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 An Inaugural Dissertation on the 
 
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AN 
 
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 INAUGURAL DISSERTATION / 
 
 ON THE* 
 
 ORIGIN AND PROPAGATION 
 
 >w OF THE 
 
 YELLOW FEVER. 
 
 SUBMITTED TO THE PUBLIC EXAMINATION OF THE 
 
 FACULTY OF PHYSIC 
 
 UNDER THE AUTHORITY OF THE 
 
 TRUSTEES OF COLUMBIA COLLEGE, 
 
 IN THE 
 
 STATE OF NEW-YORK; 
 The Right Rev. BENJAMIN MOORE, D. D. President: 
 
 FOR THE DEGREE OF 
 
 DOCTOR OF PHYSIC, 
 
 ON THE 4th OF MAY, 1802. 
 
 By JOSEPH BAYLEY. 
 
 NEW-YORK; 
 
 Printed by T. & J. Swords, Printers to the Faculty of Physic 
 of Columbia College. 
 
 1802. 
 
 
A/ /&/£&t< 
 
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 ^ 
 
Doctor WRIGHT POST, 
 
 Professor of Anatomy and Surgery in Columbia College. 
 
 i ERMIT me to offer my sincere acknowledgments for 
 the attention you was pleased to show me while I studied 
 under your care ; the remembrance of which will always 
 afford the highest satisfaction to your grateful and much 
 obliged pupil, 
 
 JOSEPH BAYLEY, 
 
Doctor rSAAC LED YARD, 
 
 Health Officer; 
 
 Doctor JAMES TILLARY, 
 
 Resident Physician; 
 AND 
 
 Doctor EDWARD MILLER, 
 
 Health Commissioner : 
 
 1HIS Dissertation is most respectfully dedicated, in 
 grateful testimony of the numerous favours conferred on 
 their much obliged and very humble servant, 
 
 The AUTHOR. 
 
INAUGURAL DISSERTATION 
 
 YELLOW FEVER, 
 
 A Dangerous and often fatal disease, which 
 is now generally called Yellow Fever, has 
 excited a high degree of public attention 
 throughout the United States of America, 
 ever since the year 1793. Although the 
 features of this disease are very strong, and 
 in most cases easily to be distinguished from 
 every other complaint, medical men of the 
 first reputation are not agreed to this hour, 
 whether it is to be considered as a native of 
 our own country, or the production of a fo- 
 reign climate, imported, like other exotics, 
 from year to year, and living" or thriving only 
 so long as it can be cherished by a warm or 
 temperate atmosphere. It has happened in 
 
this instance, as it has frequently in othef^ 
 that the advocates for the opposite opinions 
 have each been so zealously attached to their 
 own mode of viewing the question, that a 
 proper attention has not been given to facts, 
 and the arguments naturally deducible from 
 those facts, which, in a case of this kind, 
 ought to be the chief ground upon which a 
 judgment should be formed. 
 
 Considering the experience and abilities of 
 gentlemen who have written on this subject, 
 I can say with much truth and sincerity, 
 " non nostrum inter hos tantas componere 
 lites." But as I have .for some years lived 
 much among the unfortunate subjects of the 
 yellow fever, and as it has been my duty to 
 observe it in its different forms, and to inquire 
 concerning its origin and progress, I have 
 formed an opinion somewhat different from 
 either of the theories that have been com- 
 monly supported ; wherefore I shall venture 
 upon the middle ground, and shall endea- 
 vour to prove that the yellow fever may 
 be imported from foreign parts, and that it 
 may be, and has been generated in the 
 United States. . . 
 
<J 
 
 Considering the great importance of this 
 subject, whoever contributes in any degree to 
 its elucidation, may be supposed to have 
 served the public; for there is not an indivi- 
 dual in the United States whom this question 
 does not concern, either as it may affect his 
 personal safety, or his private interest. It 
 reaches alike the merchant and the planter. 
 
 The complaint which is the subject of our 
 present consideration is an infectious, not a 
 contagious fever; and it may be of great im j 
 portance that this distinction be well under- 
 stood and uniformly observed. 
 
