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The Stephen Collins Donation,

_. . . — ' II "

No. Case, ^j/!hl^i

No. Shel f, '.^^
J\"o. Book, ;%^ '
. ~Tin:r,, -



.™4U Lemmon-r-^o




Bilious remitting and intermitting





Inquiries and Obfervations :




Bilious remitting and intermitting







A Defence of Blood-letting





•' By Benjamin Rufh, M. d.








XT is common in the Preface to
Medical books to extol fads, at the expence of
theory. Were I difpofed to confider the com^
parative merit of each of them, 1 fliould derive
moft of the evils of medicine from fuppofed
fadts, and afcribe all the remedies which have
been uniformly and extenfively ufeful, to fuch
theories as are true. Fadts are combined and
rendered nfefuU only by means ot theories ; and
the more difpofed men are to reafon, the more
minute and extenfive they become in their ob-
fervations. Under the influence of thefe opi-
nions, 1 have ventured to deliver, in the follow-
ing pages, fome new principles in medicine. I
wifh it had been convenient to have kept
them a few years longer from the public eye,
in order to have improved them by flow and
frequent revifions; but the importunities of

b my


my pupils, added to a fenfe of the precarious
tenure by which I hold a laborious life, have
induced me to publifh them in their prefent
concife and immature ftate. If they lead the
reader to exercife his reafon in examining
them carefully, he v^^ill readily fupply my de-
ficiency of time and ftudy in preparing them
for the prefs. He will reject what is erro-
neous in them, and apply what is not fo, to
all the difeafes of the human body.

The Account of the Yellow Fever, as it
appeared in Philadelphia in 1794, will, I
hope, be ufeful, by bringing more fa£ts to
light upon the fubjed: of its origin, and by
exhibiting that variety in the fymptoms and
method of cure, which is produced by the dif-
ference of feafon in all epidemics*

In ftating the conduft, and oppofmg the
opinions of my medical brethren, I have not
been ad;uated by the leaft unkindnefs to any
one of them. I lament being called to this
painful duty, but it muft be performed by
fomebody, and in this way only can we dif-



charge our obligations to thofe men who, at
the expenfe of character and fortune, have
put us in the peaceable pofleffion of all our
knowledge in medicine ; for, however ftrange
it may appear, I believe we have not admitted
a ufeful medical principle, or remedy of any
kind, but what has coft the authors of them
more or lefs conflicts with cotemporary phy-

If the principles contained in this volume
fhould be received with candour, they fhall be
followed (life and health permitting) by an
application of them to the cure of the gout,
and of the difeafes of the mind.


id July, 1796.

(^ The reader is defired to correal the following mijlakes ,*—

In page 3, line 14 from the top, for them^ read the earth. In
line the laft of the fame page, for hct read become,

— p. 71, line 12, infert the word hot^ before climates.

— the laft line of p. 96, infert ivithout malignant fy^ptotns^ after
the word intermittent t and erafe the fame in the firft line
of p. 97.

— p. 103, line the 8th from the bottom, infert though it nvas
performed fparingly towards its clofe^ after the Vf or d fever.

— p. no, line the 3d from the top, inftead of appear to have
thronvn, m^trl probably threw. In line 4th, inftead oi and,
rea-d for. And in lines 8 and 9, inftead of and I thinks
read or perhaps.

* — p* 232, line 14th from the top, inftead oi conneiled auith,
read confined to.


A Page
CCOUNT of the weather and difeafes which

preceded the yellow fever in 1794, - - i

Names given to it by feme of the phyficians of the city, 13

Conduct of the Committee of Health, and their report

from an examination of fome of the phyficians, 15
Reafons why the prevalence of the yellow fever in a city

fhould always be made public, - - 23

Its predifpofing and exciting caufes, - - 25

Its fymptoms, . - _ 27

Its forms or type, • - - 44

Its predominance over all other difeafes, - 50
Its contagious quality, and its peculiar effe<5ts upon the

body, where it did not excite fever, . - 53

Methods of obviating the contagion of the yellow fever, 56

Methods of preventing its fpreading in a city, - ^^
Difference in its degrees and extent of contagion, at

different times, and in different countries, - 61

Of the origin of the fever of 1794, - - 63

An exception to the influence of rain in checking it, 67



Obfervations on the (late of the atmofphere which dif-

pofes to malignant or inflammatory fevers, 75

The influence of marfii exhalations on the bodies of

certain domeftic animals, - - 79

Comparative view of the relative contagious nature,
diftance of infedion, and mortality of contagious
fevers, - - - ,* 80

