Chapter XX: Section I: History of the Yellow Fever (1)

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.