 Infection and contagion are frequently 
 used indiscriminately to convey the same 
 idea, or indifferently to express the same dis-* 
 ease; but there is reason to believe that an in^ 
 fectious fever being mistaken for one that is 
 contagious, has proved the source of much 
 calamity: it has caused the sick in many 
 cases to be deprived of the comforts and as- 
 sistance that were essential to their recovery. 
 They have been deserted by their timorous 
 attendants, and have perished for the want 
 of proper care. 
 
 The terms infection and contagion are pro- 
 
 B 
 
perly applied to two distinct orders of diseases; 
 and if the distinction was constantly attended 
 to, people would become better judges of the 
 danger to which they are exposed by remain- 
 ing in cities or other places where endemical 
 complaints are prevailing. A contagious- 
 fever is one by which we cannot be assailed 
 more than once ;; but we may be assailed from 
 time to time by an infectious fever. A con- 
 tagious fever is generally and almost certainly 
 communicated by touching, or coming near 
 a patient who labours under that disease ; 
 but a patient who is afflicted with an infec- 
 tious fever may be approached or touched 
 with the utmost safety, provided he is sur- 
 rounded by a pure atmosphere, and is fur- 
 nished with clean bedding and clothes. 
 
 A contagious fever appears in every case 
 to proceed from a fever of the same genus ; 
 but infectious fevers seem to be anomalous r 
 their parents are not so discoverable; or, to 
 speak more correctly, they are not begotten 
 by fevers. A contagious fever is propagated 
 in cold as freely as in hot weather ; it spreads 
 in a pure atmosphere, or in that which is vi- 
 tiated; but the progress of infectious fevers is 
 
11 . ' 
 
 arrested by cold weather, and their propaga- 
 tion prevented by a pure atmosphere. 
 
 Fevers that are occasioned by putrid exha- 
 lations, whether created by animal and ve- 
 getable decomposition, or by human effluvia 
 arising from the bodies of people who are 
 crowded in damp apartments, badly venti- 
 lated, where cleanliness is not observed, 
 ought to be denominated infectious.. Xf 
 healthy people should venture into such 
 places, many of them would probably be in- 
 fected : but let the sick be removed and tho- 
 roughly cleansed; wash their bodies with 
 water and soap; take away thek dirty cloth- 
 ing,, and furnish them with that which is 
 clean ; convey them to well-ventilated build- 
 ings, situated in a healthy place; furnish 
 diem with clean bedding; then an infectious 
 fever, that much-dreaded disease, which few 
 escape who come within its original sphere 
 of action (the place in which it is generated) 
 becomes in a great degree harmless, so that 
 those whose business it is to visit and attend 
 upon the sick may perform that duty with 
 yery little risk of being infected. 
 
 Plow different from this is a contagious 
 
12 
 
 fever? Let a number of people with the 
 small-pox or measles, which are contagious 
 fevers, be placed under circumstances such 
 as I have described; what would be the re- 
 sult? It will be admitted, I believe, that if 
 one hundred persons who never had either 
 of these complaints should officiate as nurses 
 in an hospital where there were many pa- 
 tients with these diseases, after all the precau- 
 tionary methods which could be taken, hardly 
 one would escape the contagion. 
 
 Having stated what I consider the essential 
 and clear distinction that is to be made be- 
 tween the yellow fever and those diseases 
 which are properly called contagious, I shall 
 endeavour to trace the origin and cause of the 
 former. This is a question which demands 
 the most impartial investigation, and one that 
 claims our utmost attention ; for our prejudices 
 in favour of our native soil are liable to induce 
 us to doubt whether so dangerous and destruc- 
 tive a disease can be produced among us. 
 
 It is our duty to hear and believe the truth, 
 that, when the origin and cause are known, 
 our efforts may be properly directed; and 
 should the remedy be within the compass of 
 
13 
 
 human exertion, it ought to be assiduously 
 applied, until the domestic cause, if such 
 there be, is overcome. Then we may with 
 safety rely on rigid quarantine laws, faithfully 
 executed, to prevent the admission of pesti- 
 lential diseases from abroad; and should the 
 disease, by accident, escape the vigilance of 
 the Health-Officer, its baneful influence 
 would not be very extensive. 
 
