -celebrity. Its reputation was highly raised by a cure performed on -the emperor Augustus; but soon after sunk by the death of Marcellus, -the presumptive heir to the empire, to whom it had been improperly -prescribed. It was soon after prescribed again, and greatly used by -Galen; and after him was in still greater favour with the Arabian -physicians; but, since the revival of literature, has been much -neglected till of late. In the fever of Jamaica, after the fatal -symptoms were removed, Dr. Jackson says, that the tone and vigour of -the system was best restored by cold bathing, “which (says he) I am -induced to consider as the most important remedy in the cure of the -fevers of the West Indies, and perhaps in the cure of the fevers of -all hot climates. Though it might not absolutely cut short the course -of the disease, yet it seldom failed to change the fatal tendency of -its nature.” Even in the last stage of the yellow fever, where the -patient seems at the utmost extremity, our author tells us that he has -alternately employed warm and cold bathing with the greatest success. -He has even wrapped the body in a blanket soaked in water in which a -large portion of salt had been dissolved, or which had been steeped -in brandy or rum, enjoining the liberal use of wine, or more powerful -cordials. Dr. Wright also mentions the cold bath with approbation; but, -as it cannot be very generally depended upon, its use ought never to -supersede that of other remedies, especially mercury; and indeed this -may be said of every thing else; for though by the use of the remedies -already mentioned the disease has sometimes been subdued, yet the -success has never been so great but that every one under an attack of -the yellow fever must be considered as in very considerable danger. - -In the use of cooling medicines, taken internally, we must have a -particular regard to the state of the stomach, which is excessively -irritable; and it is surprising that this irritability is of such a -nature that, though it will certainly reject the mildest drinks or -medicines, it may yet retain others seemingly much more acrid, as -has already been observed in the case of Dr. Sayres’s patients. As -long ago as the time of Diemerbroeck a solution of common salt in -vinegar was recommended in the plague. Since that time it has been -found extremely useful in the dysentery; and, as in this disease the -bowels are likewise in an extremely irritable state, it would seem -from analogy that the same medicine might be useful also in the yellow -fever. Dr. Wright of Jamaica (who attests the efficacy of the medicine -in dysentery, belly-ach, remittent fever, and putrid sore throat) gives -the following improved method of preparing it: “Take of lime or lemon -juice three ounces; of marine salt as much as the acid can dissolve; -of any simple distilled cordial water one pint; and of loaf sugar a -sufficient quantity to sweeten it. The dose of this mixture must be -proportioned to the age and sex of the patient, and to the violence of -the disease. A wine glassful may be given to adults every two, four or -six hours.” - -8. _Medicines proper for relieving the most urgent symptoms of the -disease._ The most distressing symptoms attending the yellow fever -are, head-ach, vomiting, pain in the stomach, and pains in the back, -loins and limbs. Blisters were tried by Dr. Chisholm to mitigate the -pain in the head. “I have (says he) blistered the whole head, and the -inside of each thigh, at once, in several cases, without producing the -least change in that or any other symptom. I have had recourse to this -remedy to lessen pain, to remove irritability of the stomach, and to -raise the vital powers in the low, comatose stage, but always except -in two cases without success.” In one a blister to the scrobiculus -cordis completely removed the irritability; the other case is related -in the next section. Another practitioner found a blister applied to -the forehead of remarkable use in four cases; but Dr. Chisholm supposes -them to have been of the less violent kind. Others have also found them -occasionally useful; so that, though dependence cannot be placed upon -these remedies, it seems improper to reject them entirely. But the most -effectual method of allaying the irritability of the stomach was by the -exhibition of vitriolic æther. Dr. Chisholm adopted the medicine on the -recommendation of M. Poissonier, and found it to answer the character -given of it by him. Dr. Chisholm gave about a teaspoonful in half a -glassful of cool water, after which the patient continued undisturbed -about two hours, when the dose was repeated. Sometimes, though seldom, -the stomach was thus enabled to bear the bark, but otherwise the æther -was given every three hours. If the stomach retained the bark after -the first dose, æther was then given only once in five or six hours. -Æther, says he, given in the manner I have mentioned, is extremely -grateful to the patient; it occasions an agreeable warmth along the -oesophagus, and gently stimulates the stomach. This effect, however, -does not continue long; but the frequent production of it at length -gives it permanency. It appears to act as a tonic, an antiseptic, -and an agreeable stimulant; a warm glow overspreads the surface; and -thirst, nausea and oppression, often have fled before it. - -These are the remedies most approved, and which may with most reason be -expected to succeed in the cure of the disease, where it is _within the -power of medicine_. But there are certain cases in which medicines of -the ordinary kind cannot act. Sometimes, at the very beginning of the -disease, all the three stages of it seem to commence at once, or to be -mingled in such a manner that medicines have not time to exert their -force. Again, in the last stage, Dr. Jackson compares the attempts to -overcome the torpor of the system by medicine, to that of attempting -to revive a dead corpse. “I have, however (says he) seen instances of -such unexpected recoveries from the most hopeless state in fevers, -that I seldom totally despair as long as life remains.” It is evident, -however, that the remedies employed must be different, according to -the different times of the disease. In the beginning it is probable -that by bleeding to an extreme degree, so that the greater part of the -mass of blood was taken away, the disease might be subdued at once, -and the patient recover, as has been already mentioned of the plague, -p. 363. But the idea of death seems to be so firmly connected in the -human mind with the loss of a great quantity of blood, that very little -hopes can be entertained of any good being done in this way. It seems -indeed owing to this invincible association of ideas that the enemies -of Dr. Rush have found means to load him so much and so undeservedly -with reproach. Another method, less exceptionable, though probably also -less efficacious, is by injections into the veins. But what are we to -inject? Here, to the disgrace of experimenters, let it be recorded, -that such has been their innate propensity to cruelty, that though -we know a number of substances which, injected into the veins of an -animal, will _certainly_ kill it, yet we scarce know one which can -be injected with even a _probability_ of doing good. In the Medical -Extracts indeed we find it related that at Guadaloupe a physician had -cured the most inveterate diseases by injecting _certain remedies_ -into the veins. But what these remedies were we know not. In the same -paragraph indeed it is said that alarming symptoms from the bite of -a viper were removed by injecting diluted _spirit of hartshorn_ into -the blood. As the bite of a viper is attended with a dissolution of -the blood, and yellowness of the skin, we may thence derive some faint -hope that such an injection might also be useful in desperate cases of -the yellow fever; but, till further experiments are made, we can say -nothing more on the subject. - -Lastly, when the disease has proceeded so far that the blood flows out -from all parts of the body, and it is evident that the patient must -die were it only from the loss of that fluid, then, if ever, the once -celebrated remedy of the transfusion of blood may be of use. An account -of this remedy has been given in the former part of this work. It must -be evident that human blood ought to be preferred to that of a brute -creature; but the danger incurred by one who should lose a quantity of -blood so near to a person capable of giving the febrile infection must -certainly be very great. Nevertheless, there are cases in which the -death of a beloved object inspires more horror than the thoughts of -any personal danger, or even death itself, to the person who beholds -it. In such cases no doubt there are many that would run all risks; -and, should any case prove successful, no doubt the person who had the -courage to make the experiment would find ample recompense in saving -a person he loved from death, and in establishing a truth of such -importance to the world in general.[207] - - [207] From the accounts of the most eminent practitioners it appears - that the fever of 1798 differed considerably in its nature from that - of 1793. In Philadelphia particularly there were many cases that - could not bear the stroke of a lancet. In Boston it seems to have - partaken more of the nature of the true plague than in other places - and other years. The dissections of Drs. Rand and Warren manifest a - difference between the effects of it on the body at that time, and - what they were in former years. Buboes, carbuncles, or what were - thought to be so, and petechiæ, were observed here, as well as in - New York. One remarkable case, related in the next section, shows a - disposition to induration, very uncommon in the yellow fever, though - so common in the true plague that in the former part of this treatise - it is taken for the characteristic mark of the disease. None of - those eschars called _tokens_, however, were in any case observed. - The disease here bore bleeding much better than at Philadelphia; but - mercury was always the most efficacious remedy, where a salivation - could be raised. The warm bath was used in some cases with success. - Large evacuations were useful, and some patients bore three or four - bleedings, with repeated doses of jalap and calomel. The distemper is - by one gentleman styled a novel disease, and differing essentially - from other bilious complaints. In one case the patient died of - apoplexy; and another would probably have shared the same fate, - had it not been for timely bleeding. The black vomit was almost - inevitably attended with death. The matter evacuated was thought - to be extravasated blood from vessels in some cases mortified. The - yellow colour was judged merely accidental; but Dr. Lind’s opinion - of its arising from a dissolution of the blood seems now to be - universally abandoned, and the colour is supposed to arise from a - suffusion of bile, owing either to the obstruction of the ducts, or - too great secretion. - - The names of the gentlemen upon whole authority the above facts - stand cannot be mentioned, as permission for so doing has not been - obtained. Their authenticity, however, can be proved by undeniable - documents. - - The origin of the fever at Boston has, as usual, been disputed; - but the common opinion is that it was generated. It now appears, - however, that, though there are very strong reasons for supposing - it to have originated in the place, there are others equally strong - for believing that it was imported. It is ascertained that a vessel - on board which persons had died with the yellow fever lay in the - neighbourhood of the family first seized with the disease in 1798. - On the other hand, there were instances of many that were seized - with the distemper who had not even left their houses for months - previous to the contagious period. This year (1799) there have - been unquestionable proofs of the importation of the fever from - the Havana. The quarantine, however has kept the infection from - spreading; though the state of the atmosphere has been much less - favourable to the disease than last year, and has therefore no doubt - contributed to preserve the health of the people. - - We have been favoured with the following list of those affected with - the disease this year at Newburyport: - - _When taken._ _Remarks._ - Ossytaway June 8. A seaman on board the vessel. - * March 28. do. - * Sol. Haskel July 3. On board while her cargo was discharging, &c. - * His nephew 4. do. - Duggins 5. { Present when the ballast was thrown out, also - { on board. - Tho’s Norwood 6. } Worked in a hatter’s shop about 16 rods from - Tho’s Nor’d jun. 6. } the vessel when graving, the wind blowing - * Robert Lord 6. } all or most of the time from the vessel - } towards shop. - Stephen Tilton 6. { Worked on the wharf where the vessel was - { hauled in. - Paine 7. } Loaded and stowed the vessel for another - Herbert 7. } outward bound voyage. These men lived at - * Walleigh 7. } Amesbury. - * Miss Dole 9. { Worked in a tailor’s shop, by Norwood’s - { hatter’s shop. - Sally Wood 10. do. - { Along side the vessel, and filled the old - James Wood 11. { bread casks for her outward voyage. He also - { lived near the wharf. - Widow Waite 11. { Doubtful whether her disorder was the fever. - { Lived at the bottom of the wharf. - * Wm. Thompson 11. { Lived at the bottom of the wharf, & was along - { side of the vessel. - Jona Pearson 13. { Kept a store near the wharf, & was along side - { the vessel. - Danl. Favour jun. 15. Worked near the bottom of the wharf. - Goodhue 15. { On board the schooner, and trimmed the sugar - { casks. - * Rev. Mr. Milton 15. Visited the sick at Norwood’s. - * Mary Dunn 15. Lived at Norwood’s. - { Handled the bags of money that came in the - Giles Parsons 16. { vessel, and counted it. Was along side of - { the vessel. - * Sol. Currier 16. On board the schooner. Helped to haul her in. - * Sam. Currier 18. On board. Helped to discharge the ballast. - * Greaty 18. { On board when the vessel was discharging her - { cargo. - Mrs. Wood 19. Widow of James Wood, above mentioned. - * Sally Edwards 19. Lived with James Wood. - * Her brother 19. { Lived opposite, & often in, Wood’s house - { during the sickness. - - _Those marked with asterisks recovered._ - - “The fever unequivocally the same which prevailed in this town in - 1796, and in Boston and Portsmouth the last summer. - - “The vessel supposed to have introduced the disease was the schooner - Sally, Joseph Gunnison master, which arrived at Bartlett’s wharf on - the morning of the 29th of June last, after a passage of 18 days, - from St. Thomas’s, where the yellow fever prevailed and was very - mortal, with 17 tierces of sugar, and cash in bags. She discharged - her cargo before one o’clock on the day of her arrival. In the same - afternoon her stone ballast, taken on board at St. Thomas’s, was - thrown on deck. On the first of July she was moved to a wharf 10 - rods below, and her ballast was thrown on a pier wholly covered with - water. This ballast was covered with a viscous substance, which - adhered to the fingers, and was very offensive to the people working - on the pier. On the same day she was hauled in between the two - wharves, and graved, and removed back to Bartlett’s wharf, where she - was loaded with lumber for another voyage, on which the sailed the - 11th of July. - - “It is still questioned whether this fever was imported, or generated - in the town. You will find that all who have had it have been - connected with that vessel, or lived or worked near where she lay, - or visited the sick near the place where the vessel was graved. And - undoubtedly there were many persons alike connected and situated who - did not take it, although the inhabitants living near the wharf very - soon moved away. It is said that there is an old distil-house near - the bottom of the wharf, which has not been used for many years, and - that the tubs and cisterns are replete with putrid exhalations. I do - not know that this fact has been verified. It is also said that back - of the store used by the deceased Jonathan Pearson, were brewers’, - soap boilers’ and tallow-chandlers’ works which had all been used in - the last-spring. This is true; but I do not know that it is evident - that any putrid substances were formed there. Dr. Vergnies informs - me that there was one case of the yellow fever 2 days before the - vessel arrived. In my mind the weight of evidence in favour of the - importation greatly preponderates. In 1796 the evidence was very - unequivocal that the fever was generated. - - “Just before the vessel arrived we had some very warm weather, - and the heat was oppressive to the feelings. The thermometer two - afternoons was at 90 deg. Perhaps it may not be unuseful to mention - that calomel was given liberally. All who recovered were salivated. - All who could not be salivated died: and unfortunately some who were - evidently salivated died. Since forming my table I find that a Mrs. - Plummer who lived near the wharf will die.