WCF C!47e 1831 Bp:^ Hit;-': iral^'''- ^R^ ) :Q^Q(-,Q\ K)UO oOfUD tiOL -Xj ■->13^ W Surgeon General's Office ^ fffl .# CC&CH £s^? N. t.Afap...££ ■■'i: ?ocaoojg--.-jCu' >Q-C'OX:)X!VG'C'-C Professor of the Institutes of Medicine and Clinical Practice ia Transylvania University. LEXINt JTON, ivENT CCK Y Printed by N. L. Finxeli. & J. F. Herndon, 1831. 0!7e PRIZE ESSAY 02T MALARIA. TABLE OF CONTENTS. INTRODUCTION. THE present age, its enlightened views, and inventive and practical character, p. p. 1. 2. Man's deepest inter- est, what, 2. 3. Health, the value and importance of, 3. Soundness of mind and body inseparable, ibid. Health ne- glected by individuals, 3. 4.—still more neglected by pub- lic bodies, 5. Quarantine establishments and modes of cleansing cities very defective, ibid. Vaccination, its value overrated, 6. Much done to restore health, ibid. Public Hospitals of London, Paris, and other European cities, ibid—of the United States, 7. Attention due to our sea- men, 7.8. Attention paid to British seamen—Greenwich Hospital, 8. Vaccination has not eradicated, and will not eradicate small pox, 9. Inoculation, skilfully conducted, not a dangerous disease, 9. 10. Poison of small-pox nei- ther so ancient nor dangerous as the miasm of bilious fever, 11. 10. The miasm of yellow and bilious fever and that of oriental plague, the same—more constant as well as more extensive in its ravages than any other poison, 13.14.—al- so more powerful than any other febrile miasm, 14. 15. 16. —cannot be checked in its ravages, when begun, except by a change of season, 16.—productive of many forms of dis- ease, 17. 18.—produces madness, especially melancholia, 19.—also, a deep degeneracy of the human race, 19. 20- 21.—injures the intellect, 21. 22.—the moral evils pro- duced by it, 22.23. The high patriotic spirit of the Medi- cal and Surgical Faculty of Maryland, 23. 24. The great i* IV CONTENTS. importance of the object proposed by them, 25—if attained will be the most valuable improvement of the age, ibid. Prospect of success, what, 2'i. Human resolution, under proper direction and perseverance, can accomplish much, 27.2-'. Malaria, but little light heretofore thrown on it by books, 30. 31. Free discussion favourable to truth, 33. SUBJECT DISCUSSED. Subject divided into four propositions, in the form of ques- tions. What is the nature of the malaria that produces bil- ious fever? 35. It is the result of chemical agency ; but its nature is unknown, 36. No difference discoverable, by chemical tests, between a sickly atmosphere and a healthy one, 36, 37. Chemistry has injured medicine, by filling it with error and conjecture, 37 to 39. The nitrous oxid and carbonic acid gases supposed to be the miasm of bilious fe- ver—that error refuted, 89 to 43. Hypercarbonationof the blood alleged to be the cause of bilious fever—ErroT refu- ted, 44 to 48. Malaria erroneously supposed to be the same with certain other gases, 49. 50. Bilious fever sup- posed to result, not from any atmospheric poison, but from moisture alone, or changes of temperature—error refuted, 50 to 53. Source of malaria, what, 53. 54. Lancisi, remarks on his discovery of malaria, and the name he bestowed on it— Animalcular hypothesis of the cause of biliousfever,54 to61. Four elements essential to the formation of bilious malaria, 61 to 63. A tropical temperature of a month's duration ne- cessary to produce yellow fever, 63. 64. Illustrations of these several positions 64 to 69. Can large masses of ani- mal matter alone produce the poison of malignant bilious fever 1—Question considered, 69 to71. Can manufactories CONTEXTS. of soap, candles, glue, and catgut, produce the poison of yellow fever ? 71. 72. Quantity of moisture requisite to the production of malaria—Dr. Ferguson's hypothesis on this point animadverted on, 73 to 77. Best means of pre- venting the formation, and removing the sources of mala- ria—Cleanliness, 78. True meaning of the term cleanli- ness, 79. Nature's means of effecting it, 80. The pro- cess different indifferent cases, 81. 82. Certain modes of attempting it empirical, ibid. Chlorine gas, as a purifier, remarks on, 85. Means of cleansing cities—if properly employed, will render any city healthy, 85 to 90. In large cities water should be made to run daily along the gutters, during warm weather—Best mode of improving public squares in cities, 90 to 92. Cemeteries, tanyards, privies, manufactories of glue, candles, and soap, and common sew- ers, remarks on, as sources of malaria, 92 to 94. Remarks on wooden wharves, as productive of the same, 96. 97. Shallow docks injurious to health, 97. 98. Fresh water promotes putrefaction more rapidly than salt, 98. Slate and tile a better covering for city edifices, than shingles, 99. A marshy tract of country rendered healthful by banking, draining, and thorough cultivation, 99 to 101. This proved by a reference to the Philadelphia Neck—also to Calcutta and Bourdeau, 101 to 104. To be effectual in rendering a place healthy, cultivation must be general and complete, 105. The low-lands of South Carolina and Geor- gia rendered healthier by cultivation—North Carolina re- markable for the longevity of its inhabitants, 105.106. Pon- tine marshes, once healthy and populous, have become ve- ry sickly and thinly populated, from the decline of cultiva- tion. The same true of several other places, 106 to 10-< VI CONTENTS. Defective cultivation of the soil, bad effects of it on health, 109 to 112. Mill-ponds, how to prevent them from produ- cing malaria, 112 to 114. How to prevent the bad effects of malaria, when formed—subject discussed—exciting cau- ses of disease—vis conservalrix nalurce—diet—114 to 125. Clothing and exercise, as preventives of disease 125 to 127. Precautions and preventives in cities, 127 to 130. Importance of sleeping in the upper stories of houses, in sickly places in the country, 130. 131. Hazardous, when bilious complaints are prevailing, to go out in the morning, with the stomach empty—what articles of diet and drink ought to be taken, 131 to 134. Malaria travels with the wind 134.135. A cordon of trees arrests its march, 135.136. A lofty wall seems to do the same, 136 to 138. The distance that malaria can travel from its source, over land,or water, considered—means of ascertaining this, 138 to 144. All alluvial soil productive of malaria, ibid. Night-exposure hazardous—what time of the night most so, ibid. The subject of winds considered pestilential, or otherwise nox- ious, discussed, 145 to 149. Lunar influence in producing bilious fever considered, 149. 150. Medicinal articles, as preventives of bilious fever considered—purgatives—tonics, 151 to 153. Cutaneous excitement, in the form of erup- tions—issues—blisters, as a preventive, referred to, 153 to 155. The miasms of typhus and bilious fevers not the same—The miasm of yellow fever different from that of intermitting fever, 155. 156. APPENDIX. Dr. McCulloch's Essay on Malaria, some of the senti- ments of, similar to those of the foregoing Dissertation— CONTENTS. Vll faulty style of, 157 to 159. Dr. McCulloch imputes to moisture alone the production of malaria—this opinion er- roneous, 162 to 165. Ponds in the Western States not in- jurious to health, 166. Woods not sickly, as Dr. McCul- loch pronounces them, 167. Italy, Sicily, and other Me- diterranean islands, with certain maritime districts, not so sickly as he represents them, 168. Malaria cannot, as Dr. McCulloch asserts, be borne, by the east wind, from Holland to England, and produce disease in the latter coun- try, 169, 170. Dr. McCulloch mistaken on the subject of the plague in Egypt, and the malaria of the Nile, 171, 172. Identity of plague and yellow fever maintained, 172 to 175. Rome and the country around it healthier in ancient times than they are at present, 175,176. Remarks on the Doctor's hypothesis, that the increase of the alluvion of her rivers is the cause of the increasing sickness of Modern Ttaly, 176 to 178. Rome will not be necessarily reduced by sickness to the desolation of Babylon, 178, 179. Not true, in this country, as Dr. McCulloch states it to be in Rome, that the poor are most exempt from bilious fever, 179, 180. The Doctor's preventive measures neither new, nor al- ways wise—Remarks on, 180 to 187. His inordinate at- tachment to visionary speculations, such as, the levelling of the earth, and the draining of Lake Erie by the Falls of Niagara, 187 to 192. Wherein the value of his " Essay" consists;—the advantages likely to result from the project of the Medical and Surgical Faculty of Maryland, in offer- ing a Prize for a Dissertation on Milaria;—the good the Suites might do, by inviting the attention of physicians to the same subject;—Conclusion, 192 to 194 ESSAY ON TEMPERAMENT. TABLE OF CONTENTS. Subject stated p. 195 to 197. Theories respecting it- theory of Hippocrates—of Galen, 197 to 207. Humoral- ism, remarks and strictures on, 207 to 210. Vindication of the author's claim, as his own, to the opinions he deliv- ers, 211 to 215. Temperament, what it consists in—sub- ject discussed, 216 to 227. Function of the digestive ap- paratus, 227. 228.—of the lungs; 228. 229.—of the brain, 229. 230. The power of these several groups of organs, on what it depends, 230. Illustration and proof that, other things being equal, it depends on size, 230 to 242. Size of the groups of ruling organs, how discovered, 242 to 246. The comparative standing of individual man, in relation to his race, depends un the predominance of his leading or- gans—illustrations of this, derived from the inferior ani- mals, 246 to 250. Temperaments, how divided, 251. Mix- ed temperament, 252 to 254. Encephalic temperament, 254 to 263. Thoracic temperament, 263 to 265. Abdo- minal temperament, 265 to 271. Encephalo-thoracic tem- perament 271 to 274. Encephalo-abdominal temperament, 274 to 277. Thoracico-abdominal temperament, 277 to 279. The passage of one temperament into another, dur- ing the growth and decline of the body, general view of, 279 to 287. One temperament how changed into another— remarks and directions on this subject, 289 to 296. Re- marks on general education, deduced from the principles contained in this essay. REPORT OF THE " PRIZE ESSAV " COMMITTEE. *1t the Annual Convention of the Medical and Chirurgical Faculty of Maryland, held in Baltimore, June 6th, 1831, the following report was submitted by the Prize Essay Committee, and accepted by the Convention. JOHN FONERDEN, Rec. Sec. The Committee appointed by the Medical and Chirurgical Faculty of Maryland, at the last convention to award the med- ical prize— Report, That in the performance of their dutj, they selected for the subject of the Prize Essay, " The nature and sources of M \laria, or noxious miasma, from which originate the family of diseases, usually known by the denomination of bilious diseases; together with the best means of preventing the formation of mala- ria, removing their sources, and obviating their effects on the human constitution, when the cause cannot be removed.'''' As was expect- ed, from the great importance of the question, many highly re- spectable essays were presented. Several of them deserve spe- cial commendation for ingenuity and research. Your commit- tee, in the execution of their assigned duty, have adjudged the prize to that bearing the superscription— "Dies errorem delet, veritatemque illustrat." The committe, however, respectfully suggest that the other rompetitors for the prize be requested to give publicity to their productions. The subject of malaria is one of great concern to the world at large, and the results of concentrated investigation ;ire too valuable to be lost, when so much information remains unsupplied. Charles Caldwell, M. D. of Kentucky, is the author of the successful essay. THOMAS E. BOND, M. D. JOHN BUCKLER, M. D. JOHN FONERDEN, M. D. H. WILLIS BAXLEY, M. D. EDMUND G. EDRINGTON, M. D. JOHN L. YEATES, M. D. PETER SNYDER, M. D. PRIZE ESSAY, An " Essay upon the nature and sources of the Malaria, or noxious miasma, from which originate the family of dis- eases usually known by the denomination of bilious dis- eases; together with the best means of preventing the formation of Malaria, removing the sources, and obvia- ting their effects on the human constitution, when the cause cannot be removed." Offered as a " Prize Essay," according to the conditions prescribed by "The Medical and Surgical Faculty of Maryland, at their annual convention held in the city of Baltimore, on the 7th and 8th of June, 1830." Dies errorem detet, veritalemque illustrat. asa^®sK0®t?a®si3 NO age within human remembrance, or die reach of history, has been so fruitful as the present, in schemes for the improvement of the condition of man. Nor have the ef- forts of former times, to this effect, been so generally successful, as many of those that have been more recently instituted; a proof that the true interests of our race, and the means of promoting them are becoming bet- 1 2 ON 3IALARIA. ter known. Indeed usefulness of design, and a practical character and tendency in all things, as contrasted with the abstraction and hypotheses of former periods, constitute one of the most prominent features of the day, and mark, in a special manner, the projects of our own country. Mere beauty and in- genuity, however pleasing to the few, have but little attraction for the great mass of the American people. Preferring the fruit to the blossom, their delight is in something useful. Whether they make,, at times, an excessive sacrifice of embellishment to usefulness, it is not my province, at present, to decide. The deepest interest that man has at stake, is in the right cultivation of his intellect and morals. Let that be attained, and carried as far as his faculties admit, and all that is most desirable to him will grow out of it. While it furnishes him with knowledge to direct him in the transaction of affairs, both public and private, it strengthens his motives to the practice of virtue, and the promotion of general and individual happiness. When ON MALARIA. a raised to this condition, he has no further im- provement, as respects his mind, to look or wish for, in his present state of existence. Second only, as a matter of interest and a means of usefulness, to a sound and well dis- ciplined intellect, is a healthful and vigorous body. Were I to say that the two are insepa- rable, facts would not be wanting to confirm the position. An entire person, including the brain and nerves, well formed and organized, and in a condition of health, is never unac- companied by a sound mind; and the reverse. If the body be seriously diseased, or defec- tive in any of its fundamental organs, the mind participates in the malady or privation. It may be, therefore, laid down as a maxim, sustained alike by observation and principle, that mens sana is to be found only in corpore sano; a consideration which adds incalcula- bly to the value of health. Yet, singular as it may appear, it is notwith- standing true, that mankind set but a mode- rate estimate on this invaluable blessing. Such, at least, as relates to the protection of I ON MALARIA. it, is the only rational interpretation their con- duct can receive. Hence the recklessness with which they risk it, and the innumerable instances in which they sacrifice it, on trivial points, for momentary gratifications, and in useless and degrading practices. In projects of ambition, wealth, or pleasure, there is no- thing too difficult or dangerous, for aspiring minds, and bold and ardent spirits to encoun- ter. Yet, to preserve health, without which success is joyless, hope sickens, and life is a burden, they will neither incur trouble, nor forego gratification. They will not even so far control their appetites, as to satisfy them with food and drink like rational beings, but, with the heedlessness and voracity of inferior animals, swallow, in quantity and quality, what their experience a thousand times re- peated, has proclaimed to be fraught with the seeds of disease. Nor will they deny themselves the pleasure to be derived from a crowded evening party, an interesting excur- sion, or any other scene of amusement, al- though admonished almost to assurance, by ON MALARIA. i) the past, that the indulgence will visit them with a fit of sickness. But neglectful of health as individuals are, public bodies are still more so. The senti- ment has become a proverb, that " Corpora- tions never feel." Were another formed, de- claring that, as relates to health, they "never think," it would be scarcely less true. On that subject they have hitherto done little else than indulge their fears and exercise their im- aginations, or collect antiquated prejudices, obsolete hypotheses, and opinions at open war with science, and, weaving them into statutes, miscall them health laws. They certainly therefore think on it to very little purpose. Quarantine establishments founded in error, and ill-contrived schemes for purifying cities excepted—both of which, as now conducted, do more harm than good—it is not within my recollection, that states have devised and put in practice any measures of moment for the preservation of the public health. The ordinances which corporations occasionally pass to guard against small pox, canine marl- 1* 6 ON MALARIA. ness, and a few other maladies, are unwor- thy of notice. Almost all that has been done. by vaccination, for the prevention of the for- mer complaint, has been the work of individ- uals. And it is matter of regret, that even that has been overvalued. At any rate, it does not amount to the preservation of health. It is only the substitution of one disease for another—a less evil for a greater. Even that. however, is a deduction from the sum of hu- man misery, and is so far to be commended and encouraged. Vaccination moreover mit- igates small pox, if it does not always.pre- vent it. States and corporations have indeed done much for the restoration of health when lost, and the alleviation of disease and injury, when too deep to be cured. Some of the most invaluable, I had almost said glorious establishments on earth, are public hospitals. No one can visit those of London and Paris, and other large European cities, without re- ceiving an impression to this effect, which no (ime can erase. Nor has our own country. ON MALARIA. i or rather the people of it, been unmindful of them. Some of the hospitals in the United States would be distinguished, if not for their size, at least on account of their excellent ad- ministration, in the great capitals of which 1 have spoken. But they are not, I repeat. the work of states, or other public bodies. They are the product chiefly of a more sacred and endearing source, the munificent chari- ties of benevolent individuals. As far as I am informed, neither the nation nor the in- dividual States of America have done any thing for hospitals that deserves high com- mendation. Considering their means, and the nature and strength of the claims on them for aid, the donations they have occasionally made have been any thing but liberal. A more severe and narrow policy, not to call it unjust, can scarcely be imagined, than that of the government of the United States, in with- holding from mariners a portion of their wa- ges, to provide accommodations for them, in case of sickness. There is a frigidness in it, united to an act of heartless authority, that 8 ON MALARIA. chills and offends, and seems to proclaim to the world, that the fountains of our public mu- nificence and benevolence are frozen up; that, as a nation, we look only to the future, forget- ful of the past, and do every thing for interest, and nothing for gratitude. Our seamen toil for their country, and give her wealth, fight her battles, and glorify her flag. In return for this, they are richly entitled, free of ex- pense, to comfortable quarters, during suffer- ing from sickness and wounds, and the in- firmities of age. On these points the conduct of the British government is worthy of all praise and imitation. The mariners that have been the main prop of Britain's power, by ministering to her opulence, and giving her the empire of the seas, are objects of her ten- derest regard in the hour of distress. They can point, as they glide along the Thames, to the groves and magnificent edifices of Green- wich, and claim them as their own—the glo- rious reward, from a just and grateful gov- ernment, for dangers encountered, and ser- vices performed. Nor. in conferring such ;r ON MALARIA. 