 How is the yellow fever produced, or what 
 is the climate or country of which it is a 
 native? Although we should not be able to 
 find an appropriate and native soil for this 
 child of Pandora, I have many reasons for 
 thinking, that the popular opinion of its 
 being always imported, is riot well founded. 
 The very countries to which this fever has 
 been attributed deny its originating there, and 
 perhaps with the same propriety as we do. 
 Since, then, all disclaim it, and since it cannot 
 be traced to any place in particular, let us can- 
 didly examine the causes to which it has been 
 attributed, and see whether they are adequate 
 to its production. I do not pretend to know 
 what are the chemical combinations or mix- 
 ture of airs that are produced from a large 
 
14 
 
 mass of animal and vegetable matter brought 
 into active fermentation by sufficient heat 
 and moisture, but the effects of those combi- 
 nations have been severely felt; they have 
 produced fevers from the lowest to the highest 
 grades, according to the activity and continu- 
 ance of the pestilential gases, and the liability 
 of the body to receive infection. Such, inva- 
 riably, will be the result of animal and veget- 
 able putrefaction in all those countries where 
 the solar heat is sufficiently powerful, and the 
 inhabitants predisposed to febrile complaints. 
 The East and West-Indies, some parts of 
 Europe, the coast of Africa, bordering on the 
 Mediterranean, crowded ships on long voy- 
 ages, and our own country, afford recent and 
 lamentable proofs of the local origin of infec- 
 tious fevers. Witness the summer and fall of 
 the year 1798, which were unusually sultry. 
 There was scarce a seaport along the coast of 
 the United States that was not afflicted with 
 this deadly malady, while the intermediate 
 country was entirely exempted. Does not 
 this fact convey sufficient evidence, that there 
 was something particularly wrong in our 
 cities? for many persons infected with the 
 
15 
 
 cause of this fever in the towns, sickened and 
 died in the country, and did not propagate 
 the distemper. This circumstance alone 
 would almost convince the unprejudiced 
 inquirer, that the yellow fever may originate 
 in our cities. 
 
 The most conclusive argument in favour 
 of the domestic origin of this disease, is its 
 total annihilation as soon as severe frost sets 
 in ; for this at once arrests the progress of pu- 
 trefaction, and thereby stops the generation 
 of pestilential airs. 
 
 In Africa and India, where frost is seldom 
 severe, the progress of the disease is checked 
 by the periodical rains which swell their 
 rivers and inundate their low lands, thereby 
 preventing the direct action of the sun upon 
 those animal and vegetable substances which 
 had been left by the waters retiring to their 
 accustomed channels. 
 
 Do not these facts demonstrate the source 
 of this malady? and do they not clearly ex- 
 plain its occurrence in the summer and fall 
 months, and its disappearance at the approach 
 of winter? 
 
 This fever generally commences with that 
 
1(5 
 
 class of citizens who are reduced to the ne- 
 cessity of living in small and crowded houses,* 
 in the most unhealthy parts of the town. 
 Strangers from a colder climate, farmers from 
 the adjacent country, and inhabitants of the 
 city who have breathed some time a purer 
 atmosphere, are sooner taken down by this 
 fever than .people who live constantly in the 
 city. They are also attacked with more vio- 
 lence. But it is observed that strangers from 
 the West-Indies, a warmer climate, are less 
 ^endangered by the disease than our own citi- 
 zens. If it should be alleged that the 
 inhabitants of the country are accustomed to 
 breathe a purer air than those who dwell in 
 cities, which is doubtless true; then it must 
 be acknowledged that a peculiar and conta- 
 minated state of air exists in the city, which 
 becomes daily more contaminated from the 
 same vitiating cause, until it arrives at the 
 degree which produces pestilence. 
 
 The West-Indies are usually sickly in time 
 of war. Is not this to be attributed to the 
 greater number of strangers who are there on 
 such occasions, who are not accustomed to 
 warm climates? for the former inhabitants 
 
\1 
 
 are generally as healthy then as in times of 
 peace. 
 
 The yellow fever has appeared in the in- 
 terior of this country, beyond the reach of 
 imported contagion. Whence did it arise ? 
 
 During three years residence at the Ma- 
 rine Hospital, I have seen many and pain- 
 ful demonstrations that fevers of the most 
 dangerous nature may be produced by a con- 
 taminated atmosphere. 
 
