cyK 
 
 ?38 
 
 Columbia (Bntoergitj) 
 
 tntljeCttptfltogork 
 
 THE LIBRARIES 
 
Digitized by the Internet Archive 
 
 in 2011 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/inauguralessayonOOpenn 
 
AN 
 
 INAUGURAL ESSAY 
 
 ON 
 
 THE BILIOUS TYPHUS 
 
 WHICH 
 
 PREVAILED IN BANCKER-STREET AND ITS VICINITY, 
 
 » IN THE CITY OF NEW- YORK, 
 
 IN 
 
 THE SUMMER AND AUTUMN OF 1820. 
 
 BY RICHARD PENNELL, 
 
 Honorary member of the Royal Jennerian Society, London; of the London Vaccine 
 Institution; member of the Medico-Chirurgical Society of 
 the University of the State of New- York, &c 
 
 Le temps est le pere de la verite. — Voltaire. 
 
 $eto*§orfc: 
 
 PUBLISHED BY E. BLISS AND E. WHITE, 102 BROADWAY. 
 
 1821. 
 
 J. Seymour, printer. 
 
OOUDMSIA^A ' 
 
 kA 
 
 This Inaugural Essay was submitted to the Honourable 
 the Regents of the University of the State, and to the Trus- 
 tees and Professors of the College of Physicians and Sur- 
 geons of the City of New- York, for the Degree of Doctor of 
 Medicine. April, 1821. 
 
TO 
 
 DAVID HOSACK, M.D. L.L.D. 
 
 FELLOW OE THE ROYAL SOCIETIES OF LONDON AND EDINBURGH ; 
 
 Professor of the Theory and Practice of Physic and of the Institutes of Medicine, in the 
 t University of the State of New- York; President of the New- York 
 
 Historical Society, &c. Sic. Uc. 
 
 Sir, 
 
 The many disinterested proofs of friendship which you have 
 manifested in my behalf, and the numerous acts of kindness and 
 hospitality which I have received at your hands, will never be effaced 
 from my mind. 
 
 The unwearied pains and solicitude which you have constantly 
 evinced, to advance and facilitate your pupils in the progress of their 
 studies ; the eloquent and indefatigable zeal with which you are wont 
 to impart to them the rich and ample store of your long experience 
 and profound researches in Medicine ; and, above all, the particular 
 interest and care which you have condescended to bestow upon my 
 own education, place me under additional and lasting obligations. 
 
 Permit me, Sir, to inscribe to you the following account of the 
 Fever of Bancker-street, as an humble tribute of the exalted esteem 
 which I entertain for your benevolence and your understanding, and 
 as a feeble memorial of the laudable share which, in your official 
 station as Resident Physician of this Port, you took in the con- 
 troversy to which this subject gave rise. 
 
 I am, with the greatest respect, 
 
 Your obedient and humble servant, 
 
 RICHARD PENNELL. 
 
TO 
 
 PETER S. TOWNSEND, M. D. 
 
 HONORARY MEMBER OF THE ROYAL JENNERIAN SOCIETY, LONDON} 
 AND OF THE LONDON VACCINE INSTITUTION; 
 
 Fellow of the American Geological Society at IS T ew-Haven, and of the Literary and Philo- 
 sophical Society of New-York ; late Health Commissioner of this Port, &c. 
 
 Sir, 
 
 I know of no person to whom I can, with more propriety, de- 
 dicate these pages, than to yourself. Exclusive of the regard in 
 which I hold your talents, and of the particular attentions which you 
 have shown towards me, there is a peculiar reason why this Disser- 
 tation should be inscribed with your name. 
 
 For it was by the exertions of yourself, and of your colleagues, 
 as Commissioners of Health, that the character of the Bancker-street 
 Fever was first placed before the public in its true light, divested of 
 the errors and deceptions with which it was attempted to be obscur- 
 ed, and disarmed of those appalling features by which it was endea- 
 voured to excite a panic among the people. 
 
 When I recall to mind your services, in protecting the reputa- 
 tion of this metropolis from the assaults by which it was threatened 
 within ; and when I remember, at the same time, the acknow- 
 ledged zeal which, as Members of the Board of Health, you all ex- 
 hibited in guarding us from foreign infection without, though it 
 seemed to thicken around us in every quarter; I cannot but depre- 
 cate and lament that vindictive spirit of politics, which, regardless 
 alike of talent and of the public good, has removed you from the 
 situation which you filled with so much credit and ability. 
 
 I am, 
 
 With sentiments of respect and esteem, 
 Your Friend, 
 
 THE AUTHOR. 
 
TO 
 
 JOHN W. FRANCIS, M. D. 
 
 Professor of Obstetrics and the Diseases of Women and Children, in the University of the 
 State of New- York ; Member of the Medical and C hirurgical Society of London ; of the 
 Medico-Physical Society of New-Orleans; of the Massachusetts Historical Society; of 
 the Literary and Philosophical Society of New-York ; of the Academy of Natural Sci- 
 ences of Philadelphia ; President of the Medico-Chirurgical Society of the University of 
 the State of New-York, &c. &c. 
 
 THIS 
 
 INAUGURAL DISCOURSE 
 
 ON THE 
 
 MUom S&pgttg 
 
 WHICH PREVAILED IN BANCKER-STREET AND ITS VICINITY, 
 DURING THE SUMMER AND AUTUMN OF 1820, 
 
 IS INSCRIBED, 
 
 AS A MEMENTO OF FRIENDSHIP AND A TRIBUTE 
 OF RESPECT, 
 
 BY HIS SINCERE FRIEND, 
 
 AND LATE PUPIL, 
 
 THE AUTHOR. 
 
INTRODUCTION, 
 
 It may be thought by some, that the subject of 
 the following Dissertation has been already exhausted 
 by the numerous writers who have preceded me in 
 the controversy to which it has given rise. My in- 
 tention is not to involve myself in the disputes of 
 these writers ; nor do I pretend to have had sufficient 
 experience in medicine, or to be possessed of that 
 depth of penetration, which would enable rne to be- 
 come an umpire in a case of this kind. 
 
 I *have endeavoured only to collect and to arrange 
 the materials, which this investigation has brought to 
 light. In doing this, I have thought it not taking 
 too great a liberty, to dispense with the irrelevant 
 matters which are connected with this discussion, and 
 to confine myself only to the broad and marked out- 
 lines of the subject, and to those facts and reasonings 
 which appeared to me to be most important. 
 
 Unless the contributions of writers are occasional- 
 ly booked up, it is difficult to know what has been 
 done. Their labours will prove abortive, and our 
 energies will be wasted on ground that has been per- 
 haps already pre-occupied. 
 
 If I have devoted myself then to the humble task 
 of a compiler, I hope I shall not be thought to have 
 been engaged in a useless occupation ; nor shall I be 
 thought presumptuous, I trust, if in pursuing this 
 
 B 
 
10 
 
 course, I have not hesitated sometimes to bring to 
 my assistance those opinions or facts which I have 
 conceived would throw additional light on the sub- 
 ject under consideration. 
 
 I hope I shall be pardoned also for the inferences 
 or conclusions which I may have ventured to make, 
 while having the whole ground of this controversy 
 Jaid before me. 
 
NOTICE. 
 
 I have divided this Essay into three parts. 
 In the first, I have endeavoured to show, 
 
 1. That typhoid symptoms may either enter pri- 
 marily into combination with other diseases, or be af- 
 terwards superadded to their symptoms. 
 
 2. That bilious symptoms, also, are frequently 
 found blended with different diseases, more or less 
 modifying their character, but not so far as to give to 
 another disease a distinctive character, or one which 
 is essentially different from the character which it 
 would possess without them. 
 
 In the second, I have, by comparing the phenomena 
 and circumstances attending yellow fever, with those 
 of the Bancker-street fever, proved that the two dis- 
 eases are totally irreconcilable ; and, in illustration 
 of this disagreement, shown that similar fevers to that 
 of Bancker-street, are by no means a novel occur- 
 rence, either in this, or other countries : and, 
 
 In the third, I have shown that the character of 
 the Bancker-street fever was proved to be incom- 
 
12 
 
 patible with that of yellow fever, not only by the sim- 
 ple method of contrasting those two diseases by them- 
 selves, but furthermore by comparing the Bancker- 
 street fever with three remarkable instances of a 
 similar fever which occurred in this city, and with 
 one that made its appearance in Philadelphia. 
 
DISSERTATION, 
 
 Sfc. 
 
 PART I. 
 
 1st. That typhoid symptoms do frequently traverse the 
 path of other diseases, and become, as it were, engrafted 
 upon them towards the termination of such diseases, is 
 familiarly known. They are then said to give to such dis- 
 eases a typhoid character or termination. The typhoid 
 phenomena form a stage of the disease, and bear, under 
 these circumstances, the same relation to the primary dis- 
 ease, as well as to the whole system, that the gangrenous 
 stage of phlogosis does to the local inflammation, and to the 
 part affected. 
 
 Almost every disease, of which we have any knowledge, 
 may, and does, occasionally pass into the typhoid stage ; 
 preserving, however, for the most part, its diagnostic cha- 
 racter to the last. We see this exemplified in dysenteria, 
 puerperal fever, tonsillitis maligna, and in several cutane- 
 ous diseases, as rubeola nigra, scarlatina maligna, variola, 
 &c. 
 
 As the phenomena of typhus are the same, though in a 
 lesser degree, with those that attend the decomposition of 
 animal matter, it is easily explained, why, under these cir- 
 cumstances, they more usually announce themselves to- 
 wards the termination of a disease, rather than in the com- 
 mencement. It is also the more readily understood from 
 this fact why the typhoid stage of a disease is so often 
 fatal. 
 
 The phenomena of typhus do, nevertheless, form, if we 
 may be allowed the expression, binary compounds with 
 
14 
 
 th>se of other diseases. The phenomena of both diseases 
 ar< then allied together from the very commencement, al- 
 though their co-existenCe might, a priori, have been 
 thmght incompatible. The disease, in such cases, derives 
 its name from the elementary diseases which have united 
 in ts production. The phenomena of typhus associate in 
 th's manner with those diseases which affect particular or- 
 gans, or particular sets of organs, and which are with pro- 
 priety termed local affections. As the local diseases are 
 limited to particular parts of the system, their phenomena 
 ,are fewer and less complex. It is on that account, per- 
 haps, that when associated with typhus, they become se- 
 condary or subordinate to this disease, so that the affection 
 of the whole system, ought, in our opinion, to give the gene- 
 ric, and that of the part, the specific denomination to the 
 disease. 
 
 Typhus puerperalis, (puerperal fever,) as it occurs in 
 hospitals, and among the poor, typhus pneumonicus, (perip- 
 neumonia typhodes of Sauvages,) and typhus dysentericus, 
 (the dysentery of camps,) are striking examples of this or- 
 der of diseases ; so also the inflammatory typhus of Arm- 
 strong*, in which, according to him, the cerebral, thoracic 5 
 and abdominal viscera, are respectively implicated. 
 
 But inasmuch as typhus, as well as all other fevers, are 
 diseases of the whole system, and* therefore, have a com- 
 mon seat, it is not to be supposed, that the same functions 
 could be under the influence of a different chain of morbid 
 actions at the same time, and that the peculiar phenomena 
 of these fevers would readily associate together, and, at the 
 same time, preserve their distinctive character throughout 
 their course. It is, on the other hand, more presumablej 
 that one or the other set of phenomena, would take the pre- 
 cedence, or that they would succeed each other ; but not 
 co-exist at once. Accordingly we find that all fevers, not 
 commencing as typhus, may take on the phenomena of tj- 
 
 * Practical Illustrations of Typhus Fever, &c. p. 24—68. London, 1319. 
 
phus, but that this rarely or never happens until every ve- 
 tige of the primary fever has been obliterated, and its courg 
 nearly terminated. 
 
 2dly. Bilious symptoms originate from a morbid conditio 
 of the biliary organs. They are, therefore, phenomena f 
 local disorder, or derangement of those organs. The on: 
 affections in which they are idiopathic, and to which the 
 peculiarly and essentially belong, are icterus and hepatiti 
 They are occasionally sympathetic in those local affection 
 which are not seated in the biliary organs ; and also in ft 
 vers — especially in remittent fevers. 
 
 The remittent fever of the tropics is most usually disti; 
 guished from the ordinary remittent fever of colder lat 
 tudes by this feature, although it does not in any mamv 
 change the pathognomonic character of the disease. 
 
 It has been thought that an affection of the biliary c- 
 gans was an essential part of the character of yellow feve; 
 from which cause that disease has by some been consid'/- 
 ed a mere grade or sub-species of bilious remittent fpvr. 
 It has been, however, satisfactorily proved, that the [yl- 
 lowness of the skin and eyes, in yellow fever, and v(h;h 
 has been mistaken for bilious symptoms, does not conem 
 until some days after the disease has been formed ; a^d ; in 
 some instances, not until after death. 
 
 " The yellow colour of the skin, in yellow fever, ecms 
 to be more owing to this error loci of the globular put of 
 the blood, than to the over absorption of bile. Tfrs co- 
 lour does not appear first in the eye, as in jaundi'S. It 
 may, indeed, be produced in this manner in the skiflwith- 
 out any suspicion of the presence of bile. This isixem- 
 plified in the case of chlorotic women, and other cses of 
 chronic weakness. We have also a proof of it in te Ec- 
 chymosis which follows upon an external contusio. In 
 this case, the red part of the blood is mechanicalljforced 
 either into the smaller order of vessels, or into the eliular 
 -membrane, which occasions first a livid appearand, and, 
 
16 
 
 i the course of the recovery, the same part becomes yel- 
 lw; probably in consequence of the greater part of it be- 
 ig removed by absorption or otherwise; for, Sir Isaac New- 
 tn observes, that blood, reduced to thin lamina, assumes a 
 jllow colour. Jt is observed, by Dr. Rush, that in some 
 sbjects, the yellow colour did not come on till a few mi- 
 ntes after death ; w r hich seems favourable to the opinion 
 ( its arising from something in the mass of blood, and not 
 bm bile. And as the yellow colour first shows itself about 
 ie neck, and sometimes in broad spots on the trunk o[ the 
 dy, it is hardly conceivable that such partial affections 
 be owing to an effusion of bile, which would necessa- 
 act equally and generally*." Again, " Indeed the yel- 
 ljvness of the skin, like the black vomiting, is not an in- 
 iable symptom of this fever, [yellow fever.] Those who 
 a^ so fortunate as to recover, seldom have it, and many 
 dj without its appearance. Besides, the yellowness alone 
 leas to nothing certain. It may arise from an inoffensive 
 suision of bile, as well as from a gangrenous state of the 
 bllcdt." The yellowness does not appear on the skin and 
 ey: until the second stage, (or that of metaptosis,) accord- 
 in, to MoselyJ — according to Hosack, Towne, and Hil- 
 la^.not until the third day§. And the following fact, stated 
 ontle authority of Sir Gilbert Blane, puts this matter to rest, 
 anmroves that this yellowness may be owing to an external 
 caul. " Some instances occurred in which this symptom 
 (yeftwness) was contagious, without being attended with 
 the dier characters which distinguish this disease, [yellow 
 fevei] It was observed, in men belonging to the Royal 
 Oak^vithout any symptom of malignity, though evidently 
 infecous ; and at the hospital, it was known to spread 
 frommen affected with the fever, in its worst form, to 
 
 * Siflilbert Blane on the Diseases of Seamen — London, 1803, p. 411 — 12, 
 t Meley on Tropical Diseases — London, 1795 — p. 413. 
 | lb.. 420. 
 
