Consumption was an illness which had global distribution and extremely long disease states of constant change, often with unpredictable periods of remission and return. The decay associated with this disease was usually related to the ongoing loss of lung and neighboring chest cavity tissues, a stage in this illness that made death appear to be more a blessing than a curse, the release of an imprisoned soul and spirit from a body laying waste to contagion. For this reason, Osborn’s began with work on the Consumption and the ways it which is proceeded to become numerous other forms of illness in the body. Osborn’s theory for this disease and its relationship to the other diseases that followed this portion of his manuscript suggest that he felt he had a fairly reasonable understanding of this condition, enough to help him through the requirements for improving the condition of its patients.
Unlike consumption, understanding fevers was a completely different matter. This type of medical condition had numerous ways of presenting itself, none with any immediately obvious cause that could be identified. A physician could consider it to be the result of the fire within, but the exact cause for the release of the heat or fire no physician was ever that certain about. For this reason, and due to the fairly well-distributed nature of the fever around parts of the work with local water bodies and high humidity, the “miasma” produced by these waters was often considered to be the cause. This miasma was usually linked to the foul smell the local swamps often produced, these fumes and mist considered to be a poisonous vapor.
Like other physicians for the time, Osborn viewed the fever itself as the disease, possibly linked to the local miasma or effluvium. (Currently we consider fever to be a symptom.) Since Osborn and others never really knew the cause for this unhealthy condition, or the truest source for this “miasma” (quite often the mosquito), the focus for treating these patients was to first come to a better understanding of its different forms that are presented, and then use these to define the most effective therapy.
Just prior to and during Osborn’s life span, entire books were written about fevers, most of which focused on just a few unique symptoms that helped differentiate one type of fever from the next. Based on this method of review, a fairly simple method of classifying diseases was developed. The simplest of fevers, without any cycling or periods of intermittency between periods of hot temperatures, was simply referred to as the constant fever. This was completely different from fevers which expressed themselves in cycles of fever followed by normal temperatures, a condition known as intermittent fevers. The most complex fevers were those that demonstrate cycles of varying lengths between fevers and intermittent sweats, a fever type referred to as ague, for which there were 1-day, 2-day and 3-day agues.
Other signs and symptoms that helped physicians understand the complexity and recognize their theoretical causes included the patterns for discoloration of the skin. With yellow or bilious fever, the skin turned yellow. The development of pock-like markings on the skin was referred to as spotted fever (later called typhoid). The initiation of tight, painful muscle contractions in association with the condition led to the name of breakbone, bones-set or dengue fever. When a fever occurred as a side effect of another condition, the disease was still considered and treated like a fever, and assumed to be an additional manifestation of another problem already making the body ill. Fevers due to no identifiable events, like those associated with influenza, may be considered a condition brought on by a tightness of the chest, brought on by uncontrolled passions or nervous excitement, and in the worst of states perhaps even “asthma.”
To understand these differences between fevers, Osborn had to both observe patients with this condition and have some sort of source for information on how to differentiate these conditions from each other. According to his vade mecum, he indeed had already reviewed such a writing, Thomas Sydenham’s discourses on fevers. Sydenham’s work on this topic was written during the mid-1600s, and was published in Latin. It is unlikely Osborn knew much Latin beyond what he had to learn as a part of his training in the apothecary, in which case, he only learned the Latin so he could write out the prescriptions according to traditional and professional expectations. More than likely Osborn read a translated version of this book, recently produced and published and authored by another individual Osborn refers to in his vade mecum, James Shaw.
It is also possible that Osborn saw another essay on the fevers written by yet another of his favored medical writers–Daniel Turner. Around 1715, Daniel Turner produced a treatise devoted specifically to the patterns which fevers tended to follow. It is possible that if Osborn had passed by or been associated with the Yale College and its library, that he may come in contact with this reference, or had a mentor or professional acquaintance familiar with the Yale Collection. Around 1720, Turner donated some of his works to the Yale medical library to help in the plans to establish a formal library of medical books .