[208] Her case for the - first seven days was supposed to be an intermittent fever; then it - assumed the symptoms of the yellow fever. She was taken on the 11th - July. - - [208] “This patient is now dead.” - - - - -SECTION IV. - - _Remarkable Cases._ - - -So many cases have been enumerated in the course of this work, that -little more remains to be done in that way. The following are given, -not merely on account of their singularity, or to give instances of -surprising and unexpected recovery, but to elucidate some points of -doctrine hinted at before, and not sufficiently explained. - -1. _Spontaneous burning._ In the former part of this treatise several -extraordinary instances of this kind are given; but a doubt was -suggested whether the fire was produced _internally_, or _externally_. -The following account, from the Medical Extracts, determines the -matter. The circumstance took place in England, in the year 1613. One -Hitchill, a carpenter, came home from his work as usual, without being -sensible of any indisposition, and went to bed. In the night time, or -early in the morning, his wife awaked and found him dead by her side. -His body was so hot that it could not be touched, and he continued -burning internally for _three days_. No flame appeared on the outside, -only an hot steam issued from his body; and we are not told what was -the ultimate effect of the fire, or whether his body was consumed to -ashes or not. In the same work we are told of a woman who was found -dead in her room in the morning, and consumed to ashes, her very bones -being calcined to whiteness. The floor on which she lay was very little -burned. This last case, however, is not so directly in point as the -former, which seems decisive with regard to the internal origin of the -fire. - -2. _M. D’Obsonville’s case of the plague._ In the former part of this -treatise it has been said that heat destroyed the plague; but, on the -authority of the Russian physicians, that the disease could not be -treated in hot rooms. The following case, however, shows that even -exposure to a burning sun in a desert, to the cold air of night, and -to the most injurious usage, cannot always render fatal an attack -even of the most dreadful distemper in the world. M. D’Obsonville had -undertaken a journey over land to the East Indies, in order to execute -an important commission from the French government, in 1761, the very -time when the plague raged violently in the east. He describes his -case in the following words: “I felt the first symptoms of the plague -two small days journey from Aleppo, when I had entered the desert; -and at night, when going to rest, complained of a general uneasiness -and heaviness of the head. In the morning the fever was known to -be inflammatory; and from that time I had no longer any sleep. The -third, the fever and head-ach became more violent, two buboes began -to rise on my left side, my tongue was swelled, and of a brown violet -colour. The fourth and fifth days, sores began to appear on my loins, -the spine of my back, and the scrotum; some of which were as large -as the palm of my hand, and their colour at first was a red purple. -I was obliged, however, to rise, like other passengers, at two in -the morning, and travel on horseback till eleven. Unable to swallow -any thing but a little water, abandoned by my Christian servant, who -durst not come near me, and attended by an Arab, that I could not -understand, the violence even of my illness, and a little fortitude, -had hitherto contributed to support me; but my weakness increased -hourly, and I could no longer sit my horse, when an Armenian lady, -named _Tcheremani_, determined to ride him herself, and with the utmost -humanity gave up her camel to me, on which was a kind of litter. On the -sixth day the symptoms all appeared aggravated; at one moment my pulse -beat with an astonishing quickness, and fire seemed to run through my -veins; and the next, my blood was intercepted in its course, a moisture -covered my forehead, and I felt myself fainting, though without being -delirious, or losing my senses.” - -The caravan having arrived at a small ruined village named _Soccun_, -in the desert, it was resolved to leave M. D’Obsonville to his fate, -his case being considered as desperate; and indeed he says he was -left alone at his own request. A small horde of Arabs resided in that -village, though ruined, and our patient was consigned to the care -of a religious person called a _moullah_. This gentleman, like too -many others, did not choose to _serve God for nought_, and therefore -demanded fifty piastres in silver, besides some effects, in recompense -for the charity which he was about to extend to the unhappy traveller. -Having received those, and the caravan being gone, the moullah and -his wife in the night time laid M. D’Obsonville across an ass, and -carried him about a mile into the desert, where they left him to shift -for himself. Happily, however, either through accident or design, -these religious devils had deposited their prey near some water, -which undoubtedly, as he still retained his senses, was the means of -preserving his life. “It was there (says he) that, extended upon the -earth, with no other succour than a little water, nature laboured to -expel the poison by which I was oppressed. One of the buboes burst of -itself; the pestilential sores, which appeared first of a red purple, -became yellowish, then brown, and lastly black. These parts then -becoming gangrenous, formed hard and thick scabs, which, kernelling and -falling away from the quick flesh, left very deep ulcers. This was the -first epocha of health; an abundant suppuration began, and the fever -almost immediately left me.” - -Having remained alone in the desert for eight or ten days, he was found -by chance by some Arabian women, who brought him to their place of -residence, washed his sores with water, brought him dried herbs for -his bed, and gave him barley bread, butter and curds for his food; -endeavouring besides by their songs to comfort him, and alleviate -his distress as much as possible. With these women he remained twenty -days, reduced to an extremity of weakness by reason of the discharge -from the sores. At last, having learnt a few Arabic words, he prevailed -upon two of the husbands to conduct him to Aleppo, about seven days -journey distant. He was now mounted astride on a camel (a very hard -trotting animal) and by forced marches accomplished the journey in six -days, when he appeared before the consul, the European merchants, and -a crowd of people, in a condition without example; almost naked, with -five running buboes, the little covering he had foul, infected with -ulcers as long as the palm of the hand, which had eaten away the flesh, -and in some places discovered the bones, having besides two holes in -the scrotum. From this miserable condition he recovered in a month. It -would seem that in some cases the human body, as well as mind, rises -superior to every indignity; and that in proportion to the degree of -injury and oppression is the tenacity of life, as well as energy of -spirit. - -3. _Remarkable cure of the plague by exposure to cold and wet._ M. -Savary relates that the captain of a vessel informed him that, having -touched at Constantinople when the plague was raging there, some of his -sailors caught the distemper; two died suddenly, and by assisting them -he was infected. “I felt excessive heat (says he) which made my blood -boil; the disease seized my head, and I perceived that I had only a few -moments to live. The little remaining reason I had taught me to attempt -an experiment. I laid myself, quite naked, all night on the deck; the -heavy dews that fell penetrated to my very bones; in a few hours I -could breathe freer, and my head was better; my agitated blood became -calm, and, bathing the morning after in the sea, I was perfectly cured.” - -4. _Extraordinary effect of_ FEAR _in rendering the contagion of the_ -SMALL POX _effectual_.[209] “A very beautiful girl, twenty-five years -of age, servant to captain Morton, had never had the small pox, and -had the most dreadful apprehensions of that disease. On the twentieth -of January, 1791, about four in the afternoon, she was standing near -the kitchen fire, when a joiner in the neighbourhood came to the door, -which is about sixteen feet from the fire place where the girl stood. -Mrs. Morton found fault with the man for not coming sooner to finish -some work, and he excused himself by saying his apprentice was ill of -the small pox, which had delayed him. The girl immediately clasped her -hands, and exclaimed, God forgive you, but I will lay my death to you. -From that moment she became chilly, then hot and restless. She passed -a very bad night, frequently exclaiming, God forgive Calder, he has -killed me; meaning he had given her the small pox. In the morning of -the twenty-first I was sent for, and found her very hot, with a quick -pulse, great sickness and anxiety. I ordered her an emetic, and assured -her she did not need to be in the least alarmed, as she could not -possibly have caught the disease. She seemed to be convinced that her -fears were groundless; but next day, the twenty-second, a violent rash -appeared; on the twenty-third the small pox came out, of the worst kind -I had ever seen, and she died on the ninth day from the eruption.” - - [209] Haygarth’s Sketch, vol. ii, p. 405. - -5. _Inefficacy of_ FEAR _to render the contagion of_ YELLOW FEVER -_effectual_. Dr. Rush mentions a young woman so exceedingly fearful of -the disease, that she was troublesome to all around her. Afterwards she -happened to be under the necessity of attending _seven_ persons ill -of the fever, and yet escaped unhurt. This shows that fear (and the -same may be said of any predisposing cause) is not always sufficient -to produce the disease. The foregoing case is so extraordinary that -Dr. Haygarth is of opinion that the patient must have been previously -infected; but of this there is no evidence; and it is bad reasoning to -endeavour to establish a fact by our own ignorance. The only argument -that is or can be used in such cases is, “I cannot understand how such -a thing could have happened, _therefore_ it _has not_ been so.” 6. -_Boullam fever cured by a blister._[210] The patient was a tradesman in -St. George’s, Grenada, and had “all the symptoms of the disease except -the febrile heat. A blister was applied between the shoulders, without -administering any medicine previously except the solution (mentioned -p. 530) which operated very moderately. The effect was wonderful; the -discharge was uncommonly large, black, and fœtid in an intolerable -degree; and the instant this took place the patient became better; and -soon after, without the use of any other remedy, recovered.” - - [210] Chisholm’s Essay, p. 169. - -7. _Yellow fever of Barbadoes cured by vomiting._[211] The patient -was a young man, about twenty-four years of age, surgeon to a Guinea -ship. Being a lover of spiritous liquors, he had been drunk three days -and nights successively, and in that condition had run races with the -sailors on the shore, in the heat of the mid day sun. The last night -he slept in the open air under a tamarind tree, and in the morning -was seized with the fever, attended with the most violent retching -to vomit, insomuch that he could scarcely answer yes or no to the -questions asked him by the Doctor. Sixteen ounces of blood were taken -away, which was very florid, thin and dissolved. He was directed then -to drink warm water to cleanse his stomach, which he did to the amount -of three gallons, which he discharged, together with immense quantities -of yellow and blackish bilious matter. He then took a grain and an -half of opium, and slept some hours, after which a dose of manna and -tamarinds carried off by stool a good deal more of bilious matter, and, -with the help of some elixir of vitriol, mint and snakeroot tea, he -recovered in a short time. - - [211] Hillary’s Observations, p. 175. - -Dr. Rush, in a letter published in the newspapers last year, after -regretting the inefficacy of bleeding and purging, suspects “that death -occurred from the stagnation of acrid bile in the gall-bladder, or its -adherence to the upper bowels, as mentioned by Dr. Mitchell in 1741,” -which he proposes to evacuate by strong emetics and purgatives, so -as to occasion an artificial cholera morbus; and he greatly commends -this mode of practice. “Vomits (says he) are old remedies in the yellow -fever of the West Indies. I gave them on the first day of the disease -in the year 1793, and always without success. They uniformly did harm -when given in the beginning of the fever in its worst grade, in 1797. -The reason of this failure in their efficacy I now perceive was because -they were given _before_ the violent morbid action in the system -was reduced or moderated by bleeding and purging. After this change -is introduced in the disease they are perfectly safe. The time for -exhibiting them should be regulated by the pulse and other symptoms. -In moderate cases of the fever they are as proper in its first stage -as on the 4th day. As there is a blistering point in all fevers, so -there appears to be an _emetic point_ in the yellow fever. It may occur -on the second, and it may be protracted to the sixth or seventh day -of the disease. I have not given the medicine I have mentioned in any -case where the patient complained of pain or burning in the stomach; -but I have considered a nausea, and a moderate degree of puking, as no -obstacle to its use; for Dr. Physic has taught me by his dissections -that these symptoms may exist without the least inflammation in the -stomach, and that they have been absent where the stomach has appeared -after death to have been highly inflamed. - -“The cure of the fever should not rest upon a single dose of the -medicine. I have given two doses of it in a day in several cases, and -have given it in one case every day for three successive days. - -“It has often been remarked, that no two epidemics are exactly alike. -They vary not only in different climates, but in the same climate in -different years. They even vary with the changes of the weather in the -same season. The fever of 1797 differed in several particulars from the -fever of 1793; and the present epidemic differs materially from both. -In many of the cases I have seen it exceeds the fever of last year in -its malignity. These variations in diseases call for corresponding -changes in our practice.” - -8. _Extraordinary case of yellow fever at Boston in 1798._ “The subject -of it[212] was a female of about 24 years of age, in the 9th month -of pregnancy. I saw her on Monday the 17th of September. She had -then a small but painful hardness on the left parotid gland, which -had commenced some days before, and soon extended to the lips and -neighbouring parts. The centre of the tumour resembled that of the -incision of an arm about the time of the eruption of the small pox -after inoculation, exhibiting a hard, florid, shining appearance. I -recommended an emollient poultice, hoping to procure suppuration; but, -though they were repeated steadily, not the least evidence of matter -could be produced; and upon each visit I found the tumour had extended -in a rapid and formidable degree. I was called up in the course of -the night to her, and found her almost suffocated from the pressure -of the tumour on the trachea; for it had now extended itself to all -the muscles and glands of the neck and face. I changed the poultice -for an embrocation of the saturnine preparations, which were repeated -till about 10 o’clock of the following morning, when she was taken in -travail, and soon delivered of a healthy male child. For a few hours -after her delivery she appeared something better, but in the night she -grew worse, and about 12 o’clock I was called to her, when she appeared -to be expiring. At the request of her friends I entered my lancet into -the tumour the length of the instrument; but, as I had expected, not -the least particle of matter flowed, and the parts were _as hard as a -schirrus_. She continued however in agony till 3 o’clock of the day, -and then expired.” - - [212] The attending physician’s name is not mentioned, having no - permission to do so. - -9. _Two cases of spontaneous origin of yellow fever: from the Medical -Repository, vol._ ii, _p._ 333. “At Salem (Massachusetts) there was -a general prevalence of health at that season; though several cases -of yellow fever, and some of them fatal ones, occurred. Dr. Oliver -very judiciously inclines to the belief that the exemption of this -town from the ravages of yellow fever is owing, 1st, to the remarkably -clean state of the town; and, 2dly, to the houses being placed at such -distances as to admit of free ventilation. It was observable that the -yellow fever had a _spontaneous_ origin in two different places of the -town, where putrid matters had been suffered to accumulate, and proved -fatal to two persons in different families; these unclean spots forming -exceptions to the generally purified state of the town.” - -10. _Case of fever produced by the effluvia of putrid beef._ This took -place in the federal garrison on Governor’s Island.[213] The subject -was a soldier, who had been excused from duty on account of a violent -and obstinate gonorrhœa. On removing him into a lodging without the -garrison he was seized with symptoms of fever, and on the commencement -of these the gonorrhœa ceased. For four days the fever increased, and -was attended at last with vomiting, hiccup and delirium. From the first -commencement of the disease the physician had been sensible of a very -offensive smell in the patient’s room. Being assured that this was not -owing to want of cleanliness, he caused search to be made under it, and -in the cellars found three barrels of beef so putrid that it was with -difficulty they could be removed, on account of the stench. On removing -them, however, the patient rapidly recovered, though till then he had -constantly grown worse. - - [213] Medical Repository, vol. i, p. 210. - - -END OF THE SECOND PART. - - - - -APPENDIX. - - - - -N^o I. - -_Account of the Plague at Athens, in the time of the Peloponnesian -War:--From_ THUCYDIDES.