 } Hoick's Nosology, second edition, p. 191, — Towne, p. 23, and Hillary, 
 p. 149. 
 
17 
 
 others in the adjoining beds, without being accompanied 
 with any malignant symptom*." 
 
 On the contrary, if the phenomena of yellow fever be 
 primarily associated with any particular organ, there is 
 every reason to think that, that organ is the stomach, and 
 not the liver or gall bladder. " In the course of this dis- 
 ease there is not much bile in the intestines, and least of 
 all, in those cases that are most violent, and prove the soon- 
 est fatal. In those whom I inspected after death, there 
 was but little bile even in the gall bladder. Whether this 
 is owing to a scanty secretion, or an excess of absorption, 
 I will not pretend to determine, but I should rather think 
 it owing to the latter cause. In cases that were more 
 protracted and less desperate, there are frequent accu- 
 mulations of it, as appears by the vomits and stoolst." 
 Again, " In the course of this disease, though there are 
 some symptoms common to inflammations of the liver, yet 
 there are more to inflammations of the stomach ; and none 
 of the invariable symptoms which distinguish inflammations 
 of the liver from all other diseases^." 
 
 Bilious symptoms also, are not unfrequently blended with 
 the phenomena of typhus fever 5 but they do not, in any 
 degree, obscure the character of the disease. Some have 
 thought to have discovered in this association also, the 
 component elements of yellow fever; from whence it has 
 been called by them bilious malignant fever. By Hillary, 
 Putrid Bilious Fever. The best authors, however, agree 
 that yellow fever is far more of an inflammatory than a ty- 
 phoid affection. We have already seen that certain symp- 
 toms of this disease, which have been supposed to be indi- 
 cative of a morbid condition of the biliary organs, are not, 
 in reality, connected with any derangement of those organs, 
 but, in all probability, owe their origin to some other cause 
 than that of the bile. Of the association of bilious symp 
 
 * Diseases of Seamen, p. 406 — 7. 
 
 1 lb. p. 406. 
 
 t Moseley on Tropical Diseases, p. 426. 
 
 c 
 
18 
 
 toms with typhus, we shall soon have occasion to speak 
 more at large. 
 
 At present, we will illustrate the co-existence of typhoid 
 and bilious symptoms, by instancing bilious remittent fever, 
 which, from the unfavourable circumstances under which 
 it sometimes exists, is apt to terminate in typhoid symp- 
 toms. " But in many of those [cases of bilious remittent 
 fever] that arose at Jamaica, little or no remission was to 
 be perceived ; and it was distinguished from the ship fever, 
 by the bilious vomitings and stools ; more violent delirium 
 and head ache ; and by being attended by less debility. 
 The greater tendency to the continued form at this time, 
 was probably owing to this circumstance ; that the men who 
 were exposed to the land air, in wooding and watering, 
 were then exposed also to such causes as naturally produce 
 continued fevers ; such as infection ; the foul air of the 
 French prizes •, intemperance, and hard labour. There 
 was, in some cases, a yellowness of the eye, and even of 
 the whole skin, but without the other symptoms that char 
 racterize the yellow fever, properly so called, while others 
 had every symptom of it. 
 
 " In cases that proved fatal, the symptoms, for some time 
 before death, resembled very much those of the fever be- 
 fore described, [ship fever,] at the same stage. There was 
 either coma or constant delirium ; great seeming anguish ; 
 the mouth and tongue very dry, or with only a little ropy 
 slime ; a black crust on the teeth ; picking of the bed- 
 clothes, and involuntary discharges of urine and freces*." 
 According to Dr. Moseley, an extraordinary putrid bi- 
 lious fever, (thought by him to be a higher grade of 
 the bilious remittent fever of the West Indies,) made 
 its appearance among the troops quartered at Jamai- 
 ca, in the West Indies, in the latter part of October, 
 1 780. k ' This fever came on with sudden loss of strength ; 
 nausea, clamminess in the mouth ; the eyes were dull and 
 tinged with bile ; they were also sunk in the head : there 
 
 * Diseases of Seamen, p. 393 — 1. 
 
19 
 
 were besides in those who died, even from the first attack 
 of the disease, several other marks of hippecratical face, 
 particularly the sinking in of the temples ; the pulse was 
 low and quick ; the skin was moist ; with heaviness in the 
 head ; tension and uneasiness in the abdomen, and great 
 anxiety ; the skin soon became of a deep yellow colour ; 
 accompanied with coma, cold thin sweats, and deep labo- 
 rious hickupping. It ended on the second, third, or fourth 
 day, in death. Some of the gross and plethoric died soon 
 after being attacked, in convulsions*." Even here Dr. 
 Moseley considered the bile as "an effect, and an index of 
 the state of the liverf ," and not as the cause of the disease. 
 The complete success which attended the use of manna 
 and cream of tartar, in large quantities, together with the 
 symptoms of the disease, shows that it cannot be confound- 
 ed with yellow fever. 
 
 What is commonly called black jaundice, is another 
 strong example of the association of bilious and typhous 
 symptoms. 
 
 * Tropical Diseases, p. 183 — 4 — 7. 
 
 t lb. p. 186. The remittent fever of Walcheren, (as described by 
 Wright,) when fatal, terminated usually in typhoid symptoms. See Wright 
 on the Walcheren Remittent, p. 10, &c. 
 
21 
 
 PART II. 
 
 I shall now undertake to show, from a comparison of 
 the phenomena which attended the Bancker-street fever 
 with those of Yellow Fever, that those two diseases are 
 essentially and radically different ; and that the opinion 
 which maintains their identity, is not only unsupported by 
 facts, but even destitute of the semblance of probability. 
 
 There are many circumstances connected with the his- 
 tory of a disease, which have nothing to do with its symp- 
 toms, but which, nevertheless, are inseparable from its ex- 
 istence, and of the utmost consequence in determining its 
 character : such, for example, as the climate, country, or 
 locality in which a disease occurs — the season of the year 
 at which it appears — the class or description of persons 
 among whom it prevails — its cause, its duration, its fatality 
 — and whether it be epidemical, endemial, sporadic, 
 &c. &c. 
 
 These data may furnish analogical evidence enough to 
 disclose to us the general character and complexion of a 
 disease, without the aid of a practical acquaintance with its 
 specific phenomena at the bedside of the sick. They con- 
 stitute a body of information, which, for the most part, is 
 obtained without difficulty, but which is not, on that ac- 
 count, the less desirable. And where a disease makes its 
 appearance, which is suspected to be epidemical in its ten- 
 dency, or endemical to the district in which it occurs, the 
 data of which we are speaking, become of right the com- 
 mon property of the community, and the legitimate ground- 
 work of those interesting and general inquiries in relation 
 to the public health, in which it is the duty and province of 
 
22 
 
 every citizen to participate, whether in or out of the pro- 
 fession. 
 
 But I do not confine myself to the light that I may de- 
 rive from this source. My opportunities have enabled me 
 to make a personal examination of the disease itself, and 
 to become familiarly acquainted with its actual symptoms 
 and treatment. 
 
 Although, therefore, I have the liberty of employing or 
 not employing this assistance, I waive this privilege ; and, 
 in order that I may not subject myself to the imputation of 
 proceeding upon ex parte evidence, will, in my reasonings, 
 make use of all the proofs which have been put in my pos- 
 session. 
 
 I shall first contrast the two diseases in those points m 
 which they are at total variance, and in direct contradic- 
 tion — furnishing demonstration as conclusive as can be ar- 
 rived at by moral evidence, that the supposition which 
 maintains their identity is totally unfounded. 
 
 1. The fever of Bancker-street was confined almost 
 exclusively to blacks. — " From the documents obtained by 
 your Committee, it appears, the number of blacks affected 
 by the epidemic in Bancker-street and its vicinity, to the 
 whites, is in the proportion of three of the former to one 
 of the latter ; and among the blacks, the disease has cer- 
 tainly exhibited a greater degree of intense malignity and 
 fatality*." 
 
 This fact is also confirmed by the statement of the Com- 
 missioners of Health, in the following, which is one among 
 the numerous and argumentative reasons which they assign 
 to prove that this fever was not Yellow Fever : — " Because, 
 notwithstanding the white population was three times the 
 number of coloured persons in the district where this dis- 
 
 * Extract from the Report of the Committee appointed by the Medical So- 
 ciety of the City and County of New-York, to investigate the character and 
 causes of the Fever which prevailed in Bancker-street, p. 17 — published De- 
 cember, 1820. 
 
23 
 
 ease occurred, yet was the disease almost entirely confined 
 to blacks. While, on the contrary, in yellow fever, blacks 
 have always been considered to be less susceptible of the 
 infection than the whites, insomuch that coloured persons 
 have, for this very reason, been employed in nursing the 
 sick, and in the interment of the dead*." In addi- 
 tion to the testimony of the Commissioners of Health, 
 concerning the insusceptibility of negroes to yellow fever, 
 we will quote the authority of Sir Gilbert Blane, in his 
 work on the Diseases of Seamen. " It has been said that 
 it [yellow fever] never attacks either the female sex or 
 blacks. This is, in general, though not absolutely true, for 
 I knew a black woman, who acted as nurse to some men ill 
 of this disease, at the hospital at Barbadoes, who died with 
 every symptom of itf." 
 
 The committee of the Medical Society, by whom we 
 have been informed, that the blacks were the principal vic- 
 tims to the Bancker-street fever, in summing up their opi- 
 nions on this disease, positively affirm that they believe it 
 to have been the identical yellow fever of tropical climates. 
 " We do not hesitate to declare our conviction of the iden- 
 tity of Bancker-street fever ', with the malignant fever of au- 
 thors, from Hippocrates to the present day, and the yellow 
 fever of tropical climates, and our own harbours\." Seeing 
 the obvious difficulty of reconciling the character which they 
 impute to this fever, with the description of persons among 
 whom it prevailed, they seem to have imagined that they 
 might make their escape from this dilemma, by asserting 
 that the blacks constituted by far, the greater part of the 
 
 * Statement of Facts relating to the iate Fever which appeared in Bancker- 
 atreet and its vicinity, by Drs. Hosack, Townsend, and Batley, Commis- 
 sioners of Health. January 22d, 1821, Approved of and published by orde - 
 of the Board of Health, page 8. 
 
 t Page 4C4— 5. 
 
 \ Page 30 — Report of the Medical Society Committee. 
 
24 
 
 inhabitants of the district, in which most of the cases of 
 this disease occurred. " This remarkable circumstance 
 has induced many persons to believe, that the Bancker- 
 street fever, having stricken those, who were, in fact, by far 
 the most numerous inhabitants of that district, was nothing 
 more than an ordinary fever, as it occurs in jails, camps, or 
 hospitals ; or else being a distemper peculiar to the Afri- 
 can race, and people of colour, it could bear no resem- 
 blance to the ordinary bilious remittents of our cities, and 
 much less to the yellow fever*." But the actual census of 
 every house in this district, as given by the Commissioners 
 of Health, furnishes us with results widely different from 
 those of the Committee of the Medical Society. 
 
 "SKETCH OF BANCKER-STREET AND ITS VICINITY. 
 
 North. 
 
 Population of the District, from the first of August to the. 
 first of November, 182Q+. 
 
 On the northernmost side of Lombardy- 
 
 street, contiguous to the lots of Bancker- whites. Biackr. 
 street, between Catharine and Pike-streets 482 125 
 
 On the southernmost side of Bancker-street, 
 between Pike and Catharine-streets, 491 254 
 
 On the northernmost side of Bancker, be- 
 tween the before-mentioned streets, 513 162 
 
 * Report of the Medical Society, p. 17. 
 
 t This period commences before any cases occurred. 
 
25 
 
 On the east side of Catharine, and west of 
 Pike-street, and that part of Market-street, 
 between Lombardy and Bancker-streets, 246 21 
 
 Total, 1732 562 
 562 
 
 Majoritywof whites, 1 1 70* 
 
 2. This fever was unaccompanied by black vomit. The 
 exceptions are so doubtful that we have not thought pro- 
 per to qualify this expression. 
 
 " Out of 237 cases, the total number which occurred of 
 this disease, no symptom presented itself different from 
 those which usually attend typhus fever under similar cir- 
 cumstances. As it is not even pretended that out of all 
 this number more than eight cases have occurred of black 
 vomit, some of which are stated to have been ascertained 
 after the death of the patient ! f This is on the supposi- 
 tion that the aforesaid black vomit consisted of the flaky or 
 coffee ground matter, which characterizes yellow fever : 
 bnt of this there is no evidence givenj." 
 
 It is so well established, and so familiarly known to even- 
 person who has ever heard of yellow fever, that this disease 
 is peculiarly distinguished by this dreadful symptom, that 
 it would be useless to enumerate authorities in support of 
 it. So characteristic is black vomit considered by the 
 Spaniards of this disease, that they call it vomito prieto, 
 after this symptom. 
 
 3. Emetics were the most successful remedies employ- 
 ed in this disease. " The Bancker-street fever was treat- 
 
 * Statement of the Commissioners of Health p. 13, 14, 
 t See Report of the Medical Society, p. 12, 13—26. 
 1 Statement of the Commissioners of Health* p. 8, 9. 
 
