Department of History
University of California, Irvine
Instructor: Dr. Barbara J. Becker
An Enquiry into, and Observations Upon
the Causes and Effects of the Epidemic Disease
Which raged in Philadelphia from the month of August
till towards the middle of December 1793 (1794)
by Dr. Jean Devèze (1753-1829)
|A few days after my arrival at Philadelphia, the seventh of August,
1793, it was reported many persons had lost their lives in consequence
of a sore throat.
The rapid progress of the disease gave reason to suppose, it had some contagious property annexed to it; the death of many persons in the same quarter, and nearly at the same time, so far gave sanction to this opinion, that it was proved to a certainty to be very dangerous to approach those who were attacked with it.
The month of August had nearly elapsed before I had an opportunity of inspecting into the nature of this complaint, when I attended a girl about six or eight and twenty years of age, servant to Mr. Bohlen, merchant in North Water-street. She was very robust and of a sanguine habit; the family physician, a respectable and well-informed practitioner, judging the case unfavourable, and supposing she would probably share the fate that had attended many of his patients, called in and engaged me, in case she sunk under it, to open the body, and endeavour to find out the case of so fatal a malady.
I went with him to Mr. Bohlen's. We found the patient in extreme agitation, face red, eyes sparkling, skin dry and hot, tongue and lips also dry and red, the amygdale glands swelled, the uvula, palate, and inside of the throat inflamed; she swallowed with great difficulty and spoke with pain; respiration was strong, head and throat painful, pulse hard and frequent.
From these indications I proposed bleeding -- the physician consented, and I immediately performed the operation, and prescribed lemonade and a gargle made with water and oxymel [mixture of vinegar and honey], or one of honey and spirit of vitriol [sulfuric acid]. It was also agreed the patient should make use of the bath. On our return the next day she was infinitely better; the pulse had unfolded, and she spoke with more ease. As the fever continued, the heat was considerable, and the blood taken the preceding day indicated great inflammation. I proposed a second bleeding, which was performed by the consent of the physician. She was desired to continue the gargle and lemonade, to take creamed of barley or rice, a light mucilaginous diet, such as sago, tapioca, and the like. The next day we found she had quitted her bed, was in good spirits, without fever, and had no farther occasion for medical assistance. We advised her to take a common cathartic. I saw her no more, but heard her health was perfectly re-established, and she has not since felt the slightest indisposition.
I could cite many other cases of a similar nature, having seen and visited an infinite number of persons attacked with the same disease, and had the happiness not to lose any, except a child that was placed under my care at the last extremity.
Let it not be supposed, these observations are made as an apology for bleeding. I acknowledge having cured many without that help; although it was generally requisite, have often observed symptoms which forbid its use. I then substituted glysters, gargles, baths, lemonade, chicken water, skimmed milk, emulent, simples, and sedatives, and even sometimes used them in conjunction with the lancet.
If in the beginning of this unfortunate malady, recourse had been had to a similar treatment, I am convinced it would seldom have proved mortal.
But an ill-directed public often acted contrary to what was efficacious. The diseased were carefully shut up in close rooms, and covered with three or four blankets; their beverage was infusions of camomile, Madeira wine, and other inflammatory liquors, which increasing the disease brought the patients to extremity, having produced mortification and over-charged the brain. After death, the victim of this fatal practice had a livid appearance, and the vessels of the head and brain were in the same state as those who die with a fit of the apoplexy....
The same uncertainty with respect to the cause of this epidemic, gave rise, with no greater foundation, to the report of its being brought in by the privateer Sans Culotte.... I should never end if I was to relate all that had been advanced to prove the disease was imported; shall, therefore, pass on to those only which appear to me sufficient to demonstrate, that the complaint took its rise in this country.
The first cause of this scourge is the same which produces almost all other diseases, the alterations of the atmospheric air. This fluid, with which we are surrounded, is well known to be one of the elements that constitute the animal system; it is of all the most susceptible of modification; and which influences in the most powerful manner the animal economy, either by its weight or lightness, heat or cold, dryness or humidity, or the different qualities it is susceptible of, when charged with miasmata, which arise from every part....
