D The infide of the aneurifmal fac every where incrufted with bone. E The orifice of communication between the artery and the aneurifmal fac. CC The brachial artery. F Dotted lines reprefenting the fituation of the artery under the fac. The artery was not enlarged nor in any refpect difeafed. To DR. JOHN REDMAN COXE. DEAR SIR, F you think the publication of the enclosed letter, in your Museum, will promote the interest of medical science, it is at your fervice. August 23, 1804. BENJAMIN RUSH. PHILADELPHIA, 18th Auguft, 1804. DEAR SIR, AGREEABLY to your request, I fhall attempt to give you fuch information refpecting the bilious remitting fever, which prevailed at Lifburn and its vicinity in the county of Cumberland, in the fummer and autumn of 1803, as I can recollect, that may be worthy of note. This village is fituate upon Yellow Breeches Creek, about fix miles weftward of its confluence with the Sufquehannah, and contains about thirty dwelling houfes. In its vicinity there are two extensive marfhes, connected with large mill and forge dams, abundantly ftowed with materials fubject to putrefaction. Intermittents, choleras, and diarrhoeas, were the prevailing forms of disease in the months of June and July: cholera infantum proved fatal to a few. A fore mouth was, I believe, almoft univerfal. I do not recollect any cafes of a malignant nature, till toward the latter end of Auguft, at which time the exhalations from the marshes had become extremely offenfive. As ufual, this fever commenced with a chill accompanied with nausea, and most frequently a vomiting of bile. It fometimes, however, was ushered in by a diarrhoea, but most commonly the bowels were conftipated. A delirium, in most cases, continued from its commencement to its termination, which, in those that were violent, was mostly on the third day. A flight yellowness of the fkin appeared in a few cafes that came under my notice about the termination of the inflammatory stage: I do not know that it was an indication of danger. A burning fenfation in the ftomach was general. The pulfe was usually full, frequent, and feldom very tense. Flushing of the face, and inflammation of the eyes were fometimes among the earliest of the fymptoms. Coma alfo occurred early in a few cafes, which, notwithstanding, terminated favourably. Few cafes appeared to require copious depletion with the lancet; but in one cafe that I was called to, where there was apparently great proftration of the energies of life, the pulfe indicating depreffion, the loss of a very few ounces of blood happily unlocked the fyftem. Calomel combined with jalap and given in large dofes, was the most powerful remedy in my hands. I alfo gave the carbonate of potash in frequent dofes, I think with good fuccefs. Often did I reflect with gratitude upon the principles which I had imbibed in this univerfity, as they enabled me boldly to encounter, and in most cases to conquer this infidious and formidable disease. I am very forry that I can offer you nothing more fatisfactory upon the subject. I kept notes of all the particular cafes, but I have not now those notes to refer to. I alfo procured from intelligent perfons, who were eye-witneffes, a hiftory of feveral cafes of the highest maliginity that occurred fince the year 1800. The diffolution of these, (which occurred on the third day) was preceded by black vomit, of the colour and confiftence of coffee grounds, and their skins were tinged of a deep yellow hue. A cafe of this kind occurred the late season, about two miles diftant, which I did not fee. In one case that I was particularly informed of, buboes made their appearance. But from what I saw myself of this fever, I was completely satisfied that it was nothing less than a fever exactly similar to that, which has fo frequently made its appearance in this city, and is faid to be derived from foreign fources! If the above cases should be deemed fufficiently characteristic of true yellow fever, by an advocate for importation, I would ask him by what poffible means it could be introduced? If he should plead that it was only a high grade of our common autumnal fever, I fhould rejoice to know how it is to be diftinguished, for furely with respect to its mortality there is no difference. With ardent defires for your health and profperity, I conclude, and am, Your fincerely affectionate friend. WILLIAM BALDWIN. BENJAMIN RUSH, M. D. I To DR. JOHN REDMAN COXE. DEAR SIR, PHILAD. August 30, 1804. AM forry it has not been in my power to comply fooner with your request for information, respecting the fuccefs attending vaccination in the medical department of the Almshoufe this feafon; but shall now, from the few notes that I have in my poffeffion, briefly ftate the general event of those cafes that fell under my in pection. My period of attendance at the house, commenced with the month of March; and at that time there were one or two cafes of natural fmall-pox in the infirmary. We foon after this began to vaccinate those who had not been, as we then believed, expofed to the varielous contagion, and thofe who had been thus expofed we inoculated. The refult, was nearly as follows. Of fifty-four perfons, chiefly children, forty-eight were vaccinated, and fix inoculated. But unfortunately, eighteen of those who were vaccinated, having been previously expofed, by fome means, to the variolous infection, took the small-pox. The variolous eruption appeared on eight of them in feven days, on three in fix days, and on one in ten days after vaccination. But none of those who had completely gone through the vaccine procefs, during this or the last year, took the small-pox. Upon the whole, I believe we may with confidence affert, notwithstanding any exaggerated accounts which may have been in circulation to the contrary, that nothing has occurred at the infirmary of the Alms-houfe, which ought in the smallest degree to leffen the public confidence in the efficacy of vaccination, in fecuring the system against the attacks of variolous contagion. This statement has been drawn up very haftily, but if you conceive it can be of any fervice, in obviating the effects of mifrepresentation, it is at your service, to make such use of as you may think proper. I remain, very respectfully, THOMAS C. JAMES. In addition to this important document, which must sufficiently expofe the malicious falfehoods that have been fo industrioufly propagated, refpecting the fuccefs of vaccination in the Almshouse of Philadelphia; it may be proper to mention, that there is great reafon to believe, fome of the enemies of this invaluable bleffing, among the numerous quacks with whom this metropolis, (much to its difcredit,) abounds; have taken the moft wicked steps to oppofe its progrefs. One of these, (though |