 D 
 
26 
 
 ed most powerfully and successfully by emetics. Here is 
 another unheard of anomaly. — Emetics, as far as experi- 
 ence has gone, are precisely the very things that we are 
 most cautiously to avoid. They produce the most disas- 
 trous consequences, aggravate the irritation, and retching at 
 the stomach ; bring on the dreadful black vomiting, and soon 
 hurry the unhappy sufferer out of existence. On the other 
 hand, in fevers of a bilious character, the very reverse is 
 the truth. Emetics are the surest and the most rapid means 
 of cure*." In answer also to some inquiries on this subject, 
 made to Professor Hosack, we have had the satisfaction of 
 receiving, from him, the following interesting account of 
 the treatment, which he adopted in the numerous cases of 
 the disease brought to the New- York Hospital : 
 
 " The treatment which I found most useful in the cases 
 of the bilious typhus, which fell under my care during my 
 attendance, last autumn, at the New- York Hospital, con- 
 sisted, 
 
 "' 1st, In the early use of emetics, to cleanse the stomach, 
 and disgorge the biliary organs which were overloaded by 
 an inordinate secretion of bile. This being effected, 
 
 " 2dly, The bowels were emptied by cathartics of salts ; 
 or of rhubarb and magnesia, which were afterwards occa- 
 sionally administered throughout the disease. 
 
 " 3dly, Attention was also given to preserve a relaxed 
 state of the surface of the body by the use of the spiritus 
 mindereri ; the saline draught of Riverius, or by the anti- 
 monial solution : these were aided in their operation by fre- 
 quently washing the body with tepid vinegar and water, 
 and the liberal use of the ordinary diluent drinks ; but, in 
 cases showing the typhoid character in its most formidable 
 
 * Remarks on the Report of the Committee of the Medical Society of this 
 city, on " The Epidemic Fever, of Bancker-street and its Vicinity, in the 
 Summer and Autumn of 1820," p. 14 — 15. Published January, 1821. 
 
27 
 
 shape, drinks composed of the vegetable acids, as lemonade, 
 tamarind water, vinegar whey, were prepared ; and in 
 those cases, whose system exhibited great exhaustion, a 
 preference was given to porter, ale, wine whey, and vege- 
 table nourishments, viz. tapioca, sago, arrow-root ; render- 
 ed grateful by the addition of wine. Snake root and cha- 
 momile tea were also freely given, as soon as the febrile 
 symptoms abated. Anodynes were also prescribed with 
 great benefit in those cases where delirium and watchfulness 
 occurred. 
 
 " In cases of local congestion of the brain, lungs, or ab- 
 dominal viscera, or where the fever continued with unusual 
 obstinacy, blisters were prescribed with the most beneficial 
 effects. 
 
 " When a perfect apyrexia was obtained, bark, bitters, 
 and the mineral acids, were had recourse to ; animal food 
 was also then allowed, but during the progress of the fever, 
 this was altogether inadmissible ; even in the form of soup, 
 so commonly, but improperly given in the typhoid form of 
 fever. 
 
 " In some cases where the disease occurred in a full habit 
 of body, attended with symptoms indicating local inflam- 
 mation of the thoracic, or abdominal viscera, or exhibiting 
 an inordinate pressure on the brain, bloodletting was em- 
 ployed in the commencement, but, in the latter stages, the 
 lancet was, in no instance, called for*. 1 ' 
 
 " How often," (says Moseley,) " have I seen and lament- 
 ed, the effects of emetic tartar, given to remove the sup- 
 posed cause of the treacherous symptom of vomiting ! Even 
 in slight degrees of fever, [yellow fever,] in the West Indies, 
 in young plethoric subjects, newly arrived, the stomach has 
 been sometimes destroyed by it. Instead of removing the 
 irritating sickness of this fever, or exciting diaphoresis, 
 a spasm has been produced in the stomach ; incessant vo- 
 miting, and inflammation ; the vessels of the thorax and head 
 
 * Extract of a letter from Dr. Hosack to the author. 
 
28 
 
 have been stifled with blood ; and the patient has vomited 
 away his life." 
 
 Again, " Vomits are never to be given, though strongly 
 advised by Towne ; no, not so much as warm water, re- 
 commended by Hillary*." 
 
 It is admitted that gentle emetics have now and then 
 been given on the first attack of yellow fever, but, as a 
 general practice, they are universally discountenanced. 
 
 4. "Notwithstanding the white population so much exceed- 
 ed that of the blacks, yet the disease has been almost exclu- 
 sively confined to coloured persons, and particularly to 
 that description of blacks who lived in crowded apart- 
 ments, especially in cellars, and who were depraved in 
 their habits, and indigent in their circumstances : inasmuch 
 as the black population of that district is almost exclusively 
 composed of persons of that description, and that the indi- 
 gent and worthless class of whites bear but a very small 
 ratio to the whole number of white inhabitants. 
 
 " Out of the whole number of blacks in this district, viz. 
 562, — 119 lived in cellars, of whom 54 were sick of the 
 prevailing fever, 24 of whom died at their homes ; while, 
 out of the remaining number of black inhabitants, viz. 443, 
 101 were sick, of whom 46 died at their homes. From 
 which it appears that out of 443 who were better lodged, 
 only 101 were sick of this disease ; while out of 1 19 living 
 in unwholesome cellars, that nearly one, half were taken down 
 with the disease, and that nearly one half of that number died 
 at their places of dwelling. 
 
 "Out of the whole number of white inhabitants in this 
 district, viz. 1732, only 1 1 whites died out of 32 sick. 
 
 " Those persons who fell victims to this disease, were 
 scattered over the district, for the most part, in insulated 
 places, and the disease did not spread from one side to the 
 other side of the same street, nor from one house to the ad- 
 
 * lb. p. 434. 
 
29 
 
 joining house, nor even, from the cellars to the other parts 
 of the same house ; by which it is apparent that this fever 
 was not entitled to the appellation of an epidemic ; which 
 is furthermore confirmed by the fact, that those persons, 
 whether black or white, who lived a becoming and regular 
 life, and did not associate with the dissolute and intempe- 
 rate, almost always escaped, although inhabiting an adjoin- 
 ing house, and, in some instances, living under the same 
 roof with those who were the victims to it. 
 
 " The total number of sick in the whole district ap- 
 pears to have been, as nearly as we can ascertain, about 
 237 ; of which the greatest number sick on particular lots, 
 was — (See Sketch.) 
 
 " At No. 66 Bancker-street, which is on the southern- 
 most side of the street, and at the western extremity of the 
 district, and near Catharine-street — sick, 8 blacks. 
 
 " At No. 95 Bancker-street — sick, 34 blacks and 9 
 whites ; 
 
 " At No. 85 Bancker-street — sick, 8 whites ; which num- 
 bers are on the opposite side of the street to No. 66, and 
 near the middle of the district. 
 
 "At No. 132 Bancker-street — sick, 22 blacks and 2 
 whites ; which is at the eastern extremity of the district, 
 and near Pike-street. 
 
 "At No. 43 Market-street, between Lombardy and 
 Bancker-streets, 6 whites were sick, the only persons sick 
 in the street. 
 
 "At No. 85 Lombardy-street, which is at the eastern- 
 most extremity of the district, and remote from all the 
 other places mentioned — here 9 blacks were sick, and 1 
 white. 
 
 " By which it appears, that notwithstanding there are 1 48 
 lots in this district, 100 cases (nearly one half the whole 
 number of cases) occurred on 6 lots, situated in different 
 parts of the district, and remote from each other; each place 
 constituting a distinct focus for the generation of disease. 
 
30 
 
 " In that section of Market-street, embraced between 
 Lombardy and Bancker-streets, and which is the centre of 
 this district, containing 1 27 whites and 4 blacks, living on 1 3 
 lots, there were sick 6 whites, who all lived an irregular 
 life in confined and filthy apartments, in the back build- 
 ing of No. 43 ; while no other person in that street had the 
 disease. 
 
 " On the southernmost side of Bancker-street,. be- 
 tween Pike and Market-streets, occupied by 303 inhabit- 
 ants, there occurred 58 cases ; while in the houses directly 
 opposite, on the northernmost side of the street, and not more 
 than 60 feet distant, occupied by two hundred and forty in- 
 habitants, of whom one only was a coloured person ; out of 
 this number four persons only, (whites,) who had led a very 
 intemperate life, sickened and died. Two of them lived 
 at No. 135, a neat wooden building, occupied altogether 
 by only five persons, situated in the rear of the lot, with a 
 clean yard of at least 80 feet in front. 
 
 "Out of 48 blacks, living in 10 cellars, (viz. No. 138, 
 98, 96, 89, 87, 79, 84, and 78 Bancker-street, at No. 53 
 Lombardy-street, and No. 36 Pike-street,) 33 were sick, 
 of whom 14 died ; while out of 120 whites, living immedi- 
 ately over their heads, in the apartments of the same houses, 
 not one even had the fever ! 
 
 " On the lot 95 Bancker-street, 34 blacks and 9 whites 
 were sick of the fever ; on the lot 66 Bancker-street, 8 
 blacks were sick ; and on the lot 85 Lombardy-street, 9 
 blacks : while in the houses immediately adjoining these lots 
 lived sixty-one whites and twenty-three blacks, who being all 
 of good character, and having no intercourse with the inter- 
 mediate buildings, all escaped the disease. 
 
 " On the side of Lombardy-street, next to Bancker- 
 street, and between Pike and Catharine-streets, and where 
 the lots are contiguous to, and much lower than those of 
 Bancker-street, receiving of course no small part of their 
 putrefying animal and vegetable filth, there were 607 inha- 
 
31 
 
 bitants, (of whom 125 were blacks,) and 1 9 only sick ; while 
 on the contiguous lots of Bancker-street there resided 740 
 inhabitants, of whom 248 were blacks. Out of the 740 } 
 1 1 5 were sick of the fever, of whom 23 were whites. 
 
 " After the most diligent inquiries, we have not been en- 
 abled to discover that one reputable white person died of 
 this disease, with the exception of a girl recently arrived 
 from the country, who died of fever in the latter part of 
 October, at No. 130 Bancker-street. But on the other 
 hand, have satisfactorily ascertained that such whites only 
 have fallen victims to it as were in extreme poverty, 
 crowded in small fifthy apartments, and who led a profli- 
 gate life, or associated, or lived with the worthless class of 
 coloured persons. 
 
 " As at the back building of No. 43 Market-street, al- 
 ready spoken of, where there were 28 whites of low charac- 
 ter crowded into small apartments, living in the most filthy 
 condition. Out of this number, 6 Were sick. 
 
 " At No. 85 Lombardy-street, in the third story, were 
 5 white females, and a black man, husband to one of them, 
 all of whom were sick of the fever. 
 
 "At No. 58 Bancker-street, where a drunken white 
 woman with one child, lived in the same cellar with a black 
 woman, all of whom had the feyer. 
 
 "At No. 88 Bancker-street, where a poor distressed 
 family of 10 whites, occupied the same small room, and 
 were all sick with the fever. 
 
 " At No. 89 Bancker-street, in the front cellar, where 
 a white woman and her black husband lived as boarders in 
 a black family consisting of 6 persons, all of whom had the 
 fever, and 4 of the blacks died. 
 
 "At No. 95 Bancker-street, where 30 blacks and 6 
 whites lived in the same back building, and all were sick of 
 the fever. 
 
 "At No. 102 Bancker-street, where 4 white women 
 kept a brothel in the cellar, and had constant intercourse 
 
32 
 
 with negro men. Two of these women had the fever, and 
 one died. 
 
 "At No. 124 Bancker-street, where a white woman 
 and her black husband lived together in the front cellar, 
 and the black man died of the fever. 
 
 "Out of the numerous respectable white inhabitants who 
 have continued to reside in this district, since May last, 
 only one family of nine persons, (viz. Mr. Gifford's, at No. 
 139 Bancker-street,) removed into the country from fear, 
 but returned again as early as the 30th of September. And 
 not an instance of the disease took place in any of these 
 families. 
 
 "Out of 148 lots in this district, 45 lots were occupied 
 by 359 respectable white persons, of whom not one indivi- 
 dual was sick with this fever*." 
 
 With these imposing factsj'before them, the Commission- 
 ers justly conclude, that the disease which prevailed in 
 Bancker-street and its vicinity, bore the unequivocal fea- 
 tures of a genuine typhus. " Because," say they, in recapi- 
 lating, " the disease prevailed almost without an exception, 
 among those persons who were excessively intemperate, in 
 extreme poverty ; and who were crowded together in filthy 
 and confined apartments ; especially in low, damp, and ill- 
 ventilated cellars: a combination of circumstances which, 
 it is universally admitted, produces fever of a putrid or ty- 
 phoid character. Which is furthermore confirmed by the 
 fact, that where this combination of circumstances existed 
 in other parts of the city, the disease made its appearance 
 there also. Whereas yellow fever makes no distinction of 
 persons, and is equally fatal to the rich and the poor. 
 
 " Because those persons who were comfortably accom- 
 dated, who were regular in their lives, and did not enter 
 into the infected apartments or dwellings, escaped the dis- 
 ease ; which is diametrically opposed to the known laws of 
 
 * Statement of the Commissioners of Health, p. 4, 5, 7, 14, 15, 16, 17- 
 
33 
 
 epidemical diseases: and it is well known to every inhabi« 
 tant of this place, that no such exceptions were observed in 
 those portions of our city where yellow fever has prevail- 
 ed.» 
 
 So also the author of the Remarks on the Report of the 
 Medical Society Committee, and who appears to have 
 been familiarly versed with this subject : " The fever of 
 Bancker-street commenced with, and was almost exclusive- 
 ly confined to, the black population of that street, though 
 this population are, according to their own topographical 
 description, ' mingled promiscuously in the same apart- 
 ments with whites, and both sexes, of all ages.' Where 
 yellow fever prevails to great extent, all fall victims to it, 
 black and white ; but whoever heard before of its com- 
 mencing its attacks upon negroes, and confining its depre- 
 dations to that particular class? On the contrary, the 
 blacks are notoriously less subject to it ; * but in this fever,' 
 say the Committee, ' three-fourths of the patients' were of 
 this class. 
 