9 reward, has the government manifested less of sound policy, than of correct feeling. But to return from this digression. I have alleged that the process of vaccina- tion has not conferred on man the full amount of benefits that were anticipated from it, or that report has ascribed to it. It has not, as many of its advocates so confidently predict- ed it would, erased small pox from the cata- logue of disease. Nor is there the least prob- ability that it ever will. The positive bene- fits, moreover, of vaccination, are diminished not a little, by the well known fact, that under inoculation skilfully conducted, small-pox is a disease not much more severe and danger- ous than cow-pox. I know that a belief the contrary of this very generally prevails. But that does not move me, because it does not constitute authentic testimony. My reliance is on observation and experience, not on popu- lar opinion; on what I have myself seen, not on what I have only heard or read. Out of several hundred children that I have inoc- ulated, but owe died of the complaint; and 10 ON MALARIA. that was a child whose constitution was so infirm that I communicated the disease to it with great reluctance, and warned its parents of the danger of the operation. Let the weather be temperate, the atmosphere free from any endemic or epidemic taint, and the child healthy; in an especial manner, let its chylopoetic organs and skin be in a sound condition, and I repeat, that the danger from inoculation, under skilful management is far from being serious. Severe cases arise much more from some sort of mismanagement, than from the nature of the disease. Nor is it within my recollection that the face of a sin- gle child I ever inoculated was pitted by the pustules. I am sure the beauty of the counte- nance was never marred by them. By judi- cious treatment, that effect can be prevented. But let it not be imagined that I am an enemy to vaccination. Far from it. The practice of my life has proved the contrary. I am willing to take the discovery for what it is worth; but for no more. And it is not worth the price that has been set on it. Extrava- ©N MALARIA. 11 gant praise never fails to injure its subject. But admit that small-pox had been exter- minated, and its virus destroyed by means of vaccination. The event would have been surely of great value, and a source of high and well founded rejoicing to the human fa- mily. But it would not have been the most valuable that might have occurred. A febrile poison of much elder date, greater power, and wider compass, would have still remain- ed, to baffle, for a time, the efforts of science, and continue, as it long has done, one of the heaviest scourges of the human race. I al- lude to the malaria productive of bilious fe- ver; that miasm, whose nature, origin, and prevention, with the best mode of obviating its action on the system of man, are to consti- tute the subject of this dissertation. It has just been observed that the miasm of bilious fever is a much more ancient evil than the matter of small-pox. For proof of this, reference may be had to general history and the records of our profession. The lat- ter poison can be traced through the annals 12 ON MALARIA. of medicine only to the sixth or seventh cen- tury. But the former is coeval with the pre- sent order of things. Its birth was no doubt anterior to that of man. Ever since vege- table substances, such as now cover the earth, lived, grew, died, and passed to dissolution, its production was as necessary a result of the laws of nature, as the descent of ponder- ous bodies, or the refraction of light. Our records of it, moreover, extend to a period of great antiquity. Every fact and consid- eration that bear on the subject concur in proving, that it is the miasm of the true plague of Asia and Africa, no less than of the bilious and yellow fevers of Europe and America. That, in fact, it is the cause of the diseases of hot weather, through all time, by whatev- er names those maladies may be known. We clearly trace its being and ravages, therefore, to the days of Sesostris, Busiris, and the Pha- roahs. It was the breath of the " Python of the Nile," which produced then, as certainly as now, the " pestilence that walked in dark- ness," whether through the palaces of kings, ©N MALARIA. 13 among the tabernacles of Israel, or elsewhere in the midst of the surrounding nations. As far, then, as positive history, and fair inferen- ces from the nature of things may be confi- ded in, it more than trebles, in antiquity, the date of variolous matter, and all other febrile poisons. It has been employed, therefore, a much greater length of time in the work of havock. Compared to it all other miasms are of recent origin. Nor does it surpass them less in the extent and constancy of its ravages, than in their duration. Does the virus of small-pox, mea- sles, and other febrile complaints, appear occasionally, and spread disease, for a few * weeks or months, over certain limited dis- tricts of country? That of bilious fever pro- duces sickness, in some form, during a part of every year, in every country inhabited by man, and, over an extensive portion of the earth throughout the whole year. Wherev- er and whenever vegetable substances perish and decay, in the usual manner, there and then it springs into existence, and begins its 2 11 ON MALARIA. mischief. It produced, in ancient times, the pestilential and other summer and autumnal complaints, not only of Egypt, but also of Asia-minor, Greece, and Italy, as well as of Carthage, Syracuse, Iberia, and other places, of which history informs us. And there is reason to believe that, in modern days, the sphere of its action is still wider, because the earth is more extensively peopled. It certainly presents itself to us on a broader scale. In the old world, from the northern limits of Siberia to the Cape of Good Hope, and from the Pillars of Hercules to the East- ern ocean, we are acquainted with no in- habited spot that has not suffered from it. And, on the American continent, its devasta- tions reach from the extreme north to the heights of Cape Home, and from the shores of the Atlantic to those of the Pacific. Nor is j there, in any ocean, a peopled island, however j healthy, that does not feel occasionally its de- leterious influence. Such is the earthly ubi- j quity of this malaria. But it has been also represented as a poi* ON MALARIA. 15 son of greater power than the matter of small- pox, or any other febrile miasm. For evi- dence in proof of this, I may confidently re- fer to the history and character of plague and yellow fever, as well as to those of the cholera of the east. That these are the most gigantic diseases to which man is subject; and that, in their highest grade, they extinguish life most certainly, and in the shortest period, cannot be denied. In point of strength, small- pox is doubtless a very formidable complaint. When it attains its highest degree, and as- sumes its most malignant character, it is ex- ceedingly intractable, and often terminates fatally in a short period. Of measles, influ- enza, typhus fever, and scarlatina, the same is true. Their malignity and ravages are sometimes appalling. But no experienced physician will contend, that they are equal, in these respects, to plague and yellow fever. The consternation and flight, with the sus- pension of business, which the latter occasion wherever they appear, and the Lazarettos erected to prevent them from spreading. 16 . ON MALARIA. prove satisfactorily that mankind at least con- cur with me in opinion. An invading army, irritated by battle, and flushed by victory, is scarcely more terrific to a crowded city than one of these calamities. Another conside- ration which adds not a little to the formida- ble character and destructive influence of bilious malaria, is, that when it has once ta- ken possession of the atmosphere, no human means have been yet discovered, competent either to extinguish it, or put limits to its range. Experience testifies that it sets at de- fiance all efforts to that effect, and ceases from its ravages only with a change of sea- son. It yields obedience to the laws of na- ture, but refuses to acknowledge the supre- macy of man. As relates to the poison of small-pox, except when the disease is epidem- ic, which is but seldom the case, the reverse is true. It so far submits to human control, that it can, by judicious measures strictly exe- cuted, be circumscribed within given limits, and prevented from propagating disease through the community. To the truth of this also experience testifies. oiN MALARIA. 1? l$ut the forms of disease justly attributable to the miasm I am considering, are not more violent and destructive, than they are nu- merous and diversified. Besides plague, yel- low fever, and the cholera of India, which have been already mentioned, the following belong to the formidable catalogue. The bilious fever of every country and climate, in all its modifications, including, in particular, intermittents and remittents, the same com- plaint under a more continued type, but not amounting to yellow fever, and bilious opthal- mia, endemic in Egypt and some parts of Europe, and not uncommon in our own coun- try. Dengue would also appear to be no- thing but a modification of bilious fever. To these add dysentery, bilious diarrhoea, the Vommon cholera of adults, cholera infantum, rheumatism, bilious colic, and hepatitis acute and sub-acute, with enlargement and indu- ration of the liver and spleen, jaundice, drop- sy, neuralgia in all its forms, the pellagra of Lombardy, elephantiasis, and several other chronic affections incidental to the inhabitants LH 0> MALARIA. of hot climates. Of these, some are said to be but sequelae, or secondary complaints, ari- sing from neglected or mismanaged bilious affections, and therefore not fairly attributa- ble to the malaria in question. The reply to this is plain and conclusive. But for the influence of this miasm, neither could bilious fever exist, to suffer mismanagement, nor the sequelae arise from, it on that condition. The primary and secondary complaints, therefore, are equally its offspring, the former immedi- ately, the latter remotely. Like parent and child they descend from a common ancestor, whose being alone gave being to them. These chronic affections, entailing on the subjects of them all the miseries of chachectic habits and ruined constitutions, last for years. By their means, therefore, some of the terrible effects of bilious miasm are rendered every where perpetual. Although, in temperate climates, it has itself an actual existence but for a few months every year, it lives perenni- ally in its offspring and their product, and is to human comfort the worm that never dies. ON MALARIA. 19 It is the source of a much greater amount of chronic disease, with its dismal register of con- suming anguish, and the withering wretch- edness of " hope deferred," than all other fe- brile poisons. To make up the aggregate of mischief and suffering, there are not wanting other elements of peculiar moment. By a transfer of its morbid action from the chylopoetic or- gans, which are its principal seat, to the brain, marsh miasm is not unfrequently the cause of madness, especially the melancholy form of it. Thus is life rendered a cup of unmixed bitterness, and the wretchedness of the vic- tim is complete. But all the evils this poison inflicts on man are not yet recited. It produces, in time, a deep and humiliating degeneracy of the race. In our own country this result is already visi- ble ; but those who would witness it, in its highest degree, must visit some of the marshy and sickly districts of Europe, more especi- ally of France, Holland, Italy, Spain, and Portugal. In those places, where, by the £0 ON MVLVRIA. operation of (he poison, through a long and unbroken line of generations, its effect has reached its maximum, the issue is deplorable. Besides being deteriorated in complexion, figure, and general aspect, the inhabitants are lamentably curtailed, not alone in corporeal dimensions and strength, but in the duration of life, and the powers of the mind. There is a foundation in nature for the belief, that those who are born and reared amidst dense and noisome fogs, and deleterious exhalations, have saturnine imaginations and clouded in- tellects. Hence there was much more of truth than is generally imagined, in the opin- ion held by the Athenians, which attributed Boeotian dulness to Boeotian mists. In some of the fenny tracts of country, just referred to, vigorous health is scarcely known. Du- ring summer and autumn disease is acute, and chronic throughout the remainder of the year. Hence enlarged and indurated spleens and livers, preternatural and unsightly ab- dominal distention, dropsied limbs, pale and often bloated countenances, unelastic move- ON MALARIA. 21 ments, a listless look, and a drawling mode of expression every where present themselves. These marks of wretchedness and degene- racy in man, united to the heavy incumbency of morning and evening fogs, streams creep- ing slowly along their muddy bottoms, and the general monotony of a flat country, are sufficient to make "genius sicken and fancy die," even in a traveller passing through the place. What then, must be their effect on those, who are bom and reared amidst their baleful influence; whose susceptible infancy is moulded by them from the cradle; and whose blood is never vivified by a better at- mosphere, their vision cheered by a fairer sky, nor their torpor broken by brighter pros- pects?—whose sun, in winter, shines dimly on them, through a haze, and generates, in summer, exhalations to poison them? In these abodes of misery, the decrepitude of age begins to be seriously felt before the fif- tieth year of life; and real longevity is never attained. Idiotism prevails here, much more than in healthier regions. Nor, when man '>2 ON MALARIA. suffers so fearfully, do his domestic animals escape. In size, form, action, and all the higher qualities of the races, their degenera- cy is also striking. Their chylopoetic organs generally, especially their livers, are usually unsound. This bespeaks in them chronic disease; and they are often swept off in great numbers by acute epidemics. Lancisi and other distinguished writers concur with observation in testifying to this. Of the numerous evils, physical and mor- al, inflicted on the human family, by the ma- laria I am considering, the foregoing make a part. But, of the latter class, many griev- I ous ones remain to be told. Such are the distresses of relatives and friends on account I of the sufferings of the sick, their fatigues in I attending them, their deep solicitude for the issue of their complaints, the sorrows of the living for the loss of the dead, and the heavy privations which communities and nations often sustain, in the death of individuals dis- tinguished for their talents and public bene- factions. Add to this account, the disasters ON MALARIA. 23 produced in commercial cities by visitations from plague and yellow ft ver, and its amount will be appalling. This latter calamity can be appreciated only by those who have wit- nessed it. The spectacle it presents is often in the highest degree tragical and afflicting. The tumultuous flight of the inhabitants, with- out either friends or homes to receive them, and the destruction of property which this produces, the anguish of those who have not the means to fly, while the seeds of pestilence and death are around them, the interruption of trade and business, with the bankruptcy, ruin, and want, that inevitably follow, the per- nicious effects of this on commercial tran- sactions in other places, and the general gloom and despondency that prevail, consti- tute but an outline of it. It must be left to the memory of those who have beheld it, and to the imagination of those who have not, to fill up the picture. Such is the minister of mischief, which the "Medical and Surgical Faculty of Mary- land" would deprive of his power. The en- »^4 O^ MALARIA. 1 terprise is creditable to those who conceived it. It is to disarm, in modern times, and in another quarter of the globe, the Python of his poison; a work which the ancients assign- ed to a god. Be its issue what it may, the spirit of patriotism, in which it originated, must enhance the standing of the medical profession. It shows the members of it to I be in the highest degree disinterested; capa- I ble of labouring with zeal for the accomplish- ment of that, in which they not only have no interest beyond that of others, but of that which is manifestly hostile to their interest. All of them subsist in part, and many of them almost entirely on the ravages of malaria. Extinguish that poison, or teach the mode of obviating its effects, and half of the physi- , | cians of the world must abandon their pro- fession. The enterprise, then, I repeat, is eminently creditable to its public spirited au- thors. Should it succeed, the gain to sci- ence and philanthropy will be immense. The amelioration of the process of education, I say, and its happy influence in the culture of ON MALARIA. 25 the mind excepted, no projected improvement of the day can compare with it. What are the excavation of canals and tunnels, the construction of rail-roads, locomotive engines, and steam-boats, and the opening of coal- mines and quarries, to the preservation of the lives of innumerable millions from the de- structive influence of marsh effluvia?—What, to the protection and redemption of whole districts of country from desolation, actual or impending, by that formidable poison? Weighty and numerous as are the interests concerned in both schemes of improvement, it will not be denied that those of the latter infinitely preponderate. In one case the end aimed at is convenience and wealth; in the other, existence with all that belongs to it. Between objects so different in their import there can be no rivalry. It would be super- fluous, therefore, to consume time in tracing the contrast. But what is the prospect of success to the scheme projected by the Faculty of Mary- land ? This is a question of great moment; 3 26 ON MALARIA. and the experiment alone can satisfactorily answer it. Practically speaking, the pro- ject is new. It has been indeed thought of, and talked of, but never tried. Nor is that the worst. The task imposed by it is as dif- ficult to be accomplished, as the views that suggested it were liberal and praiseworthy. But this constitutes no just ground of discour- j agement; much less of despair. Projects are not to be deemed impracticable, and to be therefore abandoned, merely because they J are difficult. Man knows not the extent of ] his powers until he has fairly tried them. 1 And, for the attainment of important ends, he I should try them boldly. In an especial man- I ner, nothing but the experiment skilfully I made and duly persevered in, can determine I the issue of the efforts of numbers, acting in I concert or uninterrupted succession. Un- der the most discouraging circumstances it has been frequently astonishing. History j and observation testify, that much more good has resulted from enterprises deemed, at the time, even rash and perilous, than ever has ON MALARIA. 27 from cautious forbearance. Under pros- pects thus disheartening was the New world discovered, and its independence from Euro- pean thraldom achieved. The human mind should despair of nothing calculated for the promotion of human happiness. This senti- ment which, serving as a ground and princi- ple of action, so often saved the Common- wealth of Rome, has been an abundant source of improvement in science. The more ar- duous the task to be performed, the higher the zeal and the firmer the resolution with which it should be encountered; and the brighter the glory of him who may accom- plish it. In the present enterprise, the adventurers, I doubt not, will be numerous and distin- guished. An invitation so honorable from a source so respectable, and designed to sub- serve an end so important, cannot fail to be eagerly accepted by the votaries of medicine and the friends of our race. Although the object contemplated, therefore, may not be attained to the entire satisfaction of those who 28 ON MALARIA. proposed it. something will doubtless be done in promotion of it. By the offering of each labourer, however limited, to the common stock, an aggregate will be formed, that must facilitate the task to future adventurers. E phirihus lumm is a motto as important in defence of truth, as of States. Nothing can resist the human powers, when they act in well trained masses, successively and steadi- ly. They form a perpetual phalanx, to which, in time, every thing must yield. As relates to the object of this discussion, therefore, should one set of adventurers fail, another set. co-operating under more propitious cir- cumstances, will prove successful. And, in this case, a portion of the glory will belong to the first. They had commenced the breach, which their successors completed, and pass- ed it in triumph. It is under the influence of these sentiments, and from a wish to con- tribute my quota, however small, toward the completion of the great work, that I respect- fully submit to the faculty of Maryland the present Dissertation. That it will contain ON MALARIA. 