mestic purposes by the inhabitants, and when filtered is very sweet. The well water is very brackish, and unfit for use. The river at this part is about a mile wide. The ground on which the city stands is, as already observed, a soft loam, and it is laid out with much regularity in squares, the streets running at right angles. The levée on the margin of the river is wide, and answers the purpose of a quay or wharf, along which the vessels lay in tiers, and pass their cargoes over each other. The nearest vessel at this season lies some distance from the levée, owing to the shoalness of the water; the bank forming a steep inclined plane from the levée to the middle of the river. A great part of this bank between the vessels and the levée is laid bare by the recession of the water, when the river falls very low, which was the case this season. It is covered with filth of various kinds from the vessels, and the city, most of which is deposited there during the night; which, together with a vast quantity of decaying vegetable and other matter brought down the river with the current, and lodged here, forms an immense mass of putrifying materials, that continually exhales most disgusting and noxious effluvia.

The streets are unpaved, and have on each side, at the margin of the walks, wooden gutters, to convey off the water; but owing to the want of declivity, the whole city being completely level; the water, with the filth which is thrown into the streets, collects in them, and generates much foul air. Such is the nature of the soil, that after heavy rains, many of the streets are impassable for carriages, and very difficult even for foot passengers.

Another great source of the unhealthiness of this city is, no doubt, to be attributed to the marshy land surrounding it, more especially that above and behind it, which constantly exhales pernicious miasms.

The grounds back of the city are always more or less covered with water, and in the rainy seasons particularly so, from the nature of the soil and the low situation. When Vol. 6.

2

graves are dug in the burial-ground, which is situated in this swamp, they are almost immediately filled with water, so that the coffin floats when placed in the grave. Those who can afford the expense, have brick tombs erected above ground, in which the body is placed. The custom of following the dead to this place of interment, may have conduced to the sickness of many. Several of my patients sickened immediately after performing this duty to their deceased friends. The house in which resided a family whom I attended, and in which the fever was peculiarly mortal, was opposite, and not far from this part of the swamp.

As is often the case in warm climates, imprudent exposures are frequent, and excite attacks; the custom of sitting out of doors is much practised in the cool and damp evenings, which are very grateful after the heat of an almost vertical sun during the day, but produce chilliness and languor from the dews and fogs arising from the morasses in the vicinity. These exhalations, being no longer suspended in the higher regions of the atmosphere, descend, and hang over the city, which seemed sometimes enveloped in them, producing disease in those who will purchase a momentary gratification, at the risk of health and life. The most malignant case I attended was induced in this way, and came on in the morning. My own attack was also in the morning, after sleeping on the deck of a vessel the preceding night.

From this statement of the situation of the place, we may perceive that different local causes exist in the city and its vicinity, without resorting to importation or contagion. The line at which this pestilence begins, and along which it spreads, viz. the Levée; and the devastation it occasions among those employed among the shipping, would seem to point out its origin to be at New-Orleans.

It may be doubted, perhaps, whether animal putrefaction alone is competent to produce the disease. The smell from the point opposite the town, where the cattle are slaugh

tered, and where the butchers reside, for they are not allowed within the city, may be perceived from the middle of the river, and resembles that of a dissecting room; yet the fever is said never to occur among them; and it is impossible but that they must be often exposed to its contagion, living so near the city, were there any danger of taking it in that way. The meat too in the butchers' market, after hanging a long time, exhales the same smell; yet I could not find that those who attended the market were more unhealthy than others.

