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Bilious remitting Yellow Fever,





By Benjamin R.ujh, m.d.






JL HE delay cf the following
publication has been occafioned by the want
of health to prepare it for the prefs, during the
winter months. It now goes forward, under
the great difadvantages, of having been haffily
copied from my notes, amidft frequent pro-
feffional interruptions. Its imperfeclions
I hope will be overlooked, when it is con-
fidered, that my only defign in publishing
thus prematurely, was to obviate as much as
poffible, the danger of the difeafe, mould it
unhappily appear in our city in the courfe of
the preient feafon.



In the hiftory of the fever, I have intro-
duced an account of the fymptoms and
prognofis, in fuch places as they occurred
molt naturally, without a ftricl regard to the
artificial order of the fchools.

In the detail of the fymptoms, I have
divided the body into different fyitems.
This divifion I have found to accord more
eafily with the principles of medicine which
1 have adopted, than the common method
of defcribing them, as they appear in the
animal, natural, and vital functions.

In republifhing an account of the con-
troversies between the. phyficians of Phila-
delphia, my motives were, to prevent the
revival of certain opinions and modes of
practice, by bringing them forward under the
patronage of refpeclable names, and to juflify
in a great meafure, from their influence, the
want of univerfal faccefs, by the only fafe, and
% proper


proper mode of treating the yellow fever. I
hope I fhall be excufed for this part of the
following work, when it is perceived, that I
have been more minute in relating my own
miftakes, than thofe of other Phy ficians ; and
that rhave conneded no names with the opi-
nions and modes of practice which I have op-
pofed, but fuch as were given to the public
by their authors, during the prevalence of the


Philadelphia, 7
June i+th, 1794O


N account of the difeafes which preceded the

yellow fever I

Of the firft cafes of it - - 8
Correfpondence between Dr. Hutchinfon and the

Author, upon the fubjecl of the fever 16, 17
Proceedings and publication of the College of Phy-

cians - - - - - 21

Predifpofmg and exciting caufes of the fever - 29

Premonitory figns of an attack of the fever - 36

Hiftory of its fymptoms - - - 39

As they appeared in the blood veflels - - 40

in the liver and brain 47

in the flomach and bowels, - 51

in the fecretions and excretions 54

in the nervous fyftem - - 61

in the fenfes and appetites - 66

in the lymphatic and glandular

fyftem 6S

on the fkin - -69

in the blood - 73

Anomalous circumftances belonging to the hiftory

of the fever, - - - 78

Jts banifhment of, or mixture with, other fevers ' 84

b Account


Account of perfons, moft fubject to the difeafe, 93

of thofe who efcaped it, - 10 1

Signs of the univerfal prevalence of the exhalation,

and contagion in the city, - - 104
State of the atmofphere during the prevalence of

the fever, - - 108
Proofs of reinfection, - - 112
State of the body after death, - - 113
Appearances of the dead body exhibited by direction, 1 15
State of the City during the prevalence of the fever,
Amount of deaths, and the number on each day
from the ift of Auguft to the gth of Novem-
ber, - - - 128, 129
The caufes which checked the diforder, - 131
The difeafes which fucceeded the yellow fever, 138
The means ufed to purify houfes and clothes, 141
Sporadic cafes of yellow fever in 1763, - 144
Of the origin of the fever, - - iaj
Symptoms, and circumfrances, of agreement and
difagreement, between the yellow fever and the
plague, - - j6 9

of the yellow and jail fever, 175

Different grades or ftates of bilious fever, 178
Premonitory figns of great and mortal epidemics,

or of a fickly autumn, - - 179
Regifter of the weather from the ift of January to

the 9th of November, 1793 " " l< &$

Of the Method of Cure, - - 193

Of the remedies for the fever, - - 203

Origin of the diflcntions among the phyfickuis, 207

Four modes of treating the fever, - 243

I. Of purging, - . - - 245

is to it anfwered, - 248



Of blood-letting, - - 258

The appearances of the blood, - 261

Objections to blood-letting anfwered, - 274
Advantages of obtaining evacuations in a gradual

manner in certain cafes, - - 277

Of Cool and frefh air, - 284
Of the drinks and diet ufed in the flril ftage of the

fever, - - 285, 2?5

Of the application of cold water to the body, 287
Of the advantages of a falivation in the cure of the

fever, - - 291, 292

Ofblifters, - - 290
Of the drinks and diet in the fecond ftage of the fever
Of the remedies which were ufed to relieve painful