Another possible way for Osborn to become familiar with the fever was by way of reading the treatise on fever produced by John Huxham, another of Osborn’s recommended writers. Huxham wrote the most important book on fevers for his time, again in Latin, entitled AN ESSAY ON FEVERS And their Various Kinds As depending on Different Constitutions of the Blood with DISSERTATIONS ON Slow Nervous FEVERS ON Putrid Pestilential Spotted FEVERS ON THE SMALL POX AND ON Pleurisies and Peripneumonies (2ed, 1750). This book was published just in time for Osborn to review or learn about, just before he began writing his manuscript. With this book Huxham revealed the secrets of distinguishing between the different fever types, based on their cyclicity and sweating patterns, helping doctors to distinguish when the use of cinchona or Jesuit’s bark was more likely to be effective at treating fevers–when they were the agues.
The Topography of Fevers
Osborn’s understanding of fevers and their treatments was not as limited as we might expect based on his tendency to rely upon and emphasize medical writings from about the 1720s to 1730s. He was just a decade off in his readings of the more important texts for his time on this and other medical topics, and due to his experience in the local field and local environment, probably had an edge on other physicians trained in Europe, whose knowledge was considerable but whose clinical experience in the New World was lacking.
Fevers are the most geographic of disease patterns commonly known about and discussed during Osborn’s lifetime. There is a possibility that this common knowledge was in fact a part of Osborn’s thinking, even though he never mentions the relationship between local fevers, the land and the environment, or the notion of ‘miasma’ and fevers, a very ancient philosophy for fevers first defined by Roman architectural writer Vetruvius during the 1st century AD. This possible mechanism of disease was perpetuated in the writings of Greek physicians, alluded to in many writings of the Middle Ages such as the works of Aurelianus Celsus, and came to be associated with the similar concept–effluvium–a natural smelly and often obnoxious substance that can be emitted by the surface of disease-causing water bodies and other unhealthy materials of the earth to occasionally emit their stench from the vents and the hollows of the earth. This belief in effluvium would ultimately give way to the definition of phlogiston, the idea that a substance emitted from the body into the air, and which was often considered related to the ability of the air to support fire, could be the cause for disease by preventing the air from creating a fire. (This is an example of reversed logic used to explain the observations Robert Boyle and others had made in the laboratory–they felt phlogiston extinguished the fire as it was emitted from an object undergoing combustion; instead, it was the simple loss of oxygen, which would not be discovered for quite some time.)
As evidence for Osborn’s possible belief in the miasma or effluvia, we need to simply consider the location of his house in the Fishkill area. Osborn’s home is located slightly up the south face of Osborn Hill, right at the corner of Baxtertown Road and the Jackson Street-Osborn Hill Road junction. His house was positioned slightly above the swamps and marshes to the east, and the broad Fishkill Creek Floodplain to the south. The elevation of this place was just enough to reduce the likelihood that some sort of miasma or effluvium could make its way into his house from below.
So how did Cornelius Osborn know so much about this? I suspect this was due to his activities with his father, James Osborn. James Osborn was responsible for surveying the western shoreline of the Hudson River. More than likely he would taken Cornelius along with him on some occasions–we know this because it ends up that this was also how and why Osborn met up with and later married Helena Parmentier–who resided at the north edge of this territory James was mapping. During these travels, James would have taught Cornelius about this unhealthy feature of the Hudson Valley. At the time, James Osborn was simply trying to produce a map of the region, in order to determine the best places for roads to be laid along which future villages and hamlets could be built. More than likely this is how Cornelius Osborn knew to stay away from the swamps and marshes associated with the worst local diseases and epidemics. Thus his choice for land just across the Hudson River.