 " Moreover, the description of blacks whom it seized 
 were of the most profligate sort, with constitutions vitiated 
 and broken down by drunkenness and other low sensualities; 
 for it is such persons chiefly who inhabit this tainted dis- 
 trict, and who annually become the victims to the disease 
 which still prevails there. But yellow fever not only first 
 attacks the whites, but those of them who are most pletho- 
 ric and robust, of rigid fibre, and to whom the common 
 wants of life are easily accessible. This the Committee 
 themselves admit, saying, that ' the most robust, and seldom 
 the infirm,' are liable to it*." 
 
 Now it is well known that yellow fever is most obnoxious 
 to those who are of firm and robust fibre, of sanguine tem- 
 perament, of inflammatory diathesis, and of a plethoric habit 
 Hence it is notorious that the European or northern man. 
 
 * Page 16, 
 
 E 
 
34 
 
 hewly arrived in the tropics, is the common victim to this 
 disease. We will quote a respectable authority on this 
 subject, and one of the latest which occurs to us. " D'ou il 
 suit, et ^experience le confirme chaque jour, que les 
 hommes robustes et plethoriques seront plutot victimes de 
 cette maladie que les hommes faibles et cachectiques, les 
 jeunes gens plutot que les adults et les vieillards: les peuples 
 du Nord plutot que ceux du Midi*." M. Gerardin is speak- 
 ing here of what he calls the sporadic non-contagious yellow 
 fever, in contradistinction to epidemic contagious yellow fever. 
 Those, however, who have pronounced the fever of 
 Bancker-street the identical fever of the tropics will not 
 object to the validity of M. G's testimony on this point. 
 Again, " Subjects most likely to be attacked by the ende- 
 mial causus, are the florid, the gross, the plethoric ; — that 
 sort of strong, full, youthful people, with tense fibres, who, 
 in England, (to use a vulgarism.) are said to resemble the 
 picture of health. In short, so are all persons, who are of 
 an inflammatory diathesis, and do not perspire freelyt." 
 " Hence, it is not strange," says the same author, " that sail- 
 ors who eat, drink, and sleep, so much at sea, and use no 
 exercise, being always of a gross habit of body, should be 
 attacked with it more than other new comers to the West 
 Indies." Therefore, says he, the French call this disease 
 Lafevre matelotte.\ 
 
 If it be said that all habits and constitutions are equally 
 subject to yellow fever, the question still remains unan- 
 swered, why out of a population only one-third negroes, 
 the fever of Bancker-street selected more especially for its 
 victims people of colour, and those almost exclusively, 
 whose constitutions were shattered and broken down by in- 
 temperance, and other irregularities. 
 
 * Page 51 — Memoires sur la Fivere jaune Par. N. V. A. Gerardin, now of 
 Paris, late Physician at New-Orleans — Paris, 1820. 
 t Moseley on Tropical Diseases, p. 417. 
 
35 
 
 5th. The disease continued to prevail in Bancker-street 
 and its vicinity, after the occurrence of repeated frosts and 
 snows. " The disease has continued to prevail in this same 
 district, and among the same class of people, notwithstand- 
 ing the prevalence of constant cold, and of repeated frosts 
 and snows : cases having been received into the New-York 
 hospital as late as the last day of December, 1820, and at- 
 tended with the same symptoms and circumstances ; where- 
 as, in yellow fever, it is established beyond a doubt, that 
 frost invariably and effectually extinguishes the disease*.' 5 
 6. This fever became contagious in freezing weather, 
 and during the recurrence of frosts and snows. So that it 
 not only prevailed after the cold had set in, but actually be- 
 came contagious under this change of season. If any proof 
 were wanting to show the dissimilarity of this disease and 
 yellow fever, or if we were deprived of every other proof 
 but this, it would, of itself, resist all the reasonings which 
 ingenuity and sophistry combined, could bring against it. 
 After breaking down one of the strongest barriers which 
 separate yellow fever from all other diseases, this fever of 
 Bancker-street, as if to throw its character in yet bolder 
 relief, mocks and countefeits the very disease whose laws it 
 had trampled under its feet. 
 
 " Cases of this disease have not only been brought to 
 the New-York Hospital, since the commencement of free- 
 zing weather, but when the severity of the cold would not 
 admit of free ventilation in the wards of the house, the dis- 
 ease has, in conformity to the laws of tjphus, been in many 
 instances communicated to the nurses and patients of that 
 institution. ''t As appears by the Report of the Visiting 
 Committee to the Governors, communicated to the Board 
 of Health. 
 
 " During the months of September, October, and No- 
 vember, 131 patients, ill of fever, have been admitted into 
 
 * Statement of the Commissioners of Health, p. 9, 10, t lb. 
 
36 
 
 the Hospital ; of this number 23 have died, 89 have been 
 cured, and 1 9 remain in the house at the present time. Of 
 the above number 5 died within 24 hours of the time of 
 their admission, and three others within 48 hours of the 
 said time, having been several days sick previous to their 
 admission. 
 
 " So great was the desire of the Committee to comply as 
 much as possible with the wishes of this Board, as express- 
 ed in their former communication to the Board of Health, 
 that after having filled all the medical wards as much as the 
 Physician deemed prudent, they were induced to allow 
 some of the medical patients to be removed to such of the 
 surgical wards as could receive them. In consequence of 
 this, eight of the surgical patients, and a nurse in one of the 
 surgical wards took the disease, of whom three have died ; 
 one of their best nurses also has for some time been in a 
 very critical situation, but is now considered as convales- 
 cent. 
 
 " In the medical wards also, two of the nurses caught the 
 disease from their patients, but are also convalescent. 
 
 " While the weather remained pleasant, so as to enable 
 the nurses and attendants freely to ventilate the different 
 apartments, the Committee continued to admit all fever pa- 
 tients that were brought to the Hospital ; but at the com- 
 mencement of the present month, when it was improper to 
 ventilate the wards as freely as had been previously done, 
 fully convinced that the fever prevailing in the Hospital 
 was of a highly malignant and infectious kind, the Commit- 
 tee thought that they could not conscientiously allow any 
 more patents labouring under typhus fever, to be admitted 
 into the Hospital, and exercised the authority vested in 
 them, by rejecting them. 
 
 " In stating to the Board that they think the fever which 
 has prevailed in the Hospital is of an infectious kind, they 
 have only to state, in support of the opinion, that in addi- 
 tion to its being communicated to the nurses, several of the 
 
37 
 
 surgical patients who caught the disease, had not, for a con- 
 siderable time, been out of their wards ; and until the re- 
 moval of the medical patients into them, the surgical wards 
 were free from fever of any kind. The Attending and 
 House Surgeon also agree in opinion, that their patients 
 took the disease from the medical side of the house. 
 " All which is respectfully submitted, 
 "B. W. Rogers, 
 " John B. Lawrence, 
 "Jonathan Little, 
 
 " Visiting Committee. 
 " New-York, December 8, 1820*." 
 
 When proof after proof crowd thus upon our senses, we 
 are unable to withstand their force, and feel lost in amaze- 
 ment, that persons, possessing ordinary powers of intellect, 
 could have possibly distorted or misconceived their mean- 
 ing. 
 
 There is, however, a certain obliquity of mind, which, 
 like the optician's glass, represents objects through a false 
 medium, tinging the richest and most brilliant c lours of 
 the landscape with a pale and jaundiced hue, and convert- 
 ing the noblest proportions of figure into confusion and de- 
 formity. 
 
 I shall now proceed to examine those more unimportant 
 and minor phenomena, which, regarded by themselves, 
 might lead those who do not take a comprehensive view of 
 this subject, to suppose that a certain resemblance or agree- 
 ment existed between the fever of Bancker-street and yel- 
 low fever ; but which, when contrasted with the prominent 
 and bolder outlines of those two diseases, are shown to be 
 utterly fallacious, and not entitled to- the least considera- 
 tion. 
 
 l.The bilious symptoms which accompanied this fever. 
 
 * Statement of the Commissioners of Health, p. 10, 26, 27, 28. 
 
38 
 
 a And first the bilious vomitings. The invasion of this 
 disease was usually accompanied by bilious vomitings, 
 showing a redundance of bile in the stomach and biliary or- 
 gans. This vomiting occurs sometimes in yellow fever. 
 Many contend, however, that there is a deficiency of bile 
 in yellow fever, and Moseley, who is an advocate for the 
 non-contagiousness of this disease, positively says, that the 
 vomiting is from irritation, and not from plenitude :. " the 
 sickness of the stomach, and disagreeable taste in the 
 mouth, indicate the quality and not the quantity of the of- 
 fending secretions : the vomiting is from irritation in the 
 stomach, and not from plenitude*." But we relinquish the 
 right of making use of this opinion, and shall go on to 
 watch the progress of this symptom. Why did the vomit- 
 ings succumb to the influence of emetics, and why did they 
 decrease, and finally become entirely suspended, as the 
 disease advanced, and for a day or two before death ? This 
 almost invariably happened in every one of the numerous 
 patients that fell under our observation, and is directly the 
 reverse of what occurs in yellow fever. In yellow fever 
 the irritation of the stomach is sometimes not distinctly 
 perceptible for the first two days ; but it universally in- 
 creases as the disease goes on, until it ends in black vomit- 
 ing, and destroys the patient. Hence the distinction adopt- 
 ed by Professor Hosack, in his Nosology, between bilious 
 remitting and yellow fever : " Remittens Biliosa. Generally 
 preceded by, and, in the first stage, attended with, great 
 derangement of the digestive organs, and an inordinate se- 
 cretion of bile — the skin and eyes yellow, urine turbid — 
 the tongue loaded with a yellow sordes ; breath offensive ; 
 when fatal, terminating in typhus. 
 
 " Pestis tropicus. A fever commencing suddenly, with se- 
 vere pain in the head, back, and limbs ; remarkable redness 
 of the eyes ; unless relieved frequently about the third day, 
 succeeded by a yellowness of the skin ; accompanied with 
 
 * Tropical Diseases, p. 434. 
 
39 
 
 great anxiety, and distress in the region of the stomach 
 which generally terminates in the vomiting of black matter 
 resembling coffee grounds ; when fatal, usually proves so 
 within seven days ; in a foul atmosphere contagious."* 
 
 b. The yellowness of the skin and adnata. These symp- 
 toms too were simultaneous in their appearance and move- 
 ments, with the bilious vomitings. All showing that their 
 source and seat was intimately connected with the condi- 
 tion of the biliary organs. Moreover, the colour of the 
 eyes, which was so distinctly marked, was the bright golden 
 hue of jaundice, and not the dark muddy tinge of yellow 
 fever. Nor does the yellowness in yellow fever, usually 
 appear as we have already seen, until the disease is form- 
 ed and half through its course, and, in some instances, ac- 
 cording to Dr. Rush, not until after the death of the pa- 
 tient!. In yellow fever it is obviously, as the best writers 
 remark, an effect, and not a cause of the disease. 
 
 And Towne has gone so far as to say that the yellowness 
 is even indicative of a. favourable crisis. " The regular cri- 
 sis, therefore, of this fever, generally discovers itself by a 
 suffusion of the bile all over the surface of the body, about 
 the third day. The saffron tincture is frequently observed 
 in the space of twelve hours after the attack, if you care- 
 fully inspect the coats of the eyes, and the sooner it ap- 
 pears the more encouraging is the prognostic, if the inten- 
 tion of nature be not prevented by the preposterous use of 
 cordials and alexipharmicsj." 
 
 c. The yellow fur on the tongue constantly attended the 
 other bilious symptoms. Now it is well established that the 
 state of the tongue is by no means an infallible symptom in 
 yellow fever, and that in one half the cases at least, it is des- 
 titute of any colour, and, in many, without the slightest far 
 upon it. In the fever of Bancker-street, however, it was 
 
 * Hosack's Nosology, second edition — New- York, 1821, p. 186, 191. 
 
 t See also Burnet on the Mediterranean Fever, p. 19 and 492. 
 
 % Towne on the Diseases of the West Indies — London. 1726, p. 23. 24 
 
40 
 
 not only yellow, but from the beginning, covered in the 
 middle and towards its base, with a yellowish brown sordes. 
 As the disease advanced it became dry and chapped ; which, 
 taken in connexion with the sunken, soft, and unresisting 
 pulse, and the other symptoms, were quite sufficient to esta- 
 blish the typhoid character of the disease. I saw this ex- 
 emplified in six or seven remarkable instances of the dis- 
 ease, in which every symptom was clearly and boldly de- 
 veloped. The hectic flush on the cheeks, which I have al- 
 ways observed to be one of the most faithful attendants upon 
 the parched and scaly tongue of typhus, was also present 
 in these cases. 
 
 It is obvious, therefore, that although bilious symptoms 
 were present in this disease, they cannot, when taken in 
 connexion with the circumstances which attended them, be 
 at all explained on the supposition that the fever of Bancker- 
 street was yellow fever. If the disease, however, be con- 
 sidered to have been typhus, all the difficulties and anoma- 
 lies which perplex us in this part of our inquiry, immedi- 
 ately vanish. Bilious symptoms do frequently, we shall 
 find, become blended with typhus fever, particularly in the 
 tropics, or during the hot season of temperate climates, and 
 in the must malignant form of this disease, or that which is 
 seen in ships, jails, hospitals, camps, manufactories, and 
 other places where great numbers are crowded together 
 in i!l-ventilated apartments. 
 
 Sir Gilbert Blane, in describing the infectious ship fever, 
 enumerates bilious symptoms as a characteristic modifica- 
 tion of this low form of typhus, as it appears in the tropics. 
 " The fever we are treating of differs also from the spora- 
 dic nervous fever of England, and from most others of the 
 continued kind, in being attended with a more copious secre- 
 tion of bile, which, when thrown up, is generally green, or 
 as it is otherwise called, of a porraceous colour. This symp- 
 tom takes place in all climates ; but it is more remarkable 
 in a hot climate as might be expected*." Again, " It some- 
 * Diseases of Seamen, p. 349. 
 
41 
 
 times happens that men under the influence of this infec- 
 tion, [ship fever,] are more apt than others to he affected 
 with symptoms peculiar to the climate, upon their first ar- 
 rival*." 
 