--SMITH’_s Translation._ - - -The Peloponnesians and their allies, who had made an incursion into -Attica, with two thirds of their forces, had not been many days there -before a sickness began first to appear among the Athenians, such as -was reported to have raged before this in other parts, as about Lemnos -and other places. Yet a plague so great as this, and so dreadful a -mortality, in human memory could not be paralleled. The physicians at -first could administer no relief, through utter ignorance; nay, they -died the faster, the closer their attendance on the sick; and all -human art was totally unavailing. Whatever supplications were offered -in the temples, whatever recourse to oracles and religious rites, all -were insignificant: at last, expedients of this nature they totally -relinquished, overcome by calamity. It broke out first, as it is said, -in that part of Ethiopia which borders upon Egypt; it afterwards spread -into Egypt and Libya; and at length, on a sudden, fell on the city -of the Athenians. The contagion shewed itself first in Piræus; which -occasioned a report, that the Peloponnesians had caused poison to be -thrown into the wells; for, as yet, there were no fountains there. -After this it spread into the upper city, and then the mortality very -much increased. Let every one, physician or not, freely declare his own -sentiments about it; let him assign any credible account of its rise, -or the causes strong enough, in his opinion, to introduce so terrible -a scene. I shall only relate what it actually was, and as, from an -information in all its symptoms, none may be quite at a loss about it -if ever it should happen again, I shall give an exact detail of them; -having been sick of it myself, and seen many others afflicted with it. - -This very year, (430 B. C.) as is universally allowed, had been, more -than any other, remarkably free from common disorders; or, whatever -diseases had already seized the body, they ended at length in this. -But those who enjoyed the most perfect health were suddenly, without -any apparent cause, seized at first with head-achs extremely violent, -with inflammations and fiery redness in the eyes. Within, the throat -and tongue began instantly to be red as blood; the breath was drawn -with difficulty, and had a noisome smell. The symptoms that succeeded -these were, sneezing and hoarseness; and, not long after, the malady -descended to the breast, with a violent cough; but, when once settled -in the stomach, it excited vomitings, in which was thrown up all -that matter which physicians call discharges of bile, attended with -excessive torture. A great part of the infected were subject to -such violent hiccups, without any discharge, as brought upon them -strong convulsions, to some but of a short, to others of a very long -continuance. The body, to the outward touch, was neither very hot -nor of a pallid hue, but reddish, livid, marked all over with little -pustules and sores; yet, inwardly, it was scorched with such excessive -heat that it would not bear the slightest covering of the finest linen -upon it, but must be left quite naked. They longed for nothing so -much as to be plunging in cold water; and many of those who were not -properly attended threw themselves into wells, hurried by a thirst -not to be extinguished; and, whether they drank much or little, their -torment still continued the same. The restlessness of their bodies, -and an utter inability of composing themselves to sleep, never abated -for a moment. And the body, so long as the distemper continued in its -height, had no visible waste, but withstood its rage to a miracle; so -that most of them perished within seven or nine days by the heat that -scorched their vitals, though their strength was not exhausted; or, -if they continued longer, the distemper fell into the belly, causing -violent ulcerations of the bowels, accompanied with an incessant flux, -by which many, reduced to an excessive weakness, were carried off. -For the malady, beginning in the head, and settling first there, sunk -afterwards gradually down through the whole body. And whoever got safe -through all its most dangerous stages, yet the extremities of their -bodies still retained the marks of its violence. For it shot down into -their privy members, into their fingers and toes, by losing which they -escaped with life. Some there were who lost their eyes, and some who, -being quite recovered, had at once totally lost all memory, and quite -forgot not only their most intimate friends, but even their own selves. -For, as this distemper was in general virulent beyond expression, and -its every part more grievous than had yet fallen to the lot of human -nature; so, in one particular instance, it appeared to be none of the -natural infirmities of man, since the birds and beasts that prey on -human flesh either never approached the dead bodies, of which many lay -about uninterred, or certainly perished if they tasted. One proof of -this is then the total disappearance of such birds; for not one was to -be seen, either in any other place, or about any of the carcases. But -the dogs, because of their constant familiarity with man, afforded a -more notorious proof of this event. - -The nature of this pestilential disorder was in general (for I have -purposely omitted many of its varied appearances, or the circumstances -particular to some of the infected in contradistinction to others) -such as hath been described. None of the common maladies incident to -human nature prevailed at that time; or, whatever disorder any where -appeared, it ended in this. Some died merely for want of care; and -some with all the care that could possibly be taken; nor was any one -medicine discovered from whence could be promised any certain relief; -since that which gave ease to one was prejudicial to another. Whatever -difference there was in bodies in point of strength, or in point of -weakness, it availed nothing; all were equally swept away before it, -in spite of regular diet, and studied prescriptions. Yet the most -affecting circumstances of this calamity were, that dejection of mind -which constantly attended the first attack; for the mind sinking at -once into despair, they soon gave themselves up without a struggle; -and that mutual tenderness in taking care of one another, which -communicated the infection, and made them drop like sheep. This latter -case caused the mortality to be so great. For, if fear withheld them -from going near one another, they died for want of help; so that many -houses became desolate for want of needful attendance; and if they -ventured, they were gone. This was most frequently the case of the kind -and compassionate. Such persons were ashamed, out of a selfish concern -for themselves, entirely to abandon their friends, when their menial -servants, no longer able to endure the groans and lamentations of the -dying, had been compelled to fly from such a weight of calamity. But -those, especially, who had safely gone through it, took pity on the -dying and the sick, because they knew by themselves what it really -was, and were now secure in themselves; for it never seized one a -second time so as to be mortal. Such were looked upon as quite happy by -others, and were themselves at first overjoyed in their late escape, -and the groundless hope that hereafter no distemper would prove fatal -to them. Besides this reigning calamity, the general removal from the -country into the city was a heavy grievance, more particularly to -those who had been necessitated to come thither. For, as they had no -houses, but dwelled all the summer time in booths, where there was -scarce room to breathe, the pestilence destroyed them with the utmost -disorder, so that they lay together in heaps, the dying upon the dead, -and the dead upon the dying. Some were tumbling over one another in -the public streets, or lay expiring about every fountain, whither -they had crept to assuage their extraordinary thirst. The temples, -in which they had erected tents for their reception, were full of the -bodies which had expired there. For, in a calamity so outrageously -violent, and universal despair, things sacred and holy had quite lost -their distinction. Nay, all regulations observed before in matters of -sepulture were quite confounded, since every one buried where he could -find a place. Some, whose sepulchres were already filled by the numbers -which had perished in their own families, were shamefully compelled -to seize those of others. They surprised on a sudden the piles which -others had built for their own friends, and burned their dead upon -them; and some, whilst one body was burning on a pile, tossed another -body they had dragged thither upon it, and went their way. - -Thus did the pestilence first give rise to those iniquitous acts -which prevailed more and more in Athens. For every one was now more -easily induced openly to do what for decency they did only covertly -before. They saw the strange mutability of outward condition; the rich -entirely cut off, and their wealth pouring suddenly on the indigent and -necessitous; so that they thought it prudent to catch hold of speedy -enjoyments and quick gusts of pleasure; persuaded that their bodies -and their wealth might be their own merely for the day. Not any one -continued resolute enough to form any honest or generous design, when -so uncertain whether he should live to effect it. Whatever he knew -could improve the pleasure or satisfaction of the present moment, that -he determined to be honour and interest. Reverence of the gods, or of -the laws of society, laid no restraints upon them; either judging that -piety or impiety were things indifferent, since they saw that all men -perished alike; or, throwing away every apprehension of being called -to account for their enormities, since justice might be prevented -by death; or rather, as the heaviest judgment to which man could be -doomed was already hanging over their heads, snatching this interval of -pleasure before it fell. - - - - -N^o II. - -_Account of the Great Plague in the time of_ JUSTINIAN:--_By_ PROCOPIUS. - - -This was a plague which almost consumed mankind; of which Procopius -concludes there was no other cause than the immediate hand of God -himself. For it neither came upon one part of the world alone, nor -in one season of the year; whence subtile wits (as he saith) might -make pretensions. It afflicted the whole world, and all conditions of -men, though of never so contrary a nature and disposition; sparing -no constitution nor age. The difference of men as to their places of -dwelling, diet, complexions, inclinations, &c. did no good in this -disease. Some it took in summer, some in winter, and others in other -seasons. It began among the Egyptians in Pelusium, and spread to -Alexandria, with the rest of Egypt, one way, and the other to those -parts of Palestine which border upon Egypt. From thence it travelled to -the utmost bounds of the world, as by set journies and stages, making -destruction its only business, and sparing neither island, cave, nor -top of mountain, where mankind inhabited; for, if it leaped over a -country, returning afterwards, it left it no cause to rejoice above its -fellows. It began still at the sea coast, and thence went to the inland -parts. In the second year of its progress it arrived at Constantinople, -about the middle of the spring, where it was the fortune of Procopius -then to reside. Apparitions of spirits, in all shapes human, were seen -by many, who thought the man they met struck them in some part of the -body; and so soon as they saw the spirit they were seized with the -disease. At first when they met them they repeated divine names, and -fled into churches, to no purpose. Afterwards they were afraid to hear -their friends call them, locking themselves up in their chambers, and -stopping their ears. Some dreamed they saw such sights; others that -they heard a voice tell them they were enrolled among the number of -those appointed to die. But most, without warning, became feverish -suddenly: their bodies changed not colour, nor were hot; the fever -being so remiss till evening, that neither the patient nor physician, -by his pulse, could apprehend any danger. Yet to some the same day, to -others the next, or many days after, arose a bubo, either in the groin, -the armpit, under the ear, or in other parts. These were the general -symptoms which happened alike to all the visited persons. - -There were others different; whether made so by the diversity of -bodies, or by the will and pleasure of him that sent the distemper, our -author cannot say. Some were seized with drowsiness and slumbering, -others with a sharp distraction. The slumberers forgot all things: if -they were looked to, some would eat; some, that were neglected, starved -to death. Those who were distracted were vexed with apparitions; crying -there were men to kill them; and running away; being so troublesome and -unruly that their keepers were pitied as much as they themselves. No -physician or other caught the disease by touching sick or dead bodies; -many strangely continuing free, though they tended and buried infected -persons, and many catching it they knew not how, and dying instantly. -Many leapt into the water, though not from thirst; and some into the -sea. Some, without slumbering or madness, had their bubo gangrened, -and died with extreme pain; which doubtless also happened to those who -had the phrensy, though, being not themselves, they understood it not. -Some physicians hereupon, conceiving the venom and head of the disease -to lie in those plague sores, opened the dead bodies, and, searching -the sores, found an huge carbuncle growing inward. Such whose bodies -were spotted with black pimples, the bigness of a lentile, lived not a -day. Many died vomiting blood. Some that were given over by the most -eminent physicians unexpectedly recovered; others, of whose recovery -they thought themselves perfectly secure, suddenly perished. No cause -of this sickness could be reached by man’s reason. Some received -benefit by bathing, others it hurt. Many died for want of relief, -others escaped without it. In a word, no way could there be found of -preservation, either by preventing the sickness, or of mastering the -disease, no cause appearing either of their falling sick or recovery. -Women with child, who were visited, certainly died; some miscarrying, -some fairly delivered, and perishing with their children. Three women -only were safely brought to bed and recovered, their children dying; -and one died whose child had the hap to live. Such as had their sores -great, and running plentifully, escaped; the violence of the carbuncles -being thereby assuaged; and this was the most certain sign of health. -Such whose sores staid as they first arose, underwent the miserable -accident formerly mentioned. Some had their thighs withered, when the -sores rose upon them and did not run. Some escaped with diminished -tongues, and lived stammering, or uttering sounds without distinction, -all their days. In Constantinople the pestilence lasted four months; -raging three months with all extremity. In the beginning few died more -than usual. Then, growing hotter and hotter, it came to five, and -at last to ten thousand every day. At first they buried their dead -carefully; but at length all came to confusion, and many lay long -unburied; servants were without masters; rich men had none to attend -them. In the afflicted city little was to be seen but empty houses, no -trade going, or shops open. - - - - -N^o III. - -_Account of the Plague at London in 1665_:--_From Dr._ HODGES _and -others._ - - -In the beginning of September 1664 the people of London first became -alarmed by a report of the plague being broke out in Holland, where -it raged violently the former year. The United Provinces had received -it from some place in the Levant, and, certain accounts having been -received of the distemper being in Holland, several councils were -held by government with a view of concerting means for preventing its -introduction into Britain. These were held privately, and it does not -appear that any thing was positively determined upon; but thus the -knowledge that such a distemper existed in Holland was suppressed, and -the public fears dissipated until the beginning of December; when two, -supposed to be Frenchmen,[214] in Long-acre, or rather the upper end -of Drury lane, died with such suspicious symptoms that the people of -the house endeavoured to conceal the distemper of which they died. The -secretaries of state, however, having got intelligence of the matter, -caused their bodies to be inspected, when it became evident they had -died of the plague. This produced a general alarm; Dr. Hodges says, -that “hereupon some timorous neighbours, under apprehensions of a -contagion, removed into the city of London; who unfortunately carried -along with them the pestilential taint; whereby that disease, which -was before in its infancy, in a family or two, suddenly got strength, -and spread abroad its fatal poison; and, merely for want of confining -the persons first seized with it, the whole city was irrecoverably -infected.” The author of the Journal, however, says that the public -fear again subsided, though it had been still farther raised by the -death of another person in the same house about the latter end of -December; but, as