On Spafm in Fevers. 8s FOR the MASSACHUSETTS MAGAZINE. A Dissertation on the causes and effects of SPASM in FEVERS.—By Dr. Nathan Smith. (Concluded from page 35. J SEC T. III. WE have hitherto treated of the caufes and effects of fpafm in fevers, from the firft attack of debili- ty in the fyftem, to its final refolution. It now remains to inquire after thofe caufes of debility which we havecon- fidered as the remote caufes both of fpafm and fever. We can only judge of the nature of thofe debilitating powers by their effects, and although they are very various in this refpeft, yet as they all agree in this, that they all produce fome degree of debility in the fyftem to which they are applied, they are properly denominated debilitating powers. The fource where many of thefe re- mote caufes of fevers fpring are fuf- ficiently afcertained, while others are involved in obfeurity ; this is the cafe with the remote caufe of the late in- fluenza, of which I purpofe to treat, with a defign to inquire after its ori- gin ; but previous to an inquiry of this kind, it may not be improper to give a fhort hiftory of that difeafe. The influenza is what Dr. Cullen calls a contagious catarrh, and belongs to the order of profluvia. The fymptoms of this difeafe may be divided into two kinds, common and proper ; the common fymptoms, fuch as are common to it and ev- ery other febrile diforder of this kind, is the debility in the beginning of the difeafe, fucceeded by fpafms, reac- tion, increafed fecretion and excre- tion of bile, &c. The proper fymptoms, fuch as are peculiar to the influen- za, and diftinguim it from every other difeafe of this kind, are an inflamma- tion of the lungs, attended with cough, expectoration, Sec. an inflammation of the membrane of the nofe and eyes, accompanied with a difcharge of mucus. Dr. Cullen has marked but one fpecies of this genus of diforder? arif- ing from contagion ; that there are more may be thought uncertain, but to me it appears probable. /'•/. ///. Feb. 1791. C The influenza which prevailed in the autumn of 1789, and that in the fpring of 1790, exhibited appearances fo far different, as to induce phyficians to think they were different difeafes. The former agreed exactly with the contagious catarrh defcribed by Dr. Cullen ; the latter did not affect the membrane of the eyes and nofe fo re- markably, it was attended with great- er debility, more bile in the alimen- tary canal, higher fever, a more vio- lent pain in the head, back, and limbs, and I think it proved fatal to more people than the former. It may be urged that the difference between the two above defcribed dif- eafes, proceeded from the difference in the feafons of the year in which they occurred ; but we do not find that difeafes are effentially changed by the feafons of the year, (e. g.) the meafles are fpecifically the fame at whatever feafon they occur. The feafon of the year feems only to ope- rate by rendering the fame concourfe of fymptoms more or lefs violent. If it may be admitted that there are two fpecies of tne fame genus, I aflc whether it is not probable that there are feveral others, and that mod, if not all thofe complaints commonly termed colds, originate from fome fpecies of influenza ; to me it appears in the af- firmative. I believe there is feldom a year but that at fome particular feafon there is a very general complaint of colds, though often fo flight as not to attract the attention of phyficians, yet it fel- dom happens that we C3n refer thofe , complaints to any unufual expofure to cold ; at leaft this has generally been the cafe with me, in the courfe of my expej-ience, both with refpect to myfelf and the patients I have at- tended. I have had the influenza a number of times, fincel have had fome knowl- edge of difeafes and their caufes, but could never, with any degree of cer- tainty; refer it to an application c{ cold. 8a On Spafm in Fevtn. cold. At other times I have been cxpofed to cold, under every circum- fl.iiice that would be likely to give it effect, without ever being fein'lble of its producing the difeafe. Final!>, I am doubtful whether cold of itielf evtr produced the ca- tarrh, or any thing like it. 1 am in- duced to think that it is always pro- duced by a fpeOfOk contagion. I can it a i'.ly conceive how cold can acoravatethecaiarrh, and believe, that on further inquiry, it wdl be found that moff of the continued fevers, v. h'ch are not produced by fome other contagion, may be referred to the head of influenza, made worfe by cold or other circumftances. What the fource of this contagion is, prouuemg influenza, is difficult to determine ; but we fhould not be deterred from an inquiry of this kind, by the apparent difficulty of fucceed- ing. Perhaps the following obferva- tionS, though far horn being conclu- five, may throw fome light upon the fubject. As there is no effect without a caufe, there muff be fome efficient caufe producing this order of fevers. That the air is the medium through which it is applied to the human body, I truft will not bedifputed, but that the air of itfi-lf, aflified only by heat, cold, and moifture, can produce the effect, is highly improbable, confeqtiently we muft attribute this quality of the air to fome foreign matter fufpended in it. As it is very unlikely that we fhall ever be able to detect this matter, as it