 Thus "the increase [in 1783] of fever in the old squads 
 ron, was owing to two causes. One was the importation of 
 new raised recruits, brought from England by some ships 
 that arrived in the beginning of January. These were dis- 
 tributed to such ships as stood in most need of men ; and be- 
 ing very dirty and ill clothed, were likely to harbour in- 
 fection. They were evidently the cause of sickness in the 
 Warrior and Royal Oak, for these ships were before that 
 time healthy, and the fever began with these strangers, and 
 spread amongst the former crew. It is remarkable that the 
 ships that brought them from England were not affected by 
 them. It was caught in the Royal Oak from six men that 
 came from England in the Anson, which men, though first 
 put on board the Namur, communicated no fever there, 
 having been kept separate from the rest of the men ; but be- 
 ing sent to the Royal Oak, they were themselves first taken 
 ill with a fever, which afterwards spread to about thirty of 
 the other men. What was singular in this fever was, that 
 the eyes and skin of all that were affected by it, became 
 yellow, though without any particular malignancy, for only 
 two died on board and one in the hospital. There was one 
 whose complaint was so slight as never to confine him to 
 his bedt." 
 
 This gradation in the violence of the disease was parti- 
 cularly noticed also in the Bancker-street fever. The 
 same particular laws of contagion seem also to have belong- 
 ed to both diseases, judging by the numerous facts which 
 have been already stated in the previous part of this 
 essay in illustration of the circumstances under which the 
 fever of Bancker-street became communicable. 
 
 As I have so often had recourse to the writings of Sir Gi3- 
 
 * lb. p. 350. t lb. p. 147—8. 
 
 F 
 
42 
 
 bert Blane, it may riot be thought irrelevant to mention, 
 that he was physician of a fleet of upwards of 40 sail of the 
 line, under the command of Admiral Lord Rodney, and 
 containing more than 22,000 seamen and marines. This 
 fleet was employed in cruising in the West Indies, in 1780, 
 1, 2, and 3, and there never, perhaps, has occurred a simi- 
 lar opportunity of testing the effects of climate upon the hu- 
 man constitution, on so grand a scale, and where the expe- 
 riment was so completely under the control of the indivi- 
 dual who surperintended it. Sir Gilbert did not neglect to 
 avail himself of these advantages, and his authority on Sea 
 Epidemics, and on the modifying influence of climate, upon 
 these, as well as other diseases, is of the very highest 
 kind. 
 
 According to Sir James McGrigor, typhus made great 
 havoc among the British troops in the Spanish peninsula, 
 in the year 1812; particularly at the hospitals of Ciudad, 
 Rodrigo, and Viseu. At the latter place the disease was at- 
 tended with a yellowness and jaundiced state of the skin ; in 
 all of which it ended in death. — In one of these cases the 
 gall bladder was found distended with bile, but none was 
 perceived in the duodenum*. 
 
 Another case, directly in point, is given on the authority 
 of the Commissioners of Health : " A high grade of typhus, 
 attended with bilious symptoms, has oftentimes occurred in 
 this, as well as in other countries, at the same season of the 
 year at which this disease prevailed. And a very remark- 
 able instance of it took place in the year 1801, when many 
 vessels, unusually crowded with passengers, arrived at this 
 port, from Ireland, during the summer and autumn. Out 
 of at least 750 patients, who were admitted into the marine 
 hospital, almost all of whom were sick of this disease, 
 nearly 300 died, besides a great number who perished on 
 
 * See Sketch of the Medical History of the British Armies, in the Peninsula 
 of Spain and Portugal, &c. by Sir James McGrigor — London, 1816 — p. 31, 
 32, 33, 34. 
 
43 
 
 their passage. The disease, which was simply typhus on 
 board the ships which first arrived, became, as the vessels 
 progressively arrived later and later in the season, (from 
 the same ports — chiefly from Belfast,) combined with bili- 
 ous symptoms, which acquired more and more intensity as 
 the season advanced*." 
 
 Again, " a fever precisely analogous, in all its particulars, 
 to that of Bancker-street broke out nearly at the same time 
 in the suburbs of this city, at the penitentiary at Bellevue." 
 " During the months of July, August, and September, and 
 the early part of October, (says the physician who attend- 
 ed this institution,) there occurred, at that establishment, 
 a disease exhiting many characters of the typhus gravior, 
 jail, or hospital fever, accompanied with bilious symptoms, 
 especially among the blacks ; such as yellowness of the eyes 
 and skin, epigastric distress, in some instances, so great as 
 to render the slightest pressure intolerable!." — We shall 
 have occasion to refer to this again. 
 
 2. The vessels of the eye, in many cases, were tinged 
 with red blood, as in yellow fever. But this was a symptom 
 which, (if we may be allowed to treat this subject with levi- 
 ty,) the patient had had for many years, for it was only ob- 
 served in those who were well known to be inveterate 
 drunkards. 
 
 Admitting, however, that it was more frequently present 
 than we are willing to allow, the ablest writer who has ever 
 treated of typhus, (Dr. Armstrong,) informs us, that it is a 
 very common symptom of that disease. In the inflammatory- 
 typhus, where the brain is involved in inflammation, there 
 are, among other symptoms, according to this author, 
 " Deep pulsating pain in the head; increased heat of the 
 temples, forehead, and hairy scalp ; throbbing of the carotid- 
 arteries ; tinnitus aurium ; redness and morbid sensibility of 
 
 * Statement of the Commissioners of Health, p. 9. 
 i" Report of the Medical Society Committee, p. 11. 
 
44 
 
 the eyes ; and more or less disorder in some other of the ex- 
 ternal senses*." 
 
 Again, " But sometimes acute inflammation of the brain, 
 in typhus, is not to be discriminated by the succession of 
 symptoms above described. In such cases it is mostly to 
 be recognised in the beginning by a glary bloodshot eye ; a 
 contracted pupil ; an agitated expression of the counte- 
 nance!," &c 
 
 This redness of the eye is also sometimes a prominent 
 symptom in the attack of the congestive form of typhus, of 
 this author. " The eye is occasionally glary and vacant, 
 without redness ; but, at other times, it is heavy, watery, and 
 streaked with blood, as if from intoxication, or want of 
 sleepj." 
 
 3. The irritation at the pit of the stomach. This symp- 
 tom was, by no means, constant, and was often confound- 
 ed with the genuine inflammation of the stomach, which 
 accompanies yellow fever. In a great number of instances, 
 it was a simple irritation, attributable entirely to the pre- 
 sence of bile, and other acrid secretions, in the stomach ; 
 the proof of this we have in the fact that emetics removed, 
 or, at least, mitigated this symptom, and that it declined with 
 the bilious vomitings. In a number of instances, I ascer- 
 tained that the irritation was not confined to the pit of the 
 stomach, but extended over the whole abdomen, and down 
 to the pubis. It was in these cases, no doubt, the same ir- 
 ritation, or sub-acute inflammation, which almost always 
 affects the external muscles and integuments of the whole 
 body in typhus fever ; producing a universal soreness, and 
 leading the hasty observer to suspect that the pain is deep 
 seated, and owing to the inflammation of some internal or- 
 gan. We thus see that this mysterious epigastric affection ; 
 this distress at the prascordia, which has been dwelt upon 
 Iby so many as a pathognomonic evidence of the identity of 
 this disease with yellow fever, may, in a great number of in- 
 
 * Armstrong on Typhus, &c. p. 29. t lb. p. 29, 40. J lb. p. 76, 
 
45 
 
 stances, be satisfactorily accounted for, without the neces= 
 sity of this supposition. But we have yet stronger testi- 
 mony. The irritation at the epigastrium, may, for argu- 
 ment's sake, be admitted to have been actually present in 
 a number of cases. We will also allow that it indicated the 
 presence of a degree of inflammation in the stomach, and 
 we will now show that all this may have occurred, and yet be 
 entirely reconcileable with the position for which we have 
 contended from the outset, that the fever of Bancker-street 
 was not yellow fever, but typhus. 
 
 Epigastric irritation denoting inflammation of the inner 
 surface of the stomach, and ending repeatedly in gangrene, 
 suppuration, ulceration, and even perforation of the coats 
 of this organ, is, according to Armstrong, often complicated 
 with typhus fever. Even where the brain and its invest- 
 ing membranes, only are involved in inflammatory typhus, 
 there are, according to him, " generally transient pain in 
 the limbs ; oppression of the precordia ; torpidity of the intes- 
 tines ; uneasy respiration, attended with heavy sighs ; nausea, 
 retching, or vomiting augmented on motion*," &c. 
 
 -Again, " when an acute inflammation invades the lining- 
 of the stomach or bowels in typhus, it is generally denoted 
 by some degree of pain and tenderness, by the stools con- 
 taining unnatural mucus, a coagulable lymph, with or with- 
 out some admixture of blood, by unusual flatulence, by a 
 short hurried respiration, by an anxious countenance, under 
 pressure of the affected region, by great prostration of strengh, 
 by a small quick pulse, and by the patient lying prostrate 
 on the back, with the knees mostly elevated, and the fee^ 
 drawn upwards. If this acute inflammation be in the inte- 
 rior of the stomach, or of the upper portion of the intes- 
 tines, nausea, retching, or vomiting, is generally present 
 with a sense of heat, and an intense desire for cold drinks : 
 but if the inflammation be seated in some inferior portion 
 
 * Armstrong on Typhus, p. 28, 
 
46 
 
 of the gut, and particularly in the colon, these symptoms 
 may all be absent*.'' 
 
 Those who have been conversant with the fever of 
 Bancker-street, will not fail to recognise, in all the above 
 symptoms, a great number of those which occurred in cases 
 of that disease. 
 
 This irritability of the precordia is a symptom also of 
 the congestive typhus of Armstrong. " The pulse is low, 
 struggling, and variable ; the stomach irritable]," &c. 
 
 A disease similar to that described by Moseley |, also 
 prevails, according to Curtis, in the East Indies. He de- 
 scribes it under the name of bilious fever and flux: it dif- 
 fers materially from the putrid bilious fever of Moseley in 
 its duration. The fever he considers altogether symp- 
 tomatic of the flux, and the latter he considers as produced 
 and maintained by a superabundant and vitiated condition 
 of the bilious secretion, evinced in the beginning by the 
 nature of the discharges, and the disorder induced on the 
 alvine functions. The fever disappeared the moment the 
 bowel disorder was corrected, and in proportion to the 
 quantity of bile discharged by stool. Evacuants here too 
 were found of the utmost importance ; and, as in the fever 
 of Moseley, the combination most effectual, and at the same 
 time most acceptable to the stomach, was cream of tartar 
 and manna. Emetics were not indicated, and did harm. 
 There was not more }ellowness of the skin, eyes, or 
 urine, than commonly accompanies all the India diseases 
 where the liver or its secretion is concerned. The at- 
 tack was sudden and severe in many cases, and attended 
 with a high degree of fever ; the pulse sometimes hard, but 
 always very frequent ; tongue and skin dry, hot, and parch- 
 ed, and the patient very soon became delirious. In a 
 more advanced state, the tongue became thickly covered 
 with a yellow crust ; with a small and quick pulse ; prostra- 
 
 * Armstrong, p. 51 — 2. t lb. p. 76. % Seep. 18 of this Essay. 
 
47 
 
 lion; pale, sunk, or sallow countenance ; great heat, pain, 
 tension, and tumour of the abdomen ; fulness at the pit of the 
 stomach, and pain and tenderness there on pressure ; retch- 
 ing, vomiting, and great irritability ; now and then with 
 wild frenzy and delirium ; and sometimes with cold extre- 
 mities, hickup, cold sweats, and death. Inflammation and 
 gangrene of the intestines soon came on. Generally conti- 
 nued when mild from two to three weeks ; at other times 
 to a much longer period. There were none of the symp- 
 toms of hepatitis. 
 
 The author remarks, that typhus, synochus, synocha, 
 scarlatina, and erysipelas, were unknown. It is very evi- 
 dent, however, that the fatal and and more alarming cases 
 of the disease terminated in typhoid symptoms; and that 
 the irritability of the precordia was, particularly at this 
 time, one of the most prominent and formidable symptoms. 
 Epigastric irritation, therefore, may occur to an intense 
 degree, among an assemblage of symptoms which bear 
 much less resemblance to those of the yellow fever, than 
 to the disease treated of in this essay. And if, as Curtis seems 
 to believe, this disease was entirely produced by an extra- 
 ordinary redundance of bile, we have a complete clue to 
 the epigastric irritation and other symptoms of disordered 
 stomach and bowels, which characterized the bilious ty- 
 phus of Bancker-street*. In the fever of Bancker-street 
 the redundance of bile was not so great, but it was regur- 
 gitated upon the stomach more than on the intestines. 
 The tendency to diarrhoea is stronger in the tropics, owing 
 to the relaxed and debilitated condition of the bowels from 
 the influence of heat. But we have fresh and stronger 
 evidence at our own doors. 
 
 About two weeks before this disease began to prevail in 
 Bancker-street, a fever, perfectly similar in its character 
 -and origin, broke out and continued to spread for some 
 
 * See Curtis on the Diseases of India. &c. Edinburgh, 1807. p. 117—55. 
 
48 
 
 months in the apartments"of the Penitentiary, a building si- 
 tuated in the suburbs of this city, in an airy open field, on 
 the banks of the East River. The persons confined in this 
 institution were crowded together to a degree which can 
 scarcely be credited. A great number of vagrants, parti- 
 cularly blacks, who had been principally loungers, about 
 Bancker-street, and were of the same description of per- 
 sons as those who afterwards were seized with the fever in 
 that street, had been recently conveyed to this prison, 
 which added to the great numbers already there, rendered 
 it wholly impracticable to accommodate them. 
 
 The following letter of the Resident Physician, read at 
 the meeting of the Board of Health, of this city, July 5th, 
 1 320, gives a particular account of the condition in which he 
 found the Penitentiary, a few days before the disease be- 
 came epidemical in that establishment : 
 
 " Dear Sir — In obedience to the order of the Board of 
 Health, passed at their meeting on the 3d instant, I visited 
 the Penitentiary on the afternoon of the same day, accom- 
 panied by the House Physicians, Dr. Westervelt and Dr. 
 Belden. I examined most of the apartments of the insti- 
 tution, more especially those which were crowded, and 
 from which most danger from disease was to be appre- 
 hended. 
 
 " I was first introduced into Hall No. 2, containing 50 
 coloured females. The air of the apartment was exceedingly 
 confined and offensive, as was to be expected from so great 
 a number of persons immured within a space of 45 feet 
 by 22. 
 