When the atmospheric air is too light, it does not counterbalance the effort of the elementary air. People then experience a degree of debility and lassitude, which ignorant persons attribute to a cause opposite to the true one: the air or the weather, they say, is too heavy; whereas the uneasiness they feel is the result of a too great lightness of the fluids, which being rarified, augments the volume of blood, distends the vessels, forces them to give way by repletion, and prevents a free circulation; the lungs on their part deprived of the action afforded them by the outward air, are incapable of exercising their functions.
A patient in this situation would feel a weight upon the breast, with a quick and painful respiration, that would soon be followed by a spitting of blood, and death from suffocation. Such has been the effect some travellers have experience, whose zeal to make discoveries in natural history has sometimes carried too far, and who from the desire and glory of being useful, have climbed elevated mountains, without considering their strength, and uncautious of the danger to which they exposed themselves.
When the heat of the air is excessive, this elementary principle of life becomes equally pernicious; the blood is inflamed by being deprived to excess of its ferous particles, which evaporate through the skin; the stomach is relaxed, and incapable of performing its functions; the gastrick juice no longer retains the requisite qualities to promote digestion, or produce a chyle proper to repair the extraordinary secretions of the body; hence crudities arise, which weaken every organ, and the machine becomes totally debilitated. Such is the origin of the acrimony from which a great number of diseases take their rise.
The air may become still more fatal when filled with infected miasmata, which arise from every part. This corrupted air, if I may so name it, carries with it, when introduced into the body, the cause of many maladies, with which individuals are more or less affected, as their habit or constitution gives way or resists its morbific quality, or oppose the action of the venom; nor do I think individuals are equally affected, because it may happen the putrid miasmata being unequally disseminated in the fluids, may accumulate more in one part than in another; their being rejected, or retained, may also proceed from situations, such as the borders of rivers, the country, or forests.
It is thus that the air, more or less adulterated or modified, produces different effects, relative to the situation of places and present state of individuals, insomuch that those whose moral and physical termperament easily give way to the morbific cause, will fall sick the first, while those in a situation totally opposite will escape the danger; because nature by a perfect arrangement of the different parts of animal organization, neutralises and annihilates the principal causes of the disease, which act more strongly in the former, whose animal system is disordered. Often also we remark in those patients who are not totally deranged, a certain desire for some particular food in preference to another, a desire which is often the effect of a natural instinct that rarely deceives, and which a prudent physician, accustomed to the study of nature, will never fail to profit by, with the wisdom that inspires him with the knowledge of his art.
All this proves that the body, as I said before, gives way or resists, more or less, the morbific cause. From whence it results, that some though they resist long, are attacked in their turn; others are affected lightly, whilst it acts seriously upon a great number; which is a natural effect of an epidemic, that, from the causes I have indicated, shews itself successively in individuals, and with different gradations.
It is for want of having paid sufficient attention to the variety of effects proceeding from the same cause, that epidemic diseases have been looked upon as contagious; nevertheless, I do not pretend to say there are no diseases of that kind, but am of opinion they are not so common as in general thought.
A contagious disorder is that which is communicated from one person to another, by an efflux of miasmata spread through the air, without touching the infected body. This kind of contagion is called contagion at distance: the plague, and other similar maladies, are of this number.
Diseases are also called contagious when they are communicated by an infected person touching one that is not so, which goes under the name of contagion by immediate contact: such, among others, as the itch, &c. &c.
It results from this definition, that maladies, contagious at distance, are communicated to other bodies, surrounding the infected persons, by breathing the same air, which alternately passes into the lungs of those who live in the same place, particularly in close apartments; and then the malady may very well be characterised under the title of contagious disease. But if in an epidemic disorder those who continually touch the sick, those who without any preservative listen only to their courage and love of humanity, give themselves up to the care of the diseased, live in the midst of them, and breathe the same air; if these persons are not infected, it is clear the disease is merely epidemic, and not contagious. This was precisely the case in that we are now speaking of. I am the more pleased in relating my opinion, as it gives me an opportunity of doing homage to a citizen, who must be ever dear to his country for a zeal, courage, and virtue that has hardly an equal; a fact from which I fear no contradiction, and seems to me a certain proof that the malady, whose consequences were so fatal, was not contagious....