29 any thing new or instructive to them, I ought not perhaps to flatter myself. Nor do I know that it will be a repository of such matter to any of my fellow citizens. Its entire con- tents may have been, for ought I know, al- ready anticipated by other inquirers. All I promise or pretend to is, faithfully to embody in it such facts and thoughts, bearing on the subject, as I now possess, or as may occur to me while engaged in composing it. I trust, however, it will be permitted me to add, with- out incurring the charge of vanity or pre- sumption, that the matter it shall contain, whether useful or otherwise, is the fruit of many years' observation and research, ma- tured by a corresponding degree of reflection. I have visited and examined many sickly spots, in other countries as well as my own, with a mind awake to the condition of the inhabitants, and an earnest wish to see it amended. The subject is not therefore new to me. But I entreat the Faculty not to misun- derstand me. It is not my intention to trou- 3* 30 ON MALARIA. ble them with a Dissertation ponderous in learning and encumbered with authorities. Such a production would be alike unworthy of them and the subject. They are not now to be informed, any more than myself, that the terms learned and useful are neither synonomous, nor always convertible into each other. They are unfortunately very often directly the reverse. Nor are there many subjects, in connexion with which this would be more likely to be the case, than that which I am now considering. Learning, as respects it, would be little else than another name for a useless citation of vague conjectures and antiquated hypotheses. Much indeed has been said and written about the malaria of bilious fever, but, as far as I am informed, very little directly on it. In the course of my reading, it has fallen in my way to look into the works of almost every writer of note, who has treated of it since the days of Lan- cisi, its great discoverer; and I regret to say, that the labour has far overbalanced the re- ward. True, I have enjoyed what the world ON MALARIA. 31 calls the pleasures of variety; for no two au- thors I have ever examined have thought and written alike about it. Each had his own dream, and his own method of relating and •nterpreting it. In one I encountered a bat- tery of unrelenting dogmatism; in another a methodical array of what he called "facts," but which appeared to me to be nothing but fancies; and in a third, I was compelled to thread the brake of what admiring readers denominate ingenuity; a term which occu- pies the entire space from profound and res- olute sophistry, to the frothy surface of dex- trous trifling. But, as respected sound and useful information, all was to no purpose. I rose from my task precisely as I had sitten down to it; with the exception, at times, of disappointed feelings and an aching head. Seriously; as far as my inquiries have extend- ed, the crude views, and indefinite expres- sions of writers on malaria, are incompatible with accurate information and practical re- sults. I allude chiefly though not wholly to speculations about the nature and modus 32 ON MALARIA. operandi of the poison. Occasionally use- ful facts are presented to us scattering!)', like oases in the desert. But from being insula- ted they are almost lost. They want the force of system and concert. They resem- ble a disjointed assemblage of militia-men, whose power during action, being exerted in- dividually, is wasted without effect; while well trained regulars act in masses, and a- chieve victory. Even professed writers on Hygiene and medical police are exceedingly defective in their remarks on malaria. Much more is this the case with common writers on the diseases of the East and West Indies, and other warm climates, and marshy coun- tries, most of whom are mere practitioners, rather than philosophers, and whose object is cure rather than prevention. Indeed, as relates to the true philosophy of malaria, I do not know that any additional light, wor- thy of notice, has been thrown on it, since the time of Lancisi. That illustrious physi* cian discovered and proved the existence of the poison, and pointed out some of its laws; ON MALARIA. 33 and I am unacquainted with any subsequent writer who has done more. The abundant succession of hypotheses we have had, has obscured and retarded truth, rather than brightened or advanced it. But I must have done with these digres- sions and prefatory remarks, and hasten to my subject, lest others should say of me, as I have done of my predecessors, that I write " about it," rather than " on it." I am indeed aware that the freedom of comment I have indulged on the productions of others, invites the same in relation to my own. And my wish is to that effect. Free discussion is es- sential to truth; and that is the object at which I aim. It shall be my endeavour, therefore, as it is my wish, to proceed on the ground of fact and fair induction. With hypothesis I have no concern. I shall erect none myseif, nor consume much time in subverting those erected by others. Such toys of the fancy are suited only to the slumbers of the cloister. It is my desire to have my sentiments scruti- nized with strictness and candour. If they 34 ON MALARIA. pass an ordeal thus conducted, they will be worth possessing. If not, the sooner their mistakes are detected and refuted, the better. The issue will instruct myself as well as others, and so far free me from the thraldom of error. And that is the freedom to which I aspire. Under all the circumstances of the case, I have nothing to ask or expect but jus- tice ; and that, as relates to the present dis- cussion, I doubt not I shall receive. I shall therefore proceed in it without further devi- ation. The entire subject of this Dissertation, as I proposed by the Faculty of Maryland, is in- cluded under the four following questions. 1. What is the nature of the malaria that produces bilious fever? 2. From what source or sources does it ' arise? 3. What are the best means of preventing its formation, and removing its sources? and, when the sources cannot be removed, nor the formation prevented, ON MALARIA. 35 ■1. How may its effects on the human sys- tem be most certainly obviated ? These questions I shall now consider, in the order in which they are here proposed, treating each of them as succinctly as the subject will admit. 1. What is the nature of the malaria that produces bilious fever? To this question my answer is brief. I do not know. Nor is any one better informed about it than myself. The present state of science does not admit of better information. By no other test than its deleterious effects on the animal kingdom, more especially on man, can even the existence of the poison be established. Of its nature or composition, or the species of matter to which it belongs, :o more is known than is of the poisons of small-pox, measles, or rabies canina. Here the matter, for the present, might be suffered to rest, were it not that multiplied errors re- specting it are afloat, the exposure of some of which would seem, in its beneficial effects, to be second only to the discovery of truth. 30 ON MALARIA. The malaria of bilious fever is supposed, no doubt correctly, to be the product of chemi- cal agency. The votaries of the laboratory, therefore, have endeavoured to make it the subject of chemical experiment. But in no instance have they succeeded. Virtually they have sought a phantom and found noth- ing. Their efforts have been as unavailing as those of a child that pursues its shadow, or grasps at a moon-beam. I speak from personal observation. I have often witness- ed these attempted experiments, and some- times engaged in them myself, with equal interest and disappointment. They were tried on the atmospheres of different places, where bilious diseases prevailed in every grade, from a slight intermittent, to malignant yellow fever. But they were tried to no pur- pose. In the air where man contracted dis- ease soonest, most certainly, and of the worse character, no more poison of any kind was discoverable, than in the healthiest atmos- phere of the hill-top or the mountain. Nor could any extraneous matter, in the form of 0N MALARIA. 37 gas or otherwise, be detected in the one body of air more than in the other. In each all the common atmospherical components were present in their natural proportions; and nothing else appeared. Neither a deficiency of oxygen, therefore, nor a superabundance of carbonic acid gas, or of any other known chemical compound, could be indicated as the cause of the prevailing sickness. That evil was the product, as already mentioned, of a lurking agent, whose very existence could be recognized only by the injury it in- flicted on animated nature. But, as relates to the nature of bilious malaria, the influence of chemistry has not been merely negative. It has not only failed to confer any benefit on the medical profes- sion ; it has proved to it a source of positive mischief. This it has done by becoming a hot-bed of hypotheses, to the exclusion of observation and sober inquiry. During the late domination of ultra-chemistry, when the entire system of man was considered a chemical laboratory, and almost every sci- 4 38 ON MALARIA. ence was adulterated by the caloric of the crucible or the fumes of the retort, it was im- possible that malaria should not be consider- . ed a product of the same source. And as some chemists affected a knowledge not only of all the elements, but also of all the combi- nations of matter, it was inevitable that they should attempt to identify the poison in ques. tion with one or other of the gases formed by their experiments. From this arose a state of things which seemed to proclaim, that the only province of chemical physicians was to deal in conjecture. And their art was prac- tised indiscriminately on the phenomena of living and dead matter. Hence, as respect- ed malaria, the brain of every member of that school brought forth its own peculiar fancy, until, collectively, the motly brood al- most equalled in number, and quite in ludi- crousness, the fables of iEsop. Every single g^.s, with every imaginable mixture of gases, was proclaimed in its turn, or rather in a si- multaneous and promiscuous uproar (no can- didate for the honor of discovery waiting for ON MALARIA. 39 or listening to a competitor) to be the miasm productive of bilious fever. But, as far as I remember (for I was not so much edified or delighted by the tumult, as to treasure up all that transpired in the course of it) public at- icntion was longest and most forcibly attract- ed by the claims of the nitrous oxid, or some other nitrous compound, and carbonic acid gas. These found many advocates, some of them distinguished for ability and eloquence, who made it, for several years, their daily study and. nightly toil, to prove them the source of bilious complaints. Yellow fever was, at the time, prevailing annually in our large commercial cities. An effort was made, characterized by much ingenuity, and urged with a degree of industry and perseverance worthy of a better cause, to derive that mala- dy from nitrous oxid, or some other gas, whose base was nitrogen. The New York Medical Repository contains many papers in defence of this hypothesis, some of which are marked with much research, and an unusual share of strength and dexterity in 40 ON MALARIA. argument. But they were written to no pur- pose. Nature has decided that fact must prevail; and that all else is perishable and evanescent. However attractive and impo- sing the form and colouring that talent and labour may bestow, for a time, on hypothesis and error, they cannot establish them on the ruins of truth. The nitrous-oxid notion,there- fore, had its day. But it was short. Re- cords only say of it, that it was. Present opinion says it is no more. Two well known facts ought to have been sufficient to stifle it in its birth. No mode of applying nitrous oxid, or any other nitrous compound, to the human body, can produce yellow fever. The experiment was repeatedly made, during the period referred to, and uniformly failed. Nor could a particle of the gas in question be de- tected in the atmosphere of the places where its supposed product prevailed. Other ob- jections might be added; but they would be superfluous. Although still more palpably erroneous, not to say absurd, the hypothesis attributing ON MALARIA. 41 bilious fever to carbonic acid gas has yet some advocates. But. they are not numer- ous. Why they ever had an existence among physicians possessing any knowledge of that gas, is to me unaccountable. Its pre- sence in the atmosphere is easily detected. But experiment proves that it does not exist in unusual quantities, in places where bilious diseases prevail. Much less does it exist in quantities proportioned to the amount of dis- ease. If the report of a distinguished phy- sician may be credited, the reverse is some- times true. It is found in a comparatively diminished quantity in places of sickness. Fort Fuentis stands in a marshy and sickly district, at the mouth of the Vateline. Mount Legnone, one of the chain of the Grison mountains, which rises 8640 feet, French measure, above the level of the sea, is pecu- liarly healthy where it is inhabited, and its summit is covered with perpetual snow. In these places, when fever was raging in the low country, Gattoni made repeated experi- ments, and found, to his surprise, that, chemi- 4* 12 ON MALARIA. cally speaking, the sickly atmosphere was the purest of the two. In other words, it con- tained the greatest amount of oxygen, and, of course, a diminished proportion of its other elements. The positive quantity of carbonic acid gas in each place was the same. For the accuracy of these experiments I am un- willing to vouch. I have already mentioned, that those of a similar nature, in which I have been myself concerned, gave a different re- sult. They indicated no difference between a healthy and a sickly atmosphere. The re- sult of a series of experiments by Moschati was the same. But this is not all. Every one knows that, in whatever way it may be applied, the effects produced on the human system, by carbonic acid gas, are totally different from those that result from bilious malaria. No two classes of phenomena can be more dissimilar. Measles and influenza, scarlatina and small- pox, are much more alike. Were the hy- pothesis I am opposing true, the attendants on lime-kilns, where immense quantities of ON MALARIA. 43 carbonic acid gas are hourly evolved, would never be free from bilious fever. Nor would the complaint fail to attack us by our fire- sides, especially in winter, when we consume oil in our lamps, and spermaceti in our lus- tres. Every Laplander's hut, moreover, du- ring his long night of winter, would be a fruitful source of febrile malaria. Yet throughout that period, in particular, he is a stranger to the complaint which that poison produces. Even the chemist in his labora- tory, when preparing carbonic acid gas, would frequently suffer from his own experiments. In a more especial manner, were the notion true, what would become of our lovers of por- ter, ale, cider, champaigne, and soda-water, who are swallowing, by the hour, deep pota- tions of the reputed miasm ? In that case, every butt of beer would be fraught with the seeds of bilious fever, and every brewery and soda-water fountain, as rich in poison as the Pontine marshes. The hypothesis is lu- dicrous ; and were it not that it has received the sanction of physicians of standing, would 14 ON MALARIA. be unworthy of a moment's serious conside- ration. Another chemical notion respecting the cause of bilious fever, deserves perhaps a pas- sing notice. It is that which attributes the disease to the hypercarbonation of the blood. This again, I say, is as empty a conjecture as has ever issued from the dreams of a vision- ary. The blood of patients in bilious fever, say its advocates, is always preternaturally dark coloured, from holding in mixture a superabundance of carbon. Neither this po- sition itself, nor the attempted explanation of it, is true. As a general rule, the blood of patients in bilious fever is not preternaturally dark. It assumes that colour only under par- ticular circumstances, which have no con- nexion with the amount of carbon in it. They are explicable only on a very different ground; and on that their explanation is easy. I ven- ture to say, moreover, that the venous blood, in bilious fever, is more frequently preterna- turally florid, than preternaturally dark. Dur- ing the stage of excitement, if the reaction ON MALARIA. 45 be strong and the circulation free, its colour is always too high. Nor am I the first wri- ter who has said so. The fact is recorded by Riverius, Cleghorn, and Huxham, and, if I mistake not, also by Sydenham and Rush; and I am confident it must have been* wit- nessed by thousands of others. I doubt whether there is a practised bleeder in the United States, to whom it is not familiar. Du- ring the access and cold stage of intermitting fever, the blood is always dark, and becomes florid again, in the stage of excitement. It is also dark in deeply congestive bilious fever, where reaction is suppressed; but in open fever, of high excitement, the reverse is true. In fact, in every case, where the circulatory system is torpid, or in any way wanting in ac- tion, and respiration deficient, the blood is, and, by the laws of the animal economy, must be, preternaturally dark. But it never is nor can be so, when circulation and respiration are vigorous and free. Were it admissible for me to dwell on it, all this is perfectly ex- plicable, on principles which no physiologist 46 ON MALARIA. would controvert. Nor has carbon any more connexion with the phenomenon, than it has in giving fragrance to the rose, or lustre to the sun. That it should, by intelligent phy- sicians, be supposed to have, is matter of sur- prise. Have chemists detected, by a fair and satisfactory analysis, a superabundance of carbon in dark venous blood? Have they detected in it a particle more than is found in the florid blood of the arteries? The an- nals of their profession cannot reply to these questions in the affirmative. Or if they can, I know not where the record is to be found. Conjecture indeed has said yes; but fact has not concurred with it. Again; does a mix- ture of carbon with bright arterial, convert it into dark venous blood ? No physician of reputation will contend that it does. I, on the contrary, assert that it does not. I have witnessed the experiment, and know that I speak correctly. The hypothesis is an abuse of animal chemistry, which should receive no countenance from real physiologists. ON MALARIA. 47 Were I to say the same in general of chem- istry, as applicable to the functions of living matter, I might set opposition at defiance. It neither performs any of them, nor aids in the performance. Within its proper sphere, that science is delightful and important. None can be more so. But it is concerned exclu- sively with dead matter. With life and all its attributes it is at war. It is the great an- tagonist of life, and life of it. It is no more suited to explain a single function of living matter, than the laws of life are to explain the formation of carbonate of magnesia, or Glauber's salts. When an attempt is made to expound by it a vital phenomenon, it is dislocated and misapplied; and that disloca- tion, like every other, proves a source of mis- chief. The harmony of nature consists in every thing producing after its kind. Abro- gate this law, and chaos is recalled. Chem- ical causes, therefore, can produce only chem- ical effects, and vital causes vital effects. They are not transmutable in themselves or their action. Physiologists would escape an 48 ON MALARIA. infinity of trouble, and the profession no less confusion and error, were chemists to confine themselves to their proper laboratories, and to dead matter. The living body of man is as completely without their sphere, as its structure and economy are beyond the imita- tion of the manufacturer of chess-playing automatons, and rope-dancing harlequins.