exifls in the air, fo a9 to bring it under the examination of our fenfes, I fhall only endeavour to investigate the fource whence it fprings. That it is often communicated from one perfon to another, is very prob- able, but that it is never propagated by other means, is doubtful. I am of the opinion that it is. I have known children attacked with a dyfentery, (which is a fpecies of the fame order of fevers) who lived feveral miles dif- tant from any other family, and had never been abroad, or approached by any perfon affected with the dileafe ; in this cafe it would be difficult to account tor the difeafe on the fuppu- fition that it is always produced bv contagion from human bodies. From fuch obfervatiens, I am iridaced to believe that both influenza and dyf-* cntery are often produced by a conta- gion arihng from the putrefaction of vegetable matters. I'roin the firft of Auguft to the firft of November, and from the middle of March to the tirft of June, perhaps1 there is n.ore putrefaction going on among vegetables, than at any other peiiod of the year. By the firft of Auguft many vegetables have acquir- ed their full perfection, and begin to decline and pafs into a putrid flate, fome fooner and others later. This putrefaction continues till it is arrcfted by the cold of winter, which puts a Hop to it before the vegetables have all paired through the feveral ftage9 of putrefaction, and fufpends them in this fituation, till the warmth of fpring renews the putrefaction. When the fpring rinifties, the pu- trifaction begins in the autumn, which perhaps is not fully accomplifhed till the firft of June ; from this time to the firft of Auguft, vegetables are generally in a growing ftate, which as effectually prevents putrefaction in them, us the cold of winter. If it mould be found that the dif- eafes of which we are treating occur ofteneft in thofe feafons which I have fuppofed moft productive of putrefac- tion, it will be a corroborating cir- cumftance in favour of our opinion. I am ready to believe that this is the cafe, both from my own obfervations, and what I can collect from authors. That dyfenteries occur ofteneft in the latter part of fummer, and begin- ning of autumn, is beyond a doubt j and 1 think I have (ecn dyfenteries in the fpring, about the time the fnow went off, and things which had been frozen during the winter, became thawed. That influenzas or catarrhs are alfo moft frequent in the fpring and au- tumn, I believe is evident to thofe who have paid much attention to the mat- ter ; nor is it any argument againft our opinion if they fhould occur at other feafons, for it they are commu- nicated from one perfon to another,it is not to be expected that the difeafes fliould ceale immediately on the caufc which Female Severity. *j- which firft gave rife to them being re- moved. Another circumfhnce which may ferve to fuppoit this opinion, if duly attended to, is tiie analogy between this order of fevers and interniittents which evidently arife from a conta- gion produced by other fubftances than human bodies ; this contagion agrees with that producing influenza and dvfentei y, in its being capable of producing its effects more than once upon the fame perfon ; whereas thofe contagions producing febrile difeafes, and which arife from human bodies only, can affect the fame perfon, but once (e. g.) themeafles, fmall pox, Sec. InterimVents are aHo moft preva- lent in thofe feafons of the year meft favourable to putrefaction; and though they may appear at all feafons, yet it has long been known that they are chiefly contracted in the fpring and autumn ; and when they appear at oth- er feafons, it is commonly in confe- quence of their being protracted by fome means or other. On the other hand, thofe difeafes arifing from human contagion, appear as ofien in the winter, as at any other time ; and I think generally fpread with the greatcll rapidity in this fea- fon. It maybe fuggeffed, that if this or- der of fevers was produced by vege- table fubftanccs, it would appear equally every year at the fanif feafons j this objection I would obviate by ob- ferving, that there are fome vegetables which are not produced in plenty, but once in two or three years ; befide, if the fame fubffances were prefent every year, it might require the concurrence of feveral circumftances, fuch as a cer- tain degree of heat and moifturc, to render the contagion active—(e.g.) intermittents are not every year prev- alent alike, though the fource whcr.ee they fpring remains to all appearance the fame. for the MASSACHUSETTS MAGAZINE. FEMALE SEVERITY. TO defcant on the degeneracy of the age, to difplay the reigning foibles of particular claffes, to mourn or frown at their predominance, is a talk which belongs to the rigid mo- ralift, or preaching philofopher. To rave indifcriminately at the in- nocent indulgencies of individuals, to hurl at random, the envenomed fliafts of malicious invective at the incautious brow of youthful levity, to rail incefiantly even at the pleating fallies of female vivacity, calls for the crabbed temper of the fnarlingcynick. His unenvied province let it be ; while the more brilliant theme of fe- male merit, fhall employ the milder pen of their friendly Bramin. But if while purfuing the pleafmg office of a friend, he fhould perchance encroach that animated gaiety of temper, with