no more died for six weeks, no farther notice was -taken of it until the 12th of February, when one died in another house, -but in the same parish. Soon after this an increase was observed in -the weekly list of burials at St. Giles’s parish, which augmented the -general alarm so much that few cared to pass through Drury lane or -the suspected streets, unless upon very urgent business. In a short -time a like augmentation was perceived in the bills of the adjoining -parishes, and indeed all over the town. The Journal informs us that the -usual number of burials within the bill of mortality was from 240 to -300; but from the 20th of December to January 24th they had gradually -arisen from 291 to 474. This seems inconsistent with what he had before -said of the alarm having ceased till the 12th of February; but we -shall take his own words. “This last bill (474) was really frightful; -being a greater number than had been known to have been buried in one -week since the preceding visitation of 1656. However, all this went -off again, and the weather proving cold, and the frost, which began in -December, continuing very severe, even till near the end of February, -attended with sharp though moderate winds, the bills decreased again, -and the city grew healthy, and every body began to look upon the danger -as good as over; only that still the burials in St. Giles’s continued -high. From the beginning of April especially, they stood at 25 each -week, till the week from the 18th to the 25th, when there were buried -in St. Giles’s parish 30; whereof were two of the plague, and eight of -the spotted fever, which was looked upon as the same thing; likewise -the number that died of the spotted fever on the whole increased; being -eight the week before, and twelve the week above named.” - - [214] _Journal of the Plague Year._ - -Thus a new and still greater alarm was produced, which was yet farther -augmented by the spreading of the distemper. The journalist says indeed -that only a few were set down in the lists as having died of the -plague; the remainder of the deaths being charged to other distempers; -and accordingly one week, when the mortality bill was high, and only 14 -charged to the plague, he says, “this was all knavery and collusion; -for in St. Giles’s parish they buried 40 in all; whereof it was certain -that most of them died of the plague, though they were set down of -other distempers; and though the number of all the burials was not -increased above 32, and the whole bill being but 385, yet there were -14 of the spotted fever, as well as 14 of the plague; and we took it -for granted upon the whole that there were 50 died of the plague that -week. The next bill was from the 23d of May to the 30th, when the -number of the plague was 17; but the burials in St. Giles’s were 53; a -frightful number, of whom they set down but nine of the plague; but, -on examination more strictly by the justices of the peace, and at the -lord mayor’s request, it was found there were 20 more who were really -dead of the plague in that parish, but had been set down of the spotted -fever, or other distempers, besides others concealed.” - -The account given by Dr. Hodges is somewhat different from the above. -He informs us that “a very hard frost began in December and continued -three months, which seemed greatly to diminish the contagion, and -very few died during that season; though even then it was not totally -extinguished.” The journalist says that in this intermission of the -plague there was a difficulty which he could not well get over. The -first person who died of the plague he says (p. 234) was on December -20th, or thereabouts, 1664, though he had told us before (p. 2) that it -was the end of November, or _beginning_ of December the same year. “But -after this (continues he) we heard no more of any person dying of the -plague, or the distemper being in that place, till the 9th of February, -which was about seven weeks after; and then one more was buried out of -the same house: then it was hushed, and we were perfectly easy as to -the public for a great while, for there were no more entered in the -weekly bill to be dead of the plague, till the 22d of April. Now the -question seems to be thus: Where lay the seeds of the infection all -this while? How came it to stop so long, and not to stop any longer? -Either the distemper did not immediately come by contagion from body to -body, or, if it did, then a body may continue to be infected without -the disease discovering itself many days, nay, weeks together. It is -true there was a very cold winter, and long frost, which continued -three months; and this, the Doctors say, might check the infection; -but then the learned must allow me to say that if, according to their -notion, the disease was, as I may say, only frozen up, it would, like -a frozen river, have returned to its usual force and current when it -thawed; whereas the principal recess of the infection, which was from -February to April, was after the frost was broken, and the weather mild -and warm. But there is another way of solving all this difficulty, -which I think my own remembrance of the thing will supply; and that -is, the fact is not granted, namely, that there died none in those -long intervals, viz. from the 20th of December to the 9th of February, -and from thence to the 22d of April. The weekly bills are the only -evidence on the other side, and those bills were not of credit enough, -at least with me, to support an hypothesis, or determine a question of -such importance as this: for it was our received opinion at that time, -and I believe upon very good grounds, that the fraud lay in the parish -officers, searchers and persons appointed to give account of the dead, -and what diseases they died of; and, as people were very loth at first -to have the neighbours believe their houses were infected, so they -gave money to procure, or otherwise procured, the dead persons to be -returned as dying of other distempers; and this, I know, was practised -afterwards in many places; I believe I might say in all places where -the distemper came; as might be seen by the vast increase of the -numbers placed in the weekly bills under other articles of diseases, -during the time of the infection. For example, in the months of July -and August, when the plague was coming on to its highest pitch, it was -very ordinary to have from 1000 to 1200, nay to almost 1500, a week, of -other distempers: not that the numbers of those distempers were really -increased to such a degree; but the great number of families and houses -where really the infection was, obtained the favour to have their dead -returned of other distempers, to prevent the shutting up of their -houses.” - -The disease continued to advance, but with such intervals and -remissions as frequently gave hopes of its disappearing entirely. -Nevertheless, about the beginning of May the inhabitants began to -leave the city in great numbers. The journalist, for his own part, was -irresolute; and sometimes would have left the city with the rest, had -it not been for the impossibility of finding an horse; “for, (says -he) though it is true that all the people did not go out of the city -of London, yet I may venture to say that in a manner all the horses -did; for there was hardly a horse to be bought or hired in the whole -city for some weeks.” Many fled on foot, carrying with them soldiers’ -tents, in which they slept in the fields, it being then warm weather, -and no danger of taking cold. This way of living was also familiar in -some degree by reason of the wars which had preceded; multitudes of -those who had served in them being at that time in London. This our -author greatly approves of as a method of preventing the infection from -spreading, and thinks that had it been more generally practised, much -less damage would have been done in the country than happened at the -time from this dreadful distemper. - -Early in June the court thought proper to remove to the city of Oxford, -whither the infection did not reach. The people still continued to -remove during the whole month of July though in smaller numbers than -before; but in August the multitude of fugitives so increased that -says our author, “I began to think there would be none but magistrates -and servants left.” He informs us also that at the breaking out of -this plague the city was unusually full of people; vast numbers who -had served in the wars or who in times of trouble had been friends to -royalty had flocked into it on the restoration of Charles II, in hopes -of reaping some fruit of their former labours and sufferings; so that -on the whole he supposes there must have been upwards of an hundred -thousand people more than usual in the city. Indeed if we are to -believe that, on a representation of the state of the poor to the lord -mayor, it appeared that there were an hundred thousand ribband weavers -in Spittle-fields, we must look upon the population of London at that -time to have been incredibly great; and when the journalist computes -the number of those who fled only at two hundred thousand, we must -certainly suppose it to have been greatly underrated. - -As the plague continued to become more and more violent, the -magistrates thought proper to take some means for separating the -infected from the healthy; but unhappily their mode of procedure was -such as inspired both the infected and uninfected with the utmost -terror. The houses were marked with a red cross, subscribed with -the words “LORD, HAVE MERCY UPON US!” in large letters. They were -continually guarded, day and night; and none were allowed access to -the sick, to give them either food or medicines, excepting those who -guarded them; nor were the sick themselves allowed to go abroad until -forty days after their recovery. But, though the distemper continually -advanced, it did not get to its full height until the months of August -and September. Before this time it seemed to fly from place to place; -so that great hopes were entertained, though always without foundation, -of its total removal; but now it invaded the whole city. Four or five -thousand died in a week; once eight thousand; and, in the month of -September, for some time, twelve thousand a week died. The city was -reduced to the extremity of distress. - -The author of this journal had the courage not only to remain in the -city, during the whole time of the infection, but even took many -solitary walks to the house of his brother, who had removed into the -country, in order to preserve his goods from being stolen. At first he -went every day, but afterwards only once or twice a week. He tells us -also that he took many walks out of curiosity; and, though he generally -came home frighted and terrified, he could not restrain himself. “In -those walks (says he) I had many dismal scenes before my eyes; as -particularly of persons falling dead in the streets, terrible shrieks, -and screamings of women, who, in their agonies, would throw open their -chamber windows, and cry out in a dismal, surprising manner. - -“It is scarce credible what dreadful cases happened in particular -families every day; people in the rage of the distemper, or in the -torment of their swellings, which was indeed intolerable, running -about raving and distracted; and oftentimes laying violent hands -upon themselves, throwing themselves out at their windows, shooting -themselves, &c. mothers murdering their own children, in their lunacy; -some dying of mere grief as a passion; some of fright and surprise, -without any infection at all; others frighted into idiotism and foolish -distractions, some into despair and lunacy; others into melancholy -madness.” - -The distemper was found to rage so violently among the poorer sort, -that we are told by Dr. Hodges, some gave it the name of the _poor’s -plague_. This is confirmed by the journalist, who informs us that “the -misery of that time lay chiefly upon the poor, who, being infected, had -neither food nor physic; neither physician nor apothecary to assist -them, nor nurse to attend them; many of those died calling for help, -and even for sustenance, out of their windows, in a most miserable and -deplorable manner; but it must be added, that, whenever the cases of -such persons or families were represented to the lord mayor, they were -always relieved.” Indeed the charity of the more opulent, upon this -occasion, almost exceeds belief. Dr. Hodges informs us, that “though -the more opulent had left the town, and it was left almost uninhabited, -the commonalty who remained felt little of want; for their necessities -were relieved with a profusion of good things from the wealthy, and -their poverty was supported with plenty.” The probable reason of such -devastation among the poor, Dr. Hodges promises, p. 15, to give, and -does not; at least I have not been able to find it in his book; I -must therefore content myself with what the journalist (though no -physician) has delivered on this subject. He says, that when people -began to use proper cautions, the danger of infection was the less. -“But (says he) it was impossible to beat any thing into the heads of -the poor; they went on with the usual impetuosity of their tempers; -full of outcries and lamentations when taken, but madly careless of -themselves, fool-hardy and obstinate when well: where they could get -employment, they pushed into any kind of business, the most dangerous, -and the most liable to infection; and, if they were spoken to, their -answer would be, I must trust to GOD for that; if I am taken, then I -am provided for, and there is an end of me, or the like; or thus: Why, -what must I do? I cannot starve; I had as good have the plague, as -perish for want. I have no work, &c. This adventurous conduct of the -poor was what brought the plague among them in a most furious manner; -and this, joined to the distress of their circumstances, when taken -(with the distemper) was the reason why they died so in heaps: for I -cannot say that I could observe one jot of better husbandry among them, -I mean the labouring poor, while they were well and getting money, than -there was before; but as lavish, as extravagant, and as thoughtless of -to morrow, as ever; so that, when they came to be taken sick, they were -immediately in the utmost distress, as well for want as for sickness, -as well for lack of food as lack of health.” - -In the time of so great a calamity, the magistrates exerted themselves -as far as their power and skill would permit, to lessen the sufferings -of the people. It was natural also in such a dreadful emergency to call -upon the physicians to exert themselves. Accordingly the king (Charles -II) by his royal authority commanded the College of Physicians of -London jointly to write somewhat in English, that might be a general -directory in this calamitous exigence; nor was it satisfactory to -this honoured society to discharge their regards for the public in -that only; but some were chosen out of their number, and appointed -particularly to attend the infected on all occasions; two also out -of the court of aldermen were required to see this hazardous task -executed.[215] - - [215] _Hodges, p. 13, & seq._ - -Our author then proceeds to mention the names of some who were -employed in this laudable undertaking; particularly Dr. Glisson, -regius professor at Cambridge, Dr. Nathaniel Paget, Dr. Wharton, Dr. -Berwick and Dr. Brookes; many others he says were employed; “but (he -adds) eight or nine fell in the work, who were too much loaded with -the spoils of the enemy; among whom was Dr. Conyers, &c. After, then, -all endeavours to restrain the contagion had proved of no effect, we -applied ourselves altogether to the cure of the diseased.” - -We shall not doubt of the good intentions of the physicians: of their -success we may judge from what Dr. Hodges himself says, that many died -while prescribing cures for others. To the same purpose the journalist, -p. 43: “I shall not be supposed to lessen the authority or capacity of -the physicians, when I say that the violence of the distemper, when -it came to its extremity, was like the fire the next year (1666). The -fire which consumed what the plague could not touch, defied all the -application of remedies; the fire-engines were broken, the buckets -thrown away, and the power of man was baffled and brought to an end; -so the plague defied all medicine; the very physicians were seized -with it, with their preservatives in their mouths; and men went about -prescribing to others, and telling them what to do, till the tokens -were upon them, and they dropped down dead, destroyed by that very -enemy they directed others to oppose. This was the case of several -physicians, even some of the most eminent, and of several of the most -skilful surgeons; abundance of quacks too died, who had the folly to -trust to their own medicines,” &c. - -Thus, in defiance of every effort of human skill, the calamity -continued. “The contagion (says Dr. Hodges) spread its cruelties into -the neighbouring countries; for the citizens, who crowded in multitudes -into the adjacent towns, carried the infection along with them, where -it raged with equal fury; so that the plague, which at first crept from -one street to another, now reigned over whole counties, leaving hardly -any place free from its insult, and the towns upon the Thames were more -severely handled; not, perhaps, from a greater moisture in the air from -thence, but from the tainted goods rather, that were carried upon it: -moreover some cities and towns, of the most advantageous situation for -a wholesome air, did, notwithstanding, feel the common ruin. Such was -the rise, and such the progress, of this cruel destroyer, which first -began at London.”