tem, and this accumulation of heat is fever. This fever must, from the nature of heat, which is to excite action, be followed by a preternatural excitement of the heart and arteries. The heat is diffused over the skin, as well as through the viscera; but the skin being dry, it has no good conductor. To remove fever, therefore, it is necessary to remove the obstructions which prevent the escape of the perspirable fluid. How is this done? First, by bleeding. This abstracts a portion of heat in the blood taken; but its chief effect is by relaxing the vessels and skin, and thus aiding nature to renew the excretions. Secondly, copious drafts of liquids, which supply the body with the natural conductor of heat, where there was before a deficiency. Thirdly, by the application of moisture to the skin, by the bath, affusion, or fomentations; all which tend to relax the surface, and invite the escape of heat.

What is the crisis of a fever? Is it not always indicated by a restored perspiration? Then, upon these principles, the crisis is nothing more than the first escape of a preternatural heat, And if these principles have any just foundation, why is not the warm bath the most natural remedy for fevers? The affusion of cold water has often been tried, and sometimes with success; but this requires a force of re-action in the system that cannot often be expected when all the ducts perhaps are clogged with viscid matter. I have heard a gentleman say he had been affected with yellow fever three times, and cured in three different modes; but the last, and by far the easiest, was by the warm bath, being laid in warm water till the skin became moist, then taken out, but immersed again as soon as his skin became dry. In this way he was left without fever in a few hours.

It is common, this autumn, for our physicians to use the warm bath for dysentery; and the success, I understand, is unequivocal. It is said the warm water takes off the spasm, How? By relaxing the skin, opening the perspiratory ducts, and conveying off the preternatural heat, thus subduing the inflammation. We have been told that the application of oil to the body has been found to effect the cure of the plague. The fact is, I believe, not sufficiently ascertained; but why may we not suppose the effect of oil thus applied, to be salutary? Oil is extremely relaxing, even more so than water. It penetrates the smallest ducts, and may, perhaps, relax the skin, and open the pores more effectually than warm water; thus re

storing, or assisting nature to restore the excretions, the natural remedy for fever.

These may be crude conjectures, and it rests with your better judgmeut to publish or suppress them.

ARTICLE VII.

Some ACCOUNT of the MALIGNANT FEVER which prevailed in Philadelphia in the Autumn of the Year 1803; being Part of an Introductory Lecture to a Course of "Clinical Remarks, and Practical Demonstrations," in the Infirmary of the public Alms-House of Philadelphia; CHARLES CALDWELL, M. D. &c. Communicated in a Letter to Dr. MITCHILL, dated November 28, 1803.

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Knowledge of the histories and laws of epidemic diseases constitutes one of the most interesting and important branches in the science of medicine. You cannot, gentlemen, direct your attention to this department of your studies, either too early, or with too much zeal. A knowledge of the epidemics of your own country, in particular, cannot be acquired without much industry and labour, for it must be principally the work of your own observation. The peculiarities of our climates, seasons, state of society, habits of life, and of the general condition of our country, both physical, civil, and political, impart to the diseases of the United States new features, on which no light is shed by the writers of Europe. For your own information, therefore, as well as for the information of transatlantic physicians, who are beginning to view, with a proper regard, the medical characters and works of America, it becomes you to collect, and treasure up with assi duity and care, every thing new and interesting in the diseases which surround you, that you may be able to communicate them to the world at a future day. Considering the vast range for medical discovery and improvement, arising out of the circumstances of the country in which you reside, your time will be spent to little purpose, should you reach the meridian of literary life without making some useful contributions towards the advancement of your profession.

The malignant fever which lately prevailed in certain parts of Philadelphia excited great solicitude in the public mind, gave rise to much conjecture and controversy, and was made a sub

ject of no common degree of misrepresentation. I shall, there fore, take the liberty of laying before you a brief and, as far as I am able, a correct statement of its rise, progress, and termination. In this sketch I shall confine myself principally to facts, and touch but lightly on the controverted doctrines of importation and domestic origin. These, however, are matters so intimately connected and interwoven with the subject, that they cannot be passed over without a degree of notice. As the disease was evidently much under atmospheric influence and controul, it will be necessary to advert to the state of the weather for some time previous to its occurrence. The state of the city, in relation to the prevalence of epidemic complaints, must also receive a due share of attention.

During the months of March and April last nothing very remarkable occurred, either in the state of the weather or in that of the health of the inhabitants of Philadelphia. The season was rather cooler than usual, with a general prevalence of northerly and easterly winds. Though clouds were frequent, and oftentimes threatening, yet the quantity of rain that descended was scarcely sufficient for the purposes of vegetation. Owing to this, and the low temperature of the atmosphere, the early labours of the husbandman were scantily rewarded, and our markets but indifferently supplied with vegetables. During this period, the cow-pox and small-pox, both natural and inoculated, proved very mild and manageable; the common complaints of spring were neither numerous nor severe, and no epidemic whatever made its appearance. Though vegetation was checked through a deficiency of heat and moisture, yet all the elements were at peace with man.