The Vade Mecum Recipes
Osborn’s discussions on fever begin with “Ye Fever, an Ague, ye Cure.” This is the discussion of the most epidemic form of fever for the time–Malaria. Malaria is a disease brought in from southern, tropical settings by means of the shipping industry. But Osborn along with nearly all other physicians knew nothing of this. To Colonial physicians, this particular fever was a consequence of something taking place locally, for it did tend to show a tendency to occur in certain types of locations. The impacts of weather and climate on the dispersal of the Ague Fever seemed to be considerable. This fever died out each winter, but came back in the spring or summer at different times each year. Between groups of cases, weather seemed to play a factor in determining whether or not the disease would return. Recent rains and moderate to high temperatures were required for the Ague to set in once again, regardless of shipping habits and individual behaviors and living spaces.
Osborn’s treatment for the Ague Fever was to induce emesis, and then give one or more of several proprietary medicines–Ferdinand’s Powder, Tully’s Powder, and then Macleen’s Electuary. If ineffective at treating and preventing the sudden acute attack of the fits and chills, then he recommends Tincture Peruviana, either in the form of a tincture he himself has made, or a product obtained as a proprietary item. The intermittent nature of the fever meant that there were periods when no fever or chills existed; this implied that the fever was ready for the cure produced by Tincture Peruviana. Osborn goes on to differentiate the 3rd Day ague from the others: start with the vomit, then give the same recipes as stated earlier, but with the exception of not providing these treatments when the fever is taking place.
Much later studies of malaria demonstrate that the different intermittent periods and periods of time between ague were due to different places and the mosquitoes/pathogens associated with the disease. Unknown to Osborn and others, the cyclicity of the Ague fever depended a lot on the biology of the organisms (Plasmodium protozoans) responsible found in each mosquito carrying the disease. This along with other mosquito-born fevers would not become understood by physicians for several more generations to come.
The second type of fever Osborn was able to define very well was what he called “Continual Fever.” This fever lacked periods of no fever accompanied by chills and trembling. This fever he obviously attributed to excessive fire or heat in the blood. Unlike his treatments for the different Agues, Osborn recommends bleeding for these patients. He begins by putting the patient on an emetic, like before, but the goes on to recommend febrifuges like the Composition Powder of Contrayerva. The purpose of the therapy here is to maintain the sweat. Biologically, as we know, this cool down a patient due to evaporation, but to Osborn this was probably interpreted as being successful due to the elimination of phlegm and the opening up of more space for the other humours to travel. This migration of the humours would then result in a dilution of the hotter portions of the body’s blood and other substances and thereby dissipate the heat. Osborn recommends the use of Sage to continue the cooling process, followed by two salts (?) which he considers “Coolers” — Sal tartar and Sal Nitre.
Upon cooling the fever state (intermission), he then suggests Cortex Peruviana (Peruvian bark). Whether or not it matters if the Peruvian bark medicine is administered in tincture form or as a decoction is uncertain based on this description.
Osborn next recommended “hard clapping” blisters onto the patient. These blisters, filling with white humours (phlegm, but in actuality, as serum and a little albumin from the blood), then move the humours more into the right places.
Osborn notes the tendency for some patients to develop “traction or twisting of the sinews” in some of these Continuous Fever cases. This is probably his way of describing typhoid fever. There was a little difficulty with trying to differentiate typhus from typhoid fever during the early 19th century. The same problem exists for Dr. Osborn as well. In the simplest sense, Osborn’s nervous fever could simply be a case in which the prolonged fever resulted in a state of delirium, stupor, and cognitive disorder. But once the twitching nerves and sinews become a pronounced symptom, we are probably talking about typhoid fever, caused by Salmonella typhi or S. paratyphi. This is very easy to detect based on the development of rose spots on the skin (spotted fever) and a deep sounding gurgling of the gut known as borborygmus.
The remaining types of fever, not directly inferred by Osborn’s writings but which he may have seen regularly, are dengue fever or spotted fever and the influenza with fever.