[216] - - [216] _Hodges, p. 25._ - -But it is now time to turn from those scenes of horror. The power of -the pestilential contagion was not absolutely _immeasurable_. It had -its rise, its progress, its state and declension. Dr Hodges tells us -that, _when_ “_the worst part of the year was over, and the height of -the disease_, the plague by leisurely degrees declined, and before the -number infected decreased, its malignity began to relax, insomuch that -few died, and those chiefly such as were ill managed; hereupon that -dread which had been upon the minds of the people wore off; and the -sick cheerfully _used all the means directed for their recovery_; and -even the nurses grew either more cautious, or more faithful; insomuch -that after some time a dawn of health appeared, as sudden, and as -unexpected, as the cessation of the following conflagration; wherein, -after blowing up of houses, and using all means for its extinction to -little purpose, the flames stopped as it were of themselves for want -of fuel, or, _out of shame_, for having done so much mischief. The -pestilence, however, did not stop for want of subjects to act upon, -(as then commonly rumoured) but from the nature of the distemper. -Its decrease was, like its beginnings, moderate, &c. About the close -of the year, that is, on the beginning of November, people grew more -healthful,” &c. - -The numbers who perished in this violent plague are so variously -reported that nothing certain can be said concerning it. Dr. Morton -says that upwards of forty thousand died; but from the foregoing -accounts it is evident that this calculation must be prodigiously -underrated. The journalist indeed gives strong reasons for believing -that all the accounts of the numbers who perished were much below -the truth. He thinks that an hundred thousand at least must have -fallen victims to it; and if his own assertion be true, that thirty -thousand died in the last three weeks, we cannot suppose but that -three times that number died in the course of the twelvemonth that -the disease lasted; which would fix the calculation at 120,000. This -great mortality however was soon forgot; as soon as the danger was -over, the ravages it had committed were no longer an object of terror. -The disease had its usual effect, viz. increasing the desire of the -sexes for each other. “They had the courage (says Dr. Hodges) now to -marry again, and betake to the means of repairing the past mortality; -and even women before deemed barren were said to prove prolific; -so that, although the contagion had carried off, as some computed, -about one hundred thousand, after a few months their loss was hardly -discernible.” - - - - -N^o IV. - -_Account of the Plague at Marseilles in 1720:--From the Periodical -Publications of the time._ - - -So much hath been said concerning this plague, in the first part of -this treatise, that no particular detail is requisite here. In its -symptoms it differed little if any thing from the plague of London, -described in the former number. Many died without any previous -sickness, and, while the distemper continued severe, few outlived the -third day; and so infectious was its nature, that one person in a -family was seldom attacked without its successively attacking all the -rest. The bodies were said to putrefy in 24 hours. Very considerable -sums of money were collected here, as well as in London. The conduct -of the bishop on this melancholy occasion has been greatly celebrated -by many; among others by Dr. Darwin, in his Botanic Garden, in the -following lines: - - “So when Contagion, with mephitic breath, - And wither’d Famine, urg’d the work of death; - [217]Marseilles’ good Bishop, London’s gen’rous Mayor, - With food and faith, with med’cine and with prayer, - Rais’d the weak head, and stay’d the parting sigh, - Or with new life relum’d the swimming eye. - - [217] “The bishop of Marseilles, during the time of this miserable - calamity, was indefatigable in the execution of his pastoral - office, visiting, relieving, encouraging and absolving the sick - with extreme tenderness; and though perpetually exposed to the - infection, like Sir John Lawrence, the lord mayor of London in - 1665, was never seized with the disease--This last gentleman, with - undaunted resolution, continued in the city during the whole time - of the calamity, executing the duties of his office with the utmost - punctuality. The day after the disease was certainly known to be the - plague, above 40,000 servants were dismissed, and turned into the - streets to perish, for no one would receive them into their houses: - and the villages near London drove them away with pitchforks and - fire-arms. Sir John Lawrence supported _them all_, as well the needy - as those who were sick; at first by expending his own fortune, till - subscriptions could be solicited and received from all parts of the - nation.” (_Darwin’s Botanic Garden. Loves of the Plants, canto_ ii, - _p._ 61.) - - - - -N^o V. - -_Account of the Plague in Syria, Cyprus &c.--From Dr._ PATRICK -RUSSEL’_s Treatise_. - - -This plague was preceded by violent cold, famine, and earthquakes. -In 1759 it began in Egypt, having been imported in a vessel from -Constantinople. from Alexandria in Egypt it was brought by some Jews -to Saffat, a village in Syria, near Aleppo, which had suffered much by -the earthquake; which last was for some time thought to have been the -cause of the distemper; but, when its nature was really discovered, -they comforted themselves with the thoughts that an _Egyptian_ plague -was less to be dreaded than one which came from the northward. - -The distemper had been introduced into Cyprus as early as April 1759, -by a vessel from Constantinople, wrecked on the coast; and, having -thus got a footing in Egypt, Syria and Cyprus, its progress was marked -with the usual mortality. In Egypt the Europeans in Cairo remained in -confinement till the middle of July; a space considerably longer than -usual. Next year they shut up on the 9th of March, but were released on -the 24th of June. The distemper raged in the city with such fury during -1759 and 1760, that in the two years four hundred and fifty thousand -were computed to have perished; a number, however, which Dr. Russel -thinks must have been exaggerated. Cairo had been free from plague -during the whole of this century before, except in the year 1736, when -the distemper raged with such violence that ten thousand were said to -have perished in one day. It was supposed to have been brought from -Upper Egypt. In Cyprus it broke out at the village of Limsol, where it -destroyed four hundred people. During the hot months of July, August -and September the infection showed itself so little that it was thought -to have been extinguished; but in October it not only reappeared in -the places where it had before showed itself, but invaded Nicosia, -the capital of the island. Endeavours were used, by burying the dead -bodies in the night, to conceal the existence of the distemper; but -this soon became impracticable. Towards the end of January, 1760, it -raged so dreadfully in this city that the Mahometans were enjoined to -use prayers and processions to avert the wrath of Heaven. The crowds -brought together on this occasion spread the distemper still more wide, -and in the following month its ravages began at Larnica, a small town -considerable for its trade, and which, though alarmed, had hitherto -kept free, even though infected persons had been freely admitted. Here -it raged with uncommon malignity, insomuch that few of those recovered -that were infected during the month of March. It continued to prevail -till the month of April, when it spread to the very eastern extremity -of the island, into the province of Carpass; a thing hitherto unknown. - -Two examples of apparent insusceptibility are related; one was a young -Greek, whose constant employment was, to nurse the sick, and assist at -the burials; the other, a Greek woman, who, having with great affection -nursed her husband and two daughters who died of the plague, continued -with admirable courage to expose herself in assisting the sick in the -neighbourhood. - -Towards the end of May the infection was rapidly decreasing; the -Europeans came out of their confinement in the month of July, and the -plague at last ceased, after having destroyed 70,000 persons; nearly -one half of the whole population. - -In Syria the plague appeared first in October, 1759, in the village -of Saffat. From thence it proceeded to Tripoli, where it began about -the middle of January, and did not decline till July; neither were the -Europeans thoroughly released from their confinement till towards the -end of August. One half of those infected are said to have recovered; -but five thousand perished. The city remained free from any attack -during the whole of 1761; but early in 1762 the distemper again made -its appearance in the neighbouring villages, and again began its -devouring ravages; but, though a free access was granted to infected -persons in the city, it does not appear that any general infection took -place. - -In Latarkea the distemper appeared in March, 1760, made considerable -progress during the month of April, increased from the 17th of that -month to the 13th of May, raged with great violence from that time to -the 27th of June, when it suddenly decreased, the funerals falling from -20 to 9. On the 4th and 5th of July they again rose to more than 20 but -presently fell below six. Four thousand were supposed to have died, -though it was thought that as many recovered as perished. At Jerusalem -the contagion discovered itself in January or February, 1760, and about -the middle of March reached Damascus. In both places it made great -havock; but no accurate accounts were kept of those who died. - - - - -N^o VI. - -_Remarkable case of a Remitting Fever at Bassorah in 1780._ - - -In the first part of this treatise we have given an account of the -fever which prevailed at Bassorah during the year we speak of, and -likewise of the journey of the gentleman from Bassorah to Zebire, where -he was taken ill on the 4th of June; but as the first attack went off -for that day, we shall only begin the narrative from the day following, -as he himself does in these words: - -5th June. From this day I date the actual commencement of my fever. -About 2 o’clock after dinner I was suddenly attacked with a violent -glowing heat all over my body, uneasiness, anxiety and oppression, but -in a very inconsiderable degree to what I afterwards experienced; also -a swelling in my tongue, which had been coming on some days, and is one -of the first symptoms of the fever that prevailed. The fit continued -about two hours; a slight perspiration succeeded, which removed the -fever, but left a head-ach, thirst, and pains in my back and limbs. -In the evening with assistance I got upon the terrace, when the moon -and stars appeared of a bright yellow, and all objects had that colour -through the whole of my disease; also the pain in making water, and -across my loins, became intolerable, like that felt in complaints of -the stone in the bladder. I took some tartar emetic, which brought up a -great deal of bile, and the next morning a purgative of Rochelle salts, -manna, tamarinds and anniseeds. - -6th June. In the forenoon a free, copious perspiration, and a perfect -intermission of the fever; at night became very restless and uneasy, -could not sleep, which I partly imputed to a draught of strong -mustard whey, with some antimonial wine, which, instead of causing -perspiration, produced the opposite effect. - -7th. By the advice of a physician I took some weak decoction of -bark, 1 oz. to two pints boiled to one, in the quantity of three -tea-cupfuls before dinner. At three in the afternoon I had another hot -fit, but not very severe. In the evening grew worse--heat and thirst -excessive--drank mustard whey on going to bed, but had a very bad -night--no sleep. much oppressed, severe head-ach, and pain over my -loins. - -8th. Took a gentle purge of cream of tartar and manna, which operated, -and gave me some ease. Left off the bark, as it seemed to increase the -febrile symptoms, and drank sage and apple tea, decoction of prunes, -tamarinds, &c. At 10 o’clock in the forenoon a very severe hot fit; -heat intense, oppression in my stomach and breast almost insufferable. -Mr. -----, surgeon of the Eagle cruiser, gave me a most nauseous saline -mixture, which vomited and purged me severely. The quantity of bile -which came off my stomach was incredible, yet, I felt no relief, and -the agony of the hot fit continued till 4 o’clock in the afternoon, -when it went off by a most profuse perspiration. During this fit my -thirst was constant and intense. In the evening my skin became dry, the -thirst returned, and I had a very bad, sleepless night. - -I now began to experience some of the dreadful symptoms which are, I -believe, peculiar to fevers in Turky and Arabia; a sensation of dread -and horror, totally unconnected with the fear of death; for, while the -patient is most afflicted with this symptom, it is for the most part -accompanied with a strong desire to put an end to his existence. The -agony from the heat of the body is beyond conception. I have heard some -of my fellow sufferers roar hideously under the violence of the pain. - -9th Till noon tolerably well. About 1 o’clock the hot fit attacked me, -and was full as severe as yesterday; heat and thirst rather greater, -and but little relief for more than an hour after the perspiration -commenced. This attack left me very weak, much exhausted, with cold, -weakening sweats, quick unequal pulse, severe head-ach, confusion, -anxiety and incessant thirst; a sleepless night, startings, anxieties, -and a constant wish to terminate my sufferings by death. - -10th. Forenoon, pretty free from fever. Attacked at the same hour as -yesterday. The fit more violent--delirium. The agony of the heat not -to be expressed; the whole body as if on fire; unremitting thirst, -profuse perspiration, yet no relief till late in the evening; no sleep, -a dreadful night, &c. Pulse about 120, unequal and fluttering. - -A mere relation of facts can give but a faint idea of the wretched -situation to which the factory was now reduced: by this time eleven -twelfths of the inhabitants of Bussorah were taken ill, numbers -were daily dying, and the reports from Bagdad and Diarbekir, of the -increasing ravages of the plague, left the survivors not a ray of -hope that they could escape the calamity. On every countenance pain, -sickness and horror were strongly painted; nor were we even left the -comforts of sympathy, as every mind was too much engrossed with its own -sufferings to think of administering consolation to others. Four of us -lay under the portico of one of the squares of the factory, calling -out for water in a frenzy of thirst. We used to snatch it from each -other, and to supplicate for a mouthful with as much fervour as a dying -criminal for an hour of further life. - -About this period of the fever my eyes became very weak, and every -object I saw was quite yellow. This effect was most perceptible at -night, in looking at the moon and stars. In the evenings we were -sometimes carried in our cots upon the terrace of the factory for -air; but the wind was so heated by the burning sands of the desert, -that we felt it more intolerable than even the lower apartments. We -all remarked that the _shemaal_, or north winds, which blew without -intermission at that time, greatly increased our heat and thirst. - -The daily very evident increase of my fever, and its effects upon -others becoming more fatal and alarming, determined me, while any -strength remained, to embrace the consul’s offer of flying from the -seat of infection to Bushire, in the Ranger cruiser. - -11th. After an exceeding bad night I was carried early in the morning -on board the Ranger, and was not very ill until about 9 o’clock, when l -felt the fever coming on, with new and more alarming symptoms--violent -head-ach, giddiness, dimness of sight, approaching delirium, horror, -and a most painful oppression and burning heat in my stomach. - -In despair, and to try to quench the unsufferable heat in my stomach -and bowels, I took a pretty large dose of nitre. The oppression and -pain increased; in my confusion I took a paper of tartar emetic, which -immediately began to operate. From that time, about ten o’clock, till -half past two in the afternoon, I know but little of what passed: -I was almost all that time either distracted with pain, or in a -swoon; and had it not been for the extraordinary care and attention -of the commander of the cruiser, who supported me in his arms, and -administered such cordials as I, in the short moments of recollection, -could call for, I have not a doubt but I must have sunk under this -attack. He counted eight times that I fainted, and sometimes an -interval of ten minutes before he could perceive any symptoms of -returning life. I was chiefly supported by wine, hartshorn, and spirits -of lavender. About three o’clock I had recovered my recollection: most -copious and continued sweats had carried off the violence of the fever; -but faintings and total privation of strength and spirits remained -upon me till late in the evening, when I became to all appearance, -for a short time, perfectly well. A little strength returned, every -symptom of fever vanished, and