* *It is in vain for M. Kroussais, and other animal che- mists, to endeavour to explain away the error they, propa- gate and the mischief they do, by the terms they employ. To tell us that, by "animal and vegetable chemistry,'1 they mean the mutual action, in the form of decomposition and recomposition, of* the " radical molecules of organized matter, under the control of the vital principle," is of no avail as to the objed they profess to have in view. Chem- istry is a technical word, possessed of a definite meaning. For centuries it has been the representative of certain changes in the composition and qualities of matter, pro- duced by affinity and repulsion, under the influence of given laws. Nor is there between those changes and the phenomena of life the slightest similarity. They are, on the contrary, the antipodes of each other. Dissimilitudes stronger than those which exist between them can scarcely be imagined. Yet when the chapges in living matter are said to be produced by " animal chemistry," nine persons out of ten, I might say ninety-nine out of a hundred, attribute them to ON MALARIA. 19 There are not wanting chemical physicians who would identify yet other gases with the malaria productive of bilious fever. Of these substances some are sulphurated hydrogen gas, phosphorated hydrogen, and I believe carbonated hydrogen, with perhaps a few others. As relates to all of them, a single remark is sufficient to subvert the hypothesis which embraces them. Not one of them can be detected in the atmospheres of places where bilious fever prevails. Agitate, with a stick, the bottom of a pond, where masses of vegetable relics exist in a dissolving state, the agency of the common chemical affinities; I mean the chemichal affinities of the laboratory. They consider res- piration, digestion, and other vital functions as belonging to the same class of processes with the combustion of char- coal, the decomposition of water, and the formation of neutral aalts. Thus is error propagated by an improper use of words. Nor does there exist for that use the slightest necessity. The expressions,animal action, vegetable action, or the more general one, vital action, would be much better than animal, vegetable, or vital chemistry. The former, although not ex- planatory of any thing, do not mislead; whereas the latter do. I need scarcely add, that every phrase which propa- gates error ought to be erased from the language of science. 5 50 ON MALARIA. and some of them will indeed rise to the sur- face of the water, and may be ignited. But examine the atmosphere only a few feet dis- tant, and no trace of them will be found in it. To this may be added, as another objection, that no application of these gases to the hu- man body can produce any form of bilious disease. Another hypothesis respecting the malaria in question, which has found advocates of some respectability is, that no such poison ex- ists ; but that bilious fever results exclusively from heat, moisture, and vicissitudes in tem- perature. My reply to this notion shall be brief, but I trust satisfactory. When yellow fever prevails in a city, it is often arrested, in its progress, by the interpo- sition of a street not more than sixty feet wide. It advances to the east or the north line of the street, but goes no further. Almost all the inhabitants on that side suffer; and all those on the opposite one escape. Such a case I have repeatedly witnessed, and therefore speak confidently of it. Many others have / ON MALARIA. 51 witnessed it also. Of oriental plague the «ame is true. How is this phenomenon to be expounded? Place on each side .of the street a thermo- meter, a barometer, a hygrometer, and a plu- viometer, and they will show the atmosphere to be, in both places, precisely alike in tempe- rature, weight, and moisture, as well as in the changes it undergoes, and the rain it precipi- tates. To no difference, in these respects. then, can the difference in healthfulness be ascribed. But one source of solution re- mains. The disease arises from a subtle poison, which reaches the street, but does not cross it. A stream of water of mode- rate width has arrested the progress of sick- ness on the same principle. Again. Yellow or common bilious fever is raging along the bank of a large river, or some other body of navigable water, and a ship is lying in it, at cable's length from the land. Provided the vessel be kept clean, and her government be judicious, the crew will continue healthy, unless they are permitted 52 ON MALARIA. to visit the shore; in which case they will suffer from the prevailing disease. This is a common occurrence, which no difference in the sensible qualities of the atmosphere can explain. No difference indeed exists in them. At the edge of the water, and seven hundred feet distant from it, where the ship lies, those qualities are the same. But there is a miasm at the former place, which does not reach the latter; and hence the difference, as relates to disease. Some of those who deny the existence of malaria, attribute bilious fever to the delete- rious influence of atmospherical moisture alone. Were this hypothesis true, no mari- time situation could ever be healthy. The atmosphere of such places being necessarily surcharged with humidity, bilious fever would be an annual scourge to them. It would be rather perennial, prevailing during the win- ter as well as the summer, the atmosphere being humid throughout the year. But if free from swamps and marshy ground, maritime situations are peculiarly healthy. Of insu- ON MALARIA. 53 lar places, especially small ones, the same may be said. The marine air sweeping en- tirely across them, their atmosphere is satu- rated with moisture, and often darkened by fogs; and yet they are among the healthiest spots on earth. Bermuda, the Bahamas, and particularly most of the Scottish isles are of this description. The atmosphere of a ves- sel at sea is necessarily very humid. Yet, provided she be clean and well governed, she is always healthy. To neither humidity, then, nor any other sensible quality of the atmosphere, can bilious fever be reasonably ascribed. It is the product of an aerial poison, significantly enough denominated malaria, whose effects alone on the animal kingdom proclaim its existence. 2. From ichat source or sources does bilious malaria arise? From vegetable and animal matter, more especially the former, in a state of dissolu- tion. I say "dissolution," not putrefaction; because there is good reason to doubt wheth- er that process, in the technical meaning of 54 ON MALARIA. the term, be necessary to the result. Bilious fever, in all its varieties of type and degree, often prevails in places where no putrefaction is discoverable. But dissolution, by which I mean the decomposition of dead organic substances, and the reunion of their elements, producing new compounds, is present. In no other way can the malaria be formed. At least it never manifests itself, except in situa- tions where traces of the process referred to appear. That my remarks may be the bet- ter understood, when I shall speak hereafter of the prevention of this miasm, I must treat of its production somewhat circumstantially. The medical world is in the habit of refer- ring to Lancisi, as the discoverer of the ma- laria of bilious fever. In a certain view of the subject, I have already admitted that the reference is correct. He was so far the dis- coverer of it as to be the first to pronounce it the azotic or lifeless result of the chemical dissolution of vegetable and animal substan- ces, and to bestow on it a name expressive of what he considered its nature. Others, who ON MALARIA. 55 had spoken of it, believed it to be, as will ap- pear presently, not dead matter, but a count- less brood of animalculae, infinitely small. He called it paludum effluvium—marsh ex- halation—because he believed a marsh, lake, or some other form of.stagnant water neces- sary to its production. But he was far from being the first to indicate fens and marshes as sending forth, directly or indirectly, va- pours and other kinds of matter productive of bilious and pestilential diseases. In ex- pressing their conviction of the pestiferous influence of such places, the ancients were as clear and decided as he was. But they spoke in poetry, he in prose; they in the language of fiction, he in that of philosophy. Each treated the subject in the spirit of the a the conservative powers of the system. But such are not the effects of morning drams. They rouse the stomach to preter- natural action, for a time, only to sink it deep- er in exhaustion. It is a disquieting sense of this that leads to a repetition of them, until intemperance is the result. Is any one inclined to ask me, would not bread and cheese, with a draught of water, or a breakfast of bread and milk, protect from malaria as well as coffee, beer, or cider? To this question I am not prepared to answer in the negative. Perhaps an affirmative reply would be nearer the truth. But the experi- ment alone can answer definitively. And I know of no instance where it has been deci- sively made. For many years before his death, the late Dr. Tilton, of Delaware, break- fasted on the product of his own ground. If I mistake not, the meal consisted chiefly of fruit, bread, and milk. Yet he enjoyed per- fect health, and attained a very advanced age. On this topic I shall only add, that were our "Temperance Societies" to denounce ex- 12 134 ON MALARIA. cess in eating as well as in drinking, marking with equal dispprobation the use of improp- er food, and setting correct examples them- selves in relation to the whole, the prospect of a thorough reform would be much bright- er than it is. A very frequent cause of intem- perate drinking is intemperate eating, connec- ted with the use of indigestible aliment. And for every drunkard in our country, we have a hundred gluttons, if, by that term, we mean those who eat too much. Nine hundred and ninety-nine out of every thousand persons in the United States eat to excess, and suffer by the practice. Like other matters floating in the atmos- phere, malaria travels with the wind. It therefore does mischief on the leeward side, at a much greater distance from its source, than on the windward. Suppose it indispen- sable that a dwelling, fortress, or town be built near to a marsh that cannot be imme- diately drained and cultivated, and that the prevailing summer and autumnal wind of the place is from the southwest. Let the buil- ON MALARIA. 133 dings be erected on the same side. Why? Because the wind will carry the malariafrom them, and their inhabitants will be healthy; while it will convey it directly to them, if they occupy the northeast side, and they will suffer from sickness. Hence the well known fact, that in the southern section of the Uni- ted States, where the prevailing winds of sum- mer and autumn are from the south and west, the dwellers on those sides of marshes, swamps, rivers, and mill-ponds, are often in the enjoyment of good health, while the peo- ple on the opposite sides*, although further perhaps from the laboratory of the poison, are victims to fever. Another precaution, by which a town or single dwelling may be protected from the malaria of an adjacent marsh, is the inter- position of a cordon of trees and underbush. If a growth of such timber, therefore, be al- ready standing between the marsh and the buildings, let it remain; and if it be wanting, plant it. Trees of moderate elevation, with bushy tops, and which throw out limbs and 136 ON MALARIA, foliage along their trunks, are best suited t6 form the barrier required. Many places in tropical climates have been rendered uninha- bitable, by the felling of trees and the destruc- tion of underbush between them and neigh- bouring swamps and marshes; and their sa- lubrity has been restored by the regeneration of the timber. In the United States similar events have occurred. The evidence on the subject is therefore complete. This mode of obstructing the march, and obviating the mis- chief of malaria, has been practised time im- memorial in Persia and other oriental nations. Would a lofty wall arrest the progress of malaria, issuing from a neighbouring source? I doubt not it would. Facts seemingly to that effect exist. The plague of Moscow found its way in but few, if any instances; within the walls of the Kremlin. I think. but cannot, on this subject, speak confident- ly, that the prisoners in the Philadelphia jail remained healthy, during the prevalence of yellow fever, in that city, in 1798. Yet the disease, during that season, spread in all di- ON MALARIA. 137 rections around the prison, where any inhabi- tants remained. Theur'ni.^rrupted health of the inmates of monasteries and nunneries, enclosed by walls, during the devastations of pestilence around them, is almost proverbial. It has been as- cribed to different causes; strict temperance in diet and drink; general regularity of ha- bit; exemption from strong and irritating passions; and a life of seclusion, leading to an avoidance of contagion from the sick. That the three former of these causes acted as means of protection from disease, cannot be doubted. But that the latter did not is equally certain, in as much as there was no contagion in the case. Others have regarded the escape of the meek recluses from pesti- lence, as a special blessing from above, on account of their piety. Persuaded that Hea- ven always stays natural calamities by natu- ral means, I cannot abandon the belief, that the surrounding walls, which shut in those devout ascetics from the world, shut out ma- laria from them, and thus contributed to their 12* 138 ON ^IVLARIA. safety. That those peaceful retreats of de- votion may be the more secluded, the walls enclosing them are usually lined with rows of trees, and sometimes of shrubbery. These have therefore added strength to the protec- tinp; barrier. I have no hesitation in believ- ing, that a rampart thus composed, provided the wall be lofty enough, and the rows of trees sufficiently dense; and provided also that the entrances be kept closed, will arrest com- pletely the progress of malaria, and afford protection to the residents within. A knowledge of the exa*ct distance from its source, to which malaria can travel, may aid much in the selection of secure situations for residence. But that knowledge is not now possesssed by any one; nor does it appear to be attainable in the present state of sci- ence. Well established facts seem to ren- der it eertain, that, under different circum- stances, the poison travels different distances. Itjhas been already observed, that it moves farther from its source with the wind than against it. And it may be added, that it ON MALARIA. 139 *. travels farther with a current of air, than through the calm atmosphere. Is the country level? The poison fills a wider sphere than if it were bounded by hills. For although it can attache summit of a hill of considerable elevation, it is weakened by the journey, and rarely does much mischief on the opposite side. The distance it can pass along water is very limited. As already mentioned, it never reaches a ship lying cable's length from the shore. This has been satisfactorily as- certained in innumerable instances. During the prevalence of yellow fever in Philadel- phia, families have taken refuge in vessels, anchored in the ship-channel, not more than from two hundred and fifty to three hundred paces fiom the wharves, and escaped dis- ease. 1 doubt whether marsh miasm has ever passed over a river the fifth part of a mile in width. Unquestionably the inhabi- tants along one bank of such a stream are often healthy, while those on the other are suffering from bilious fever. Of a river not more than a hundred paces wide, I have 140 ON MALARIA, known the same to be true. Families resi- ding immediately on the leeward brink of such a stream are often healthy, during the summer and autumn, while those on the same side, but a few hundred paces distant from the water, suffer from bilious fever. The reason of this is plain. The wind cannot convey the poison across the river to the for- mer, while it removes from them that pro- duced on the same side, and carries it to the latter. Nor is this all. Between the margin of the stream and the families living a short distance from it, there usually exists an in- terval of low ground, which is itself a labora- tory of febrile malaria* This is also borne by the wind from the inhabitants resident on the water's edge, and thrown on those a little remote from it. Bilious miasm is said, by some writers, to travel from one to three miles, and by others as many leagues, from its source, and produce disease. The asser- tion wants proof. No authentic facts can be adduced in susport of it. I have never known an instance, in which malaria, even when ON MALARIA. 141 most abundant, produced fever more than half a mile from its source, perhaps not so much. I say, "when most abundant;" and certainly its amount must affect materially the distance it may reach. A large volume of it must be more diffusive than a small one, for the same reason that a gallon of wine, mixed with water, will give taste and flavour to a greater quantity of that fluid than a gill. In cases where malaria is believed to travel so far, intermediate sources of it are over- looked. I have already stated, and now re- peat, that wherever there exists a bed of al- luvial soil, or fertile soil of any kind, there the poison may be generated. And, in those instances, where it is supposed to travel so far, if a competent examination be made, such beds will be found between the most striking source of it, erroneously considered the only source in the case, and the extreme point to which it extends. It is exceedingly doubtful whether any wind can carry mala- ria a mile from its source, in a state of such concentration as to produce disease. 142 ON MALARIA. As relates to the means of ascertaining something of the mode and distance of the march of bilious malaria, the following facts may not, perhaps, be without value. Many years ago, the late Professor Wistar remo- ved annually, with his family, to a summer residence, about half a mile, or perhaps a little more, in an eastern direction from the Schuylkill. Compared with the bed of the river, the ground he occupied was lofty. But several ravines, of considerable depth, ran from the edge of the stream toward his dwelling. None of them however reached it. Some of his neighbours, especially those between him and the river, were subject to intermitting fever. There was reason to be- lieve, that the malaria productive of the dis- ease came from the Schuylkill. While in- vestigating the subject, the Professor discov- ered that the morning fogs, which arose from the river, without reaching the summit of the heights on either side, travelled along the ravines, to their termination, and then spread to given distances along the plain, in the ON MALARIA. 143 neighbourhood of their mouths. This lead- ing to further inquiry, his next discovery was, that the sickness which prevailed, was con- fined almost entirely to the range of the fog. Those living without it were healthy, those within more or less diseased. Here, then, it would seem, that the limits of the malaria and the fog were the same; and that the lat- ter, being visible, indicated the extent of the diffusion of the former. On the banks of the Ohio, the same is said to be true. Is it not probable, then, that, as a general rule, habitual fogs from marshy ground, may serve as a " cloud by day," to designate the places where human habitations may be safe- ly erected? Let them be kept without the range of the visible exhalation, and they will be the more likely to be without that of the invisible. Where it is practicable to avoid it, dwellings ought not to be erected on alluvial ground, especially modern alluvion. Such a situation may, in time, be rendered healthy, but not without much labour and skill, ac- companied probably by no little suffering. 