Dengue fever would have come in as a result of slave trade and global shipping trade involving the tropical settings of Central and South America, the Orient, and Africa. Aside from generic symptoms such as headache, joint and muscle ache, fatigue, nausea and vomiting, the primary symptoms of this disease are lymph node enlargement, dehydration and in long term cases convulsions and death. The initial presentation of this type of fever may have appeared to Osborn to be another “nervous disease.” A ‘traction or twisting of the sinews’ without convulsions and death would imply dengue fever beginning to take form. Without this diagnosis yet defined (differentiated in 1779 as breakbone fever), Osborn would have considered it another version of the nervous fever.
Influenza with fever is simply influenza. Whereas febrile diseases like Malaria, Yellow Fever, Typhoid, and Dengue are due to organisms being spread by mosquito (different species however for each fever type), influenza does not require mosquitos and therefore is not impacted by climatic and meteorological factors, or spread by vectors that are dependent on certain climatic conditions. Influenza can occur any time of the year, but does have a certain seasonal behavior that became more pronounced in Hudson Valley history during the late 1700s and early 1800s (see Shadrach Ricketson’s biography on this site). Since this form of febrile disease is easily spread in aerosol form (very small sputum droplets released through coughs), it tends to be a disease more apparent and prevalent during the colder months when indoor living and socializing is preferred.
Again, Osborn does not differentiate this fever from the rest. To him, it is simple another form of continuous fever, treated as so described.
In his final recipe for treating Continual Fever (“8ly”), he refers to the Radix Virginiana Serpentina (Virginia Snakeroot). This is the famous Virginia Snakeroot popularized earlier by a number of writers by the 1720s, but made famous locally due to Jane and Cadwallader Colden’s work on botany. The Coldens resided just across the River.
Osborn likened the value of Virginia Snakeroot to the value of the traditional favorite–Contrayerva (Dorstenia contrayerva or D. brasiliensis) from South America. The Contrayerva became famous in Europe due to its use by Dr. Nathaniel Hodges (1629-1688) to treat the victims of the Great Plague of London. The success of his work led to the subsequent publication of the Hodges’s book Loimologia, sive, Pestis nuperæ apud populum Londinensem grassantis narratio historica (1672), in Latin. But Osborn was probably familiar with it due to the more recent translation of this work published in 1720, Loimologia, or, an historical Account of the Plague in London in 1665, With precautionary Directions against the like Contagion.
The slight to moderate differences between the different fevers, and the tendency for Osborn to once again write about the different forms, as if they are due to some problem moving about the different parts of the body to cause the symptoms, suggests he is once again focused on some sort of humoural-based ideology for defining fevers. It is not so much the humour as it is the heat that his treatments focus upon. As suggested by the names for their generic uses, such as coolants, cooling powder, and febrifuges, fire was the cause and so required that the physician try to cool the body and induce a sweat. Then, the goal of the doctor was to determine whether or not a cupping or a bleed was required , and whether or not peruvian bark was to be recommended in the near future. Obviously, the earlier and more immediate a fever is eradicated, according to Osborn’s thinking, the less likely this fever or its causes will migrate to other tissues, such as the muscles, nerves and the brain. Such a transition would make the fever more physically and mentally incapacitating, and more importantly, help to turn it into a more deadly form of fever like that assocaited with the Black Plague.
Osborn’s ability to differentiate the fevers from other diseases which he had already defined causes for is also uncertain. To Dr. Osborn, the dengue fever for example might consist of two conditions, the shingles or St. Anthony’s Fire (see on other page), and continuous fever. The small pox may have been considered much the same way as the measles, only worse and more fatal. This inability to differentiate many of the cases is a common problem in colonial medicine, regardless of the education a physician might have received. Cadwallader Colden’s discussions of disease indicate that he faced much the same dilemma. He likened a possible diphtheria epidemic in Kingston in 1737 with the measles and small pox previously noted in Boston, considering each to be different forms of the same cause and problem. Since Osborn was pretty much a “skin-out” physician (see Daniel Turner on this), who viewed his patients more like Sydenham and less like an anatomist and pathologist such as Robert Hunter or Giovanni Morgnani.
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Brian Altonen, MPH, MS 