or diftreffing fymptoms, - - 292

Symptoms which attended the convalefcence, 295
Of the benefits of bleeding, purging, and low diet in

preventing or mitigating the difeafe, - 295

II. Obfervations on the ufe of bark, in the fever, 289

of wine, - 299

of laudanum, 299

of the cold bath, 300

III. Obfervations on the combined ufe of evacuations,

and tonic medicines, - - 302

IV. Obfervations on the ufe of the French remedies, 302
Inquiry into the comparative fuccefs of each of the

four modes of practice, which have been mentioned, 303

Of the tonic method - - 308

Of the antiphlogiftic method, - 308
Of the combination of the tonic and antiphlogiftic

methods, and of the French practice, 319, 320
2 obfervations


Obfervatlons on the fuccefs of the antiphlogiftic
remedies, in the hands of perfons not educated
to the profeffion of phyfic - 320

Inferences from their fuccefs, and from other confi-
derations, in favour of teaching the people at
large to cure themfelves of the yellow fever,
and of all other peflilential fevers - - 325

Narrative of the ftate cf the Author's body and

mind during the prevalence of the fever 339




Of THl

Bilious remitting Yellow Fever %



IN THE YEAR 1 793.




JLjEFORE I proceed to defcribe the fever
which is to be the fubject of the following hiftory,
it will be proper to give a fhort account of the
.difeafes which preceded it.

The (late of the weather during the flrfl feven
months of the year, and during the time in which
the fever prevailed in the city, as recorded by Mr
Rittenhoufe, will be inferted immediately after the
hiftory of the difeafe.

The Mumps which made their appearance in

December 1792, continued to prevail during the

month of January 1793. Befides thisdiforder,

there were many cafes of catarrh in the city,

B 2 brought


brought on chiefly by the inhabitants expofing
themfelves for feveral hours on the damp ground
in viewing the aerial voyage of Mr Blanchard on
the 9th day o^ the month.

The weather which had been moderate in De-
cember and January became cold in February.
The mumps continued to prevail during, this month
with fymptoms fo inflammatory, as to require in
fome cafes two bleedings. Many people com-
plained this month of pains and fwellings in the
jaws. A few had the fcarlatina anginofa.

The mumps, pains in the jaws, and fcarlatina
continued throughout the month of March. I was
called to two cafes of pleurify in this month, which
terminated in a temporary mania. One of them
was in a woman of ninety years of age, who re-
covered. The blood drawn in the other cafe,
(a gentleman from Maryland) was diffolved. The
continuance of a tenfe pulfe, induced me notwith-
standing to repeat the bleeding. The blood was
now fizy. A third bleeding was prescribed, and
my patient recovered. Several cafes of obflinate
eryfipelas fucceeded inoculation in children during
this, and the next month, one of which proved



BloiToms were nniverfal on the fruit-trees, in
the gardens of Philadelphia, on the firft day of
April. The fcarlatina anginofa continued to he
the reigning epidemic in this month.

There were feveral warm days in May, but the
city was in general healthy. The birds appeared
two weeks fooner this fpring than ufual.

The regifter of the weather mews, that there
were many warm days in June. The fcarlatina
continued to maintain its empire during this

The weather was uniformly warm in July. The
fcarlatina continued during the beginning of this
month, with fymptoms of great violence. A fon
of Mr James Sharfwood, aged feven years, had with
the common fymptoms of this diforder, great
pains and fwellings in his limbs, accompanied with
a tenfe pulfe. I attempted in vain to relieve him
by vomits and purges. On the 10th day of the
month, I ordered fix ounces of blood to be drawn
from his arm, which I obferved afterwards to be
very fizy. The next day he was nearly well. Be-
tween the 22d and the 24th days of the month,
there died three perfons whofe refpc&ive ages
were 80, 92, g6$. The weather at this time

B 3 was


was extremely warm. I have elfewhere taken no-
tice of the fatal influence of extreme heat, as well
as cold, upon human life in old people. A few
bilious remitting fevers appeared towards the clofe
of this month. One of them under my care,
ended in a tedious typhus mitior, from which the
patient was recovered with great difficulty. It
was the fon of Dr Hutchins of the ifland of Bar-