Method of treating the yellow fever of 1794, - 83

Appearances of the blood, - - - 86

Comparative view of the fuccefs of the Philadelphia
and Baltimore methods of treating it, with that
Tk'hich has been common in the Wefl: Indies, 114

AN Inquiry into the Proximate Cause of Fever, 121

Of the fymptoms of fever, - - 141

Of the ftates of fever, - - - 149

Of the nofological arrangement of difeafes, 150
A table of fevers, according to their different degrees

of inflammatory adion, . * 153

Of ftates of fever which are general, * 155

which are general and local, 167

Of mifplaced ftates of fevers, - - 174

A DsFENCE OF Blood-letting, * • jS^

its natural indications, ». - J 86

Its advantages, - - - J 88

The objeclions to it ftated and anfvvered, - 195
Comparative view of the effeds of blood-letting, and

other depleting remedies, - ^ 214



Of the indications of blood-letting from the (late of

the pulfe, - - - 223

from the chara(5ler of the reigning epidemic, 228

• from the conftitution of the patient, - 229

, from the place from which perfons have lately

arrived, or in which they have been born, ibidem

from the appearances of the blood, - 230

Of the quantity of blood which may be drawn in in-
flammatory fever, - - - 234
Of the quantity which fliould be drawn at one time, 239
Of arteriotomy, - - - - 241
The place from which blood fliould be drawn, 242
Of cupping, - - - - 245
Of the time for bleeding in fevers, - ibid.
The effefls of blood-letting about the celTation of men-

ftruation, - - - - 246

Of its effedts in faciHtating parturition, - - ibid.

in hydrophobia, - - 247

. in diilocations, - - ibid.

in certain difeafes of old people, 248

Oppofition to blood-leiting in the United Stares, ibid.

Its origin derived in part from a political caufe, 251

"General refle<^ions and conclufion, - 254



1 CONCLUDED the Hiftory of the fymp«
toms of the Bilious Remitting Yellow Fever as
it appeared in Philadelphia in the year 1793, by
taking notice that the difeafes which fucceeded that
fatal epidemic, were all of a highly inflammatory

I have formerly defcribed the weather and dif-
eafes of the months of March and April in the
fpring of 1794.

The weather during the firfl: three weeks of the
month of May was dry and temperate, with now
and then a cold day and night. The ftrawberries
were ripe on the 15th, and cherries on the 2 2d
day of the month in feveral of the city gardens*

VOL. IV. A A (liower


A fliower of hail fell on the afternoon of the 2 2d,
which broke the glafs windows of many houfes. A
Ungle flone of this hail was found to weigh two
drachms. Several people collected a quantity of it,
and preferved it till the next day in their cellars,
when they ufed it for the purpofe of cooling their
wine. The weather after this hail florm was rainy
during the remaining part of the month. The
difeafes were ftill inflammatory. Many perfons were
afflifted with a fore mouth in this month.

The weather in June was pleafant and tempe-
rate. Several intermittents, and two very acute
pleuriiies occurred in my praflice during this month.
The intermittents were uncommonly obllinate, and
would not yield to the largell dofes of the bark.

In a fon of Mr. Samuel Coates of feven years
old, the bark produced a fudden tranflation of this
ftate of fever to the head, where it produced all the
fymptoms of the firfl ftage of internal dropfy of
the brain. This once formidable diforder yielded
in this cafe to three bleedings, and other depleting
medicines. The blood drawn in every inftance
was fizy.

J'rom the inflamjnatory complexion of the dif-
eafes of the fpring, and of the beginning of June,

I cxpe^ed


I expelled the fevers of the fummer and autumn
would be of a violent and malignant nature. I wa*
the more difpofed to entertain this opinion from
obferving the flagnating filth of the gutters of our
city ; for the citizens of Philadelphia having an in-
terefl in rejecting the proofs of the generation of
the epidemic of 1793 in their city, had negleci:ed to
introduce the regulations which were neceffary to
prevent the producSiion of a fimilar fever from do-
mefliic putrefafiion. They had, it is true, taken
pains to remove the earth and offal matters which
accumulated in the ftreets ^ but thefe, from their
being always dry, were inoffenfive as remote caufes
of difeafe. Perhaps the removal of them did harm,
by preventing the abforption of the miafmata which
were conftantly exhaled from the gutters.