144 ON MALARIA. When it is possible to avoid it, an alluvial situation should never be selected for the en- campment of an army. Such a place has often,*produced sickness in a single night. It was observed, in a former part of this Dissertation, that, in a district subject to bil- ious fever, night exposure is particularly hazardous. Is it equally so at all times of the night? I apprehend it is not. It is most dangerous during the descent of the dew; an event which occurs twice in the night; once, soon after sunset, and again a little be- fore day-break. The hours at which this meteor falls, in different latitudes, and under different temperatures, are not the same. Ob- servation alone can ascertain them, and enable those concerned to regulate their movements accordingly. Their safety con- sists in avoiding exposure during the fall of the dew. If their duty, therefore, calls them out at night, let them select the period between the times of the desent of that meteor. Another precaution of great mo- ment, is to continue in action while in the ON MALARIA. 145 humid atmosphere. Exposure, at night, in a state of quietude, more especially in a sitting or lying posture, is full of peril, and should be strictly avoided. To fall asleep during the time is still worse. Is any one wind more deleterious than another?—I mean, is it more heavily charg- ed with pestilential miasm?—No; not in the abstract, and generally. If it is so, in any particular case, it is attributable to local cau- ses. Much error, not to call it superstition, prevails on this subject, both in the minds of living physicians, and the writings of dead ones. The medical and poetic writers of Greece and Rome have said so much about the humidus and pestifer auster, that it al- most makes a part of our professional creed, that the south wind is necessarily moist and pestilential. But nothing can be more des- titute of truth. The Sirocco, which blights and kills from a lack of moisture, but has no pestilential taint in it, comes as frequently from the south as from any other quarter. And, in many places, the south wind is pecu- 13 146 ON MALARIA. liarly salubrious. Instead of being always, moreover, surcharged with humidity, it of- ten beats back the haze and vapours that come from the north, and renders the atmos- phere dry and serene. In Greece and Italy the south wind is humid, because it comes directly from the Mediterranean, bearing along with it much of the exhalation from that sea. It blows moreover during the hot- test weather, when bilious and pestilential fevers most frequently prevail. Hence its supposed connexion with those complaints. But it is not the south wind, it is the high temperature of the atmosphere, that con- tributes to produce the febrile miasm. Let hot air stream in from any other quarter, as it does from the north, in the southern hemis- phere, and the issue will be the same. Ma- laria will be produced. Wind derives its character, not from the point of the compass from which it comes, but from the nature and condition of the surface over which it passes. Is that surface moist? So is the wind. Is it dry? The wind answers to it. Hot? ON MALARIA. 147 The wind is also hot. Cold ? Again the wind corresponds. And it carries malaria along with it, and may therefore be called pestilential, for a short distance after passing over a sickly morass. Such is the true phi- losophy of that meteor. On the Atlantic bor- ders, in the United States, all winds from northeast to southwest, taking east in the semi-circle, are humid; and all in the oppo- site semi-circle, from southwest to northeast, are dry. The reason of this is obvious. The former come from the ocean, saturated with exhalation; and the latter arrive from the in- terior of the continent, exhausted of their hu- midity, by a long journey over land. Dr. Lind speaks of a certain effect of the east wind, on the eastern coast of England, in terms which prove him to have been more of a mere observer, than of a philosopher. He says that this wind "raises a copious- va- pour from water, mud, and all marshy or damp places." And he insists that is does positively "raise" the vapour, and does not produce it in any other way; and that hence I IS ON MALARIA- that wind is peculiarly deleterious. An er- ror grosser than this can scarcely be imagin- ed. It is the counterpart of the belief, that the moisture, which, in a hot day, settles on the outside of a bottle or pitcher, filled with cold water, has passed through the pores of the vessel, in the character of sweat. Hence, by the uninformed, it is believed that the ves- sel actually does sweat. The east wind does not "raise" vapours, in the part of England referred to; it only renders visible those that are already raised. Coming immediately from the sea, it is cool and humid, and there- fore robs the ascending exhalations of a por- tion of their caloric. The necessary effect of this is, to condense them immediately and render them visible. On the west coast of England the east wind acts differently. By passing over the island it has lost a portion of its humidity, and received in return a portion of caloric. It is not therefore a condenser of exhalation arising from water, and does not reduce it to a visible form. On that coast, the west wind, being more humid, is better fitted ON MALARIA. 149 to produce a vapour. It is on thp same prin- ciple, I say, that a bottle, filled with any cold liquid, takes from the warm air in contact with it a portion of its matter of heat, conden- ses the humidity it contains in a state of va- pour, and renders it visible in the form of water. Is there any particular period of the moon's revolution around the earth, at which bilious fever more usually makes its attack, than at others? Yes; at the times of her full and change. This is neither "hypothesis," nor "vis- ion ;" although both terms have been affixed to it. It is a fact, as satisfactorily ascertained by observation, as any other connected with the complaint. The history of epidemic diseases, when circumstantially given, proves that attacks and deaths occur most numer- ously at the periods referred to. Some of the most distinguished members of our profes- sion have recorded their observations to that effect. Were my own testimony of any weight, I would say that it fully concurs with that of others, who advocate the doctrine of 13* 150 ON MALARIA, lunar influence. Nor is the reason of this con- cealed. The vicissitudes in the sensible quali- ties of the atmosphere, which are greatest and most frequent about the times of the full and change of the moon, act as the exciting cause of the complaint, in those who are already pre- disposed to it. Am I asked for the names of any of the writers, to Whom I have referred, as high authority on this subject? I answer the demand, by mentioning Diemerbroek, Mead, Balfour, Mosely, and Rush. And I could add twice as many more, were it ne- cessary. The prophylactic precept founded on this doctrine is plain, and not without its value. During the prevalence of an epidem- ic fever, let those who reside within the sphere of the malaria be especially cautious of exposure to the weather, about the periods of the full and change of the moon.* * There is not, in the science of meteorology, a single fact that rests on a broader or more solid foundation, than that a great majority of the most sudden and striking chan- ges which occur in the atmosphere, from heat to cold, and from moisture to dryness, and the reverse, and an equal ma- jority of tornados, tempests, and other violent atmospherioa) ON MALARIA. 151 Are there any medicinal substances calcu- lated to obviate the effects of malaria? I know of none. All nostrums administered for that purpose, are but the fruits of empi- ricism. Some physicians speak with confi- dence of the beneficial effects of repeated purgatives, in protecting the system from bilious fever. I consider the opinion unfound- commotions occur about the periods of the full and change of the moon. This truth is supported alike by the records of the past, extending even to ancient times, and events that are constantly presenting themselves to our observation. That such vicissitudes in the atmosphere are uniformly prejudicial to the health of valetudinarians, is another fact which will not be controverted. But, during the preva- lence of a bilious epidemic, every one exposed to the poi- son of it is so far valetudinary, as to be more than usually lia- ble to disease. Exposure and unfriendly impressions of every kind, which would be innocent, at other times, pro- duce sickness now. Such impressions are necessarily made by great and sudden changes in the sensible quali- ties of the atmosphere. It is on this ground that the at- mospherical vicissitudes, occurring about the times of the full and change o'lthe moon, act as exciting causes, and aid in producing new cases of the disease. Of all other epi- demics the same is true, for the same reason. Hence, dur- ing the prevalence of every complaint of the kind, the same periods of the moon are most productive of fresh attacks. 152 ON MALARIA. ed, and the practice it recommends hazard- ous, not to say injurious. They are the growth of hypothesis. Sound science does not countenance them; and they derive no support from experience.. Repeated pur- ging, like the excess of any other evacuation, deranges the system, and enfeebles its con- servative power. Instead of resisting, this invites disease. The alvine evacuations should be kept, as nearly as possible, in their state of habitual regularity. Change would be much more likely to prove injurious than useful. Medicinal substances are intended and suited, as their name imports, to restore health, when lost, not to sustain it when pos- sessed. Let them be reserved therefore for actual indisposition, and then administered without loss of time, and with the skill and vigour required. Does constipation of the bowels occur? It threatens disease, if it is not the commencement of it, and should be promptly removed. But actual and con- tinued diarrhoea, the result of the repeated administration of purgatives, is not the best ON MALARIA. 153 substitute for it. Too much purging is as bad as too little. Let both be avoided. Ibis tutissimus medio, is here the precept of ex- perience and wisdom. In fine, I say of the functions generally of the alimentary canal and the organs connected with it, as I did of diet and drink; let them be maintained in the condition that has been found most favour- able to health and strength. As far as they are concerned, this will afford the best pro- tection from disease. The use of bitters, Peruvian bark, and sundry other articles denominated tonics, has been recommended as a security against a prevailing bilious epidemic. This advice does not rest on any sound principle of Hy- giene, with which I am acquainted; nor, as far as I am informed, does experience testify to the success of the practice it enjoins. I cannot therefore confide in its efficacy. By inducing an unnatural state of things, I ap- prehend it would be ultimately injurious. A degree of cutaneous excitement some- what preternatural, but not so high as to 154 ON MALARIA. amount to disease, would seem to promise some security from bilious complaints. Chil- dren affected with prickly-heat escape chole- ra infantum, unless, from a sudden change in the atmosphere, or some other cause, the eruption disappear. The same is true of adults, as relates to dysentery and bilious fe- ver. Individuals who labour under elephan- tiasis are exempt from the fevers of hot cli- mates ; and the same is often the case with those who are troubled with cutaneous ul- cers. Lazars of this description rarely suffer from oriental plague. Such, I say, are the facts; and the phylosophy of the cases must be sufficiently familiar to every physiologist. What, then, would be the effect of preter- natural excitement of the skin produced in- tentionally, as a means of prevention, during the prevalence of an epidemic fever?—of one or two issues, or small perpetual blisters, for example; or of the irritation produced by tartarized antimony? These expedients I have never tried to such an extent as to enable me to speak of th^n- from personal ON MALARIA. 155 observation. But some of them are recom- mended on high authority. I shall only add, that they tend to the maintenance of cen- trifugal action, which is well calculated to prevent disease. Under proper regulation, therefore, they may possibly be found worthy of more attention than they have heretofore received. It was my intention to have expressed my opinion, with the grounds of it, on the sub- jects of the two following questions, which are remotely connected with some of those discussed in this Dissertation. 1. Does the same malaria produce typhus and common bilious fever? 2. Is the malaria productive of yellow fever the same with that which gives rise to intermittents and remittents; or is it a differ- ent form of miasm prepared from the same elements? In each case my present views would in- duce me to give a negative answer. I con- sider the malaria of typhus different from that of bilious fever, in both its nature and 156 9N MALARIA. origin; nor, although formed from the same materials, do I believe the miasms of yellow and intermitting fevers to be identical. But, as the consideration of these points is not essential to the solution of the questions pro- posed by the Faculty of Maryland; and as I have already trespassed on the limits I had prescribed to myself in this inquiry, as well, I fear, as on the indulgence of the Faculty, I decline further discussion, and close my Dissertation. APPENDIX. THE Dissertation, to which the following pages are appended, had been written a con- siderable time before I perused "McCulloch on Malaria.'' Had the case been otherwise, I would not have expressed myself as I have there done, respecting the writers who had preceded me on the subject. In a particular manner, I would not have admitted into the Dissertation the two following sentences. "Much indeed has been said and written about the malaria of bilious fever, but, as far as I am informed, very little directly on it"— "Seriously; as far as my inquiries have ex- tended, the crude views, and indefinite ex- pressions of writers on malaria, are incom- patible with accurate information and prac- tical results." Of all I have ever read on the subject, Dr. McCulloch's k,Essay" excepted, these sen- timents are true. But of that work my report must be different. To condemn it would be 11 158 APPENniX. a sort of literary suicide; because it would amount to a condemnatory sentence on no small portion of my own Dissertation. On many leading points the coincidence of opin- ion in the two productions is striking. Wtre it not for this, and that therefore my praise of it might perhaps be regarded as self com- mendation, I would pronounce the "Essay" a publication of great merit. But as to speak thus of it might be deemed exception- able in me, it is fortunately also unneces- sary. The work will not suffer from my si- lence. It speaks for itself in terms that are convincing; and the medical profession will listen to it, be instructed by it, and do it jus- tice. I am not dissatisfied to find that Dr. Mc- * Culloch's opinion of preceding writers on malaria is the same as my own. On that point I was apprehensive that, should I even escape the charge of presumption, in sup- posing myself better informed than others, I would at least be considered unnecessarily censorious. Still I deemed it right to incur APPENMX. 159 the hazard, for the sake of representing things as they are, and thus aiding in the sub- version of hypothesis and error, and the es- tablishment of truth. It was therefore grati- fying to me to meet, in the following passa- ges, with the support of a writer so exten- sively versed in medical literature, especially on that subject, as Dr. McCulloch is. "As far as my reading extends, I have not found one luminous and philosophical view of the production and propagation of the poison (malaria) and little which can even serve the purpose of preventing diseases"—"It is far too common to find entire volumes (on the cause of bilious fever) filled with idle hy- potheses, respecting pyrites, and volcanos and mines, and attributing to electricity, au- rora borealis, magnetism, and similar visions, what the writers had forgotten to seek in that which ought to have been obvious to the most superficial and ignorant." p. 87. Another topic, on which I was somewhat apprehensive of being considered an extrava- gant colourist, is the picture I have drawn of 160 APPENDIX. the degeneracy of man, produced by malaria, in many of the sickly districts of Europe. But here again I am amply supported by the vivid and graphical representation of the same subject, by the same author. Indeed, although I well knew that truth would fully sanction the effort, I did not dare to paint as boldly and brightly as he has done, lest I might be supposed to be delineating the creations of a heated fancy, rather than the results of sober observation—recording what I had imagined or dreamt, not what I had seen. Hence my portrait falls short of truth, instead of exceeding it. But, notwithstanding the merit of Dr. Mc- Culloch's "Essay," it is not faultless in either manner or matter. I regret to add, far from it. A few pages excepted, which are com- posed with uncommon spirit and elegance, its style throughout is periphrastical,involved, and indefinite, in a degree rarely witnessed in any publication. Nor is this the worst. It is, in many passages, so obscure, as to ren- der their meaning exceedingly doubtful. APPENDIX. 161 Were it not that the author has proved him- self capable of fine writing, it might be deemed hypercritical thus "to censure his style, especially in a work devoted to science rather than letters. But no writer should be indulged in broad negligence. He is before the public, and, from respect to them, no less than to himself, ought not to appear in the character of a sloven. If he does not choose to be in full dress, he ought at least to put off his rags. Besides, a style strikingly faulty, especially if obscure, detracts not a little from the value of the work. It prevents it from being read with the same amount of either pleasure or benefit, that would be readily derived from it, were it suitably com- posed. But, if I mistake not, there are, in the " Es- say," other faults, which much more seri- ously concern the profession. As they re- late to the subject of the foregoing Disserta- tion, a brief notice of a few of them will not, I trust, be deemed inadmissible. But as this appendix must not be protracted, my re- 11* 162 APPENDIX. marks on them can be but little more than hints. As respects sundry points of which he treats, Dr. McCulloch appears to be inordi- nately influenced by apprehension and cre- dulity. He fears and believes imaginary things, and earnestly discusses them, and ad- monishes with regard to them, as if they were realities. This renders him, as relates to such topics, an alarmist and an enthusiast, in a degree far beyond the warranty of facts. To be particular. He has too deep a dread of moisture, as if it alone could generate malaria; although he expressly denies it that power. He would prohibit the formation of all fountains, ba- sins, fish-ponds, lakes, canals, and other sorts of water-ornaments, in gardens, parks, and pleasure-grounds. His apprehension, as to such improvements, is a professional hydro- phobia. He would shun, in warm weather, especially about eve-fall, the vicinity of a crystal rivulet, purling over pebbles and sand, and bedewing, with its light and glittering APPENDIX. 