 " Hall No. 4 is of the same dimensions, and contains 45 
 white females. The air of this apartment was similar to 
 the former, scarcely respirable. But the back Hail No. 6 
 was in a still more offensive state, containing both black and 
 white females intermingled — 28 of the former, and 21 of 
 the latter. 
 
t 49 
 
 •"From thence we proceeded to the apartment allotted 
 to the boys. This too was crowded with 30 boys, some co- 
 loured, others white, and all within a room not exceeding 
 8 or 10 feet in width, and about 40 in length, with small ad- 
 jacent sleeping rooms. The inhabitants of this apartment, 
 by breathing this confined and impure air, have lost their 
 healthy hue, the greater part of them exhibiting a remark- 
 ably pale and sickly visage. 
 
 " In this part of the establishment, the three boys whose 
 sudden death was reported to this Board, sickened with ty- 
 phoid fever, and fell victims to this disease after two or 
 three days illness. Their sudden death is probably to be 
 ascribed to the unhealthy scorbutic condition of their sys- 
 tems, antecedent to the invasion of fever, but doubtless in 
 part induced by the confined state of the air in which they 
 lay sick. And it is to be apprehended, should the conta- 
 gion be renewed in any other members of the same crowd 
 ed apartments, the same fatal result may be expected. 
 
 " The condition of the hospital attached to the institu- 
 tion, instead of being well ventilated, is no less crowded 
 and injurious to the sick. 
 
 " Upon inquiry, too, it was found that a very unusual 
 number, especially of females, have been recently taken 
 up as vagrants, and sent to the penitentiary. 
 
 " To this cause the present evils are to be attributed, the 
 apartments not being of sufficient dimensions for their ac- 
 commodation. 
 
 " The only method by which still further fatality in that 
 institution is to be guarded against at this hot season of 
 the year, is either to discharge from the house some of the 
 vagrants, or to provide additional temporary buildings for 
 their reception ; for, under the present state of things, a. 
 commitment to the penitentiary involves a punishment 
 much more severe than that which was contemplated by 
 the Legislature in the organization of that establishment. 
 I also recommend, and have expressed the same to the 
 
 G 
 
50 
 
 keeper, that the walls be again whitewashed without delay, 
 and that this process be repeated at least monthly during 
 the summer season ; that the floors be frequently cleansed, 
 and fresh vinegar daily sprinkled through the apartments, 
 at the same time that the prisoners be supplied with a large 
 proportion of fresh vegetables and fruits. But as the insti- 
 tution is under the care of eminent physicians, further re- 
 marks on this subject become unnecessary. 
 " I am, dear sir, very respectfully, yours, 
 
 (Signed) " David Hosack- 
 
 " TJie Hon. Peter A. Jay, President, pro tempore, 
 of the Board of Health*, ," 
 
 These predictions were lamentably verified, and more 
 than one hundred cases of fever, the greater number of 
 which were blacks, broke out in this institution, similar, in 
 every respect, to the fever which very soon afterwards 
 made its appearance in the cellars and filthy apartments of 
 the negroes, in Bancker-street and its vicinty. We have 
 the authority of several intelligent and highly respectable 
 physicians for saying that the disease in the penitentiary, 
 at Bellevue, and that in Bancker-street, carried the most 
 indubitable evidence of identity, both in the assemblage of 
 their symptoms, and in the causes which gave rise to them. 
 For while cases were occurring at the penitentiary, and 
 placed in the hospitals there, those afflicted with the fever 
 in Bancker-street, were conveyed to the same hospitals, by 
 which means the diseases were brought together and faith- 
 fully compared. 
 
 The Attending Physician at Bellevue, also, who had the 
 care of the patients ill of this fever, confesses it to have 
 been the same as the low typhus of hospitals and ships ; and 
 says that the epigastric irritation, was a notable symptom 
 of the disease. His own words show how closely the peni- 
 
 * Statement of the Commissioners of Health, p. 17,18, 19. 
 
51 
 
 ientiary fever resembled that of Bancker-street. " During 
 the months of July, August, September, and the early part 
 of October, there occurred at that establishment a disease 
 exhibiting many characteristics of the typhus gravior, jail, 
 or hospital fever, accompanied with bilious symptoms, es- 
 pecially among the blacks, such as yellowness of the eyes 
 and skin, epigastric distress, in some instances so great as to 
 render the slightest pressure intolerable* '." 
 
 It has appeared, therefore, somewhat unaccountable to 
 us, how this gentleman should have signed his name to a 
 statement, declaring yellow fever and the fever of Bancker- 
 street to be one and the same disease!- 
 
 But again, as if proofs were constantly multiplying at our 
 hands, and opportunely presenting themselves for our use, 
 while the fever was prevailing in the penitentiary and 
 Bancker-street, a disease having precisely the same cha- 
 racteristics broke out, at the very same time, among the 
 blacks in the filthy alleys and courts of Philadelphia. This 
 too was confounded by the physicians with yellow fever, 
 until the unfortunate opportunity occurred of contrasting 
 them together, when those who had adhered to their pre- 
 judices with the greatest obstinacy, were now the readiest 
 to admit that they had been deceived. The preconceived 
 notions which they had formed of the disease, took their 
 rise, like most of the errors which cloud this subject, from 
 a stubborn persuasion of the domestic origin of yellow 
 fever. 
 
 The only account we have of this fever, which has been 
 communicated to the public, is contained in a letter from Dr. 
 Joseph Klapp to J. B. Sutherland, Esq. It triumphantly es- 
 tablishes the identity of the disease with that of Bancker- 
 street and of the penitentiary, and shows that this epigas- 
 tric irritation, as well as all the other symptoms and cir- 
 
 * Report of the Medical Society Committee, p. 11. 
 
 * See Report of the Medical Society Committee. 
 
52 
 
 cumstances of the Bancker-street fever, may and do oc- 
 cur in genuine typhus. 
 
 The disease appears to have prevailed between the first 
 of July and last of September, during which time there were 
 brought to the sugar-house or fever hospital, at the alms- 
 house, about two hundred patients. They chiefly came 
 " from Atkinson's court, Pine alley, Miles's court, and 
 from other equally filthy and dirty places both in the city 
 and Liberties. The particular forms of disease which they 
 laboured under, appeared to be the low remitting fever and 
 the different grades of typhus. These complaints are such 
 as physicians are accustomed to meet with at this period of the 
 year, but their particular prevalence this season among the 
 blacks must be attributed to a general want of employment, 
 to vicious as well as indolent habits, to which many of the 
 lower class of these people are known to be addicted j and 
 further, their scanty and often unwholesome diet, with an ha- 
 bitual disregard of cleanliness, both personal and in their 
 dwellings, have doubtless contributed much to disseminate 
 the disease. Many of them pass through the first stages of 
 their disease, before their situation becomes known to the 
 guardians of the poor, and consequently (as Mr. Jones has 
 already asserted) are put down at the door of our hospital, 
 either in a state of actual dissolution, or they have been so far 
 exhausted as to preclude all hope of deriving benefit from me' 
 dical application. Under such circumstances, the mortali- 
 ty of the disease should cease to be a matter of surprise. 
 The typhus disease was the one most prevalent. It was 
 usually introduced by a chill, and considerable subsequent 
 excitement of the circulation, by pain in the head and ver- 
 tigo, much soreness and tension of the epigastrium, a white 
 tongue, and a prostration of the muscular system. Much 
 general debility usually appeared between the third and 
 fifth days, and the disease in many instances came to a termi- 
 nation between the seventh and tenth days*." 
 
 * American Medical Recorder, vol. IV. No. xiij. p. 83. 
 
53 
 
 Again ; " The principal determinations were to the head 
 and stomach. In the latter respect, there was a difference 
 from ordinary typhus, and from its being a symptom com- 
 mon to both it and yellow fever, some were at first dispos- 
 ed to believe them the same. This opinion, however, at- 
 tained to a very limited extent, and I believe in the latter 
 part of the season, when all had an opportunity of contrast- 
 ing them, the opinion of their identity was relinquished b} r 
 every one. A circumstance evincing the diversity of their 
 character, is Ihe fact of their prevailing in different districts of 
 our city. I do not recollect to have heard of a single well-mark- 
 ed case of yellow fever originating in the dirty alleys, remote 
 from the river Delaware, though abounding throughout the 
 summer with cases of typhus, intermittens, and remittents. 
 My public and private practice afforded me many opportu- 
 nities of instituting a comparison between the symptoms of 
 the two epidemics, which enabled me to detect the follow- 
 ing differences between them : First, in the typhus of the 
 blacks, in the very first stage, the epigastric region evidences 
 great sensibility to the touch, whereas in the malignant yellow 
 fever this sensibility does not usually occur until about the 
 third day. The particular seat of this morbid sensibility is 
 different in the two diseases ; in the former it is more exter- 
 nal, while in the latter it is more internal. Secondly, in the 
 typhus the most active as well as the most unpleasant re- 
 medies are generally retained with ease on the stomach ; 
 not so in the yellow fever. Thirdly, in the different stages 
 of typhus, the tongue undergoes the several changes cha- 
 racteristic of that disease, but in the yellow fever it pre- 
 sents a different appearance ; in no case of that disease, 
 have I met with the hard and glossy tongue, the usual attend- 
 ant on the former. Fourthly, haemorrhages in the second 
 and last stages of typhus are uncommon, but very common 
 in yellow fever. Fifthly, in the typhus there b- an early 
 prostration of the muscular powers ; not so in yellow fe- 
 ver. Sixthly, the yellow or icteric eye marks the first stage 
 
54 
 
 of the typhus, but in yellow fever it rarely occurs before the 
 third day- Seventhly, black vomit very common in the se- 
 cond and last stages of yellow fever, and very uncommon in 
 the typhus of the coloured people. Eighthly, the convales- 
 cent state of yellow fever is generally short, and as gene- 
 rally tedious in the typhus*." 
 
 Out of the large number who died of this disease, there 
 were five cases in which a dark coloured matter was void- 
 ed from the stomach, " something like black vomit." The 
 substance " appeared to be composed of a mucous secre- 
 tion of blood, and the common contents of the stomach in- 
 timately blended." Dr. Klapp judiciously observes, that 
 these suspicious cases ought to be considered as anoma- 
 lous, and by no means as conclusive evidence of this dis- 
 ease having been yellow fever. For we are told by this 
 writer that black vomit may occur in intermittents, remit- 
 tents, cramp of the stomach, pleurisy of the winter season, 
 gastritis from drinking cold water when the body has been 
 much heated, in dropsy, consumption, &ct. 
 
 Fevers similar to that of Bancker-street, not only in be- 
 ing accompanied with bilious symptoms like that of 1801? 
 but also with a peculiar irritation of the precordia, have re- 
 peatedly occurred in this city in previous years. And if 
 sufficient evidence had been adduced of the occurrence of 
 vomiting of dark matter in the Bancker-street fever, we 
 have, in addition to the remark of Dr. |Klapp, proof di- 
 rectly in point, that this symptom too may now and then 
 exist in true typhus, but that it is essentially different from 
 the black vomiting of the yellow fever. " I began," says 
 Dr. Samuel Bard|, " to practise medicine in New- York 
 in 1766. Remitting fevers have, since that time, prevailed 
 more or less every fall. They frequently were attended 
 
 * American Medical Recorder, vol. IV. No. 13. p. 85. 
 t lb. p. 86—7. 
 
 % Now President of the College of Physicians and Surgeons of the Univer- 
 sity of New- York. 
 
55 
 
 with bilious discharges, and a yellow skin ; and in propor- 
 tion as these symptoms prevailed, were termed bilious re- 
 mittents ; in some instances these symptoms have run very 
 high, and the accompanying fever, in such cases, has gene- 
 rally been more ardent and constant ; but nevertheless sensible 
 remissions so generally accompanied them, that they were ge- 
 nerally looked for; and it is now thought the duty of the 
 physician to watch for them, and by emetics, other evacua- 
 tions, and blisters, to promote them, so as to procure an 
 opportunity to administer the Peruvian bark, by which the 
 cure was generally completed. Now and then, and parti- 
 cularly during the war, when the city was much crowded, 
 and little attention paid to cleanliness ; fevers of a more ma- 
 lignant nature have prevailed, in which a foul mouth, he- 
 morrhages, petechial eruptions, and other marks of dissolu- 
 tion, have either characterized the disease from its com- 
 mencement, or been superadded to the bilious symptoms in 
 the latter stages ; and then the disease has been termed 
 malignant, putrid petechial, jail, or hospital fever. In such 
 cases I have now and then seen profuse bloody discharges, 
 and black, or, as it is now more generally named, coffee- 
 ground vomiting* ; but a more frequent symptom in these 
 fevers, and one I do not remember to have seen in yellow 
 fever, is the apthous crust with which the mouth and throat 
 is often lined. In these fevers death seldom occurs, nor is 
 a crisis often to be expected before the seventh day, and 
 both are frequently protracted to the fourteenth, or even to 
 the twentieth. Such were the cases of my sister during the 
 war, and of my son about six months ago, which you have 
 frequently heard me mention. Just before, and what gave 
 occasion to the appointment of health officer of New- York, 
 about the year 1758 or '59, a ship crowded with Germans 
 
 * " Is this of the same nature," says Dr. Bard, in a note, « with the black 
 vomiting of the yellow fever ? I suspect not." 
 
56 
 
 arrived there in a very sickly state, and were put under 
 my father's care. He procured accommodations for the 
 sick at a little distance from town ; and I have heard him 
 say, that out of five or six pupils and attendants, he was the 
 only person who escaped the disease. This disease he al- 
 ways called ship or jail fever, but never yellow fever; and 
 it is worthy of observation, that he had seen the yellow fe- 
 ver which prevailed in New-York about the year 1744. 
 Another instance of the same kind occurred whilst I was 
 health officer — I mean the ship in which Mr. M'Clain came 
 from Scotland ; in which, out of, I think, about three hun- 
 dred passengers, upwards of seventy died ; but of those, I 
 saw no one which in the least resembled yellow fever. 
 The first case of fever I ever saw with that assemblage of 
 symptoms we have since denominated yellow fever, was 
 the case of Mr. Jenkins (1795), &c*." 
 
