such means be communicated, and become epidemical. Is not this an assertion without proof?* Besides, it would be very extraordinary that a disease should not be communicable through the same means by which it was received. It appears to me, therefore, however sufficient local causes+ may be to generate a fever of this kind, that all the arguments which have been so industriously collected, and so strenuously urged against the contagious nature of it, are far from being conclusive. Like jail fever, &c. being once generated, it is susceptible of being propagated in the same manner, viz. by effluvia from sick bodies, and from these adhering to clothes, &c. and it is not impossible or improbable that "the spark which first kindled up the epidemic in many places might have been imported."‡ Having thus stated, as briefly and explicitly as possible, my sentiments on the subject, I shall conclude by making reference to the facts and circumstances on which my opinion is founded. In the first place I must refer to the facts stated by Dr. Chisholm, which, notwithstanding their being called in question, have not yet been invalidated, and remain, in my judginent, unanswerable. 2dly. Although Dr. Chisholm has been represented as being almost the only advocate for contagion in the West-Indies, the contrary of this is the truth. Most of the practitioners in the West-Indies concur with him, and various facts and cases have been brought in proof of what he has stated. * There are various instances quoted of the disease having been imported from the West-Indies in the clothes of those deceased. (See Lining, Rush, &c.) † It is the opinion of many, that putrid effluvia may of themselves, in persons highly predisposed, generate the disease, and that from them it may be communicated, and become epidemic. (Med. Rep. Hex. I. vol. i. p. 321. See also Chisholm.) Seaman. Some persons, rather than allow of the existence and operation of contagion in any case whatever, refer epidemical diseases, 1st, to an unknown constitution of the air; 2dly, to a decomposition of the atmosphere by caloric-to the aspect and conjunction of the heavenly bodies-to earthquakes, volcanoes, &c. and, lastly, to the particular curse of God. If any such there are who still delight in mysteries, and in explaining things in the most far-fetched and improbable manner, let them talk of occult qualities, and let them believe, with Dr. Moseley, that carbuncles and buboes in the plague are owing to the gross food of the Turks. Is it not to be regretted that men really respectable for their talents should indulge in such whimsies; and, while arraigning others for their credulity, should exhibit such melancholy proofs of it in themselves, betraying a weakness bordering or puerility or dotage? Many similar instances of the contagious nature of yellow fever are related in the Medical Repository, which ought to have at least as much weight on the one hand as any stated to the contrary should have on the other.* It is well known to the practitioners of this island, that the pestilential yellow fever prevails only on certain occasions that it generally begins among seamen and soldiers lately arrived from Europe-that it has no apparent connection with local causes-that is to say, it makes its appearance during the most healthy seasons, and in the healthiest situations; while, on the other hand, it is never found to prevail in unhealthy or marshy spots. Lastly, it appears, contrary to what has been again and again asserted, to be directly communicable from one person to another, and from a single person to many. For example, one man only, going on board an infected ship, and contracting the disease, shall communicate it to several others, who never had been otherwise exposed to the infection. Many histories in proof of this might be adduced, but I' deem the following letter from my friend Mr. D. Brown, assistant surgeon to the 6th battalion of the 60th regiment, quartered at Up-Park Camp, to be more than sufficient. See Med. Rep. Hex. I. vol. vi. p. 160. Dr. Rush has mentioned a fact which he justly terms a very important one, viz. that if a person who had taken the yellow fever in town went to a family residing in a healthy inland situation, he did not communicate the fever; but, on the contrary, if he went to a family residing near the river, that is to say, in a swampy or unhealthy situation, the family caught not a bilious remittent, but the yellow fever. This might be deemed proof sufficient of the contagious nature of yellow fever. But Dr. Rush will not allow it. He says that the exhalations from persons in yellow fever act on others as a stimulus. This is what the contagionists will not cavil about; but they will not allow this stimulus to be similar to beat, intemperance, or other exciting causes. It must be a stimulus sui generis, or it would not produce yellow fever. That yellow fever patients did rarely communicate yellow fever, or any other fever, to persons in healthy situations, admits of an easy explanation. †This Dr. Rush has admitted, but has explained the matter differently. (See Med. Rep. Hex. I. vol. vi. p. 160.) Agreeable to the information I have received from several country practitioners, the crews of ships stationed at the out-ports are generally healthy till one or more persons fall sick; but as soon as a single instance of yellow fever occurs, the disease spreads from one to another till it goes through the whole ship, and afterwards from ship to ship. The disease has also been traced from estate to estate fifteen miles into the country. VOL. I. 2 K Copy of a Letter from Mr. DAVID BROWN, Assistant Surgeon to the 60th Regiment, Up-Park Camp, to Dr. DANCER. DEAR SIR, Military Hospital, Sept. 10, 1803. In respect to the fever that has lately raged with such violence in our hospital, it was without doubt contagious. The reasons I have for entertaining this opinion are shortly these: 1st. No local cause existed that could produce the disease.* 2dly. It went progressively through the battalion; the persons nearest the sick being always the first who were affected. 3dly. The medical gentlemen who attended (five in number) were all taken ill; one of whom died, and the rest recovered with difficulty. 