which nature originally embcllifhed. her faireft work of creation, he mould pre fume moft finccrely to condemn, that fupercilious deportment, that ill nattired feverity, thofe malicious and indelicate farcafms, which fo awkard- ly diflinguifh the manners and con- vention of our modern belles ? It is perverting the fyftem of female fnbor- dination ; it is proftituting the very temper and com'litution of the 1 down again he revived : this was repeated feveral times, and always with the fame eft'eQ •. and I have no doubt but that if he had continued in an erect poirure'. he would never have furvived the firft time of faintins ; but by being kept in an horizoa- tal pofture, his life was yrefcryed feveral hour*. As the ftrength and motion of the* fyftem in general, depends much on the quantity of blood in the brain ; an increafed quantity circulating through it in a given time, will increafe the action of the arterial fyftem.* This increafed action of the heart and arteries, is what is called reac- tion ; and appears to be the chief agent in the cure of fevers ; for if the vefTels on the furface of the body are contracted, it will require a greater force to reftore them to their natur- al capacity,* than it did to retain them in that fituation, before they had been collapfed : this makes fome ad- ditional force in the action of the ar- terial fyftem ablolutely neceflary in the cure of fevers : and I think it may be obferved as a rule in practice, never to reduce the pulfe by bleeding, and other evacuations in the begin- ning of fevers, to as low a ftandard with refpect to force, as it was at with the fame perfon in time of health : on the other hand, this increafed ac- tion may need a check ; for when a fpafm has taken place, it cannot be removed inftantaneoufly : and while this ftricture remains, the blood has a peculiar determination to the brain and lungs ; which though fo neceflary in the cure of fevers, yet may be fo violent as to render thofe organs un- fit for the purpofes of life : fhould it remain but a fhort time in this cafe, by bleeding we may moderate the im- petus of the blood in thofe parts : while the actions of the arterial fyftem remain fufticiently ftrong, to over- come the fpafm, in a fafe and grad- ual manner. The due regulation of the action of the arterial fyftem^ I apprehend re- quires as much caution and judgment as any point in practice : and we ought particularly to be on our guard not to miftake quicknefs for ftrength in the pulfe: for it is the very reverfe ; and nature often feems to endeavour to compenfate the want of ftrength, by frequency of pulfe. On bpafm There is a phenomenon in fevers which I think may be referred to the l*cad of reaction, or an operation of the Vis Medicatrix Naturae : it is a preternatural quantity of bile, fecret- ed and poured into the alimentary ca- nal : this has by fome been looked upon as a part of the difeafe ; and confequently they have prefcribed methods to diflodge it : but I am fo far from thinking it an aggravating occurrence in fevers, that I believe it has a confiderable fhare in the cure : I am led to this conclufion by the fol- lowing obfervation. i. Nature is commonly uniform, in oppofing the fame remedies, to the fame difeafe : And accordingly we find that a preternatural quantity of bile in the alimentary canal, is a pret- ty conftant attendant on fevers ; and fo far as we can judge, nearly in pro- portion to the debility and fpafm, which took place in the beginning of the diforder. 2. The increafed quantity of bile, does not appear to exift previous to the acceflion of fever : But fucceeds it : And is produced by a preternat- ural quantity of blood being thrown into the vena porta, in confequence of the fpafm of the extreme veflels. 3. The medicines commonly em- ployed to evacuate bile, do not appear to produce their effect on the fyftem by doing fo : But in a very oppofite manner. Sicknefs and vomiting are common fymptoms in the beginning of fevers : And are often attributed to bile collected in the alimentary canal: In order to evacuate it, emeticks are often prefcribed, and they are com- monly fuccefsful in curing the fymp- toms : But that they do it by evacu- ating bile is very doubtful : For we do not find that they are more effec- tual when much bile is evacuated by them, than when little or none is brought up : This has been remark- ed by different authors. Befide if the action of emeticks is attended to, I believe it will appear, that they are not weJl calculated to leffen the quan- tity of bile in the alimentary canal : For the agitation and comprefiion i;i Fevers. 35 which the liver undergoes, in the op- eration of puking, while it is fur- charged with blood, muft necelfaiily increafe the fecretion of bile, fuffi- ciently to compenfate for any fmall quantity, w hich may be evacuated by the emetic. 