On the 6th of June Dr. Phyfick called upon
me, and informed me that he had a woman in the
yellow fever under his care. The information did
not furprife me, but it awakened fuddenly in my
mind the mod diflreffmg emotions. I advifed him
to inform the mayor of the city of the cafe, but
by no means to make it more public, for I hoped
that it might be a fporadic inflance of the diforder,
and that it might not be general in the city.

A 2 On


On the 1 2th of the month my fears 6f the re-
turn of the yellow fever were revived by vifiting
Mr. Ifaac Morris, whom I fouftd very ill with a
violent puking, great pain in his head, a red eyc^
and a flow tenfe pulfe» I ordered him to ht bled,
and purged him plentifully with jalap and calomeL
His blood had that appearance which has been
compared by authors to the wafliings of raw ilefli
in water. Upon hk recovery he told me that he
*^ fufpefted he had had the yellow fever, for that
his feelings were exa£i:ly fuch as they had been in
the fall of 1793, at which time he had an attack
of that diforder."

On the 14th of June I was fent for in the ab-
fence of Dr. Meafe, to vifit his filler in a fever. Her
mother who had become intimately acquainted with
the yellow fever by nurfmg her fon and mother in
it, the year before, at once decided upon the name
of her daughter's diforder. Her fymptoms were
violent, but they appeared in an intermitting form.
Each paroxyfm of her fever was like a hurricane to
her v/hole fyllem. It excited apprehenfions of im-
mediate diiTolution in the minds of all her friends^
The lofs of fixty ounces of blood by five bleedings,
copious dofes of calomel and jalap, and a large blif-
ter to her neck, foon vanquiihed this malignant in-


termittent, without the aid of a fingle dofe of

During the remaining part of the month I was
called to feveral cafes of fever which had fymptoms
of malignity of a fufpicious nature. The fon of
Mr. Andrew Brown had an hcemorrhage from his
nofe in a fever, and a cafe of menorrhagia occurred
in a woman who was affefled with but a flight de-
gree of fever.

In the courfe of this month I met with feveral
cafes of fwelled tefticles, which had fucceeded fevers
fo flight as to have required no medical aid. Dr.
Defportes records fimilar inllances of a fwelling in
the teft^icles which appeared during the prevalence
of the yellow fever in St. Domingo in the year
1741. *

In the month of July I viflted James Lefferty and
William Adams, both of whom had, with the ufual
fymptoms of yellow fever, a yellow colour on their
flcin. I likevv^ife attended three women, in whom I
difcovered the difeafe under forms in which I had
often (een it in the year 1793. In two or them it
iippeared with fymptoms of a violent colic, whicli

' Hiiloire des Maladies d-e Saint Domingue, p. 1*2.

A 3 yielded


yielded only to frequent bleedings. In the third,
it appeared with fymptoms of preurify, which was
attended with a conflant haemorrhage from the ute-
rus, although blood was drawn almofl daily from
her arm for fix or feven days. About the middle
of this month many people complained of a ficknefs
at ftomach, which in fome cafes produced a puking,
without any fymptoms of fever.

During the month of Auguft, I was called to
Peter Denham, Mrs. Bruce, a fon of Jacob Crib-
ble's, Mr. Cole, John Madge, Mrs. Gardiner, Mifs
Purdon, Mrs. Gavin, and Benjamin Cochran, each
of whom had all the ufual fymptoms of the yellow
fever. I found Mr. Cochran fitting on the fide of
his bed, with a pot in his hand, into which he was
difcharging black bile from his flomach, on the 6th
day of the diforder. He died on the next day.
Mrs. Gavin died on the 6th day of her diforder,
from a want of fufficient bleeding, to which llie ob-
je<!led from the influence of her friends. Befides
the above perfons, I vifited Mr. George Eyre at
Kenfmgton, Mr. Thomas Fitzfimons, and Thomas
M'Kean, jun. fon of the chief juflice of Pennfyl-
yania, all of whom had the diforder, but in a mo-
derate degree. From none of them had 1 as yet
obferved the fever to be propagated by contagion,
?.Vid therefore I took no ileps to alarm my fellow-


citizens wftb. the mrwelcome news of its being in
town. But my mind was not eafy in this fituation,
for I daily heard of perfons who died of the difor-
der, who might probably have been faved had they
applied early for relief, or had a fufpicion become
general among all our phyficians of the exiflence of
the yellow fever in the city. The colera infantum
was common during this, and part of the preceding
month. It was more obilinate and more fatal than
in common years.