 In the summer and autumn of 1801, se- 
 veral vessels arrived at this port from Ireland. 
 In one of these vessels, which was not large, 
 upwards of four hundred men and women 
 were cooped up for eight or ten weeks, in 
 the warmest season of the year; many of them 
 Without a change of clothing sufficient to 
 keep themselves clean, and using a diet to 
 which they had not been accustomed. All 
 these contaminating circumstances, heighten- 
 ed by the indescribable languor caused by 
 sea-sickness, whereby men become negligent 
 of their persons, and sometimes indifferent as 
 to their existence, produced an infectious 
 fever among the passengers, and several of 
 them died with the characteristic symptoms 
 
18 
 
 of yellow fever, such as black vomit, livid 
 spots, eyes highly inflamed and protruded 
 from their sockets, and universal yellowness 
 of the skin. 
 
 The resources of the quarantine establish- 
 ment were not at that time competent to 
 afford an asylum with all the requisite apart- 
 ments for the numerous sick and distressed 
 emigrants who arrived in the space of a few 
 weeks; for they were three times the number 
 that had come to the marine hospital in any 
 former year. Hence it was that the sick were 
 crowded together more than could be desired ; 
 whereby their recovery was retarded, and 
 the danger to which the attendants were ex- 
 posed was greatly beyond what had ever be- 
 fore occurred at that institution; so that of all 
 the attendants on the health establishment, 
 fifty-eight in number, none, except the boat- 
 men and one washerwoman, escaped a dan- 
 gerous illness; many of them were infected 
 three or four times, and one of the nurses 
 seven times. 
 
 The Health Officer, Doctor Richard 
 Bayley, whose medical knowledge was par- 
 ticularly directed to the m-ost useful part of 
 
19 
 
 ibis profession ; whose assiduity in alleviating 
 the pains of the distressed, and tranquillizing 
 the mind, was no less conspieuous than his 
 skill in restoring the body to its accustomed 
 vigour; whose accurate judgment was no less 
 highly esteemed, than his benevolence -dis- 
 tinguished for the innumerable acts of public 
 and private good in which his talents and 
 means were constantly engaged; this inesti- 
 mable man, while executing, with scrupulous 
 fidelity^ the important trust reposed in him as 
 guardian of the public health, caught the 
 fatal fever which terminated his useful life. 
 Remembrance oft recals the afflicting scene, 
 and reminds me how much I am indebted to 
 his parental care, who first exhibited to me 
 the inimitable structure of the human frame; 
 explained the various parts of the body, and 
 the diseases to which they are liable; and 
 showed the union and harmony of this chief 
 and most perfect work of him, whom we 
 cannot sufficiently adore as the author of 
 every good. 
 
 What could have produced the prominent 
 symptoms of yellow fever, viz. constant nau- 
 sea ending in black vomit, dark-coloured 
 
 
20 
 
 stools, protruded and highly inflamed eyes^ 
 with universal yellowness of the body, which 
 appeared on board of the Irish ship? It was 
 not imported from the West-Indies — It must 
 have been the effect of a vitiated atmosphere. 
 Why do the seaports of Great-Britain, 
 when such an extensive and direct intercourse 
 is constantly kept up between them and the 
 West-India islands, escape the yellow fever? 
 Is it not because their climate is not suffi- 
 ciently warm to corrupt the atmosphere to 
 such a degree as to be capable of generating 
 and propagating the fever? 
 
 The most plausible argument that has been 
 advanced against the possibility of domestic 
 origin, and which is by some conceived a 
 very important one, is the circumstance of 
 the city of New- York having been exempted 
 from the yellow fever during the revolutionary 
 war, at which time there was apparently more 
 offensive matter in the city than there has 
 been at any time since. The following solu- 
 tion of this objection is humbly submitted for 
 consideration. 
 