 The spotted fever, which has occasioned so much inter- 
 est among the physicians of this country, and particularly 
 of the New-England States, appears to have been a disease 
 of the typhoid type. It prevailed in the winter, about the 
 month of January. There was here also an indescribable 
 anguish about the precordia. Vomiting also frequently oc- 
 curred, which from being at first merely the ingesta or a 
 greenish liquor, obeyed, as the spring advanced the influ- 
 ence of the season, and became bilious, like that of the 
 Bancker-street fever. 
 
 There was neither yellowness of the skin or adnata ; but 
 its course, like that of the bilious typhus of Bancker-street, 
 was also hurried, terminating when fatal usually before the 
 fifth day. 
 
 The tongue was generally moist, but if the disease con- 
 tinued beyond the third or fifth day, it became darker co- 
 
 * Additional Facts and Observations relative to the nature and origin of 
 the Pestilential Fever, by the College of Physicians and Surgeons of Phila- 
 delphia. Philadelphia r 1806. Letter of Dr. S. Bard to Dr. D. Hosack, 
 pp. 15, 16, 17. 
 
57 
 
 loured, and yellow or brown. Other circumstances also 
 bespeak its typhoid character, such as great prostration of 
 strength, low frequent pulse, depraved sensations, deliri- 
 um, coma, and finally petechia? all over the surface, toge- 
 ther with the tonic and cordial treatment most generally 
 had recourse to, and which was most successful. We are 
 furthermore confirmed in this opinion by the committee of 
 the Massachusetts Medical Society, who have furnished 
 the most accurate and authentic accounts of this dis- 
 ease : 
 
 " It appears also," say they, " that in various parts of 
 the Commonwealth, the common typhus is much more fre- 
 quent than usual at this season of the year ; appearing in 
 many instances with its ordinary symptoms, but in others 
 with a character more or less resembling the disease which 
 we have described." 
 
 As in the fever in Bancker-street, in that described by 
 Dr. Bard, and in that of the Philadelphia alms-house, there 
 were not wanting cases with dark and suspicious vomit- 
 ings ; which gave occasion to considerable alarm, and led 
 several to suppose that the matter ejected, was no more 
 nor less than the real black vomit. The language of the 
 committee will place this subject in its proper light, and 
 taken in conjunction with the time of year in which the 
 spotted fever was most prevalent, [January,] and the ap- 
 pearances on dissection, show us how much credit was 
 to be attached to these conjectures. " In several fatal 
 cases at Lancaster, and two not fatal, a dark matter was 
 thrown up, which was called black vomit. Whether this 
 matter was the same called by that name in the autumnal 
 fevers of warmer climates, the committee are not assured." 
 Again ; " The coats of the stomach were generally free 
 from the slightest morbid appearance: its contents had 
 sometimes a resemblance to coffee grounds, or more 
 nearly to brown soup, while in other cases they con- 
 
 H 
 
58 
 
 sisted of greenish mucus : each without any offensive 
 odour*.' 5 
 
 These important facts teach us, that we are not always 
 to attach such frightful apprehensions to symptoms of pre- 
 cordial irritation, and that Ave are by no means to suppose 
 that this or the vomiting of a dark greenish bile are always 
 to be looked upon as the certain forerunners of gangrene 
 and sphacelus of the stomach. Much less is the detection of 
 a discoloured water in the stomach, after death, to be taken 
 as the consequence of such derangement, or an indication of 
 the existence of the matter of black vomit during life\. 
 This mode of reasoning a posteriori rarely leads to satis- 
 factory results ; but it is one which, however unphiloso- 
 phical it may be thought to be, is, we regret to see, too 
 often employed J. 
 
 The irritation at the prcecordia, is one of the symptoms 
 also of the autumnal inflammatory remittent of the Southern 
 States, a disease peculiarly obnoxious to strangers, and ve- 
 ry different from the endemial bilious remittent of that part 
 of our country, or from typhus fever§. 
 
 In the endemic fever of Bengal, commonly called marsh 
 
 * See Transactions of the Massachusetts Medical Society, vol. II. Also, 
 American Medical and Philosophical Register, vol. I. p. 12, 373, 176. Vol. 
 III. p. 482. 
 
 f Burnett, a voluminous author on the Mediterranean Fever, avers that 
 this disease continues through the winter, and is then "often accompanied 
 by severe and evident inflammation of the lungs." What must be thought of 
 this assertion- when it is-known that the Mediterranean fever was the iden- 
 tical yellow fever of the tropics ! Burnett was desirous of proving the iion- 
 contagionsness of this disease, and that it 'was entirely attributable to at- 
 mospheric influence. To do this, it was necessary, as much as possible, to 
 liken it to the ordinary fevers of the Mediterranean. Hence, perhaps, the 
 explanation how this remark escaped him, and another still more singular 
 and incredible, that black vomit was in some cases found to be a very rare 
 occurrence. — Burnett on the Mediterranean Fever, Land. 1816, p. 11, 423, 
 491, kc. 
 
 \ See Report of the Medical Society Committee of this city, p. 26 — 7. 
 § Vide JNToicom's Observations on the Fevers of North Carolina. Ame- 
 rican Medical and Philosophical Register, vol. I. p. 17. 
 
59 
 
 remittent fever, occasioned by the inundation of the Gan- 
 ges, one of the most distinguishing symptoms is oppres- 
 sion on the prcecordia, and excruciating pain at the stomach. 
 The vomitings were always bilious, and emetics were dan- 
 gerous. The disease being of an inflammatory type, ve- 
 nassection was found eminently useful. The disease, like 
 the inflammatory remittent spoken of by Norcom, prevails 
 in August and September, and attacks more particularly 
 strangers*. Indeed, the gastric or precordial irritability, 
 according to Johnson, together with pain of the head, con- 
 stitute the pathognomonic symptoms of the bilious fever, 
 or grand endemic of hot climates. This is a fever which 
 occurs on land or at sea, independent of marsh miasmata, 
 which seem however to have a modifying influence upon 
 it, as in the endemic of Bengali. 
 
 4. Duration. In some few instances, the fever of Banck- 
 er-street terminated fatally within the space of a week. 
 Great pains were taken to make a handle of this circum- 
 stance ; and it was held forth as a strong evidence of the 
 analogy between yellow fever and this disease. The do- 
 cuments in possession of the Board of Health, however, and 
 under the signature of the physicians who reported these 
 cases, show that not one of them was seen by these gentle- 
 men more than once, and then in several instances not un- 
 til after death ! The account of their symptoms, there- 
 fore, was derived from the persons in whose apartments 
 they died, and cannot be fully depended upon. As far as 
 has been ascertained, however, it appears that their 
 symptoms were very nearly those of the more sudden 
 forms of congestive typhus described by Armstrong, as oc- 
 curring in England ; where yellow fever has never been 
 supposed to exist, strange as it may seem, even by the 
 
 * Johnson on the influence of tropical climates on European constitutions 
 London, 1818, p. 40 — 87. Also Clarke and Lind, who have also treated of 
 this fever. 
 
 f lb. p. 105. 
 
60 
 
 most inflexible advocate of the domestic origin of the dis- 
 ease. 
 
 The congestive typhus of Armstrong sometimes termi- 
 nated in death in 40 or 72 hours*. Among other symp- 
 toms which showed themselves in the cases described by 
 Armstrong in the beginning of the disease, were " invo- 
 luntary sighing, and a sensation of weight and distress at the 
 pit of the stomach. The countenance soon acquired a look 
 of extreme agitation, and the skin was dry on the trunk, 
 and damp on the extremities ; the centre of the tongue 
 white, but moist ; and evidences of internal excitement 
 gradually dexeloped themselves ; the pulse being small 
 and hurried, the beat sharp and concentrated about the 
 prsecordia, but lower than natural on the wrists, ankles, 
 forehead, and lobes of the earst." On dissection, " the 
 brain, liver, and spleen were the only parts chiefly engorg- 
 ed with blood, the two latter organs [as is mentioned of the 
 spleen by the Medical Society Committee, p. 27] being 
 ruptured by the forcible pressure of the handj," Most of 
 the cases that proved fatal in this manner in Bancker- 
 street, occurred in subjects whose systems were complete- 
 ly paralyzed and destroyed, by the use of ardent spirits and 
 a most violent course of debauchery. In the majority of 
 cases, the fever of Bancker-street extended beyond a week ; 
 and generally, when it terminated fatally, ended in less 
 than a fortnight. In instances more mild, its duration was 
 protracted to longer periods, observing the same diversity 
 in this respect with ordinary typhus. So in the inflamma- 
 tory typhus of Armstrong, where the brain was deeply in- 
 volved, the disease was not protracted much beyond the 
 first week§. In that where the chest was implicated, it of- 
 ten terminated " within the first nine days||,'' and where 
 the bowels were the seat of the local inflammation, the 
 
 * Armstrong on Typhus, &c. Cases, p. 71, 2, 3. 
 
 + lb. p. 73. % lb. p. 73, 4. § lb. p. 30. || lb. p. 41. 
 
61 
 
 disease was known to terminate " at the expiration of the 
 first week*." The bilious form of typhus which prevailed 
 simultaneously in Philadelphia with the Bancker-street 
 and penitentiary fevers, we have also seen terminated, in 
 many instances, between the seventh and tenth days. 
 
 The author of a very able Review on the Report of the 
 Medical Society Committee, which appeared in the Ameri- 
 can Medical Recorder for April, 1 821, has also collected a 
 great number of high authorities to prove that typhus may 
 run a very rapid course. We will avail ourselves of his 
 remarks and references on this point, without deeming it 
 necessary to make an apology for so doing. 
 
 Sir John Pringle, in speaking of hospital fever, says that 
 " when the air is at the highest pitch of malignity, the course 
 of the disease comes to be very rapid* so as to terminate in 
 jive or six days, in death, or a favourable crisis!." Wilson 
 says, " typhus sometimes terminates in 10 or 13 davs, or 
 within that periodic Both Drs. Bateman and Rogan, in 
 the works already quoted, relate cases of typhus terminating 
 on the 6th and 3th day of the disease§. Even Dr. Thomas, 
 an author from whom we suspect most of the medical 
 knowledge contained in the Report has been derived, 
 speaks in the following terms : " In warm climates it (ty- 
 phus) seldom continues above a week or ten days, if so 
 long\\. 
 
 Some of the cases of this disease were nearly as rapid in 
 their course as the putrid bilious fever described by Mose- 
 leylT. This has probably induced the author of the re- 
 marks on theMedical Society Committee's Report, toob- 
 
 * Armstrong on Typhus, &c. Cases, p. 61. 
 
 t Observations on the Diseases of the Army, &c. p. 304. 
 
 X A Treatise on Febrile Diseases, by A. P. Wilson, vol. i. p. 137. 
 Am. Ed. 
 
 $ Bateman on the Contagious Fever, &c. p. 50. Rogan on Epidemic of Ire- 
 land, p. 25. 
 
 || Practice of Physic, p. 52. 4th American edition, 
 
 TT See p. 18 of this Essay. 
 
62 
 
 serve, that the two diseases were nearly alike. There 
 does not appear, however, to have been so great a disposi- 
 tion to putrescency in the fever described by Moseley as 
 in that of Bancker-street, though there was a much great- 
 er redundancy of bile. Whereas in the Bancker-street fe- 
 ver, the putrid generally predominated over the bilious 
 symptoms, particularly in fatal cases. The putrid bilious 
 fever, when fatal also ; terminated as soon as the third or 
 fourth day. But it will be said, perhaps, that all these dif- 
 ferences may be easily explained away. In truth, it would 
 prove no easy task to say where the line of demarcation 
 between the two diseases actually exists. Nor would it 
 be difficult to conceive, from the strong analogy between 
 many of their more important phenomena, that they both 
 belong to the same species. The disease is called by 
 Moseley, putrid bilious fever, or a high grade of bilious re- 
 mittent. This is somewhat contradictory : for if it was 
 a putrid bilious fever, we ought to understand by the 
 phraseology that it was a bilious typhus ; and if it was a 
 bilious remittent of a high grade, we are naturally to take 
 it for granted, that it commenced as an ordinary bilious re- 
 mittent, and terminated in putrid or typhoid symptoms. 
 Those who believe it to have been the same disease as the 
 fever of Bancker-street, and that both were of the typhoid 
 type from the commencement, will say that the putrid bi- 
 lious fever of Moseley was not so strongly marked by pu- 
 trid symptoms, because the climate of the tropics being 
 unfavourable to animal ization*, as well as to the concen- 
 tration of febrile infection, exercises an antiseptic influ- 
 ence over the system. In support of this argument they 
 will adduce the fact that typhus more frequently occurs, 
 and that the septic tendency is much greater in cold than 
 in hot latitudes, in winter than in summer. They will 
 moreover allege that the putrid bilious fever of Moseley, 
 originated as the worst forms of typhus usually do, in asitua- 
 
 * Moseley on Tropical Diseases, p. 92. 
 
63 
 
 tion where great numbers were crowded together, and where 
 the disease might have been reasonably anticipated. And 
 that the great redundance of bile was the natural conse- 
 quence of the season of the year at which the disease pre- 
 vailed, and its occurring in the tropics, where, according to 
 Blane, typhus is usually accompanied by bilious symptoms. 
 That as to the duration of putrid bilious fever, all fevers 
 run their course sooner in hot than in cold climates!. In 
 opposition to this we would urge that the bilious symp- 
 toms had undoubtedly more to do with its fatality than its 
 typhoid character, which is proved by the complete success 
 which attended the introduction of manna and cream of tar- 
 tar, after the disease had carried off a great number of the 
 troops. For by giving this combination until the bile was 
 entirely evacuated by the stools, the disease was effectually 
 subduedj. This important fact in regard to the treatment 
 of the disease, together with the circumstance that the 
 troops were exposed to the influence of marsh miasmata, 
 and, therefore, to remittent fever ; as also the fact that the 
 remittent fever of the tropics, is peculiarly charaterized by 
 bilious symptoms, ought, we think, without taking into view 
 the rapid termination of the disease, or the absence of well- 
 marked typhoid symptoms, to incline us rather to the opi- 
 nion that the two diseases were specifically different. 
 
 5th* The season of the year at which the disease ap- 
 peared. It has been contended by some persons, with 
 zeal not very creditable to their medical erudition, that 
 this disease could not have been typhus because cases 
 of it happened to occur in the latter part of August, when 
 the summer heat was not yet expended. We acknowledge 
 that the fever of Bancker-street was rife in the month of 
 September ; a month which is nominally autumnal, but cer- 
 tainly, in this climate, a genuine summer month in its tem- 
 perature. Is it then an unalterable law of typhus, that it 
 
 + Blane on Diseases of Seamen, p. 395, &c. 
 % Moseley on Tropical Disease, p. 181, &c. 
 