163 spray, the verdure and blossoms on its banks, as if it were exhaling the poison of pesti- lence. Of the effects of every pool or other body of water, whether it be pure or foul, stagnant or in motion, and whether it cover miles, acres, roods, or inches, he entertains the same dread. Meadows he pronounces unhealthy, because the ground is not suffi- ciently dry. In fact, it would be scarcely extravagant to say, that he seems to regard water, in every form and condition, in which it can exist on the surface of the earth, as a nuisance during warm weather. All this, I say, is extravagant and errone- ous. Meadows, if properly drained and cul- tivated, are not unhealthy; but, if defective- ly prepared and unskilfully managed, they are so, in common with every other portion of fertile soil, suffered to lie in a similar con- dition. All experience testifies to the truth of this. Nor, if well constructed and care- fully superintended, are either fountains, ba- sins, lakes, or other ornamental forms of wa- ter, sources of malaria. It is the abuse of 164 APPENDIX. them only that renders them so; and the abuse of the greatest good is productive of mischief. I could refer to hundreds of in- stances, in which such water-improvenlents have been, for many years, some of them for ages, familiarly approached and regular- ly frequented, both by night and day, with- out having produced, by malaria, a single case of disease. As relates to the formation of that poison, Dr. McCulloch and his coun- tryman Dr. Ferguson are the antipodes of each other. The one flies for safety from moisture, and the other from dryness; and science sanctions the conduct of neither. Let ornamental bodies of water be surroun- ded by well cultivated grass-ground, and have their margins paved, gravelled, or peb- bled, and lined with shrubbery and trees with branchy trunks, and they will produce no poison to injure those who may stray around them, admire their beauties, and enjoy their freshness, either by sun-light or moonlight. Let the borders of lakes, ponds, and pools be muddy, and strewed with vegetable mat- APPENDIX. 165 ter running to dissolution, and they will soon become active laboratories of malaria; not otherwise. Were it true that this poison is formed, in warm weather, wherever there is moisture, and that so minute a portion of it as Dr. McCulloch pronounces sufficient, could produce disease, health would be a stranger to the human family. In summer and autumn disease would be acute; and chronic affections, in the form of our au- thor's "ill health," would be a source of mis- ery during the other portions of the year. If the Doctor will examine the matter a lit- tle more accurately, he will find that in nine cases out of ten, if not in nineteen out of twenty, this "ill health" or "indisposition," which prevails so extensively, and which he ascribes in every instance to the influence of malaria, is the product of indiscretion in diet and drink, or of excess or irregularity in the indulgence of the passions. In other words, it is the issue of some sort of intemperance, which is one of the most productive sources of bad health. 166 APPENDIX. Our author's representation of this entire subject is eminently extravagant, and calcu- lated to mislead. Who that has travelled through the western portion of the Union, especially the States of Ohio, Kentucky, and Tennessee, has not seen, in innumerable in- stances, large families in blooming health, with a pond to water their cattle during sum- mer, and also for their geese to sport in, with- in a hundred paces of their dwellings, and often much less? I confess that when I first saw those sink-holes (for such many of them are) I considered them fertile sources of malaria. But my own observation, and the experience of others, the only correct in- structors in such matters, soon convinced me of my error. And a brief examination un- folded to me the cause. The ponds have but very little alluvion around their edges, and contain no dissolving vegetable matter; or if they do, the water in contact with it is too abundant to favour the production of mi- asm, or it absorbs it when formed. Be this solution right or wrong, the fact is certain. The ponds are innocent. APPENDIX. 167 The "Essay" pronounces "woods" un- healthy. I have already mentioned, and now repeat, that, in the United States, they are not so. Our forests when free from fens and marshes, are healthy. The "pine woods" of the south and west, as stated in another place, furnish secure asylums from malaria. This is probably owing to several causes. The surface of the ground is covered by very little vegetable matter; that which lies on it is chiefly resinous, and therefore not well suited to be dissolved and to produce miasm; and the soil being sandy imbibes and carries down the water that falls on it, together with any poison it may contain. In our common forests, it is only when the large timber and the underbush are removed, and the soil torn up by the plough, that malaria begins its reign. In a state of nature, those places are free from disease. Hence the vigorous health of our hunters, trappers, and other forest-rovers, notwithstanding their ex- posures, privations, and hardships. It is well known that, in many large dis- 168 APPENDIX. tricts, Italy is very sickly. But it is not, as a country, the terrific pest-house that Dr. McCulloch represents it. Nor is Sicily. Nor are the maritime and and fluvial regions of the continent of Europe generally. If they were, they would become deserts. So would all the islands of the Mediterranean, were they such haunts of malaria, as our author pronounces them. The inhabitants of those places, moreover, would have neither the robust bodies, nor the vigorous minds which they are known to possess. In his account of many of the districts referred to, the Doc- tor seems more of a poet than a historian. He addresses himself to the imagination ra- ther than the judgment. I doubt not but he honestly believes what he states. But he is too credulous. He does not seem to under- stand the value of doubting, and has not therefore learnt the art. Hence he believes too much of what he hears and reads, es- pecially if it harmonizes with his previous views. One instance of his credulity is astonish- APPENDIX. 169 toiiishing. Holland is separated from Eng- land by the German Ocean, which is from a hundred to a hundred and fifty miles wide. Yet the Doctor asserts gravely that, in the spring, the east wind conveys malaria from die former country to the latter, and produ- ces intermittents!! This neither needs com- ment, nor deserves opposition. Its own ex- travagance refutes it, and renders it inno- cent. No body will credit it. Malaria borne by the wind one hundred miles, along the surface of an agitated sea!! As soon shall it be brought from the seacoast of the moon! Have the crews of vessels cruising in the midst of the German Ocean ever been sick- ened by the east wind, in either spring, sum- mer, or autumn? No; never. On the con- trary, sickly vessels have often sailed from British ports, and become healthy by cruis- ing in that body of water. They are even sent there occasionally for that purpose. But I need scarcely add, that the case would be otherwise, were they assailed by malaria from the coast of Holland. J^or are the Holland- 15 170 APPENDIX. ers themselves always labouring under in- termittents, when the poison of that disease is said to be carried from them to the Eng- lish. Our author's plea that the moisture of the east wind qualifies it thus to convey malaria cannot avail him. From having swept across an extensive tract of interior country, that wind is dry when it leaves the coast of Holland, and becomes moist in its passage over the ocean. But the Doctor acknowledges that a dry wind is an unfit vehicle for the poison, because it has not the requisite affinity for it. The east wind there- fore must leave Holland without it; and there are neither lakes, fens, nor marshes by the way, from which it can collect it. Our author is mistaken in all his views, as to the distance to which malaria can be carried from its source, and produce disease, else that poison is not the same in Europe and the United States. I repeat what is sta- ted in my Dissertation, that the space it trav- els over land, in this country, is short; and that over water much shorter. If the Doc- APPENDIX, 171 tor will take the trouble to visit and careful- ly examine the places, where he contends that miasm produces fever a "league" or even a "mile" from its source, he will find intermediate repositories of dissolving vege- table matter, from which it arises. Dr. McCulloch does not appear to have correct views of the general philosophy of the diseases produced by the malaria" of the Nile. Plague is incontestibly one of them, although he does not think so. That terror and scourge of the Old world is nothing but a modification of the yellow fever of the New; and neither disease is contagious. Nor can the miasm of either adhere to clothes, merchandise, or any other solid sub- stance, and be separated from them again, and still retain its virulence. It cannot there- fore be conveyed in ships or caravans, from one country to another, and there communi- cate disease. A belief that bilious malaria can thus attach itself, and still maintain its febrific power, from year to year, constitutes another of the errors of our author. The IT2 APPENDIX. notion is not sustained by a single fact, and is therefore entitled to no credit. The opinion that plague and yellow fever are but different forms of the same disease, rests on evidence which must command ulti- mately universal assent. Some of it is to the following effect. In all leading and es- sential points the two complaints are pre- cisely ' alike. They prevail in similar situa- tions, during the same season of the year, and under the same degrees of atmospher- ical heat. In their rise, progress, decline, and termination they are identical. They spread only in an atmosphere replete with malaria, produced by the dissolution of or- ganic matter. In other words, they are ne- cessarily associated with a want of cleanli- ness. They attack most readily and most certainly destroy the same descriptions of persons. When cases of either of them are removed beyond the sphere of a miasmatous atmosphere, they never communicate dis- ease to the attendants of the sick. Palpa- bly, therefore, I repeat, they are not conta- APPENDIX. 173 gious;* nor can the poison which produces them subsist from one year to another. It is, in every case, a fresh production of the place and period of its prevalence. There exists between them sundry other points of resemblance, which I forbear to mention. Shall I be told that these two diseases dif- fer so widely in their fundamental symp- toms, that tiiey cannot be the same? That plague is characterized essentially by buboes and carbuncles, and yellow fever by black vomit and a jaundiced skin? I reply that this objection has no weight. Neither are buboes and carbuncles essential to plague, *The opinion that the plague is not contagious, the au- thor has maintained since an early period in his medical studies. He asserted it in the year 1801, in an oration delivered before the Philadelphia Medical Society, and published by that body. For aught he then knew or yet knows to the contrary, he at that time stood alone in the belief, which was pronounced exceedingly wild and vis- ionary. All he has since learnt respecting it has only served to convince him that it is true. Nor is he now sol- itary in the opinion. He is supported in it by several dis- tinguished physicians, with whom itjs honorable to con- cur. He feels persuaded that time will render the belief universal. 15* 174 APPENDIX. nor a yellowness of the skin or black vdmit to yellow fever. In the most malignant and suddenly fatal cases of plague the former symptoms do not appear, nor do the latter in the worst cases of yellow fever. To every one competently informed on the subject, this fact is familiar. Of the slightest forms of the two complaints the same is true. They are not marked, in the one case, by buboes or carbuncles, nor, in the other, by black vomit or a yellow skin. Those symptoms, therefore, are not fundamental. The dis- eases can exist without them. It is only un- der certain grades of violence that they are marked by them. Nor is this all. In some cases of plague a dark discharge from the stomach and a yellowness of the skin have been observed. And that glandular swel- lings and carbuncular sores exist occasion- ally in yellow fever, is well known to Amer- ican physicians conversant with the com- plaint. In what are truly their fundamen- tal symptoms the two diseases are alike. Their seal and pathology are the same, as APPENDIX. 175 appears from accurate post mortem inspec- tion. The abdominal viscera constitute the former; and the latter consists in a deep con- gestion of some of those organs, the result of irritation by the miasm of the complaints. Their symptoms, therefore, really fundamen- tal, are the usual manifestations of great chy- lopoetic derangement. I mean derangement of the chylopoetic system. Hence I feel justified in asserting, that in every thing es- sential the diseases are identical. Dr. McCulloch is inclined to believe, that, in ancient times, when Rome contained her millions, and the surrounding country was densely populated, that part of Italy was as sickly as it is at present. This hypothesis is highly improbable, not to pronounce it neces- sarily unfounded. The existence of a pow- er which governed the world was incompat- ible with such a state of things. Pestilence alone would have been fatal to it. The crowded population which once covered the Pontine marshes, the Campagna di Roma, and other portions of the surrounding coun- 176 \PPENDIX. try, could no more exist there now, than it could in the mangrove swamps of the Con- go, or among the lagunes and jungles of the Ganges. The soil of that district of Italy must have been much more thorougly cul- tivated in ancient times than it is at present, else it could not have afforded subsistence to its numerous inhabitants. Virgil, moreover, testifies, in his Georgics, that, in his day, Italian agriculture was in high condition. And that was a preventive of the formation of malaria. Compared to its present state, therefore, Italy must have been healthy. Our author attributes much of the sickli- ness of modern Italy, and of other maritime and fluvial districts, to the constant aug- mentation of alluvion along the banks and at the mouths of rivers and smaller streams. This is certainly, at the present time, a source of disease; but not necessarily of so much as the Doctor ascribes to it. It is doubtful whether it is necessarily the source of any. Indolence and neglect are indirectly the cause of the mischief. Let an enlightened ■s. APPENDIX. I7f cultivation of the soil keep pace with the pro* gress of alluvial deposition, and the evil will be greatly diminished, if not entirely prevent- ed. Land rescued from the water by art dif- fers but little, in many instances, from allu- vion. Virtually it does not differ at all. Yet it is well known that, by proper means skil- fully applied, that can be prevented from producing sickness. Meadows thus formed and managed produce no disease; and even Venice was once a place of health. As mankind advance in knowledge and wis- dom, and attain the requisite government of themselves, as individuals and in communi- ties, they will learn to apply to their own benefit the good gifts of nature. The rich alluvion that rivers are daily forming is one of these. Instead therefore of suffering it to depopulate countries, by the production of malaria, industry and enterprise will con- vert it, by suitable modes and degrees of agriculture, into healthful abodes and fertile fields, for the accommodation and mainten- ance of the human race, under their steady 178 APPENDIX. increase in number. Even in our own coun- try, the alluvial tracts that were formed cen- turies ago, and are still covered annually, some of them perpetually, by the waters of the Mississippi, will support hereafter the population of an empire. As to the apprehension expressed in the "Essay," that Rome will be depopulated, and reduced to the desolation of Babylon, by malaria, I consider it unfounded. Or, should it be realized, man will be in fault. I should rather perhaps say, that the Papal government will be in fault. Let that tyranny be overthrown, or so mitigated that the Ital- ians may feel that they are labouring for themselves, and not for inexorable and ra- pacious task-masters, and their beautiful country will soon put on a new aspect, and rise, in all respects, to a new condition. Her fields will become as fresh and pure in ver- dure, as her skies are in azure. Her inhabi- tants will be no longer enervated by sloth, and broken in body and spirit by poverty, nor her balmy breezes tainted with poison; and APPENDIX. 179 the healthfulness of ancient times will revisit her. The country being thus improved, add to each town and city a wise and energetic police, and the work will be complete. Of every other place where sickness is increa- sing from the same cause the same may be said. Agriculture, skilfully pursued, and cleanliness, strictly maintained, are compe- tent to arrest the mischief and restore health. Dr. McCulloch asserts that close, narrow, small, crowded, and of course dirty streets and houses, where the poor reside, are better calculated to resist the progress and prevent the bad effects of malaria, than wide streets, lined with the large and airy dwellings of the rich. He points to Rome in verification of the fact, and then attempts to assign the cause of it. He seems to think that the fe- brific poison is, in some way, neutralized in such places. I shall only reply, that things are otherwise in the United States; and that I cannot perceive any correctness or feel any force in our author's reasoning. When any form of bilious disease prevails in the large 180 APPENDIX. cities of this country, the poor are the earli- est and the principal sufferers; and the nar- rower and filthier the streets, and the smaller and more crowded their houses, the more certainly are they attacked, and the more formidable are their complaints. To this I have never witnessed an exception; nor do I remember to have read of one, until I opened the "Essay." I know that, at times, some forms of epidemics attack certain classes of the community, in preference to others. But both observation and reading have taught me to believe, that bilious complaints always visit first and most fatally the abodes of pov- erty. • In Dr. McCulloch's preventive measures there is nothing new; nor, in prescribing them, does he appear to have been always under the direction of sound physiological principles. Some of them are not only use- less but injurious. The Doctor recommends the kindling of fires, as a means of dissipa- ting or destroying malaria, and thus protect- ing those who would be otherwise exposed APPENDIX. MM to it from its deleterious effects. "He alleges that the smoke and heat co-operate in their prophylactic agency. That fires may be rendered useful cannot be doubted; but not on our author's princi- ple ; not by acting on the malaria so much as on the human system. By preserving the proper temperature around the surface of the body, they maintain the vigour' and secre- tions of the skin, sustain centrifugal action, which is that of health, and thus enable the powers of life to resist the assault of the mi- asm. They counteract, moreover, the influ- ence of atmospherical moisture, which might otherwise prove an exciting cause of disease. But they do not and cannot so dissipate or destroy malaria, as to prevent it from corn- ins iuto contact with those who are around them. Their necessary effect is to create a conflux of air from every point toward them- selves. The air, thus flowing from the cir- cumference of the circle to the fire in its centre, and bringing malaria along with it, must inevitably precipitate that poison on 16 182 APPENDIX. those who are in the vicinity of the fire, be- fore it can be materially affected by the heat. On this ground it might even be suspected to do harm radier than good. That they might act on Dr. McCulloch's principle, the fires should be so arranged as to form the cir- cumference of the circle, and those to be protected from miasm by them occupy the centre. Then indeed the enemy might be scorched, in the fiery ordeal, before reaching its object. But are matters ever so managed ? No; never. Nor does our author so direct them. Fires kindled in the streets and else- where, on an extensive scale, with a view to dissipate or destroy the malaria of the great plague of London, are said to have done mischief. Be this as it may, I have certainly seen fires kindled through the streets of a city, to protect the inhabitants against the poison of yellow fever, and strongly odorous matters consumed in them, without doing any good. Indeed to think of purifying, Dy all the fires that can be kindled and kept burning, the entire atmosphere of a city or VPPENDIX. 