my feelings were almost the same as if -in perfect health. Some circumstances having prevented the Ranger’s -carrying me to Bushire, I was taken ashore in the evening. When I was -brought to the factory I had an appetite, and ate some chicken broth -for supper. Mr. Ross, who had hitherto escaped the fever, administered -a potion of laudanum, and, I believe, antimonial wine, on going to -rest. I slept pretty well, and awoke refreshed in the morning. I, -however, soon became ill, and at noon I had a severe attack, which -continued three or four hours, and left me greatly weakened, my skin -extremely dry, pulse quick, fluttering and irregular, beating from 100 -to 120, with an unquenchable thirst, which no liquids could allay. We -had no acids of any kind, which we had great reason to regret. - -I did not know till late in the evening that Mr. Abraham, the -vice-consul, who for some days past had been ill of the same fever, had -determined to embark in the Eagle cruiser next morning for Bushire, -as the only chance of saving his life; and a conversation which I -overheard to this effect, that as I was so very ill, and no hopes of -my recovery, it would be better to leave me to die at Bussorah, made -me still more anxious to fly from the place, although I remember well -I had not the most distant hope that I could live. I had suffered much -at the factory, and in the peevishness of illness I thought (perhaps -unjustly) that my living or dying seemed to be a matter of too little -consequence to those whom in health I had treated with much kindness -and affection. - -About ten o’clock, as I was lying in my cot, on a terrace adjoining -the stairs from whence the boat was to put off, I was seized with -such a fluttering, palpitation, starting, difficulty of utterance -from the swelling of my tongue, that I lay in momentary expectation -of breathing my last. This was, however, probably the cause of my -hearing the preparations for the departure of the boat. About midnight -they were leaving the shore. I could not make myself heard, and I was -too weak to get up without help. I made several efforts, and at last -overset the cot I was lying upon, and brought myself to the floor, -from whence I crawled on my hands and knees to the side of the river. -Humanity pleaded for me, and I was taken into the boat, in a situation -of wretchedness I never can forget. We were, after being several hours -on the Euphrates, carried on board the Eagle, opposite to Margil, -a country house belonging to the factory, a few miles distant from -Bussorah. - -12th. The day was uncommonly hot, and my fever came upon me about -ten o’clock. The heat was intense. Mr. ----, a young unexperienced -Frenchman, gave me tamarind water and cream of tartar, which had not -a good effect. I now discerned the first symptom of a cold fit; but -it was slight and of short duration. This day, however, I supported -the fever rather better than usual, and in the evening had a short -intermission, and slept a little during the night. The air on the river -was this day cooler and more refreshing than on shore. - -13th. About eleven o’clock had a regular cold shivering fit, succeeded -by a very severe hot fever, which continued till five in the evening, -when I was somewhat relieved by perspiration. This day the agony of the -hot fit was inexpressible, with great pain in my loins, and a constant -inclination to make water, which came from me in drops like blood. I -had a very bad, sleepless night. - -14th. By Mr. ----’s advice I took a dose of tartar emetic, which not -working, he gave me some ipecacuanha. I brought up a great deal of -bile, but the fever increasing, my sufferings under it were greatly -increased by the operation of the emetic, which worked powerfully both -upwards and downwards. This was a trying day indeed. I can give no idea -of what I suffered, which must have been intolerable, attended with -intervals of delirium and frequently swooning. About five the fever -began to abate a little, and at six Mr. ---- gave me a small dose of -decoction of bark, which seemed instantly to cause a return of the -fever, heat, thirst, anxiety and pain. - -My fellow-sufferer, Mr. Abraham, was in violent agony this day; he -cried out repeatedly that a fire was consuming his bowels, and that -he was in exquisite torture. The captain of the cruiser had been -complaining; he, Mr. Abraham and myself lay in the same cabin. About 4 -o’clock in the afternoon, when my pain was excessive, I crawled from -my cot, with an intention to drop myself from a port-hole which was -under the captain’s bed, into the river. I had nearly accomplished my -purpose, when the captain perceived me, and had me carried into my bed. -I was not delirious; and, in spite of all my resolution, the agony I -suffered this day made me repeatedly scream out. One of our seamen died -suddenly, and the blood, I was told, instantly flowed from all parts of -his body. - -This evening we arrived at Bushire. On our coming to an anchor Mr. -Abraham was immediately carried ashore; but I was too ill to be moved, -and accordingly followed in the morning with Capt. Sheriff, after a -very severe, sleepless night. - -The heat was so excessive this day that even the natives we had on -board sunk under it, and many of them were struck down with the sun. -By noon nobody could keep the deck; and about this time the vessel -ran aground on the bar at the mouth of the Euphrates, but fortunately -beat over, and got into the gulf. Two more of our people died in the -evening; and I should have mentioned that, in sailing down the river, -we saw them throwing many dead bodies from the vessels which were at -anchor below Bussorah, and many boats crowded with people from the -Arabian shore, passing over to Persia. - -The Persians at first opposed the landing of our sick, and threatened -to burn the ship; but they were prevailed upon by the company’s agent -at Bushire, a most worthy man, to permit us to come ashore. - -15th. I was so weak that it was with difficulty they could carry me -ashore in my cot; my strength was quite gone, and I was helpless as an -infant. Some grapes, water-melon and ice had been got for Mr. Abraham: -of the latter he had eaten freely; I was much pressed to do the same -but was afraid of its increasing my pain, and could hardly be prevailed -upon to taste it; I, however, swallowed a little, but by this time my -tongue and throat were so swelled that I had difficulty in getting any -thing down. About 10 o’clock I was attacked as usual; but I was become -so weak, and the fever running higher than usual, that I appeared in -the course of this day, more than once, to be in the agonies of death; -perspiration gave no relief to the violent pain and oppression I -laboured under. - -The factory at Bushire is a miserable, wretched mud building, bearing -more resemblance to a stable than a human abode: the few rooms, or -rather cells, are insufferably hot, even to those in health, and the -rest of the building has no cover from the sun. In one of the best of -these recesses in the wall Mr. Abraham and I were placed, and on the -same bed, as there was not room enough for two: our agonies were great, -and our cries dreadful. About 7 o’clock in the evening I perceived my -companion in the agonies of death. The company’s agent, Mr. Beaumont, -most humanely afforded him every assistance in his power; and when -every other person was afraid to come near us, he himself attended, -and administered such cordials as he thought might give us relief. Mr. -Abraham died in great pain; and, for fear of alarming the inhabitants, -or rather commandant or sheik of the town, Mr. Beaumont thought it -necessary to conceal his death. It was some time before the dead body -could be removed, which had become very putrid, and covered with -purple spots. I have been since told that immediately after death a -great quantity of blood or bile flowed from him as black as ink, and -so highly offensive as to be smelt at some distance from the factory. -Past midnight we were both removed to the terrace, but, unfortunately -for me, there was only one spot where we could lie, and the smell of -the dead body became intolerable; I was, however, cleaned and put into -another bed by the humane assistance of Mr. Beaumont, who sat by me, -and treated me with uncommon tenderness. I recovered a little, but -passed a dreadful night indeed. I shuddered at the agony which I was -to feel on the return of the sun, and most anxiously wished for death, -as the only relief from pain that I could expect. I was unable at this -time to move hand or foot, and at times could not speak. I told Mr. -Beaumont that I thought a gentle dose of physic, if it could be got -down, might alleviate the racking pain in my breast, stomach, bowels -and loins; he accordingly prepared some salts, manna and tamarinds, and -gave it to me in the morning. - -16th. At eleven o’clock the violence of the fever came on; I grew -delirious, swooned, and the symptoms of approaching death, I was -afterwards told, grew evident to those around me. My eyes were fixed, -my tongue hung from my mouth, and my face grew quite black. I recovered -from this fit about twelve o’clock, and felt excruciating pain, and a -burning suffocating heat. My stomach and bowels seemed all on fire, -my lungs played with the utmost difficulty, and I felt a pain and -sensation about my heart which I cannot describe. I was unable to move; -my servant lifted me; I fell into a swoon for a few minutes, and, -when I came to myself, a great quantity of black putrid bile flowed -from me. Relief was instantaneous, and I slept or swooned till about -5 o’clock, when I found myself free from fever, and able to speak, my -recollection clear, and my mind perfectly composed, but my body so weak -that I had no power of moving, except one of my hands. They gave me -some sustenance; I had a little sleep; but about midnight I fell into a -situation which I had all the reason to think indicated the immediate -approach of death. My tongue cleft to my mouth, my extremities were -as cold as ice, and the coldness also appeared to extend up my thigh; -my arm was destitute of pulse, nor was the smallest pulsation of the -heart perceptible; I never had my recollection clearer, or perhaps so -clear, in my life. My servant was lying by my bedside; I was convulsed -for some minutes; and, on recovering, I got out the word _boy_. -Fortunately for me he was not asleep, and heard me; I then got out the -word _wine_; on which he brought me a glass of claret, which, with -much difficulty, I got down; I felt myself much revived; I reflected -on my situation; and, although I had not the most remote idea of -surviving that night, I recollected that I had some fine powdered bark -in my trunk, and it occurred to me that, if any thing could be done to -preserve my life, it would be that medicine taken in red wine; but, my -speech immediately failing me, I could not direct the servant to give -it to me. Death seemed approaching; coldness had seized all my limbs; -my sight became confused, as I perceived from looking at the stars, -which danced before me; and the rattle or noise in my throat was very -perceptible to the servant, as he afterwards told me. I fainted and -continued in a state of insensibility, I believe, for about an hour. -The loud lamentations of the servant, bewailing his own misfortune in -losing his master in a country so remote from his own, seemed to recall -me to life; I felt as if refreshed with a little sleep, and got out -the words _bark and wine_; it was instantly brought, and the man gave -me two large tea-spoonfuls in a large glass of claret. The effect was -instantaneous, and operated like a charm; the coldness left me, I could -speak intelligibly, and could move my hands. I told the servant to give -me a tea-spoonful of the bark every hour, in a glass of claret. By 8 -in the morning I had taken six doses, and more than half a bottle of -claret. I was considerably strengthened, and could converse with Mr. -Beaumont, who encouraged me to persevere in the bark, and treated me -with uncommon attention. I had been sadly neglected at Bussorah, but -this was amply made up to me by the humane and tender attentions of -Mr. Beaumont, who was a great predestinarian, and who never shunned -danger when he felt it a duty to assist a fellow creature. He waited -upon me like a nurse, consoled me under pain and sickness, and, when -my fever was at its greatest height, he has often held me in his arms, -when I wanted to be removed, or my bed shifted. About this time my -legs and thighs became covered with blotches of a dusky brown hue, -some of them as broad as the palm of the hand, quite dry, and they -itched intolerably. At the same time several little boils broke out -in different parts of my body, but there was only one, over my eye, -that came to suppuration; the others, and the eruption on my legs and -thighs, all disappeared. - -I continued the bark till 12 o’clock, and then left it off till 4, -when I took another dose. The dreadful fever of the preceding days -did not return on this, but I was still extremely ill, had very great -difficulty in speaking and breathing; a swelling also in my throat, -parched tongue, and unquenchable thirst. I had not the most distant -hope of living. I tried to take some broth, but the swelling in my -throat prevented my swallowing. I passed a very bad night, with -startings, anxiety, and great pain over the kidnies; and what little -sleep I got seemed to make me worse; I was fatigued with it, and under -the constant dread of suffocation: towards morning my throat grew -worse, and my thirst was excessive. - -18th. Left off the bark, uncertain what I ought to do--no fever, but -the same symptoms as the day before--drank a little chicken broth, -which was the only sustenance I had taken for four days before--great -oppression and heat in my stomach and bowels. Mr. Beaumont found out -an Armenian who professed physic. This man gave me a clyster, which -gave me great relief, and a water to drink, famous as a febrifuge among -the Persians; I drank of it freely, and found much benefit from it. -But the most extraordinary of all the symptoms I experienced was this, -that, the third day after the first intermission of my fever, one of my -teeth, and one of the nails of my hand, came out without the smallest -pain, only a little swelling in the gum; and, on the nail falling -off some matter flowed from the end of my finger. I never had the -tooth-ach. At this time the boil on my eye suppurated. - -From the 18th of June to the 5th of July, being seventeen days, my -fever did not return. I recovered strength slowly, and could walk a -little, supported by two men. My food was chiefly chicken and veal -broth and about a glass and a half of Madeira wine a day. Yet I -had many symptoms of disease hanging about me--restless, fatiguing -nights--great thirst--bad taste in my mouth: every thing I took seemed -bitter and salt--pains in my back, sides and loins and great difficulty -in making water. In this time I passed much bile, naturally and by -clyster; and I had a purgative from the Armenian, which weakened me -greatly. - -The springs lifted, as seamen term it, three days before the change. -The opinion is universal in those countries, and also in India, -particularly Bombay, where intermittents are prevalent, that the change -and full of the moon has an effect upon all intermitting diseases, -of which afterwards I had many proofs in my own case. To prevent a -relapse, I took some decoction of bark, but in too small quantities to -answer the purpose. - -4th July. My water, from being thick and muddy, became quite clear. - -The 5th of July, after dinner, I was taken with a slight hot fit, which -continued about two hours, and then went off by copious perspiration; -the remaining part of the evening I was entirely free from fever. - -6th. I took decoction of bark--no fever. - -7th. At 11 o’clock a regular cold and hot fit; the former continued -three quarters of an hour, the latter two hours. Although much less -severe than my former fever, yet I suffered a good deal from the hot -fit. Left off the bark by the advice of the Armenian, who told me that -it heated me and made me worse. Much weakened by this day’s illness; -nor did the perspiration entirely free me from the fever. - -8th. Had a clyster thrown up, and early in the morning took a draught -from the Armenian, composed of fine vinegar, sugar, and a country -seed infused over night in water.