Throughout the whole of May and June, except about seven days in the course of the latter month, the weather continued unseasonably cool, the prevailing winds still preserving a northerly direction. It was not till near the close of June that the citizens were able to dispense entirely with fires in their parlours. Nor were the falls of rain during this period either frequent or copious, though clouds, particularly distant ones, accompanied by lightning and thunder, were no unusual occurrences. It is scarcely necessary to remark, that, under such a temperature and state of weather, the progress of vegetation, and the ripening of fruit, were still slow and imperfect. Animal nature, but particularly man, seemed still the favourite of the season, for he continued unusually exempt from diseases of every description. A few cases of intermitting, and some of remitting fever, and dysentery occurred, but they yielded very

readily to the common mode of treatment. At this period, even tropical climates seemed to have laid aside their wonted malignity, and become friendly to the human race. The crews of most West-India vessels entered our port in full health, and without having experienced a complaint during their voyage. Nor had we certain information of the prevalence of disease in any of the islands.

Throughout the month of July, the state of the weather, in general, was widely different from what it had been during the preceding part of the season. The cool refreshing northerly breezes of May and June were now exchanged, either for oppressive calms, or for the humid and sultry winds of the south. Such are the changes which the state and temperature of the atmosphere undergo in the islands of the Mediterranean, the West-Indies, and elsewhere, previously to the eruption of some mortal epidemic. Even in the south of Europe, a long continuance of the " humidus australis," during the summer or autumnal months, is a seldom-failing harbinger of some wasting disease. The history of the late malignant fever which ravaged certain provinces of Spain, furnishes evidence in confirmation of this truth; that epidemic calamity was preceded by an unusual prevalence of southerly winds.

Under such heats, the citizens began to complain of languor and debility, and vegetation, as if rejoicing in an atmosphere unfriendly to animal life, became more luxuriant. During this month, the mercury in Fahrenheit's thermometer was seldom below 80 degrees, for several hours in the day, and sometimes rose to 90 degrees and upwards. This temperature, concurring with cloudy weather, and frequent falls of rain, (some of them very profuse) gave us a state of atmosphere perfectly tropical. Privies, sewers, and other reservoirs of filth, emitted a smell more than usually offensive. From the joint effect of these considerations, apprehensions began to be entertained, that our late scenes of health must soon close for the season. Accordingly, on the nineteenth of the month (July), two cases of disease occurred in adjoining houses, at the corner of Chesnut and Water-streets, which were but too well calculated to realize and confirm these melancholy anticipations. It will be held in remembrance, as a fact of much consequence, relative to a point which we shall presently endeavour to establish, that, at this time, we had no account of the prevalence of malignant fever in the city of New-York; nor is there any reason to believe that it had made its appearance there more than two days previously to the occurrence of the foregoing cases. The VOL. I.

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seventeenth of July appears to be the earliest date to which the late fever of that city has been traced. I think the proclamation of the Mayor extended no further back than to the twentieth.

The two persons who sickened at the corner of Chesnut and Water streets were females, under the age of sixteen years. One of them died on the fifth day of her illness, and the other recovered; but they both exhibited unequivocal symptoms of malignant fever. It is worthy of remark, that adjoining to the houses where these persons resided, were a yard and private alley, containing stagnant water and putrid substances, which, for a week or ten days previously, had emitted a smell highly offensive to the neighbourhood. The families where the sickness occurred did not hesitate to attribute their misfortune to this insufferable stench. The physicians who attended these two cases of disease entertain, or at least profess a belief, that malignant (commonly called yellow) fever, can arise only from contagion. But, after searching for the West-India vessels, diseased sailors, trunks of clothing that had passed between the thirty-second degree of north, and the same degree of south latitude;* and being unable to discover, in the vicinity, either such sources, or any other fomes whatever, they very prudently declined giving a decided opinion on the nature of the disease, lest they might injure the doctrine they had pledged themselves to support. By such disingenuous artifices is error suffered to hold an ascendency over truth!

From the twenty-eighth of July, till the fifth or sixth of August, four other cases of malignant fever appeared in the same neighbourhood, three of which terminated fatally. It is particularly worthy of notice, that the persons here attacked never had the slightest intercourse with each other, nor with any common source, except the atmosphere of the place where they resided. A knowledge of this induced most of the citizens to consider their disease as nothing else than a high grade of autumnal fever, or what was afterwards very emphatically denominated the Water-street fever. It is remarkable that this name was bestowed on the disease by a physician who is ostensibly an orthodox importer. But it is among the misfortunes of the time, that we have hypocrites in medicine as well

*

By a late health-law for the city and port of Philadelphia, the leading features of which were sketched by the college of physicians, every vessel coming from a port or place between the thirty-second degree of north, and the same degree of south latitude, during the summer and autumnal months, was considered as infected, and condemned to a quarantine of fifteen days.