The weather for the firft two or three weeks in
Auguft was temperate, and pleafant. The colera
morbus, and remitting fevers were now common.
The latter were attended with fome inflammatory
action in the pulfe, and a determination to the
bread:. Several dyfenteries appeared at this time,
both in the city and in its neighbourhood. During
the latter part of July, and the beginning of this
month, a number of the diflreflfed inhabitants of
St Domingo, who had efcaped the defolation of
fire and fword, arrived in the city. Soon after
their arrival, the influenza made its appearance,
and fpread rapidly among. our citizens. Thefcar-
latina (till kept up a feeble exiilence among chil-
dren. The above difeafes were univerfal, but
they were not attended with much mortality. They
prevailed in different parts of the city, and each
feemed to appear occaflbnally to be the ruling



epidemic. The weather continued to be warm
and dry. There was a heavy rain on the 25th of
the month, which was remembered by the citi-
zens of Philadelphia as the lad that fell, for many
weeks afterwards.

There was fomething in the heat and drought
of the fummer months, which was uncommon
in their influence upon the human body. La-
bourers every where gave out (to ufe the coun-
try phrafe) in harveft, and frequently too when
the mercury in Fahrenheit's thermometer was un-
der 84 . It was afcribed by the country people
to the calmnefs of the weather, which left the
iweat produced by heat and labour, to dry ilowly
upon the body.

The crops of grain and grafs were impaired by
the drought. The fummer fruits were as plentiful
as ufual, particularly the melons, which were of an
excellent quality. The influence of the weather
upon the autumnal fruits, and upon vegetation in
general, fhall be mentioned hereafter.

I beg pardon for the length of this introduction.
Some parts of it, I hope, will not appear ufelefs
in the fequel of this work.

B 4 I now


I now enter upon a detail of fome folitary cafes
of the epidemic, which foon afterwards fpread
diftrefs through our city, and terror throughout
the United States.

On the 5th of Auguit, I was requefted by Dr
Hodge to vifit his child. I found it ill with a fever
of the bilious kind, which terminated (with a
yellow ikin) in death on the 7th of the fame

On the 6th of Auguft, I was called to Mrs
Bradford, the wife of Mr. 1 nomas Bradford. She
had all the fymptoms of a bilious remittent, but
they were fo acute, as to require two bleedings,
and feveral fucceflive dofes of phyfic. The laft
purge flie took was a dofe of calomel, which ope-
rated plentifully. For feveral days after her re-
covery, her eyes and face were of a yellow

On the fame day, I was called to the fon of
Mrs. M'Nair, who had been feized violently
with all the ufual fymptoms of a bilious fever.
1 purged him plentifully with falts and creamor
tartar, and took ten or twelve ounces of blood
from his arm. His fymptoms appeared to yield
to thefe remedies; but on the 10th of the month



an hemorrhage from the nofe came on, and on
the morning of the 1 2th he died.

On the 7th of this month I was called to vifit
Richard Palmer, a fon of Mrs. Palmer in Chef-
nut-ftreet. He had been indifpofed for feve-
ral days with a fick ftomach and vomiting after
eating. He now complained of a fever and head-
ach. I gave him the ufual remedies for the bilious
fever, and he recovered in a few days. On the
15th day of the fame month, I was fent for to vifit
his brother William, who was feized with all the
fymptoms of the fame diforder. On the 5th day
his head-ach became extremely acute, and his
pulfe fell to fixty ftrokes in a minute. I fufpected
congeftion to have taken place in his brain, and
ordered him to lofe eight ounces of blood. His
pulfe became more frequent, and lefs tenfe after
bleeding, and he recovered in a day or two after-

On the 14th day of this month I was fent for to
vifit Mrs. Learning, the wife of Mr. Thomas Lea-
rning. I fufpected at firft that flie had the influ-
enza, but in a day or two, her fever put on bili-
ous fymptoms. She was affected with an uncom-
mon difpofition to faint. Her pulfe was languid,
but tenfe. I took a few ounces of blood from her,



and purged her with falts, and calomel. I after-
wards gave her a fmall dofe of laudanum which
difagreed with her. In my note book, I find
I have recorded, that " me was the worfe for it."
I was led to make this remark by its being fo very
uncommon, for a perfon who had been properly
bled and purged, to take laudanum in a common
bilious fever, without being benefited by it. She
recovered however flowly, and was yellow for
many days afterwards.