4. From the analogy, bile has to other bitters, it fliould feem that in- ftead of caufing ficknefs, it would cure it : Other bitters have this effect i And we have known the bile of fome animals, when given as a medicine, to operate in this manner. Upon tiie whole, I am inclined to think, that emeticks do not produce their good effects in the cure of fe- vers, by evacuating bile : Nor by their immediate action on the fto- mach, without its afliftance : But by applying ihe bile, to a larger furface of the alimentary canal ; and efpeci- ally by bringing it into the ftomach, which has a greater connection with the fyftem in general, than any other organ, they remove the ficknefs ; and by means of the fympathy between the ftomach and furface of the body, they determine the blood into the ex- treme vefTels; and have a confiderable effect in reftoring them to their nat- ural ftate. In like manner, I imagine naufeating dofes of emetics produce their effect, viz. by inverting the pe- riftaltick motion of the duodenum and ftomach, they bring the bile into the ftomach, &c. After all, I would not be under- ftood to mean that the bile never errs either in quantity or quality ; On the contrary, I am convinced that it does, but do not think, that this is the cafe, fo often, as fome would have us believe : For though the bile may be very different, both in quantity and quality, in difeafe, from what it is inhealth ; yet this change is a- dapted to the cure of the difeafe ; and the bile anfwers the exigencies of the animal economy better than it would, if it fhould remain in its heahhv ftate, uader the fame circumftances of the fyfwtn in general. ''To be concluded.) \ A Dissertation 36 On Revenge and Cruelty. A Dissertation on REVENGE and CRUELTY. REVENGE and cruelty are paflions of near alliance to one another, and are, beyond doubt, the moft bafe and abject, as well as the moft detef- table of all vices. The firft ot thefe, in whatever falfe lights the foul may view it (for men too often endeavour to gild it over with the borrowed names of honour, magnanimity, and courage) is, in real- ity, ever the child of cowardice alone, in the moft weak and fervile minds ; and the latter in itfelf is fo truly brut- ift), and fo univerfally hateful, that the general content of the world has in all ages agreed, in compliment to our nature, tocall it inhumanity. The valiant and generous mind contt mns thefe favage paflions, difdain- ing even to know what revenge is ; and the greateft of all inftructors has taught us, that true greatnefs of foul confifls not in revenging ourfelves of, but in doing good to our enemies : and it is worthy obfervation, that the greateft men of the world have ever been of the fame opinion, and Alex- ander and Co-far, Epaminondas and Sci- pio, with a long et cetera of heroes, have, by mere innate virtue and no- blenefs of foul, been taught to obey this precept as ftrictly as if they had heard it from the mouth of the divine teacher. Cruelty is the vice of cowards on- ly ; the man of true courage meets, with open force, his refitting enemy ; but no fooner has he conquered, and fees him proftrate.unrefifting, and at his mercy, but he exerts and puts in act that mercy which is ever the cha- racteriftick of great minds ; and, in- ftead of butchering him, will tear off his own garment to tie up the wounds he had before made. True courage is itfelf an amiable virtue ; and as, with regard to reli- gion, thofe, who will not be at the pains of living up to its precepts, of- ten put on hypocrify in the place of it—fo the coward, not daring to tread the paths of this honourable qualitv, makes mafTucre and murder his pre- tence to it. Fear is the true parent of cruelty. Civil wars are, of all others, ever the moft bloody, bctaufe thev are carried on by perfons who are each in conftant terror of his neighbour ; and tyrants are bloody, merely becaufe they fear : It is their general terror alone that makes them the general butchers of their people. Mauritius, who well knew the human mind in this refpe6t, when he was told that Pbocas had a defign to kill him, en- quired what was the caufe, and who and what the perfon r and on Philip's telling him, That he was a mean per- fon, and a known coward, anfweied. Then I wonder not that he is cruel, and a murderer 1 It is eafy to conceive, from the na- ture of caufes and effects, that this favage temper cannot be long exercifed without bringing on, one way or o- ther, the destruction of the perfon whoispoflefTedwithit. Revenge is, to him who is poflefTed with it, a conti- nual anguifti, and an excruciating pain; it is an eating canker at the heart, a biting plague that gnaws and incef- fantly preys upon the very foul. The revengeful man wears in his breaft a torment greater than any he can in- flict on the perfon his malice aims at the deftruction of, and has often the additional mifery to fee his enemy fmiling in eafe and fecurity, while his own heart is burning and torn to pieces within him for the mifcarriages of his defigns againft him. Let us put even the beft face pof- fible upon the defigns of the revenge- ful man, and they will not then appear other than mifery to a wife or difin- terefted perfon. The means of re- venge are generally flow, tirefome, and uncertain ; and theexecution difficult, painful, and dangerous. If he fuc- ceeds, the confequence is, often, that he muft be a vagabond for life after- wards, a torment to himfelf from the flings of his own confeience, and ei- ther an eternal wanderer, with the dread of juftice at his heels, or acurfe to his friends, if there are any fuch, in the continual care of hiding him from it. This is the beft face that revenge wears ; but we are to confi- der, that it much more frequently happens, that its plots mifcarrv, or the mifchief intended by the revenge. ful 5 LZCxL )f?l /#$.