--A slight hot fit, but of short -continuance. - -9th. The draught of yesterday repeated--at 10 a regular cold and hot -fit, rather less violent than the last. - -10th. No fever--tolerably well. - -11th. Between 8 and 9 in the morning a cold and hot fit, much more -severe than the last--great heat, thirst and oppression--much weakened. -I now perceived I had got a regular tertian, and determined on the -bark, but was prevailed on by the Armenian not to use it, he promising -to cure me in a day or two. He gave me water-melon and his infusion of -vinegar and seeds. - -12th. No fever--find the water-melon to disagree greatly with my -stomach. - -13th. Had not as yet indulged much hopes of recovery. I felt still, -even in those days previous to this last relapse, many alarming -symptoms of disease, which made me apprehend I could not recover; and -this last attack had again reduced me so low, that it was evident that, -unless I could get removed from those scorching climates, a very short -time would put an end to my life. Except in the humanity and goodness -of Mr. Beaumont, I was without a single comfort or conveniency of life -at Bushire. The heat of the weather seemed daily to increase, and the -house we were in hardly covered us from the direct rays of the sun. -My servant was taken ill, and appeared to be dying: it was with the -greatest pleasure, therefore, I received the accounts this day of the -Eagle cruiser having arrived last night from Bussorah, on her way to -Bombay. - -At half past seven o’clock I had a very severe fit; the hot fit was -uncommonly violent, and continued about three hours. I was much -reduced, and resolved at all events to take the bark in powder, and -in large doses, and to dismiss the Armenian. In this I was confirmed -by Mr. Puget, who informed me that the few survivors at Bussorah owed -their lives entirely to the bark, which had at last been given in very -large doses. - -14th. I took four doses, or eight tea-spoonfuls, of powdered bark. -It purged me, and carried off a great quantity of black putrid bile. -This evening I was carried in my cot on board the Eagle, resolved at -all events, even if I had been certain of dying in the boat, to leave -Bushire, where I had hardly shelter from the sun, and where the heat -was so excessive, that Capt. Alderson of the Eagle and two passengers -were taken ill from it last night. I got on board very late, yet found -myself refreshed from the sea air. - -15th. The fever did not return. I continued to take the bark as -yesterday, and found myself surprisingly strengthened. I persevered -under this course till the 3d of August, when the vessel arrived at -Muscat, and I was astonishingly recovered for the shortness of the time. - -From the 14th of July to the 3d of August I had taken seven ounces -of bark; and as the fever had returned upon me the last day of the -springs at the preceding change of the moon, two days before this -change I increased my daily dose, and continued in this manner till the -4th, when the springs being over, and perceiving no symptoms of fever -remaining, I left off the bark entirely. I had generally taken six -tea-spoonfuls every day. - -From the 15th of July till my arrival at Muscat, a seaport on the coast -of Arabia, my recovery was exceedingly rapid. I had a keen appetite, a -pretty good digestion, sound, refreshing sleep, and my daily increase -of strength was very perceptible. My diet, till this time, had been -generally chicken broth, rice and boiled fowl, light pudding, &c. On -leaving off the bark I observed no particular regimen, only abstaining -from salted and high-seasoned meats, and confining myself to three or -four glasses of Madeira. I found that an infusion of prunes, with a -small quantity of cream of tartar, was of much service to me during -the course of the bark, as it kept me cool, and my body open. I was -sensible, at times, during my recovery, of a slight but troublesome -pain under my fifth rib on the right side, especially when I lay on -that side; but from feeling and pressing my hand over the region of the -liver, and from other circumstances, I had no reason to suspect that -my liver was affected; and, as it soon left me, the cause was probably -trifling or accidental. - -On my leaving Muscat a large boil came upon the hip-bone, the size of -a small melon, extending some way up the side, and down the thigh, -with a hard basis. After arriving at Bombay, which we did in fourteen -days, it broke, and in a few days healed up. I shall only add, that -at Bombay I was detained four months before I had an opportunity of -proceeding to Europe. In that time I had three returns of my ague, but -on taking a few doses of bark it left me. Those attacks happened at the -change of the moon. From Bombay to Europe I had three or four slight -fits of the ague; the worst on our making the coast of South Guinea, at -the settlement of Benguela, where we found the wretched remains of a -Portuguese garrison, the survivors of a fatal putrid fever, which, as -they told us, raged in those parts for eighteen months before. The last -attack I had was the day we made the Rock of Lisbon, since which time I -have had no returns of the ague, although, when the wind continues long -at east, I am sensible of a tendency to that complaint. - -I shall now give a brief account of the fate of my fellow sufferers at -Bussorah. This unfortunate party consisted of capt. Sheriff, of the -Eagle cruiser; Mr. Brown, a Bengal merchant, carrying goods from India -to Aleppo; Mr. Palmer, a gentleman returning with his fortune from -Bengal to Europe; Mr. Robson, surgeon to the factory; Mr. Abraham, the -vice-consul; Dr. Ross, who had practised many years at Constantinople, -some time in Bengal, and was then taking the opportunity of -accompanying me across the desert; Mr. Smith, a merchant from India; -and an Italian Carmelite, the vicar of Bussorah, who came from Bombay. -It is unnecessary to say that the _seca dab_ is a common symptom in the -Turkish fever, or, in other words, a strong desire of self-destruction. -We had a fatal instance of it in our party. Mr. Brown, the second day -of his fever, being left alone, got to his pistols, and, throwing in -four or five balls, discharged them into his breast, and was found dead -a few minutes afterwards. I believe every one of us at times would have -done the same, had we been possessed of the means of accomplishing -it. Mr. Robson died the third day of his fever, in great agonies, -but perfectly sensible. His was a continued high fever, without any -remission. Mr. Palmer died the 4th day, under the same symptoms as -the preceding. The Carmelite, the second morning after he was taken -ill, had opened a vein in his arm, and bled to death, most probably -intentionally. Captain Sheriff was seized with the fever on his return -from Bussorah to Bushire. He died the third day, in a manner which -is even painful to relate. He was a man of singular strength of -constitution, and suffered unusual agonies before he died. His cries -were heard all over the factory; he foamed at the mouth, gnashed with -his teeth, and tore his arms with his teeth. Those who heard him -compared his cries to the bellowing of a mad bull. He was no sooner -dead but his body was covered with purple spots, and so offensive that -the people could hardly carry it out to be buried. Mr. Sheriff’s was -what they call the worst kind of plague. - -Mr. --------, formerly mentioned as having escaped the plague at -Bussorah by shutting himself up in a mud house, was seized on his -voyage to Bussorah with a kind of insanity, imagining that people were -conspiring against his life, and that he was capable of overhearing, -at a great distance, even a whisper spoken to his disadvantage. He, -however, escaped the infection, and returned to England in health. - - - - -N^o VII. - -_Set of Queries furnished by Doctors_ AIKIN _and_ JEBB; _and by Mr._ -HOWARD _put to several foreign Physicians, during his tour; with -their Opinions concerning the Plague_. - - -1. Is the infection of the plague frequently received by the French? - -Answer, by _Raymond_, physician at Marseilles: Sometimes it -is.----_Demollins_, surgeon do: In the lazaretto some have touched -infected bodies and things with impunity. Attributed to the temperament -of the body.----_Giovanelli_, physician to the Leghorn lazaretto: The -plague cannot be communicated but by very near approach, or touch: air -cannot be the vehicle.----_They_, physician to the Malta lazaretto: It -may happen that one person may inhabit the same chamber, or even touch -an infected person, with impunity; of which I have known instances; but -all who approach the atmosphere of an infected body may receive the -infection by respiration. Contagion is almost always received before -touching or approaching the infected person.----_Morandi_, physician -at Venice: Contact is one of the most powerful and dangerous means of -communicating the infection; but for the developement of its effects -a predisposition in the receiving body is necessary.----_Verdoni_, -physician at Trieste: It is most frequently communicated by the touch. -It has been given by a flower held and smelt at, first by two persons -who remained free; and then by a third, who sickened and died in 24 -hours.----_Jew_ physician at Smyrna: The infection is in reality -communicated by the touch alone; for all who keep from contact of -infected persons or things remain free. To the effect of contact, -however, a certain disposition of the air is necessary; for we often -see infected persons arrive from other countries, yet the disease does -not spread. But what this disposition is can scarcely be conceived. -Commonly in this climate, the disease appears at the end of spring, -and continues to the middle of summer; with this particularity, that, -in cloudy weather, and during the _sirocco_ winds, the attacks are -more frequent. Also in the same diathesis of the air some receive -the infection, while others exposed to the same dangers escape it. -From observation it appears, that cachectic persons, and those of -constitutions abounding in acid, do not readily take it. The contagious -miasmata may be dormant in the body for some time without doing the -least harm, till set in motion by sudden fear, or the excessive heat of -a bath.----_Fra. Luigi di Pavia_, prior of the hospital of San Antonio -at Smyrna: The plague is communicated by contact, according to all the -observations I have been able to make for eighteen years. - -2. Does the plague ever rise spontaneously? - -_Raymond_: Incontestible experience shows that it only proceeds from -contact.----_Demollins_: From all ages the plague has been brought to -Marseilles by merchandise or persons beyond sea.----_Giovanelli_: As -the disease always appears with the same symptoms, it is not probably -spontaneous, but the consequence of a particular contagion.----_They_: -Some contagious fevers come of themselves; others proceed from the -communication of contagion. The plague is thought to have originated -in Egypt, and spread itself from thence.----_Morandi_: Contagious -fevers do not arise of themselves, but are always the product of a -peculiar poison--_Verdoni_: I know no fever that can properly be -called contagious, and doubt if even the plague can be considered as -such. My reasons are drawn from the very different manner in which -the plague appears in different years, and the different degree in -which it spreads. I therefore conclude that contagious fevers come -of themselves.----_Jew_ physician: According to the most ancient -authorities, the plague has always been brought to Smyrna by contagion, -and was never produced here.----_Fra. Luigi_: Ancient and common -observation in this city prove that the plague is derived _solely_ from -contagion. - -3. To what distance is the air infected? How far does actual contact, -wearing infected clothes, or touching other things, produce the disease? - -_Raymond_: The infected are safely conversed with across a barrier, -which separates them only a few paces.----_Demollins_: The air round -the patient is infected more or less according to the degree of poison -which exhales. Here in the lazaretto they are spoken with across two -barriers, a few paces from each other, without fear of contagion. -Hence it would appear that the plague is communicated only by the -touch, or still more by wearing infected clothes.----_Giovanelli_: If -one speaks of an infected person shut up in an unventilated chamber, -it may be said that the whole chamber is dangerous; but if one speaks -of a patient exposed to the open air, it has been proved that the -infection does not extend beyond five geometrical paces from the body. -Beyond this distance one is in safety. The actual touch of an infected -person or thing is proved to be very dangerous by fatal experience; -but to what degree, is not ascertained.----_They_: The infection -extends only some paces; and the miasms, at the distance of about ten -paces, are so corrected by the air as to lose all their activity. -It may be communicated by touching infected things, especially of -a porous nature, as cloth, wool, skins, &c.----_Verdoni_: From the -moment of infection to the time when nature has entirely dissipated -the contagious principle, which usually happens in forty days, there -is always a capacity of communicating the infection. The degree of -infection is in proportion to the volume of air surrounding the -patient; the air being what absorbs, dissipates and communicates the -contagious principle. Infected substances communicate the disease for -many years, in proportion to the ventilation they have undergone, or of -which they are susceptible.----_Jew_ physician: The degree of infection -in the air about the sick depends upon the greater or less malignity of -the disease, and other circumstances. The air about poor patients is -more infectious than about the rich. These things being established, I -am of opinion that, in the greatest contagion, we may securely see a -patient at the distance of two ells, if the chamber windows be not all -shut.----_Fra. Luigi_: The infection is greater or less in proportion -to the virulence of the contagion; but I have made no observation as to -the distance. The disease is communicated by contact of all infected -things, and by close inspiration of the breath of the sick. - -4. What are the seasons in which the plague chiefly appears; and what -is the interval between the infection and the disease? - -_Raymond_: The plague shows itself at all seasons, but less at the two -solstices.----_Demollins_: Great ravages may be made in all seasons, -but principally in the greatest heats of summer. From the infection to -the disease is two or three days.----_Giovanelli_: The plague appears -at all times, in the same manner as poisons at all times produce their -effects. But observations show that its ravages are greater in hot -seasons than in cold; and it seems that summer and the first months of -autumn are most to be dreaded. There is no certainty as to the interval -between the infection and the disease, as it depends on the particular -constitution of the patient.----_They_: Warm, moist seasons contribute -to the production of all infectious diseases. The interval from the -infection to the seizure is various, according to the virulence of -the poison, and the constitution of the patient. Sometimes it acts -slowly, sometimes like a stroke of lightning.----_Verdoni_: The -spring is the principal season. Generally the disease shows itself at -the instant of touch, like an electrical shock. Sometimes a person -retains the contagious principle without any sensible effect, and then -unknowingly communicates it to a third, in whom, if predisposed to the -disease, it becomes active; or, otherwise, it may be communicated to -others successively in the same way, till it becomes dissipated and -annihilated, as happened at Smyrna in 1783. In bodies predisposed it -very rarely conceals itself till the third day.----_Jew_ physician: -Answered in the first.----_Fra Luigi_: The plague is most fatal in -Smyrna from April to July; and it is constantly observed that great -colds and heats much diminish it, and copious dews extinguish it. The -infection shows itself in 24 hours, more or less, according to the -difference of temperament. - -5. What are the first symptoms of plague? Are they not frequently a -swelling in the glands of the groin and armpit? - -_Raymond_: The plague often conceals itself under the form of an -inflammatory, ardent or malignant fever. Tumours of the glands are -often its first symptom.----_Demollins_: The first symptoms of the -plague vary; but the most common are, buboes in the armpit and groin; -parotids and carbuncles in various parts of the body.----_Giovanelli_: -The first symptoms are, debility, fever, excessive thirst, followed -by great heat; after which carbuncles or buboes appear in the -armpits, groin and parotids. The groin is sooner attacked than the -armpit.----_They_: Swellings in the armpits and groin are indeed the -characteristics of the plague; yet they are not the sole nor the -first symptoms, and often are not seen at all; as when the plague -disguises itself under the form of other diseases.----_Morandi_: -Glandular swellings are properly the symptom of the second stage, -and are preceded by those febrile symptoms which are immediately the -consequence of receiving the infection; such as pain in the head, -drowsiness, great prostration of strength, dryness of the tongue, -vomiting, hiccough, tremor, diarrhœa.----_Verdoni_: Its first symptoms -are relative to the constitution of the year, and of the body seized, -and the place where it was produced, or whence it came. In 1783 all the -parts of Natolia were infected; and the disease transported to Smyrna, -which is the centre, was extinguished without the loss of a single -person. Generally the plague of Constantinople, transported to Smyrna, -does little harm. That of Egypt causes havock, as in every country. -That of the Thebais is always cruel, and, carried to Lower Egypt, -is fatal. The inguinal glands are most generally affected.----_Jew_ -physician: The swelling of the glands is seldom the first symptom. -Patients are every day seen who, being supposed ill of another -disorder, in two, three or more days show glandular swellings, or -carbuncles, by which the plague is manifested. On the contrary, many, -who from the usual signs are supposed to have the plague, become well -in a day or two, without any external swelling. The first symptoms -are, horripilation, or actual shivering, nausea or vomiting, loss -of strength, and fever. These are common to many diseases; but the -pathognomic signs are, a difference in the pulsations of the two sides, -with this circumstance, that from the diversity a prognostic arises; -it having been observed that if the pulse on the side of the tumour -or carbuncle be greater or more frequent, it bodes well; whereas, if -it be smaller, it shows greater malignity, and more is to be feared. -Further, there is observed among the first symptoms a visible pulsation -in the carotids, greatest on the affected side; and also a crystalline -vivacity in the eyes, with a kind of contraction or diminution of the -eye on the affected side.