Let's clear the air of that nocturnal miasma. Cigar anyone?

Ever since they could remember, Thaddeus and Alexandra enjoyed listening to their father’s accountings of mysterious illnesses —assembled stories that were meant to be enlightening and entertaining. Some were told them by their father, others by their grandfather; still others had been acquired from friends and acquaintances located throughout the world. And then there was their extensive reading of the medical literature. Now that Thaddeus was a junior in medical school and Alexandra hoped to soon follow in the family tradition, these stories took on an even greater fascination — each hoped to become a medical detective in real life. Home for the holidays on this cold winter’s evening, December 21, 1990. Thaddeus and Alexandra had earlier seen their younger sisters to bed. They now sat on the couch with their mother Elizabeth, a former nurse, who eagerly awaited tonight’s puzzle ready to add her own perspective to the health care dilemma that would unfold. As was so often the case when he told these stories, Theodore Conrad was nestled in a well worn armchair, his trusty pipe emitting a smokey tendril and distinctive fragrance in keeping with his long-time favorite cavendish tobacco. And then there were story titles laced with his own brand of humor. Tonight’s story, he suggested, with a twinkle in his eye, would be titled ‘‘Let’s Clear the Air of That Nocturnal Miasma. Cigar Anyone?’’. It began in Philadelphia, Pennsylvania, in August of 1793. August, 1793. Philadelphia, the Colonies’ capital, was in the midst of an epidemic similar to those of 1699, 1741, 1747 and 1762. This time, one tenth of the city’s population would die of the mysterious illness. Death was often preceded by black vomitus, considered a most deadly contagion. What caused this illness and from where did it arise? After a 30-year hiatus when had it arrived and by what means? Was it imported by vessel from ports in the West Indies? Why had it appeared so suddenly, so mysteriously, and killing so mercilessly? The origins of the scourge were obscure — contagion was considered most probable. Some thought it emanated from a nocturnal miasma that appeared in low marshy places borne by a swamp breeze, like the moist sultriness of a tropical jungle. Perhaps it came from morbid exhalations of organic decomposition found in gutters and wharves, like the putrid smell found along Water and Front Streets. The mayor ordered a purification of the atmosphere and cleansing of the city. Bonfires dotted streetcorners to eradicate fomites belonging to the ill; cannons were sounded periodically to clear the air. Warding off evil humors, women and men alike smoked cigars to the point of intoxication; they chewed garlic and carried vinegar or camphor-soaked sponges at their mouths when leaving their homes; tarred rope was worn at the neck or waist as a talisman. Dr. Benjamin Rush, one of 5 physicians to affix their signature to the Declaration of Independence, would chronicle the city’s epidemic. A majority of patients had fever, some to profound levels. In response to the miasmata, Rush divided cases into 3 categories: seOere, accompanied by coma, languor, a weak, slow pulse, and a disposition to syncope; moderate, with headache, delirium, vomiting, thirst, and quick pulse; and mild, often found in suburbs. In vivid and compassionate terms, Rush wrote of the devastation that affected entire families, rich and poor alike, and frenzied masses that crowded Philadelphia streets fleeing the city in every direction.This deadly malady had and would continue to ensnare other ports along the eastern seaboard, including New York, New Haven, Boston and Baltimore. The illness disappeared with October’s rain and frost; peace and tranquility were restored. Elsewhere in the Americas this illness would also claim many lives. In 1794, one half of the 12,000 man English army that occupied the West Indies would succumb. In 1798, 90% of the 24,000 member French army in Santo Domingo was lost. Spanish soldiers, who managed to survive the illness in the Caribbean, brought it home. Deadly epidemics followed in Barcelona and Seville. In the 19th century, ports along the Mississippi Valley and