183 tract of country from the malaria, constantly pouring into it from innumerable sources, is visionary. The cause is too limited and fee- ble for the effect contemplated. When those who are exposed to bilious miasm, therefore, so employ fires as to keep their persons com- fortable, and their dwellings, especially their bed-chambers dry, they have nothing further to expect from them. As respects certain other protecting agents, the Doctor expresses himself as follows. " The other class of preventive remedies comprises modes of exciting the animal powers by food, spirituous liquors, and so on, or of diminishing the sensibility by narcotics, such as tobacco and opium. Of the utility of these expedients, the experience is ample." If by "exciting the animal powers by food," our author means maintaining health in perfect vigour and firmness, by aliment found by experience to be salutary, I concur with him; not otherwise. All excitement beyond this, whether by food, condiments, or drink, tends to exhaust and debilitate the "animal 184 APPENDIX. powers," and is pernicious. In other word^ it weakens the conservative energies of the system, in common with every sort of excess. Of "spirituous liquors," as a means of pre- vention, I have expressed my opinion in my Dissertation, and am not inclined to retract or alter it. In the abstract they are injuri- ous. Other things being alike, persons who have never used them are more likely to es- cape bilious fever than those who have; and, should they be attacked by it, their suffering will be lighter, and their recovery more pro- bable. But, as I have elsewhere stated, it is hazardous for those who have been long ac- customed to the moderate use of spirituous drinks, to abandon them suddenly, because they are exposed to bilious malaria. To take them in larger quantities, as a prophy- lactic measure, is worse. Health is best se- cured by making no change. Of wine the same is true. Abstractedly considered, its use is no means of safety. To wash the skin with it and distilled liquors would be much more beneficial than to drink them. APPENDIX. 185 Officers are more healthy than privates, not because, as our author alleges, they drink more wine, but because they are more regu- lar in their general habits, and also less ex- posed. They are likewise more cleanly and more suitably clothed. In plain language, they take better care of themselves, know better how to do it, and are better provided for the purpose. Those, however, who have been accustomed to the temperate use of wine, and have enjoyed good health under it, ought not to relinquish it, on account of the occurrence of a bilious epidemic. As to "tobacco and opium," I do not believe that they ever acted as a safeguard against bilious malaria, in a single instance, or that they ever will. In that respect, neither science nor experience attests their usefulness. Opi- um-eaters are said to be as liable to plague as other persons; and, as respects yellow fe- ver, I know this to be the case with the vo- taries of tobacco. They suffer from that complaint no less certainly than the rest of the community. Nor does the Frenchman's 16* (86 VPPENDIX. snuff, or the offensive smoke of the Holland- er's pipe protect either of them from the bil- ious diseases of his country. Confidence in such nostrums is discreditable to physicians, and injurious to those who rely on them for safety. Of the practice of applying a hand- kerchief or the corner of a cloak to the mouth and nose, and covering the head by a veil or ranopeum of gauze, as means of protection, in a malarious atmosphere, our author speaks doubtingly, but is evidently inclined to con- sider it useful. Here agian I am compelled to differ from him, and to pronounce such expedients no better than quackery. They are to be classed with the employment, for the same purpose, of volatile salts, the "com- mander's balsam," the "vinegar of the four thieves," bags of camphor and saffron tied to the scrobiculus cordis, coughing and spit- ting while in sick-rooms, and washing the hands, face, and mouth, immediately on coming out of them, with all other charms and amulets, which superstition confides in, reason laughs at, and experience rejects. I APPENDIX. 187 have seen them all tried to no purpose; indi- viduals without them escaping as well as those employing them; perhaps better. Ti- midity is the usual accompaniment of their adoption; possibly it is in no small degree the cause; and that, by debilitating the sys- tem, invites disease. Next to a removal be- yond the reach of malaria, fearlessness, tem- perance, regularity, and prudence, are the best safeguards. For a practical man, Dr. McCulloch has too strong a predilection for things border- ing on the marvellous. I mean that he spec- ulates too much on certain future and very remote and doubtful contingencies, not to ap- ply to them a less respectful term, which the human mind can scarcely grasp. One of these is the reduction of the surface of the earth to a level, by the disintegration of all mountains and hills, and their being washed by rains and dissolving snows into the seas, valleys, and low-lands generally! When this event shall have occurred, the amount of al- luvion is to be terrific, that of malaria in pro- 188 APPENDIX. portion, and the prevalence of sickness in proportion to each. In direct terms, man and all other animals inhabiting mountains, hills, and plains are to be extinct, the earth to be a huge quagmire, and peopled only by crocodiles, alligators, frogs, and turtles, and such other foul and misshaped beings as sub- sist in water and delight in mud!! Another of these wonderful doings is to be the draining of lake Erie, and, of course, in time, of all the other lakes connected with it, by the travelling of the Falls of Niagara up stream, cutting a channel for themselves through all obstructing matter, until they shall have reached the extreme point of the lake of the Woods, or whatever other lake of the entire chain is most remote!! Then there is to be terrible havock on our north- west borders, by the malaria issuing from the basins of the lakes, thus deserted by their waters, and converted into sinks of festering alluvion! Compared to this new manufac- tory of poison, the marshes of Italy, France, and Holland will be but so many MontpeN APPENDIX. 189 hers! Lake Superior alone will exceed them all in magnitude and mischief, as far as the Palaiotkerium incognitum, whose bones have been recently discovered, sur- passed in size the elk or the buffalo, which he swallowed at a mouthful! How far this atmosphere of lake-poison is to be carried by the wind, our author has not informed us. But, according to some of his other compu- tations, the distance must be prodigious; in one direction, at least to the Gulf of Mexico; in anodier, to the Rocky mountains; m a third, to Hudson's Bay, if not to the North Pole; and, in a fourth, to England, Russia, "or the Lord knows where!" Nor has he told us, whether the levelling of the earth, or the draining of the lakes is to occur first; or whether they are to be contemporary events. Respecting the precise epoch of the catastrophes, whether before or after the millennium, he has left us equally in the dark. He has not even given us to under- stand, which could perform its journey in the shortest time, a sloth to the moon, the 190 APPENDIX. mountains to the sea, or the Falls of Niag- ara to the furthest end of the lake of the Woods! Nor has he favoured us with his opinion, whether, by the time of these won- derful occurrences, man may not, to be pre- pared to meet them, have made such won* derful advances in knowledge, as to be able, by some preparation of " tobacco or opium," to render himself poison-proof! On all these momentous topics he has left us to the indul- gence of our dreams and fancies, because perhaps he has the charity to consider them as good as his own. Seriously; such speculations in such a book as the "Essay" by Dr. McCulloch, are grieviously out of place* They tend to *It is not unknown to me, that, in the opinion of many, there is a seeming probability in the speculations of our author, respecting the washing down of the mountains and hills, and the draining of lake Erie by the Falls of Niag- ara. From the highlands, say those individuals, a certain amount of matter is daily conveyed, by currents of water, into the low. Hence, in the lapse of time, including per- haps many myriads of centuries, the former must be re- duced to a level with the latter. Again, say our calcula- tors; the Falls of Niagara have already travelled up stream APPENDIX. 191 give a temporary reality to visions of the kind, and thus to divert the attention of read- ers from substance to shadow. Should a second edition of the work be called for, as I doubt not will be the case, they ought to eight or nine miles, and are now, every moment, washing particles from the edge and front of the precipice, over which the water tumbles. Within a period of time, there- fore, short of infinite duration, they must arrive at the mouth of lake Erie, make a breach in its bank, and liber- ate its waters. All this, while viewed as a mere abstraction, looks well enough. So does the enigma of the infinite divisibility of matter. But let an attempt be made to regard either prop- osition as a practical truth, and it becomes an absurdity— certainly it turns to a thing incomprehensible. The cal- culator who endeavors to fathom it is immediately lost in the abyss of infinitesimals. Besides; admit the infinite di- visbility of matter or space, according to the common in- terpretation of the phrase, and it may be contended with great plausibility, if not reduced to a demonstrated truth, that the moon may be compressed into a lady's thimble, and that the sun is no farther from the earth, than Wash- ington is from Baltimore. But this is mere badinage. For boys to amuse themselves and sharpen their wits, by at- tempting the solution of philosophical conundrums, maybe allowable. But when men are writing books, to instruct the world on soW and important subjects, it is unbecom- ing jn them to concern with toys or puzzles*. 199 APPENDIX. be withheld from it, in common with several other hke disquisitions, in which the author has indulged himself. They resemble too much the empty notions of Captain Basil Hall, about the filling up of the basin of the Gulf of Mexico, and its conversion into dry land, by the alluvial depositions from the wa- ters of the Mississippi. In the pages of a publication treating of grave and important matters, they are as incongruous as a pun in a funeral sermon. Am I asked, what there is in Dr. McCul- loch's " Essay" worthy of praise, seeing I have found so much in it to censure? I an- swer, that there is an abundance in it to be praised; much more than I have either space or leisure to specify. Let the reader examine it for himself, and he will not only find this true, but will be amply rewarded for the time spent and the trouble incurred in perform- ing the task. Added to the many important truths which the work itself contains, it will do much good, by inducing physicians to be- stow more attention on the subject of mala- APPENDIX. 193 rra than they have heretofore done. On the same ground the present project of the Med- ical and Surgical Faculty of Maryland will be eminently useful It will do much toward procuring for the poison in question a thor- ough investigation. Were the Legislatures of the several States to institute inquiries re- specting the malaria of bilious fever, in all its relations, and invite physicians to com- municate the result of their observations in reply, the issue would be in time an invalu- able accumulation of knowledge, on a matter of infinite moment to the public welfare, ac- companied by an amelioration of the condi- tion of our country, which no human fore- sight can compute. Nor would the benefit of the measure he limited to our own coun- try; the civilized world would partake of it. To conclude; although the perusal of Dr. McCulloch's work has both gratified and in- structed me, it has not induced me to alter a single view, or surrender a single principle. previously laid down in the body of my Dis- sertation. On the contrary, by the able sup- 17 L94 APPENDIX. port it has given to many of them, it has strengthened my confidence in their correct- ness, and rendered my adherence to them the more firm. In its original condition and dress, therefore, that production and its ap- pendix are respectfully submitted to the judg- ment of the Faculty. THOUGHTS ON TEMPERAMENT. WHEN an accurate observer enters an assembly of human beings, or even looks on a collection of inferior animals, that which perhaps first and most forcibly arrests his at- tention, is the striking difference he discovers between beings of the same race. If he be possessed of a contemplative character, and strongly inclined to the study of relations, this would necessarily be the case, did not the familiarity of the phenomenon take from it some portion of its impressiveness. So extensive and multifarious is this difference, that no two individuals can be found, who, on a strict examination, prove exactly alike. In but very few instances are they even nearly so. Were the whole of mankind that are now living collected together, and could the countless myriads of the dead, clothed in their former appearance, and possessed of all their attributes of life, be called up and intermingled with them, it is doubtful wheth- 196 ON TEMPERAMENT. er there would be two persons in the might) crowd, that might not be easily distinguished from each other. We have even strong ground for believing that there would not be. Nor is this dissimilitude confined to any one or even to all of the external and visible properties. It pervades the entire being. comprehending every kind of manifestation corporeal and mental. It includes looks, ges- tures, modes of expression, sound of the voice, manner of standing and moving, amount of muscular and of adipose substance. condition of many individual functions, pro- portion of solids to fluids and of the hard parts of the body to the soft, degrees of irri- tability and sensibility, likes and dislikes of both animate and inanimate objects, techni- cally termed sympathies and antipathies, fashion, facility, and vigour of thought with their external indications, and every thing else that can either constitute or vary charac- ter. Nor is it in the animal kingdom alone that this interminable diversity is observable. Vegetables also partake of it; not indeed so ON TEMPERAMENT. 197 strinkingly, but in a perceptible degree. Let the forest be examined with the requisite at- tention, and no two trees of the same species will be found in it exactly alike in their ex- ternal marks. Examine them internally, and the difference there will be equally obvious; in many cases more so. Let the scrutiny be extended to all other forms of vegetable pro- duction, and, in relation to them, the same will prove true. No two of them will be precisely alike, either externally or internally. So boundless is the variety, which the obser- vation of all time has discovered in the char- acter of living matter. And the record of it is every where to be found in the written, and its recognition in the traditionary history of human knowledge. But man is as prone to reason as to ob- serve ; to look into causes, as to notice effects. Hence the cause of this diversity, especially as relates to the human race, has been long a subject of eager inquiry. At what particu- lar period this investigation began, no exis- ting records inform us. But it can be regu- 17* 198 ON TEMPERAMEN'l. larly traced, through those of medicine, to the time of Hippocrates. Not only was that great observer sensible of the diversity in mankind that has been referred to; he en- deavoured to account for it. Yet specula- tions of that description do not appear to have been as attractive to him, as to many others who have flourished in our profession. His mind was not of a cast to be deeply engross- ed by them. His writings testify, that he de- lighted in a knowledge of facts and events, rather than of their relations, and that he was more attentive to the study of the for- mer than to that of the latter. In other words, he observed more than he theorized. Hence he did not embark in the investiga- tion just specified with the fervid zeal of some of his successors. To a certain extent, however, he did embark in it, and, in pur- suing it, indulged more in fancy and hypothe- sis, than he has done perhaps on any other subject. He had evidently no correct knowr- ledge of the structure and economy of the human body. He was not acquainted even ON TEMPERAMENT. 199 with the principal organs of the system, much less with their functions. He considered the body as composed of four humours, blood, phlegm, common bile, and atrabile or black bile. Of these, the blood was essentially hot, the phlegm moist, the common bile dry, and the black bile cold. The usual rea- ding of this hypothesis is, that the blood is hot and moist, the phlegm cold and moist, the yellow bile hot and dry, and the black bile cold and dry. Such were also, in his opinion, the ruling qualities of the four sea- sons of the year. Between the seasons and the humours, therefore, there was so strong an affinity, or rather sympathy, that the for- mer exercised a predominant influence over the latter, and tended to augment them in quantity, in conformity to that sympathy, du- ring the time of their own prevalence. The spring, in consequence of its kindred quali- ties, augmented the blood, the summer the common bile, the autumn the black bile, and the winter the phlegm. Nor did they add only to the quantity of the humours; they 200 ON TEMPERAMENT. heightened also their qualities, and thus im- parted more strength to the nature of each. These humours were the source of tem- perament. According to the predominance of one or more of them, was the tempera- ment of the individual, in whom the pre- dominance occurred. Did the blood supera- bound ? The temperament was hot. Com- mon bile? It was dry. Black bile? It was cold. Phlegm? It was moist. But as the seasons of the year regulated each its kindred humour, the temperament changed, if not en- tirely, at least in part with every change of season. Hence the sanguineous tempera- ment prevailed in spring, the bilious in sum- mer, the atrabilious in autumn, and the phleg- matic in winter. There were therefore four simple temperaments, out of which were formed certain compound ones, by the mix- ture of different portions of the humours, and the joint predominance of some two of them. Such appears to have been the hypothesis of Hippocrates on the subject of temperament; and it is abundantly visionary. Yet, as al- ON TEMPERAMENT. 201 ready mentioned, he was much less imagina- tive than many physicians of distinction who flourished at subsequent periods. This is true, more especially in reference to Galen, who possessed a mind in a great measure the reverse of that of his master. He was the prince of theorists, and one of the ablest and most fascinating speculators in science, that has ever shed a lustre on any profession. In his estimation, facts, without a knowledge of their causes, and some view of their own operation and effects, had com- paratively but little value. He no sooner, therefore, discovered the universality and multifarious nature of the diversity, that marks the aspect and character of the human fami- ly, than he commenced an ardent inquiry in- to its causes. And to the theory which he formed, for the explanation of the phenome- non, is the whole subject indebted for the name he bestowed on it, in his native tongue, and which, translated into other languages, it still retains. In common with preceding and contemporary philosophers, he believed 202 ON TEMPERAMENT. in the natural and permanent attachment of certain different and specific properties to the different fundamental elements of matter. These properties, which were heat, cold, moisture, and dryness, were in themselves radical, and one or another of them belong- ed to every kind and particle of matter, and gave it character. The elements of matter thus endowed, entering into the composition of living bodies, were mixed together; and the mixture formed by them derived its char- acter from the relative proportions it received and retained of the different fundamental'par- ticles, each kind bringing along with it its specific property. The character of the compound, therefore, depended on the pre- dominance in it of one or more sorts of mat- ter over the others. Did the elements pos- sessing heat superabound? The nature of the mixture or composition was hot. Did those possessed of cold superabound? Its nature was cold. Its dryness and moisture depended, in like manner, on a predomi- nance of their kindred particles. Were the ON TEMPERAMENT. 