4thly. The sergeants and orderly men were all affected, and many of them died. But,: 5thly. What was most singular, every man employed in shaving the sick fell a victim to the disease. These are a few plain facts, known to every officer and private in the regiment. I remain, dear Sir, Not to extend this paper beyond the prescribed limits, I shall forbear any comment on the above. not to be withstood! Kingston (Jamaica), Sept. 18, 1803. The conclusion is The situation of Up-Park Camp is as healthy a one as can be well imagined, being two miles from the sea, at a considerable elevation, and fully exposed to the strong sea breezes. There are no swamps or other sources of putrefaction in the vicinage. The barracks are not crowded nor filthy. The hospital, which is lately built, is a model for all others, being spacious, well ventilated, and clean, to almost an extreme of nicety. Yet, notwithstanding all these circumstances, upwards of ninety men have lately, in the space of a few weeks, and during a dry, healthy season, died of a malignant fever, having all the characteristics of yellow fever. Dr. Ferriar says, "I have known a pestilential fever produced in a new raised regiment, in a quarter where regular troops are always very healthy, and where there is a constant ventilation of the briskest kind." It would appear that there was some fomes of contagion which showed its effects only with persons who had a susceptibility to be acted on. ARTICLE VI. ADDITIONAL OBSERVATIONS on the NATURE of FEVER, and on the IMPORTANCE of REMEDIES applied to the SKIN. In a Letter from NOAH WEBSTER, Esq. to Dr. MILLER, dated New-Haven, Oct. 3, 1803. 'N DEAR SIR, IN my letter to you of the 30th ult. I offered to your consideration some ideas respecting the proximate cause of feThe following case, however trifling, may deserve to be recorded. ver. Some time in September last I was stung upon the back of my hand, by a worm which is common upon the maize plant; a worm chiefly of a green colour, and covered with sharp, prickly hairs. These hairs, when applied to the skin, occasion a sensation like that of nettles. The part affected soon became of a florid colour, to the extent of more than half an inch in diameter. The sensation was, in no slight degree, inconvenient. Within a few minutes, perhaps fifteen or twenty, as I sat writing, I observed the red spot on my hand to be covered with moisture, equal to that of the most copious sweat; although my skin, in general, was perfectly dry. This excited my curiosity, and I wiped off the moisture with a handkerchief. Within a minute, or less, the moisture occurred a second time, and was removed. This was repeated, perhaps, ten times; and, at last, the efflorescence of the part gradually disappeared, the skin resumed its natural colour, the uneasy sensation abated, and no further perspiration appeared. -In this instance the whole process of disease, from poison to recovery, was carried on and completed in about half an hour. The morbid action of the poison probably destroyed, at least in part, the tone of the skin and cutaneous vessels; a slight fever succeeded, accompanied with an accumulation of blood, which disappeared in a few minutes, in consequence of a copious excretion of moisture, which carried off the preternatural heat, while the parts were resuming their natural tone. There are many considerations which incline me to believe that, while the saliva, the gastric liquor, the bile, the chyle, the lymph, and other secretions, are destined to carry on the process of deglutition, digestion, nourishment, and the dis * See page 134. charge of the fecal matter, the excretion by the skin is destined chiefly to carry off the superabundant heat. Indeed, no other means equal to this purpose seem provided by the constitution of animal bodies. The air undoubtedly receives a portion of heat from the skin with which it is in contact; but a dry air is an imperfect conductor, and by no means sufficient to answer the purpose. Aqueous particles seem by nature destined to this end; and hence the tendency of a moist atmosphere to occasion perspiration. The moisture relaxes the skin, and invites the discharge of heat, in an undue degree. This I presume to be the reason why a damp air occasions chilliness, or tends to occasion it, though sometimes counteracted by extreme heat in the air; and hence the debility occasioned by such a moist air. The heat and juices escape with a preternatural rapidity, leaving the surface of the body cold, languid, and prone to disease. The proximate cause of fever, thus, is any obstruction of the natural discharge of heat; the primary or remote cause is any thing which induces debility in the system, and especially in the parts which secrete the necessary aqueous or perspirable matter. Whatever destroys or impairs the action of the excretory organs must occasion a preternatural accumulation of heat or fever. Where this action is only impaired, or partially obstructed, a slight fever ensues: where the obstruction is more general and entire, a proportional degree of fever must follow. Many theories have been framed to account for the preternatural heat of the body in fever. But why should we resort to spasm, excessive excitement, &c. to account for one of the plainest operations of nature? All the heat of the body, which exceeds the temperature of the surrounding air, must be, and the most of it is, inhaled by the lungs, and why, should we resort to any other cause for an unnatural degree of it, than to an obstruction which prevents its regular discharge? What is local inflammation but an accumulation of blood and heat in a part, the vessels of which are so impaired as to be unfit to separate the red from the serous part, and to carry off the heat which is constantly conveyed to the part by the circulation? Is not topical inflammation cured by an abstraction of blood, and by epispastics, or other vesicatories and fomentations, which occasion a discharge of the serous part of the blood; in short, by renewing the excretions? Why is fever attended with a dry skin, but because every particle of moisture which can find its way to the surface instantly flies |