This disease, then, was neither brought in by men or vessels; it took its rise in the country; the cause which produced it, had long been acting on the animal economy. What proves the truth of this assertion is, that very few persons newly arrived were infected with the sickness....
The constitution, age, sex, the manner of living situation of the place in which they lived, the actual state of the humours, and passions of the soul, were the causes of the variations I observed during the epidemic.
I shall be asked, without doubt, from what cause the air and aliments were so far vitiated as to make them susceptible of engendering this disease? Although there often exists in nature effects, the causes of which are beyond the reach of human sagacity, I will nevertheless endeavour to present some, though without pretending to advance them as the only causes of the scourge which ravaged this city....
The general causes are known to all: the little cold during the preceding winter, and extreme heat of the succeeding summer, which was unaccompanied by the usual storms, to which may be added the fruit of the year being unusually bad.
Among particular causes we may reckon burying grounds in the midst of the city. These places of interment are injurious from the vapours which exhale from them and corrupt the atmosphere, and also by the miasmata which the rain-water carries with it, as it filters through the earth and passes into the wells. This water, used by the whole city, must be pernicious, and should be particularly attended to, if in the end those dangers are to be avoided which result from it.
There is another cause of corruption in the city -- the tan-yards, and starch manufactories, and also the quays, where at low water the mud is uncovered, from which a quantity of pernicious vapours arise; in short, the ditches with which the city is surrounded, from the earth being taken out to make bricks, where the water from stagnating during the summer, sends forth infectious exhalations, and also serves, as it passes through the earth, to carry with it corruption into the wells.
All these causes united must necessarily corrupt the blood, and give to the bile such a degree of acrimony as to become the principal cause of the epidemic....
The French patients under my care at the time and since the epidemic, were attacked, some with symptomatic fevers, diarrheas, dysenteries, inflammations of the lungs, or other internal diseases; many had dangerous wounds, and other chirurgical complains, which obliged me to perform the most serious operations and they were attended by the greatest success. There were also a great number of patients with diseases both external and internal, who occupied the same beds, blankets, pillows, and in short every thing made use of by the epidemic patients; yet never knew any of them experience the slightest symptom of the disease that made such ravages in the city of Philadelphia, in America.
Facts so convincing must surely dissipate every remaining terror, occasioned by the idea of the epidemic being contagious, and that even at a future period the clothes made use of by the diseased might communicate the malady. Some incredulous persons may perhap say there are no proofs of its not being contagious, since these patients, as well as those persons who escaped the epidemic, might not at that time be disposed to receive it. This objection might be easily answered, but I will content myself with observing, that among so many sick of other complaints at the hospital, and the great number of French who arrived here from the hospital at the Cape [François, Haiti], where they were in want of every thing, and afterwards exposed to the greatest misery, it is more than morally impossible not even one should have been disposed to receive the epidemic disease.
After these observations, extracted from a number of others which I made at Bush-hill and in the city during the disease, a judgment may be easily formed, 1st, of the nature of the malady; 2dly, how far my remedies were efficacious; 3dly, the contrary effect of those made use of in the beginning; and 4thly, that it was not contagious.
This fact being proved, it can no longer be doubted the epidemic took its rise in this country; and it appears indispensibly necessary to seek the cause, and proper means to prevent its return, or render the effects less fatal.
I should not think my intentions sufficiently answered if I did not offer a few ideas upon this important subject, and the means likely to preserve the city from the dreadful consequences of such a scourge. Puerile and critical minds will perhaps exclaim against my observations, but flatter myself I shall be made amends by the opinion of the philosophic and sensible, to whom there is not any think [sic] extraordinary or superfluous when the object is the good of mankind. I only propose general means as preventatives, for if an epidemic again appears, it will most probably assume a different form, and consequently require another mode of treatment.