On the 1 2th of this month a letter from Baltimore
announced the exiflence of the yellow fever in that
city. One of the patients whom I vifited in this
month, in the fever, Mr. Cole, brought the conta-
gion of it in his body from that place.

On the 25th of the month two members of a
committee lately appointed by the government of
the flate, for taking care of the health of the city,
called upon mc to know v/hether the yellow fever
was in town. I told them it was, and mentioned
fome of the cafes that had come under my notice ;
but informed them at the ftime time, that 1 had
fecn no cafe in which it had been contagious, and
that in every cafe where I had been called early,
. and where my prefcriptions had been followed, the
dii^?afe had yielded to medicine.

A 4 On


On the 29th of the month, I received an invita-
tion to attend a meeting of the Committee of
Health, at their office in Walnut Street. They
interrogated me refpe6ling the intelligence I had
given to two of their members on the 25th. I re-
peated it to them, and mentioned the names of all
the perfons I had attended in the yellow fever fmce
the 9 th of June.

As I confidered the filth of the gutters, and the
ftagnating water in the neighbourhood of the city
to be the remote caufes of this fever, I advifed the
Committee to have them both removed, and thereby
to prevent the fpreading of the diforder.

On the firfl week in September the difeafe ap-
peared to be contagious in feverai families, and the
number of my patients w^as thereby daily multi-
plied. I now confidered it as criminal to conceal
any longer the prevalence of the difeafe in our city,
or to elude the inquiries that were diredted to me
by my fellow-citizens, refpec):ing it. In vain did I
"wait for the alarm to come from another quarter.
I recollected the flanders to which I had expofed
myfelf the year before, by giving the firll notice of
the prevalence of the fever in our city. But I did
not hefitate in this fituation, to offer up my reputa-
tion a fecQiid time as a facrifice for the lives of my



fellow-citizens. In order to render the information
as public as polTible, I addreifed a letter to the
mayor of the city on the 2d of September, in which
I dated the exillence, and rgntagious nature of
the difeafe. The contents of this letter, and my
information to the Committee of Health refpe<5ling
the yellow fever, drew upon me the following at-
tack in Mr. Fcnno's newfpaper.

For the Gazette of the United States.

'^ Mr. Fenno,

"I BEG leave, through the channel of
your paper, to enquire of the phyfician who re-
ported to the infpeiflors of health lail Friday, that
'' the yellow fever had again made its appearance
in this city, but that it was not at prefent conta-
gious," what could have induced him to make fuch
a report ? No benefit can arife to the public from
a knowledge of fuch a fa£l:, admittinq^ it to be as
ftated ; but a great deal of damage : becaufe fuch
reports cannot fail of alarming and filling with
dread, the minds of thofe who are not poiTciTed of
the Do(^or's fine difcernment and capacity of fplit-
ting difeafes into grades, fub-grades, and femi-
grades ; therefore fuch a report will not only ren-
der multitudes uneafy, and interrupt the ufual courfe



of buHnefs, but injure the interefl and reputation of
the city in fever al other refpefts.

" If the difeafe really exifled, it would be com-
mendable to found the alarm — it would be crimi-
nal to be filent ; but if it is not in the city, or if
being in the city, it is not contagious, it is the
height of cruelty to create ufelefs terror and alarm
in the minds of the citizens.

*^ But Mr. Fenno, is it not very extraordinary,
if the difeafe is in the city, and the phyfician allu-
ded to has had twenty-fix cafes of it fmce June,
fhat it has appeared to none of the other phyfi-
cians, not even to thofe who attend the Difpenfary,
wliich I am aifured from the befl authority is the
cafe ?

*^ A phyfician who has great weight with the cre-
dulous and ignorant, has already attempted to ruin
the reputation of this flourifliing and delightful
city, by publilhing an opinion that the late pefti-
lential fever was generated in it ; and that its fitua-
tion and climate is favourable to the generation of.
the moil malignant maladies. If fuch an opinion
was not believed by every man who knows the cha-
rafter of that phyfician to be a mere invention to
fupport a miltaken theory, or that it proceeded



from a rage for being efleemed the mofi: learned
man in the univcrfe ; the author would in a few
years have the divine fatisfa^flion of feeing this po-
pulous and profperous city deferted by all its opu-
lent inhabitants, and become a folitary waile where
he might fit alone, ' fmiling ghaftly o*er its ruins,
and enjoying the fruits of his lingular opinion.*

" If the opinion of that phyfician was founded
in fa£t, Mr. Fenno, fuch would be the blelTed con-
fequence ; for who that has any regard for health
or life would venture to remain in a city notorious
for generating plagues which put hfe in perpetual
jeopardy ?