 Heat, which is one of our greatest blessings, 
 whose influence and effects are so essential to 
 
ill 
 
 our very existence, has, from ill-directed la* 
 hours, been the active agent in extinguishing 
 the vital flame which it first inspired. There 
 is not any reason to believe that the general 
 temperature of the atmosphere in the United 
 States is warmer during the summer months 
 at present than it was twenty years ago. But 
 it will readily be perceived, that the heat of 
 the atmosphere wdthin the last twenty years 
 has been very much aifected in the city of 
 New- York by the increase of brick walls and 
 stone pavements, by which the rays of the 
 sun are reflected and the heat greatly aug- 
 mented. 
 
 In the mean time, the increased heat is not 
 the chief cause of the late corrupted state of 
 the atmosphere. Many acres of ground have 
 been made, principally on the East-river, 
 within the last twenty years; and the advan- 
 tage of wholesome earth with which the first 
 docks were made, has been, of late years, in 
 some measure dispensed with, for it was not 
 so cheap and easily to be procured as formerly. 
 A considerable part of the materials with 
 which these docks have been formed is perish- 
 able; and these huge masses of corrupting 
 
22 
 
 matter are kept constantly moist by water, 
 which penetrates into those made grounds and 
 greatly accelerates the putrefactive fermenta- 
 tion. This mixture requires no other assist- 
 ance than a sufficient degree of heat to vola^ 
 tilize and disengage its deadly gases, which 
 the south-eastern side of the city receives 
 from the sun, by its favourable exposure, 
 through the greater part of the day, When 
 the water is in larger quantity than the earth 
 can absorb, which frequently * happens, it 
 oozes into the cellars in the most populous 
 parts of the city, where it discharges the 
 noxious qualities of the putrefying substances, 
 which, in that state, become far more inju- 
 rious to health than if they were exposed td 
 the correcting power of the general atmos- 
 phere. The greater part of these immense 
 hidden masses of corrupting materials, whose 
 fair exterior conceals the destructive instru- 
 ments of death, have been deposited since the 
 revolutionary war. i 
 
 A constant intercourse was preserved with 
 the West-Indies during the revolutionary war, 
 and until the year 1793; and no precaution 
 was taken against importing infectious fevers, 
 
23 
 
 until the dreadful calamity which befel Phi- 
 ladelphia gave us the first awful warning to 
 guard against foreign plagues. During all 
 that time no yellow fever raged here, although 
 the disease existed in the West-Indies; nor 
 did it become epidemic until 1795, although, 
 previous to that period, there had been a fqw 
 sporadic cases on the East-river yearly, when 
 it neither was called yellow fever, nor was 
 imported contagion thought of. 
 
 The natural situation of this city for health 
 is scarcely exceeded by any in the world; and 
 if the inhabitants had been content with the 
 site as nature formed it, I am convinced that 
 the fatal effects of the yellow fever would 
 have been very * limited ; and even these 
 might have been totally prevented by effi- 
 cient quarantine laws, carefully and faithfully 
 executed. 
 
 From the facts that have been stated, the 
 following conclusions, respecting the cause 
 and progress of the yellow fever, may be 
 drawn. 
 
 The air, in some cases, appears to be charged 
 with certain miasmata exhaled from putre- 
 scent bodies, which are of a deleterious qua- 
 
24 
 
 lity. Those miasmata, entering into the cir- 
 culating fluids by means of the lungs, the 
 stomach* or of the absorbent vessels of the 
 skin, operate as a ferment, and produce fever. 
 Some constitutions are more easily affected by 
 these fermentative particles than others; 
 wherefore some persons are unhurt by a por- 
 tion of corrupted air, which proves deadly to 
 others. Those who are accustomed to any 
 kind of contaminated air, are less affected by 
 it than others. Thus men may accustom 
 themselves, by degrees, to swallow, with im- 
 punity, such dcses of opium as would occa- 
 sion almost instant death in those who had not 
 been habituated to this drug. 
 
 In all crowded cities the air is contami- 
 nated ; for it is highly charged with perspir- 
 able matter from the lungs and skins of men 
 and beasts. Such an atmosphere, in its di- 
 lute state, frequently produces a moderate 
 typhus. When it is more concentrated, or 
 more virulent, it produces what is called the 
 jail fever; and with a little variation in its 
 quality, it produces what is called the yellow 
 fever. It is believed that the perspirable mat- 
 ter, from persons labouring under the yellow 
 
 
25 
 
 fever, when added to the common contami- 
 nated air in small houses, in the narrow streets 
 of large towns, and in warm weather, may 
 prove dangerous to attendants, though it 
 would have been perfectly harmless in the 
 country, or in any other place where it was 
 unassisted by a corrupted atmosphere. 
 