----_Fra. Luigi_: The most remarkable symptoms -of the plague are, turbidness and sparkling of the eyes, the tongue -furred with a white mucus, and very red at its tip, frequent biting -of the lips, violent pain in the head, and inability to hold it up; a -sense of great cold in the loins, vomiting, debility. Swellings of the -glands are not among the first symptoms. - -6. Is it true that there are two distinct fevers with nearly the -same symptoms, one of which is properly termed the plague, and is -communicated from a distance by the air, and without contact; while the -other, which is properly termed contagion, is only communicated by the -touch, or at least by near approach to infected persons or things? - -_Morandi_: It is certain, from multiplied observations, that there are -two sorts of pestilential fevers, similar in appearance; one of which -proceeds from the contamination of the air alone, and is communicable -to any distance; the other is produced alone by contact, or near -approach. The former of these is properly termed a pestilential fever, -the latter a contagious one.----_Verdoni_: The distinction of these -fevers is useless; since the same which is communicated by the touch, -is that also conveyed by the air to a certain distance, especially in -a close place.----_Jew_ physician: That there are two kinds of plague -is absolutely to be denied; yet sometimes it happens that persons are -attacked with the plague without knowing from whence it came.----_Fra. -Luigi_: I hold it for certain that there is only one species of plague, -though differing in malignity. - -7. What is the method of treatment in the first stage; what in the more -advanced periods? What is known concerning bark, snakeroot, opium, -wine, pure air, the application of cold water? - -_Raymond_: The disease is treated as inflammatory. No specific has -been discovered for it.----_Demollins_: At the beginning, bleeding, -vomiting, purgatives, diluents, refrigerants and antiseptics are used; -afterwards antiseptics and cordials, relatively to the temperament -and symptoms----_Giovanelli_: The plague causing always a disposition -to inflammation and putrefaction, it is always proper to bleed -proportionally to the strength, and to use a cooling regimen, with -the vegetable acids. The repeated use of emetics is also proper, both -to clean the first passages, and to dispose the virus to pass off by -the skin. In the progress it is necessary to favour the evacuation of -the virus by that issue which nature seems to point at. Thus either -antiphlogistic purgatives are given, if nature points that way, or -suppurative plasters are to be applied to any tumours which may appear. -Epispastics to the extremities are proper where nature wants rousing. -The vitriolic acid in large doses has been found very serviceable in -the plague at Moscow, attended with carbuncles. When the inflammation -is over, and marks of suppuration appear, the bark, with wine and -other cordials, is proper. The surgeon’s assistance is proper in the -treatment of boils and anthraces, which last are seldom cured without -the actual cautery.----_They_: In the beginning of pestilential fevers -bleeding is sometimes proper, and vomits almost always. In their -progress frequent subacid and cold drinks, the bark given liberally, -and vitriolic acid, have been found powerful remedies when there -was a dissolution of the blood----_Morandi_: In the first period, -evacuations, according to the particular circumstances of the case, are -proper: in the second, bark mixed with wine, and opium as a temporary -sedative. Pure air is very necessary; and fire as a corrective, with -the burning of antiseptic and aromatic substances.----_Verdoni_: As -soon as a Christian finds he has got the plague, he eats caviare, -garlic and pork; drinks brandy, vinegar and the like, to raise the -buboes. Upon these he applies greasy wool, caviare, honey of roses, -dried figs, &c. to bring them to suppuration. The Turks and Arabs drink -bezoar in powder with milk, and other sudorifics, in order to expel -the virus. They vomit, and possibly a second time. At Cairo they take -opium, and cover themselves with mattresses in order to excite sweat; -and, though parched with heat and thirst, they drink nothing. They open -the immature buboes with a red hot iron. At Constantinople and Smyrna -they eat nothing, and drink much water and lemonade. The Jews drink a -decoction of citron seeds, lemon or Seville orange peel, and their own -urine. They abstain scrupulously from animal food. In 1700 a physician -in Smyrna found bleeding very useful. Another, in another year, cured -the plague by bleeding, and an antiphlogistic regimen. My brother -in Cairo treated it like a biliary fever, with vomits, saponaceous -attenuants, and antiphlogistics; and successfully. Some sailors at -Constantinople in the frenzy of the plague have thrown themselves -into the sea; and it is said that on being taken out of it they have -recovered. My opinion upon the whole is, that the treatment ought to -be relative to the constitution of the year, and of the patient, by -which the nature of the disease itself is greatly altered.----_Jew_ -physician: Bleeding in many cases may be serviceable, as I have known -patients, who were bled by mistake, recover; and others recovered -from a most desperate condition by a spontaneous hemorrhage. On the -other hand, persons have been apparently injured by both these -circumstances. The difference of effect seems to depend on the state of -the blood, whether it be disposed to coagulation or dissolution. In the -former, bleeding is useful, in the latter, hurtful. Vomits, according -to my experience, have not succeeded; yet I should not hesitate to try -ipecacuanha in substance, exhibiting half a scruple at two or three -times, in the expectation that in this manner it would not run down. -Bark may be useful in dissolutions of the blood; and also small doses -of opium, and other medicines prudently administered. In excessive -watchfulness I have known relief procured by anointing the temples with -ung. populeon. In a case of hiccough the liquor anod. miner. Hoffmanni -succeeded with one. The Turks, in the violence of the fever, take -handfuls of snow, and apply it all over their bodies, and also eat it; -and sometimes throw cold water on their feet. But whether this is of -service or not cannot be determined; as these people in other respects -pay no regard to rules of diet.----_Fra. Luigi_: They who practise -empirically in the plague use none of the recited methods, but only -strong sudorifics, and ventilation of the air; and complete the cure by -proper treatment of the sores by suppuration. - -8. When the plague prevails, do the physicians prescribe to those who -have the disorder a more generous, or a more abstemious diet? and do -they prescribe any thing to the uninfected? - -_Jew_ physician: In times of the plague, many are accustomed to eat -no flesh; others, no fish; but I know not whether by the advice of -physicians. For myself, I have been in many plague years, but have made -no alteration in the management of myself.----_Fra Luigi_: In Smyrna -the plague is generally treated with a rigorous diet. They only use -rice and vermicelli boiled in water; and sometimes, when the patient is -too costive, juices and herbs boiled without seasoning. From time to -time they give some acid preserves, and raisins, and, in great heats, -some slender lemonade; and a dish of good coffee with a biscuit every -day. For drink they only use toast and water; and they follow this -abstemious regimen till the fortieth day of the disease is completed, -after which they take chicken broth, lamb, and other food of easy -digestion. - -9. Are convalescents subject to repeated attacks from the same -infection? - -_Raymond_: Not unless they touch something infected.----_Demollins_: -Convalescents are sent to fumigated chambers, and there is no instance -of relapse.----_Giovanelli_: No instance of relapse, after being -well recovered from the first attack, have come to my knowledge; but -they are liable to fall into other disorders, such as consumption, -hæmoptoe, &c.----_They_: Convalescents are without doubt liable to -a relapse, and authors are full of instances of it. In the plague -of Messina M. Cotogno says that a man had successively fourteen -buboes, and was cured at last.----_Morandi_: All convalescents may -relapse.----_Verdoni_: They have it not twice in the same year----_Jew_ -physician: Convalescents are often attacked anew, and die; but this -does not usually happen from a fresh infection taken elsewere, but from -some remains of their own contagion, excited by intemperance in food, -or the venereal act.----_Fra. Luigi_: From irregularities in eating and -drinking, bodily fatigues, affections of the mind, especially anger, -they are liable to repeated and very dangerous relapses. - -10. What is the proportion of deaths, and the usual length of the -disease? - -_Raymond_: The mortality is different in different seasons and -years.----_Demollins_: In the plague of Marseilles in 1720, half -the inhabitants perished. The usual length of the disease is that -of other acute disorders; but longer when the tumours come to -suppurate.----_Giovanelli_: The proportion of deaths is variable and -uncertain. As to duration, when the disease is very acute and fatal, -the patient generally dies within five days from the first invasion -of the fever, or first marks of the plague. When he recovers, no -certain termination can be assigned. If the time of healing all -the sores be reckoned, it may be to three, four or five months, or -more.----_They_: The mortality is very various. Of ten whom I treated -in the lazaretto, three died. I have observed that the fever generally -runs on to twenty or twenty-one days.----_Morandi_: The bills of -mortality in places visited by the plague usually amount to thirty -per cent, sometimes to fifty. (He seems to mean of the whole number -of inhabitants.)----_Verdoni_: The proportion of deaths varies -infinitely. It has been observed that the Jews in Constantinople and -Smyrna lose only one third; which is attributed to the care they -take of their sick. At Cairo, on the other hand, they are the first -attacked and lose more than three fourths. The Turks lose two thirds; -other nations a little more or less. Europeans in Cairo lose five -sixths. Sometimes it kills immediately; sometimes in twenty-four hours; -commonly in three days. When the patient gets over the ninth day -there are great hopes of recovery, as the buboes are then suppurated. -They may, however, die within the fortieth day, especially if they -commit any irregularity, the principal of which is eating flesh, which -instantly causes a return of fever, and death. It never passes beyond -the fortieth day.----_Jew_ physician: The mortality is various, as -also the duration: some in two, three or four days; some hold out six, -eight, or more---_Fra. Luigi_: Generally more die than survive; but in -our hospital of San Antonio of Smyrna, from the care taken of the sick, -the number recovering has, for eighteen years past, exceeded that of -the dead. - -II. What are the means to prevent the plague, to stop its contagion, -and to purify infested places? - -_Raymond_: There is no other method of preserving one’s self from -the plague, than avoiding the contact of infested things. Goods are -purified by exposing them to the open air for forty days; and furniture -by a strong fumigation with aromatics and sulphur.---_Demollins_: -Here, in the lazaretto, infected goods and furniture are exposed to a -current of air for forty days. The air of infested places is purified -by burning all sorts of aromatics.----_Giovanelli_: The method of -prevention is, to avoid all communication with infected persons or -goods. The means of stopping the contagion form a body of police, too -extensive to be here mentioned.----_They_: The means of prevention, -besides avoiding infected things and persons, are sobriety in living, -the use of vinegar internally and externally, and an issue. Infected -places are purified by fumigation and ventilation, by scraping the lime -from the walls, (which is then thrown into the sea) and whitewashing -them anew with lime and sea-water, by washing the floors, windows, -doors, &c. first with sea-water, and then with vinegar, taking great -care to leave nothing that is infested. The bodies of the dead are -buried in a place set apart for that purpose; and their beds and -bedding are burned. As to other things not used during the illness, -the linen is washed with soap and ley; the woollen clothes are put -into sea-water for two days, and then ventilated for twenty days. -Those which would be spoiled by water are hung on a line in the air -for 40 days, and fumigated from time to time according to their -quality----_Morandi_: A fire is to be kept constantly in the sick -chamber in all seasons. All fæces, &c. are to be immediately removed. -Clean sheets and shirts daily. The healthy must avoid commerce with -the infected; must purge gently now and then, smoke tobacco, drink -pure wine medicated with wormwood, gentian, zedoary, &c. and avoid -fear and other passions, and excess of all kinds.----_Jew_ physician: -No means of prevention are used in the Turkish dominions.---_Fra. -Luigi_: Fire, water and air are used for stopping the contagion, and -purifying places.----_Verdoni_: The best preservatives are supposed -to be sprinkling the room with vinegar and perfumes, ventilation and -fumigation. The Greeks in Smyrna during lent, when they eat only -vegetables, are seldom attacked; while among those who eat flesh the -contagion makes great havock. Hence the best means of prevention are -to eat moderately, and not at all of animal food; to drink water and -vinegar; to sprinkle the chamber with the latter; and use frequent -ventilation; to change the clothes, especially the linen, daily; -hanging in the air such as has been used, for 15 or 20 days. For -suppressing the infection every thing is to be washed that can undergo -the operation, and the walls of the chamber to be whitened with lime, -but after the 24th of June no further care is taken. - - -FINIS. - - - - -ERRATA. - - - PAGE. LINE. - - 20. 23. For ‘destroying three or four thousand,’ read - ‘destroying sixteen hundred out of three or four - thousand.’ - 39. 13. from bottom, for ‘Zabira,’ read ‘Zebire.’ - 86. 10. for ‘obscured.’ read ‘obscure.’ - 153. 20. for ‘acid other,’ read ‘acid in the other.’ - 202. 15. from bottom, after ‘the inhabitants,’ add, ‘Farther - east it does not go.’ - 280. 7. from bottom, for ‘flattering,’ read ‘fluttering.’ - 303. 8. from bottom (in a few copies) for ‘gout, fever,’ read - ‘gaol-fever.’ - 309. 10. for ‘safety to,’ read ‘safety of.’ - 460. 2. from bottom, for ‘fluid,’ read ‘fluids’ - 480. 12. from bottom, for ‘Black assizes,’ read ‘Black Hole.’ - 486. 5. for ‘Hansforth,’ read ‘Hansford;’ also in pages 489 & - 510. - 502. 1. for ‘parcity,’ read ‘paucity.’ - 513. 1. bottom, for ‘vol. x,’ read ‘vol. iii.’ - - - - -Spelling inconsistencies include (but are not limited to) the following: - - idiosyncracy/idiosyncrasy - occured/occurred - eat/ate - superintendant/superintendent - etherial/ethereal - oxygen/oxygene - syncopy/syncope - alledged/alleged - adviseable/advisable - -Corrected misspellings include the following: - - acccording → according - ackowledged → acknowledged - an an → an - and and → and - and thing → anything - attemps → attempts - authoriry → authority - bails → balls - bemost → be most - bilous → bilious - by → be - calls → call - certainiy → certainly - christain → Christian - debelitated → debilitated - destoyed → destroyed - determinining → determining - Diermerbroeck → Diemerbroeck - Dr. Power → Dr. Dover - draw → drawn - exeecd → exceed - flattering → fluttering - follwing → following - frequenly → frequently - fundemental → fundamental - gave → grave - his his → his - hulhed → hushed - imperceptiple → imperceptible - in in → in it - injuctions → injunctions - instanly → instantly - is → it - Lavosier → Lavoisier - let → lest - lways → always - must been → must have been - occuring → occurring - oelophagus → oesophagus - pamplet → pamphlet - particulaly → particularly - paticles → particles - peppercoorn → peppercorn - persons → person - phenomana → phenomena - plagae → plague - presumtive → presumptive - promiscously → promiscuously - Pythou → Python - reaching → retching - Reamur → Reaumur - Reamuru's → Reaumur's - recal → recall - remianing → remaining - sensibilty → sensibility - siuation → situation - slips → ships - steams → streams - surounding → surrounding - sypmtoms → symptoms - terrestial → terrestrial - that that → that - the → The - the the → the - though → through - to to → to - vaccillating → vacillating - vegatable → vegetable - whereever → wherever - willl → will - - - -*** END OF THE PROJECT GUTENBERG EBOOK A TREATISE ON THE PLAGUE AND -YELLOW FEVER *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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