The methods requisite to be observed relate not only to society in general, but includes each individual in particular.
That which belongs to society in general and public order, seems particularly to require, first, that the interior part of the city be cleared of tan-yards and starch manufactories; secondly, that the police particularly attend to the cleanliness of the quays and streets, to prevent the water stagnating in the ditches that are in the environs of the city, in cavities where buildings are erecting, and streets not yet paved; the same attention should be paid to the markets, to prevent green and bad fruit being sold: last summer I observed peaches, melons, and other fruits so far from their maturity, they could not fail proving very injurious. There is another cause, which in my opinion acts infinitely more on the animal economy, the prodigious number of burial places in the heart of the city. The vapours continually attracted from these places of corruption by the sun, infect the air, whilst the rain penetrating, washes in the graves the putrid remains of the bodies, and carries with it into the wells detached, infected particles, from which it could not be disengaged by filtration, in the short space it has to go.
After this remark, which I can only think of with pain, may not an individual say before he drinks a glass of water, "I am about to feed upon a being like myself, to swallow particles from dead bodies, and perhaps those once dear to me, and whom I still regret." Independent of other inconveniencies from burial places in the city, this reflexion alone is surely sufficient to determine upon following the example of almost all the cities of Europe; where, I repeat, experience has induced them to banish such places as they are capable of injuring the healthiest constitutions, and affecting them with the most fatal diseases. I have not dissembled, and am sensible how few will think with me. I expect the sarcastic laugh of the half-learned critic, and persons much attached to their own opinion; but as I have already said, philosophers will know how to value my reasons, and desire of being useful to society.
I think among other means proper to prevent this inconvenience, a fire-pump might be placed on the river Delaware, to raise water into the city, which should be conveyed into fountains properly situated, for the convenience of the necessaries of life. A quantity of healthy water might easily in future be procured from the Schuylkill, by means of the canal upon which they are now at work; whilst that from the pumps would only be used for domestic purposes and in cases of fire.
Before such establishments can be formed, or any good arise from them, I would advise those to whom it is convenient, to have the water they drink fetched from the river when the tide is down, and put in earthen vessels to settle, or, which would be better, let it pass through a filtering stone. Such are general means that appear to me most necessary for the healthiness of the city.
The particular means which regard individuals only, consist in some precautions. The most necessary is to fortify the mind, and resist as much as possible the fears naturally inspired by epidemics. This emotion of the soul disorders the mind, effaces reason, and occasions in the whole machine such a commotion as to influence the animal economy, and injure the health. It is therefore highly necessary to resist this childish fear, which cannot cure, but may render the body more liable to disease. Excess of every kind must also be avoided; the air of houses and apartments continually changed, and every thing kept in the greatest state of cleanliness. This neatness consists in the frequent change of linen, bathing often in summer, washing the mouth every morning and after each meal with water and vinegar.
I cannot finish these reflexions, and pass unnoticed those little bags of camphire, and spunges filled with vinegar, that were so generally made use of last autumn; and do not pretend the means were not salutary, but the manner they were used in was pernicious: the mouth and nose were so closely pressed, as totally to interrupt respiration for a time, which must naturally produce the most fatal symptoms. The air, that humid and fluid substance, that serves for respiration, loses its elasticity, and is easily corrupted by the acrid humours drawn from the lungs; this humour mixed with it produces a stimulating quality, which excites in the bronchiae, and other aerial vessels, a contraction that prevents a free dilation of the lungs, and circulation of the blood, from whence the worst disorders may proceed. Those who place confidence in this means, should use it with moderation, to avoid finding a source of disease in the real principle of life.
Such are the reflexions I think a duty to lay before the public. From what I have seen, observed, and studied, I have acted agreeable to my knowledge and capacity. If my efforts and zeal have been crowned with some success -- if the result of the observations I now present to the public is useful, my end is attained and shall be happy of any opportunity I may have of being [useful] to my fellow-creatures.