64 
 
 cannot become matured and ripened except under the 
 frosts of winter? We know that the disease deriving its 
 origin most usually from human effluvia, does not need 
 the aid of marsh miasms to bring it into existence. The 
 effluvia arising from persons being crowded together into 
 close confined apartments, will alone engender the disease 
 without any other cause whatever ; and although the sur- 
 face of the earth be at the same time frozen and covered 
 with snow. But have we not the very highest authority — 
 have we not our own daily experience to show us, that ty- 
 phus will appear under the very highest temperature of 
 summer ? Is it not possible to conceive that the same efflu- 
 via to which it is so generally indebted for its production, 
 may, from a peculiar concurrence of circumstances, be 
 accumulated in such force and quantity, that even the high 
 temperature of August, could not fast enough volatilize it, 
 io prevent it from innoculating the human system with its 
 poison ? Sir Gilbert Blane, who first suggested the ingeni- 
 ous opinion that the matter of infection or contagion, is 
 readily dissipated under a powerful sun, gives, neverthe- 
 less, innumerable examples of the susceptibility of the hu- 
 man constitution to typhus, even under the heat of a tropi- 
 cal summer. In the immense fleet of the line of which he 
 had the superintendance, and to which we have already al- 
 luded, instances constantly occurred of typhus in certain 
 ships in which the presence of peculiar causes particularly 
 favoured its production and development*. 
 
 "In England (says Armstrong) typhus is evidently favour- 
 ed Hy a low temperature, being most prevalent in the cold 
 seasons of winter and spring, generally abating or disap- 
 pearing, as the heat of summer advances, and often pre- 
 vailing to a considerable degree in cold wet autumns ; but, 
 nevertheless, it occasionally prevails at all times in the 
 year, and is even undiminished by the hottest weather in this 
 
 * Vide Blane on Diseases of Seamen, passim. 
 
65 
 
 country, as 1 once witnessed when the thermometer was un- 
 usually high during the greater part of a summer*. 
 
 We again call to our assistance the researches made into 
 this part of our subject, by the author of the masterly re- 
 view of the singular production which issued from the Medi- 
 cal Society. 
 
 .Sir John Pringle, in his observations on the hospital or 
 jail fever, which is the same as the typhus gravior, tells us 
 that " the hospitals of an army, when crowded with sick, or 
 when the distempers are of a putrid nature, or at any time 
 when the air is confined, especially in hot and dry weather, 
 produce a fever of a very malignant kind, and very mor- 
 tal!. " In confirmation of this, he states, that in 1 743 the 
 hospital or jail fever prevailed in the army in the month of 
 July and Augustf . In 1 746 it broke out in May and June§, 
 and in 1 748 it raged in July, when the weather is described 
 as having been extremely hot and dry||. 
 
 Dr. Willan describes typhus fever as occurring in London 
 in August and September, and adds, " this disease is ex- 
 tended by infection, during the months of October and No- 
 vember, but its progress is generally stopped by the frosts 
 of December^." 
 
 Dr. Bateman says, " at all times there appears to be a 
 greater disposition to fever in London during the autumnal 
 months, which diminishes with the approach of winter. 
 The present epidemic, (typhus,) if we may deduce such an 
 inference from the demands upon the house of recovery, 
 was most particularly prevalent from the beginning of Au- 
 gust to the middle of November. The monthly admissions 
 were — in June 28, July 22, August 67, September 81, Oc- 
 tober 109, November 92, December 68**." 
 
 * Armstrong on Typhus, p. 9. 
 "(^Observations on Diseases of the Army, &c. p. 291. 
 $ lb. p. 27. i lb. p. 57. || lb. p. 75. 
 IT Willan on the Diseases of London, p. 43. 
 
 ** Bateman on the Epidemic, &c. prevailing in London, 1818, p. 16. 
 
 I 
 
66 
 
 In 1817 and 18, typhus raged epidemically in Belfast, 
 Ireland. It commenced in May, and prevailed extensively 
 throughout all the summer and autumnal months*. We 
 shall now quote two or three American authorities, to prove 
 the same point. A very sensible physician and writer, Dr. 
 Gallup, of Vermont, says, " this disease (typhus) prevails 
 most frequently in August and September ; but no month is 
 free from it, especially the fore part of the cold seasonf ." 
 
 The seventh volume of the New-England Journal of 
 Medicine and Surgery, contains an account of a typhus fe- 
 ver, which prevailed in the Boston alms-house in 181 7, 18, 
 and which broke out in the month of MayJ. " In the hot 
 months of the year, (says Johnson,) the fever [at Seringa- 
 patam] becomes remittent or typhoid^." 
 
 7. In many cases of the Bancker-street fever, instead of 
 the biting heat or calor mordax of typhus, there was ob- 
 served a peculiar coldness and dampness of the skin, indi- 
 cating a much lower temperature than natural. This has 
 been compared to the moist clammy state of the surface, so 
 often seen in the second stage of yellow fever. Overlooking 
 the ensemble of phenomena, premature inductions have 
 been made from this symptom, in favour of the identity of 
 the two diseases. In the Bancker-street fever this symptom, 
 as well as the low sunken pulse, were seen in those cases 
 where there existed an extreme degree of prostration, the 
 natural effect of the poison of the disease operating upon a 
 habit of body already exhausted and broken down by de- 
 bauchery. The same symptom was noticed in a fever which 
 appeared among the British troops at Mariegalante, West 
 
 * See Observations, &c. on the Epidemic in Ireland, by Francis Rogan, 
 M. D. &c. p. 150—1. 
 
 t Sketches of Epidemic Diseases in the state of Vermont, &c. by Joseph A. 
 Gallup, M. D. p. 363. 
 
 X See Vol. VII. p. 105. 
 
 § Johnson on the influence of Tropical Climates upon European constitu- 
 tions, p. 99. 
 
67 
 
 Indies, in December, 1808, the phenomena and circum- 
 stances of which disease, bore, indeed, in most of the cases. 
 an extraordinary resemblance to the fever of Bancker-street. 
 It commenced at night with chill ; heat, followed by low tem- 
 perature of the skin, lower than usual in the commence- 
 ment of yellow fever — thirst — flushed face — eyes tinged — 
 pulse now full, firm, and frequent — skin moist and soft — re- 
 mission in the morning — pulse less full, and often irregular 
 — tongue before white, now thickly coated with mucus, 
 whitish round the edges, but very foul and brown in the 
 middle — debility — dull, heavy sensation in the head — pro- 
 pensity to sleep — at noon, febrile symptoms recur, but in- 
 creased in violence and duration — remmission then less 
 complete, and exacerbation earlier. In general J.here is 
 no third remission — the fever becomes continued, and is 
 early accompanied by great irritability of the stomach, be- 
 ginning with a vomiting of bilious matter — distressing retch- 
 ing, uneasiness and pain there — dull pain in the forehead, 
 and constant, as also of the limbs — bowels loose — continues 
 thus four or five days — then stupor — pulse sinks — is un- 
 equal, and scarcely perceptible — coldness and dampness of 
 skin remarkable in a great number of cases — tongue dry 
 and hard, and teeth and lips covered with a dark coloured 
 fur — at night delirium — frequently complains of pain of sto- 
 mach, but vomiting now often ceases, returning frequently 
 at the same time of day — vertigo — now, in most cases, 
 there comes on complete coma, muttering delirium, subsul- 
 tus tendinum, and involuntary discharges — pulse no longer 
 felt — in some cases, a deep yellow colour of the skin — - 
 average duration twelve days — one half of the cases died. 
 In the early stage venesection was found useful, if the pa- 
 tient told his complaint in time. Sometimes there was no 
 remission — emetics were of doubtful utility. The disease 
 was considered an intermediate type between yellow fever 
 and typhus. No mention is made of dark or black vomitings*. 
 
 *See Dr. Dickson's account of this Fever, in Johnson, on the influence of 
 Tropical climates upon European constitutions, p. 364 — 9. 
 
We might go on to enumerate authorities in support of 
 our position, that fevers, in every respect similar to that 
 which forms the subject of this discourse, have repeatedly 
 been observed in other parts of the world. 
 
 For the present we shall content ourselves with the fol- 
 lowing observation : 
 
 We are informed, by Lind, that the most frequent and 
 fatal diseases in the sickly [wet] season, in Guinea, are n^t 
 of an inflammatory nature ; but generally of a bilious type, 
 attended with a low fever, sometimes of a malignant, at 
 other times, of a remittent kind. The pulse was always 
 low, and the brain and nerves seemed principally affected. 
 There was a tendency to remission. The disease began 
 sometimes with a vomiting — often with a delirium, follow- 
 ed by coma — sunken pulse — skin became yellow — frequent 
 bilious vomitings and stools — Expired sometimes in forty- 
 eight hours — generally in fourteen days. Venesection was 
 not admissible, but emetics were used with benefit*. 
 
 * Lind on the Diseases incidental to Europeans in hot climate?, p. 72, 3, S. 
 8, and 80, 
 
69 
 
 PART III. 
 
 We have then four notable instances of the occurrence 
 of a fever in our own country, analogous in its details to 
 that of Bancker-street. Three of these happened in this 
 very metropolis, of which one went on pari passu, at the 
 same time with the Bancker-street fever; and the other 
 two of which occurred here at two distinct periods of time 
 not very remote, and at the same season of the year. The 
 fourth instance occurred also at the same time and season 
 with the Bancker-street fever, and at the distance of less 
 than one hundred miles from the city. 
 
 In two of these instances, viz. the fever of the Peniten- 
 tiary in the suburbs of this city, and that brought to the 
 alms-house at Philadelphia ; the coincidence of character 
 was extremely remarkable in this ; that they broke out 
 simultaneously with the fever of Bancker-street, and criti- 
 cally resembled this disease in every particular, both as to 
 the description of persons whom they attacked, and in the 
 general concourse of their symptoms. 
 
 The fever at the penitentiary, that of 1 801, and that des- 
 cribed by Dr. Bard, also powerfully strengthen the chain 
 of our argument in another respect : for they not only ap- 
 peared at the same season of the year, attacked the same 
 description of persons, and were distinguished by the same 
 symptoms with the Bancker-street fever, but occurred in 
 the same locality and district of territory, showing thereby 
 that they were exposed with this disease to the modifying 
 influences of the same soil and temperature. These three 
 instances prove that certain causes have heretofore existed 
 in this locality, capable of producing the same form of ty- 
 phus, at three distinct and successive periods of time not re- 
 
70 
 
 mote from each other. We have good reason, therefore, to 
 think that these causes, whatever they may have been, were 
 the same, and that they may continue to operate also at fu- 
 ture periods of time. But since the Bancker-street fever 
 so intimately agrees with these three several fevers, both 
 in its symptoms, the season at which it appeared, and the 
 description of persons whom it attacked, and also in the 
 several circumstances derivable from the influence, of lo- 
 cality, we are under the necessity of believing that they 
 were all one and the same disease, and were produced by 
 the same cause, or combination of causes. 
 
 But the fever at the Aims-House, at Philadelphia, al- 
 though it occurred at the same season, attacked the very 
 same description of persons, was distinguished by the same 
 symptoms, and went on like that of the Penitentiary, simul- 
 taneously with the fever of Bancker-street, nevertheless 
 differed in its locality. The causes connected with locali- 
 ty or position, therefore, do not appear to be essential in 
 this form of fever. 
 
 What then are those causes in which all those five several 
 fevers agree, and which of them effected the peculiar phe- 
 nomena in their character, different from those which be- 
 long to the ordinary forms of typhus ? 
 They all agree in these particulars. 
 
 1. Season of the year at which they appeared. 
 
 2. Description of persons whom they attacked, viz. the 
 poorer classes, those who are intemperate, and live in un- 
 healthy and confined apartments. 
 
 3. Symptoms. 
 
 The secret of their production then is concealed here. 
 The second trait they have in common with typhus, as it 
 appears in jails, ships, hospitals, he. at all seasons of the 
 year, in summer or in winter. This, therefore, could not 
 have given the characteristic aspect to this disease. It fol- 
 lows, of consequence, that the season, the only attribute 
 
71 
 
 remaining to them in common, besides their symptoms, 
 must have given this disease all its peculiarities. In all the 
 five instances, the disease was rife at the hot season of the 
 year, i. e. in the last summer month, and beginning of Au- 
 tumn. On recurring to their symptoms, and the parallels 
 we have drawn of common typhus, under the influence of 
 tropical heat, we shall perceive that the natural conse- 
 quences resulting from this peculiar circumstance in the 
 history of these five several instances of fever, must have 
 been the production of bilious symptoms. 
 
 As the hot season, therefore, was the cause, so were the 
 bilious symptoms the effect wrought in this fever, and the 
 characteristic feature by which it was distinguished from or- 
 dinary typhus. 
 
 The comparison which has been made between the fever 
 of Bancker-street and yellow fever, in those points in which 
 they are at total and direct variance, shows that the opi- 
 nion which maintained their identity, is utterly fallacious, 
 and carries on the face of it its own refutation. But here we 
 have had an additional, collateral, and analogical mode of 
 testing the merits of this opinion, by comparing the fever 
 of Bancker-street with the co-existing fevers in the Peniten- 
 tiary of this city, and the Aims-House of Philadelphia, and 
 with those which appeared here in the year 1801, and dur- 
 ing the revolutionary war. 
 
 If then we can put confidence in the copies given by their 
 historians of these four several fevers ; if we bear in mind 
 that the details of these diseases do not come to us in a mu- 
 tilated or garbled state, but unwarped by controversy, and 
 unobscured by hypothesis ; if we call to our recollection 
 that their character has been presented to us unembarrassed 
 by rival or counter testimony, and that no person has ever 
 contended that either of these fevers was yellow fever, or 
 other than some modification of typhus ; surely we may be 
 allowed to conclude that they have been truly and con- 
 
72 
 
 scientiously described, and are, therefore, what their his- 
 torians have represented them to be, diseases of a typhoid 
 type. Whence it also follows that the fever of Bancker- 
 street, which has been shown to bear an exact resemblance 
 to these diseases, was also typhus, and not yellow fever. 
 
 FINIS. 
 
JUL 21942