 If it be admitted that the yellow fever 
 may be caused by contaminated air, it must 
 also be admitted that this fever may be im- 
 ported ; or* to speak more qorrectly, the cause 
 of it may be imported. He must be a care- 
 less and very inattentive observer* provided 
 his occupation is mercantile, who has not dis- 
 covered that goods from the hold of a vessel, 
 from a warm climate, in warm weather, are 
 charged with air that appears, by its smell, 
 to be of a quality very different from the 
 surrounding atmosphere* And it must be 
 admitted that goods packed up in a city or 
 port where the yellow fever prevails, are 
 fully saturated with contaminated air; nor 
 can it be supposed that a morbid gas, capable 
 of exciting yellow fever in such port, will be 
 improved or corrected by close confinement 
 in the warm hold of a ship: on the contrary, 
 
 D 
 
its deleterious qualities may„ and no doubt 
 are increased. When goods charged with 
 such a virulent gas happen to be opened in 
 another city, in warm weather, where the air 
 is already contaminated, they may, and per- 
 haps frequently do produce yellow fever or 
 other typhus. 
 
 In a word, after all the views we have been 
 able to take of the yellow fever, we are com- 
 pelled to believe that it may be generated in 
 our own cities, and may be propagated by 
 the medium of impure air; and that the seeds 
 of it, imported from a foreign country, may 
 be cherished and propagated among ourselves 
 by a corrupted atmosphere. 
 
 If the yellow fever cannot be generated in 
 the United States, it would follow that there 
 can be little use in removing filth from our 
 streets and wharves, and that cleanliness, 
 which has long since been deemed half a 
 virtue, might safely be neglected. And if 
 that fever be the exclusive production of this 
 country; if, like the West-India hurricanes, 
 it cannot be imported ; it would follow that 
 quarantine laws, and all attentions of that 
 kind, are absolutely useless. But if the rea- 
 
21 
 
 sonings we have advanced are well founded, 
 it is evident that cleanliness at home and pre- 
 caution by sea are equally advisable. 
 
 When the source of a disease is known, the 
 means of evading it are more easily disco- 
 vered ; and it is believed the mode adopted 
 by the enlightened corporation of this city 
 will be productive of very salutary effects. 
 They propose, we are told, to fill up the 
 present slips, and give a solid front on the 
 East-river, that shall extend from the Battery 
 to Corlaer's Hook. By this operation the 
 eddy tides will be prevented from leaving 
 putrescent vegetable and animal substances in 
 the slips, which, exposed to the sun at low 
 water, have been volatilized, and have be- 
 come a fruitful source of the cause of yellow 
 fever among the warehouses and dwellings 
 on the East-river. May those useful citizens 
 persevere in their laudable exertions to re- 
 medy and remove nuisances which have im- 
 perceptibly crept in among us, and have lately 
 increased to a very destructive degree ! May 
 they live to see health and happiness beam in 
 every countenance, as the just reward of their 
 paternal care ! Then quarantine laws, which 
 
28 
 
 prevent persons sick of pestilential diseases 
 from entering our city, detain infected mer- 
 chandize at a distance from our dwellings, 
 and order infected vessels to be perfectly 
 cleansed, will be productive of all the benefits 
 which the most zealous advocates for importa- 
 tion can desire. # 
 
 It is conceived that much advantage might 
 be derived from an additional improvement 
 on the East^river. Let the surface of the 
 made grounds be covered with a layer of lime 
 five or six inches deep, and let that lime be 
 covered with gravel. It is known that lime 
 is very powerful in destroying such parts of 
 animal and vegetable bodies as are subject to 
 the putrefactive process, which it does by its 
 eager attraction of their constituent principles, 
 and by neutralizing them. Therefore it is 
 presumed that the proposed layer of lime 
 would arrest the ascent of destructive airs, by 
 forming compounds which would possess 
 properties different from those airs in their 
 separate state, and not injurious to. the healtlv 
 of man. 
 
 FINIS. 
 
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