On the morning of the 18th of this month, I
was requeued to vifit Peter Afton, in Vine-ftreet,
in confultation with Dr Say. I found him in the
3d day of a mod acute bilious fever. His eyes
were inflamed, and his face flufhed with a deep
red colour. His pulfe feemed to forbid evacua-
tions. We prefcribed the ftrongeft cordials ; but
to no purpofe. We found him at 6 o'clock in
the evening, fitting upon the fide of his bed, per-
fectly fenfible, but without a pulfe, with cold clam-
my hands, and his face of a yellowifh colour. He
died a few hours after we left him.

None of the cafes which I have mentioned,
excited the lead apprehenfion of the exigence of 3.
yellow fever in our city; for I had frequently feen
fporadic cafes in which the common bilious fever



of Philadelphia, had put on fymptoms of great ma-
lignity, and terminated fatally in a few days, and
now and then with a yellow colour on the ikin,
before, or immediately after death.

On the 19th of this month I was requeued to
vifit the wife of Mr Peter Le Maigre, in Water-
ftreet, between Arch and Race ftreets, in conful-
tation with Dr Foulke and Dr Hodge. I found
her in the lafb ftage of a highly bilious fever. She
vomited conftantly, and complained of great heat
and burning in her ftomach. The mod powerful
cordials, and tonics were prefcribed, but to no pur-
pofe. She died on the evening of the next day.

Upon coming out of Mrs Le Maigre's room,
I remarked to Dr Foulke and Dr Hod^e, that I
had feen an unufual number of bilious fevers, ac-
companied with fymptoms of uncommon malig-
nity, and that I fufpe&ed all was not right in our
city. Dr Hodge immediately replied, that a fever
of a mod malignant kind had carried .off four or
five perfons within fight of Mr Le Maigre's door,
and that one of them had died in twelve hours af-
ter the attack of the diforder. This information
fatisfied me that my apprehenfions were well found-
ed. The origin of this fever was difcovered to



me at the fame time, from the account which Dr
Foulke gave me of a quantity of damaged coffee
which had been thrown upon Mr Ball's wharf,
and in the adjoining dock, on the 24th of July,
nearly in a line with Mr Le Maigre's houfe, and
which had putrefied there to the great annoyance
of the whole neighbourhood.

After this confutation I was foon able to trace
all the cafes of fever which I have -mentioned to
this fource. Dr Hodge lived a few doors above
Mr Le Maigre's, where his child had been expo-
fed to the exhalation from the coffee for feveral
days. Mrs Bradford had fpent an afternoon in a
houfe directly oppofite to the wharf and dock on
w r hich the putrid coffee had emitted its noxious
effluvia, a few days before her ficknefs, and had
been much incommoded by it. Her fifter Mrs
Learning had vifited her during her illnefs, and
probably caught the fever from her, for fhe per-
fectly recollected perceiving a peculiar fmell unlike
to any thing flie had been accuftomed to in a fick
room, as foon as fhe entered the chamber where
her fifter lay. Young Mr M'Nair and Mrs Pal-
mer's two fons had fpent whole days in a compting
houfe, near where the coffee was expofed, and
each of them had complained of having been made



fick by its oifenfive firiell, and Mr Afton had fre-
quently been in Water-ftreet near the fource of
the exhalation.

This difcovery of the malignity — extent — and
origin of a fever which I knew to be highly con-
tagious, as well as mortal, gave me great pain.
I did not hefitate to name it, the Bilious remitting
Tellow Fever. I had once feen it epidemic in
Philadelphia, in the year 1762. Its fymptoms
were among the firfl impreffions which difeafes
made upon my mind. I had recorded fome of
thefe fymptoms. I had likewife recorded its mor-
tality. I mall here introduce a fhort account of
it from a note book which I kept during my ap*

" In the year 1762, in the months of Augufr,
" September, Oclober, November and December,
" the bilious yellow fever prevailed in Philadel-
" phia, after a very hotfummer, and fpread like a
" plague, carrying off daily for fome time, upwards
" of twenty perfons.

" The patients were generally feized with ri-
" gors, which were fucceeded with a violent fever,
" and pains in the head and back. The pulfe was
" full, and fometimes irregular. The eyes were

" inflamed,


" inflamed, and had a yellowifh caft, and a vomit-
" ing almoll always attended.

" The 3d,, 5th, and 7th days were moftly criti-
" cal, and the difeafe generally terminated on one
" of them, in life or death.

<c An eruption on the 3d or 7th day over the
" body, proved falutary.

" An exceffive heat, and burning about the
M region of the liver, with cold extremities, por-
" tended death to be at hand."