The diversities of practice, all of which sometimes fail in this disease, would seem to prove the insufficiency of medicine in overcoming it; but this must be attributed to the malignant and varying character of the symptoms, which would seem to indicate to the practitioner to vary his remedies accordingly, following up the state of the system, and marking peculiar idiosyncrasies. For if always we judge of the state of the system by indications drawn from other diseases, we should be frequently led into error, mistake a debilitated for an oppressed state, and bleed when we should stimulate, or vice versa. The failure of the most opposite plans of treatment was often observed, and was conspicuous in one family in which I attended, and in which the disease was peculiarly fatal, leaving but three persons, two of whom were not sick, though in constant attendance on the others. Different modes of practice, pursued by different physicians, proved ineffectual. The one that recovered had but a slight attack,-from which many would be led to conclude, that none but slight cases recovered, and such as would have done well without medicines; but from what I experienced in my own person, as well as saw in others, I am disposed to dread so sweeping a conclusion against our profession.

Venesection, when resorted to early, promptly, and fully, was most beneficial, and obtained at least a temporary mitigation of the symptoms, relieving, for a time, the excruciating pains, and restoring disordered intellect. I re

gret to say, however, that it did not always save the patient: for the pains, &c. would frequently return, and falling suddenly with fury on some vital part, (generally the brain,) relieve the patient from all future suffering. All the cases which terminated favourably, were bled freely; and I never had reason to regret using the lancet, though I had for forbearing its use. If a full, frequent, and tense pulse did not indicate it at first, the use of that remedy would produce that indication, so that the state of the pulse could not always be relied on, since the most opposite states called for the same remedy. It was an excellent plan to bleed for pain, although no other symptom should indicate it. Never shall I forget the relief from pain I myself experienced from its use.

Emetics, which have been generally decried in this disease, I used in two cases without any disadvantage; both of which recovered. I am, however, by no means inclined to recommend the practice. Cathartics.-The obstinate constipation of the bowels called for powerful and repeated purges, as well as enemata. For the former, the Sub. Mur. Hydrarg. and Jalap, I found the most effectual, and in much larger doses than ten grains of each. I gave to one patient the amount of two drachms at one dose,--he recovered with a slight ptyalism and purging. I most commonly resorted to it; and if it produced both these effects, so much the better. By giving the medicine in these large doses, I did not find the chance of producing ptyalism so much diminished as is generally supposed. It often occurred, indeed, although vomiting was in the first instance induced. But I did not depend so much on ptyalism towards the close of the season as at first, it not having answered the expectations I had been taught to look for; and I regret to say, that it did not always save the patient,-for sometimes it produced an ulceration of the gums, which was always fatal; and in several cases, where the mercurial action had taken place, and no ulceration followed, the patient sunk under a renewed assault of fever, the ptyalism receding, notwithstanding

calomel was continued. These cases induced me to think, that where ptyalism follows the diseased action, and a recovery succeeds, the mercurial, occurs only because no longer opposed by its adversary; and that post hoc ergo propter hoc, is too often applied here, as elsewhere. It appears doubtful, at least, how far we may calculate on the mercurial agency to produce a solution of the fever; and that when its peculiar effects are substituted for the disease, they are not always powerful enough to prevent its recur

rence.

The ptyalism itself, is to be considered rather as an effect than a cause; and, as such, indicates the absence of the disease for the time. It may be suggested too, perhaps, that where it has not the power to overcome and substitute its own peculiar action in place of the diseased one, that, like every other stimulant, it may add vigour to the disease.

I do not wish to depreciate this "Sampson of the Materia Medica, but merely to suggest my want of dependence on it in all cases of this fever. A more extensive observation may, perhaps, change these views. Purging, kept up until the stools became light coloured, was always necessary; for which purpose the calomel was the best, and next to that the Ol. Ricini. Saline purges did not appear to be of service: they debilitated the patient, without evacuating the fœtid contents of the intestines. Calcined magnesia proved of essential service in obviating the effects of the acrid matter ejected from the stomach, on the fauces, and perhaps too on the stomach and bowels.

Enemata were of great service in giving the first impulse to the cathartics, as well as in keeping up the evacuations; yet to trust to them entirely, would prove fallacious. The common brown turpentine soap was very useful, used in this way; and the Ol. Terebinthine was also serviceable in the latter stage.

Cold Affusion.-At the instance of my friend, Dr. Mercer, I made use of this remedy twice in my own case, and