*' This, however, fortunately is not credited, and
the city, in fpite of the reveries of philofophers,
phylicians, and conjurers, will flourilli for ages yet
to come ; and when all the fources of ilagnant w^a-
ter in its fuburbs come to be removed or corrected,,
it will be one of the moll healthy fituations in Ame-
rica. Open on every fide to the accefs of the
winds — with a dry foil — flreets favourably arran-
ged — the inhabitants induflrious, cleanly, and well
informed — it cannot in the nature of things be un-
healthy. Compare its bills of mortality with thofe
of Paris, London, Edinburgh, Vienna, or Stocks



holm, and you will at once be convinced how much
more healthful it is than either of thofe.

" Be under no concern my fellow-citizens, the
yellow fever is not in our city, nor is it poffible for
it to be generated in it, in its prefent fituation.


On the i3tli of September I wrote a fecond let-
ter to the Committee of Health, in which I de-
clared the difeafe to be contagious, and urged them
to make the information I gave them public. My
reafons for this advice were flated in the follow-
ing words : '' It will excite the citizens to apply
early for medical aid, and it will produce in the
minds of fuch of the phyficians as are unprejudiced,
nn early fufpicion of the prefence of the difeafe, in
thofe cafes where it comes on with its lefs obvious


None of thefe communications produced the ef-
fect: that was intended by them. Dr. Phyfick and
Dr. Dev/ees fupported me in my declaration, but
ihtlr tellimony did not protedl me from the grolTefl
calumnies of my fellow-citizens. One of my friends
informed me tliat he had heard a propofal in a



public company to " drum me out of the city." A
charge of infanity which had been made againft
me the year before, was now revived, and propa-
gated with fo much confidence, that one of my
patients who had believed it, exprefled her furprife
at perceiving no deviation from my ordinary man-
ner, in a fick-room. Several of the phyficians of
the city united in the llanders which were thrown
out againfl me j and notwithftanding they daily at-
tended, or lofl patients in the yellow fever, they
denied that any cafes of it had occurred in their
praftice. To thefe cafes they gave other names.
I fliall briefly enumerate thefe names, together
with the opinions of fome of the phyficians refpe<5l-
ing the fever. This detail will be ufeful ; for by
expofing the danger and fatal confequences of error
and deception, we fhall prevent their being repeat-
ed, and thereby prepare the vv^ay for the more
ready and univerfal admifilon of truth, upon the
fubje£l of the fever. Thus ignorance and vice will
appear, even in the fcience of medicine, not to have
exifted in vain.

It was called,

1. A common intermittent. 2. A bilious fever.
3, An inflammatory remitting fever. 4. A putrid
fever. 5. A nervous fever. 6. A dropfy of the



brain. 7. A lethargy. 8. Pieurify. 9. Gout.
10. Rheumatifm. 11. Colic. 12. Dyfentery.
And 13. Sore throat.^

It was faid further, not to be the yellow fever
becaufe it was not contagious, and becaufe forae
who had died of it, had not a fighing in the be-
ginning, and a black vomiting in the clofe of the
difeafe. Even where the black vomiting and yel-
low ikin occurred, they were faid not to conftitut^
a yellow fever, for that thofe fymptoms occurred in
other fevers.

A further detail of the names of this fever, and
of the opinions of the phylicians will appear pre-
fently in their report to the Committee of Health
on the 30th of September.

Truth, it has often been faid, is an unit, but
this is not the cafe with error. While the phy-
ficians v/ho aiTerted that the yellow fever was in
town, agreed in fixing the fame name to every cafe
of it, the phyficians who propagated the contrary
opinion, gave diiferent names to the fame fever.

* A fore throat fometimes occurs as a fymptom of the yel-
low fever. It is taken notice of by Dr. Blane in his Hiftory
of the Fever in the Weft Indies.



In one inflance a citizen of Philadelphia was faid
by one of his phyficians to have died of a lethargy,
and by another, of a nervous fever. To keep iip
the latter idea, his death was announced in the
public papers, to have occurred after an illnefs of

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