1 have taken notice in my note book, of the
principal remedy which was prefcribed in this
fever by my preceptor in medicine, Dr Redman;
but this fliall be mentioned hereafter.

Upon my leaving Mrs Le Maigre's, I expreflfed
my diftrefs at what I had difcovered, to feveral of
my fellow-citizens. The report of a malignant
and contagious fever being in town, fpread in
every direction, but it did not gain univerfal cre-
dit. Some of thofe phyficians who had not feen
patients in it, denied that any fuch fever exifted,
and afferted (though its mortality was not denied)
that it w r as nothing but the common annual re-


mittent of the city. Many of the citizens, joined
the phyficians in endeavouring to difcredit the, ac-
count I had given of this fever, and for a while,
it was treated with ridicule or contempt. Indig-
nation in fome inftances was excited againft me,
and one of my friends whom I advifed in this
early ftage of the diforder, to leave the city, has
fmce told me that for that advice, " he had hated

My lot in having thus difturbed the repofe of
the public mind, upon the fubjeft of general
health, was not a Angular one. There are many
inftances upon record, of phyficians who have ren-
dered themfelves unpopular, and even odious to
their fellow citizens, by giving the firft notice of
the exiftence of malignant and mortal difeafes. A
phyfician who afferted that the plague was in Mef-
fina in the year 1743, excited fo much rage in the
minds of his fellow citizens againft him, as to ren-
der it neceffaryfor him to fave his life, by retreat-
ing to one of the churches of that city.

In fpite, however, of all oppofition, the report
of the exiftence of a malignant and contagious fe-
ver in the city, gained fo much ground, that the
governor of the (late directed Dr Hutchinfon, the
infpeclor of fickly veffels, to inquire into the truth



of it, and into the nature of the difeafe. In con-
fequence of this order, I received the following
letter from Dr Hutchinfon.

Dear Sir,

A considerable alarm has taken place,
in confequence of the appearance of an infectious
diforder in this city; from which the governor has
been induced to direct me to make enquiries rela-
tive to the exigence and nature of fuch diforder.
In executing this duty, I muft rely on the afliftance
of fuch of my medical brethren as may have been
called to attend any of the perfons fuppofed to
have been infected : as I underftand you have had
feveral of them under your care, I would be much
obliged to you to communicate to me (as fpeedily
as can be done with convenience to yourfelf) fuch
facts as you have been able to afcertain relative to
the exiftence of fuch diforder; in what part of the
city it prevails; when it was introduced; and what
was the probable caufe of it.

I am, Sir,

With the greateft refpe&,

August 24th, 7 Your obedient fervant,

1793- J ^'


Dr Benjamin Rujh*


J 7

To this letter I wrote the following anfwer a
few hours after it came to hand.

Dear Sir

A malignant fever has lately ap-
peared in our city, originating I believe from feme
damaged coffee, which putrefied on a wharf near
Arch-ftreet. The fever was confined for a while
to Water-ftreet, between Race and Arch-ftreets ;
but I have lately met with it in Second-flreet, and
in Kenfington; but whether propagated by conta-
gion, or by the original exhalation, I cannot tell.
The difeafe puts on ail the intermediate forms of a
mild remittent, and a typhus gravior. I have not
feen a fever of fo much malignity, fo general, fince
the year 1762.

From, dear fir,

Augufl 24th t \ Yours fincerely,

1793- 3


A few days afterwards, the following publica-
tion, by Dr Hutchinfon, appeared in the Ameri-
can Daily Advertifer of Anguft 28th.

C Ths


The governor having directed an inquiry to afcertairi'
the facts, refpeiling the exigence of a contagious fever
in the city, and the probable means of removing it, Dr
Hutchinfon, the phyfician of the port, has made the
following ftatement upon the fubjecl:, in a letter to
Nathaniel Falconer, Efq. health-officer of the port of

Dear Sir 7

Immediately on the receipt of your
letter, with the enclofure from the governor, da-
ting that a confiderable alarm had taken place, in
confequence of the appearance of an infections dis-
order in this city, I endeavoured to take meafures
to afcertain the facts, relative to the exiflence of
fuch difeafe : for this purpofe, I wrote to fuch of
my medical brethren, who had been called on to
attend perfons fuppofed to have been infected ; and
from their anfwers, as well as from my own obfer-
vations, I am convinced that a malignant fever has

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