203 elements so proportioned that there was no predominance of one sort of them over anoth- er? The mixture was perfect, its funda- mental properties balancing each other, and preventing any constitutional tendency to disease. I allude here to the human body, whose native predispositions, whether morbid or sound, were supposed to depend on its ori- ginal composition. When this composition was such, that the primitive elements, with their properties of heat, cold, moisture, and dryness maintained in it, in relation to each other, an exact equilibrium, the constitution of the individual, for the maintenance of health, was as perfect as it could be made. Of course the liability to disease was in pro- portion to the deviation from this balanced condition. Persuaded of the correctness of these views, Galen bestowed on the entire subject 4he Greek name of krasis. This word may be rendered in Latin temperamentum, which, turned into English, is mixture. We, there- fore, in this instance, deriving our nomencla- 204 ON TEMPER VMENT. ture from the Latin, instead of the Greek, re- tain the technical term temperament, and still designate by it, as its author did, the marked differences in the aspects and char- acters of men, to which reference has been already made. Nor is this the case with En- glish and American physicians only. The same word, so modified as to suit the gen- ius of each different language into which it has been translated, or one of similar import, is used to 'indicate the same subject, by all modern writers in medicine. Hence the in- fluence of the theory of Galen has descended, through his followers, to the present time, and is probably destined to be as lasting as the profession he adorned. So deep and indeli- ble is the impress of genius, aided by indus- try, ambition and attainment, on the mind of mankind. Intrepid as he was in thought,and endow- ed with an ardent and creative imagination, that great physician found no difficuly in ap- plying his doctrine to the human body. Somewhat in conformity to the views of ©N TEMPERAMENT. $05 Hippocrates, he pronounced the blood to be hot and moist, the yellow bile hot and dry, the lymph or phlegm cold and moist, and the melancholic or &&w& &i7e co£d and dry. Corresponding to these four humours, he dis- covered, or rather imagined an equal num- ber of temperaments; the sanguineous, which, because the blood predominated in it, was hot and moist; the bilious, which, from a predominance of yellow bile, was hot and dry; the pimitary or phlegmatic, which a superabundance of phlegm rendered cold and moist; and the melancJwlic, which, through a redundancy of black bile, was cold and dry. Thus did the character of the temperament depend on the predomi- nance of one or more of these fluids, the lat- ter condition rendering the case more com- plex. And according to the degree of pre- dominance was the strength of the tempera- ment, and the liability of the possessor of it to certain kindred complaints. To the san- guineous temperant strongly developed, be- longed diseases accounted purely inflamma- 18 206 ON TEMPERAMENT. tory, such as pleurisy, peripneumony, and rheumatism; to the bilious, fevers marked by a redundance of bile; and to the pituitary, complaints of defluxion and obstruction, with eruptions on the skin. This class in- cluded dropsy, scrophula, and other diseases of an indolent character. The complaints allied to the melancholic temperament were chiefly mental and nervous. Hypochondri- asis and melancholy madness were the most formidable of them. But fevers occurring in melancholic constitutions were also pecu- liarly modified by the temperament. Out of these four primary temperaments Galen formed an equal number of secondary or compound ones, in each of which two of the humours predominated over the oth- ers. Add another, making the ninth, in which the humours were in a state of equi- librium, and his system is complete. Each temperament, moreover, was said to be as- sociated with certain personal appearances and attributes of mind, which clearly desig- nated jt, and distinguished it from the others.; ON TEMPERAMENT. 207' On details of this description, however, I must not dilate. The limits within which it is my purpose to confine this article forbid it. Much less do they permit me to give a sy- nopsis of the theories of Stahl, Haller, Ca- banis, Richerand, Halle, and other writers on the subject I am considering. Nor, al- though the preceding notions, some of which still find advocates among physicians of standing, are, as already mentioned, highly visionary, and many inferences deduced from them plainly injurious, shall I consume time in a formal refutation of them. If the views I shall exhibit hereafter be true, the prevail- ing doctrines on the subject of temperament are unfounded; and on that form of opposi- tion to them shall I chiefly rely. Before proceeding further, however, it is not only requisite, as relates to certain ends I have in view, but is also a tribute to truth, which I may not withhold, to observe, that the whole hypothesis of Hippocrates, in com- mon with that of Galen, is the growth of hu- moralism. And what is humoralism? I 208 ON TEMPERAMFNT. reply, one of the most fearful and destruc- tive monuments of error that has ever been erected. True science disavows it, and humanity has wept for ages over the desolation it has produced. It is a profes- sional Idol, which, throughout the many cen- turies of its existence,, has done nothing but falsify and adulterate the principles and la- mentably pervert the practice of medicine. Under the fatal spell it has thrown over diem, physicians have not only worshiped it in sen- timent, but sacrificed to it millions of their fellow beings. This assertion is neither vi- sionary nor extravagant. Were there leisure to dwell on it, and were the occasion a suita- ble one to do so, the charge could be sub- stantiated by volumes of facts. The solids of the body make man what he is. They, of course, form the fluids, and give them their character. Nor do they, in health, receive any more of real character from them, except as the result of their own ac- tion, than they do from the vapour that rises or the dews that fall. The solids are the cause, the fluids the effect: the former the ON TEMPERAMENT. 209 tree, the latter its fruit. When, therefore, the order of things shall be so reversed, that the cause shall be subordinate to the effect it pro- duces, and the tree to the fruit that grows on it, then may it be admissible to allege, that, by some unprecedented mode of operation, the human fluids bestow character on the hu- man body; not before. The hypothesis is at war with every principle of sound physi- ology ; and, worst of all, it is at war with common sense. As well may it be contend- ed that the mountain receives its form and character, and produces all its effects, from the torrent that dashes over its cliffs, or the placid stream that washes its base, as that the human system does from the fluids it con- tains. And as many useful inferences could be drawn from the one notion as from the other; but not so many pernicious ones. True; when the blood and the other hu- mours are formed, they are not without their influence. But that influence, whether for good or evil, is fairly attributable to the solids that produced them and gave them their 18* 210 ON TEMPERAMENT. qualities. If the solids are sound, so will be their product; and the reverse. All disease therefore begins in the solids. I might add, that it virtually continues in them, and is not correctly predicable of the fluids. Blood, chyle, lymph, bile, and other humours, can be vitiated in their condition, but not diseas- ed, in the common meaning of the word, or according to any legitimate interpretation of it. If there be a seeming exception to this in favour of the blood, it is only seeming, and not real, as might be readily made appear by a fair discussion of the subject. The term disease relates as exclusively to the solids, as the terms sensibility and secretory action do. Besides, however deeply vitiated the condition of the fluids may be, under abnor- mal action in the parts which prepare them, let soundness be restored to the functions of the solids, and that vitiation will soon be re- moved. So absolute is the control of the latter over the former. Having, without reserve, passed the pre- ceding strictures on the views of others, re- ON TEMPERAMENT. 211 specting the cause of temperament, it will probably be expected of me, that I present my own with equal frankness. The expec- tation, if entertained, is reasonable, and must not be disregarded. I shall therefore enter on the task, asking of my readers nothing more, than to receive my opinions, with such matter as may be offered in illustration and support of them, for as much as they may be worth. But I must beg to be indulged previously in a brief explanation. At the commencement of my lectures on the Institutes of medicine, in Transylvania University, in 1819, and for a few years af- terwards,! expounded to my classes, with considerable modifications and additions of my own, the prevalent doctrines on the sub- ject of temperament. But I was far from be- in°; satisfied with the views I communicated, and freely expressed myself to that effect. I did not therefore actually teach the doctrines, because I considered them fundamentally er- roneous. My lectures on them bore the char- acter of an analytical and condemnatory criti- 212 ON TEMPERAMENT. cism, rather than of an exposition unfolding and maintaining their truth and recommend- ing their adoption. I contended then, as I do now, that the solids, being the controling portion of all living organized matter, must be looked to exclusively as the ground of tem- perament. In this state of dissatisfaction with my teaching, I persevered in my inqui- ries, with a view to its improvement, and made, from time to time, material alterations in it. I felt myself approaching what was more satisfactory to me, because it appeared to be more consistent with the principles and laws of the animal economy. But it was not until my course of lectures delivered during the winter of 1825-6, that I fonud myself pre- pared to communicate to my class a portion of the views which I now entertain on the subject. Since that period I have inculcated them regularly, making annual additions to * them, and endeavoured to illustrate and sus- tain them by such facts and arguments as appeared most pertinent, some of which will - be embodied in this essay. ON TEMPERAMENT. 213 This narrative is intended as a vindication of my claim to opinions which are my own; and I am induced to offer it for the following reason. My views on the subject of tem- perament bear a striking resemblance to those of Dr. Thomas, as exhibited in a vol- ume of great interest, entitled " Physiologie des Temparamens ou constitutions," pub- lished by him, in Paris, in 1826. I do not not deny that I have even somewhat modifi- ed them, in conformity to the principles so happily stated and so ably defended by that distinguished writer. But I did not derive them from him. They were mine at least a year before the appearance of his work, and upwards of two years before I was apprized of its existence. The volume itself I have never seen; nor do I believe that it has yet reached the United States* I am indebt- ed for all my knowledge of it to a brief analy- sis of it, contained in Nos. XV and XVI of the Edinburgh Phrenological Journal, prin- *Since writing this I have received Dr. Thomas's work from Paris. 214 ON TEMPERAMENT. ted in 1827, but which I did not receive until 1828. Without the least intercourse with each other, then, either by letter or otherwise, Dr. Thomas and myself formed, about the same time, similar views on the same subject. Nor is this an event of rare* occurrence. On the contrary, many such might be cited. The reason moreover is obvious. Owing to new light being thrown on it by the progress of knowledge, a branch of science is ripe for dis- coveries, or opinions respecting it not before promulgated; and it is equally open to the inquiries of thousands. It would be singu- lar, then, if some two or more of these, resi- ding even in different parts of the world, and possessing no knowledge of each other, were not to form occasionally the same new views of it. The event is as natural, I might say as inevitable, as that two or more of a large par- ty of Botanists or Zoologists, exploring sepa- rately the same tract of country, never ex- plored before, should discover, about the same time, the same new species of plants or ani* mals. Neither Dr. Thomas nor myself, then. ON TEMPERAMENT'. 215 is to be suspected of plagiarism. Each is entitled to the claim of paternity toward the views he entertains. He certainly did not receive his opinions on temperament from me; because, my notes from which I lecture excepted, I am now writing on the subject for the first time.* As a matter of equal cer- tainty, I did not receive my opinions on it from him; because it is known to many, that I entertained and taught them a year anteri- or to the date of his publication. Nor, al- though identical on most leading points, do our opinions respecting temperament concur on all. But, without further preface, I must proceed in my inquiry. * This is true only in part. In the summer and autumn of 1822 my "Outlines of a Course of Lectures on the In- stitutes of Medicine" were written, and printed in 1823. In that syllabus I have spoken of a " Cephalic and nervous Temperament," a "Pectoral or Pulmonic and muscular Temperament," and an " Intestinal Temperament;" and my exposition of those topics, in my lectures, contained many of the elements of my present views on the same subJ3cts. My " Outlines," however, being altogether ele- mentary and academical, consisting of brief sentences and phrases, intended as texts for my Lectures, and remembran- cers and indices for my class, though printed, were neve* 216 ON TEMPERAMENT. The difference between individuals, or rather classes, of the human family, which temperament is made to designate, appears to depend on two causes; diversity of organi- zation in par;s or the whole of the bodies of different persons, giving rise to a correspond- ing diversity in the vital properties; and dif- ference of size and vigour in certain ruling organs of the system. The existence and in- fluence of the former of these causes are in the highest degree probable; those of the latter certain. The one is susceptible of strong support, the other of proof that may be termed positive. By "organization" is here meant, the minute interior or radical struc- published. Nor do I believe that any copies of them found their way to Paris. I am satisfied therefore that Dr. Tho- mas never saw them. Nor, if he had, could he have derived. from the hints they contain, any material information re- specting my views of temperament, at the time when they were written. I have also spoken expressly, in my " Outlines," of the prevailing temperaments of the body, and the diseases ac- companying them, at the different periods of life. On this topic my lectures have been full, ever since my appointment to the medical school of Transylvania, m 1819; and the same views had been familiarto me many years previously-. ON TEMPERAMENT. 217 ture of the tissues which compose the hu- man body. That diversity in this creates a diversity in the vital properties, anp! that again a diversity in character, cannot I think be doubted. Whether the difference of organi- zation here referred to consists in different proportions of the elements of living matter that form the tissues, united in the same way, or in their different modes of arrangement and union, or both, or whether it may not arise in part from different proportions of the simpler tissues entering into the formation of the more compound organs, is not known. Minute anatomy has not yet attained a de- gree of perfection competent to settle a point of such subtlety. That I may be the more clearly under- stood in this inquiry, and that the result of the discussion in which I must engage may be the better judged of, my views respecting the effects of diversity of organization on vital properties require I think to be further illustrated. This can perhaps be sufficiently 19 218 ON TEMPERAMENT. effected by a few remarks on the nervous sys- tem. No single nerve can perform two distinct functions. The optic nerve cannot subserve the purpose of hearing, nor the gustatory that of vision; nor is a nerve of voluntary compe- tent to that of a nerve of involuntary motion; or the reverse. Each nerve, or rather class of nerves is capable of one mode of action, and no more. Of all other organs the same is true. Glands and secreting tissues pro- duce each its own specific fluid, and muscles, as such, do nothing but contract. But those organs cannot interchange functions.—Such are the facts; and many other analogous ones might be adduced. To what are they attributable? Chiefly, I apprehend, if not exclusively, to diversity of organization. I know of no other cause to which they can be reasonably referred. Throughout the whole of living nature, as far as it has been explored, diversity in organization appears to be the only source of diversity in action; I mean vital action. True; we are not able, ON TEMPERAMENT. 219 at present, to distinguish any difference be- tween the organization of a nerve of sensa- tion and that of a nerve of motion; nor be- tween the organization of one nerve of specific sensation and that of another. But that con- sideration constitutes no solid objection against the existence of such difference. It only indicates the limitedness of our research. And we must not make a premiss of our ig- norance, and attempt to draw an inference from it involving knowledge. Reason affirms, and all analogy concurs with it, that the dif- ference exists. Nor, as I hope and believe, will the labours of the anatomist, at a future period, fail to demonstrate it. It may be safe- ly affirmed that between a nerve, a muscle, and a gland, the only difference known to exist is that of organization, according to the interpretation which the term has just receiv- ed. Organize them alike and endue them with life, their properties will be similar, and they will act in the same way. This may be regarded as a primitive truth in physiology. If then, in the person of the same individu- 220 ON TEMPERAMENT. al, difference of organization creates a spe- cific difference between nerves and other parts of the body, may not a slighter differ- ence in the organization of corresponding nerves and other parts produce a difference in the persons of different individuals ? Does the optic nerve of one man differ slightly in organic structure from the optic nerve of another? Must not its function differ accor- dingly ? Can the two men see all things pre- cisely alike? We apprehend they cannot. That different individuals, whose vision is equally perfect and keen, do not see all things alike, is true; nor does it seem practicable to imagine any other cause, to which the phe- nomenon is ascribable, than some difference of structure in their optic nerves, or those parts of the brain with which they unite, or both. It is known to be a common occur- rence for the same substances to communi- cate different tastes and smells to different persons, especially when the odour and taste are delicate. In such a case two individ- uals rarely concur in opinion, as to the pre- ON TEMPERAMENT. 221 cise degree and character of the sensations produced. They agree as respects the class and kind of sensation; but each contends for the existence of some peculiar modification of it. Nor can this be attributed to any oth- er source, than a difference of structure in the nerves concerned. In health and dis- ease, moreover, the taste,* smell, and sight of the same substances are often exceedingly different; a result that cannot be ascribed to any thing else, than a temporary constitution- al difference in the nerves. Of secreting sur- faces the same is true. This is strikingly * Few things are more common in disease, than for the sick to loathe their favorite articles of food. In these cases a return of taste and other deranged sensations to their nat- ural condition, is one of the most decisive evidences of con- valescence. Chewers of tobacco and great lovers of coffee have usually a distaste for those articles during sickness. In such cases, it is a favourable sign for the patients to ask to be indulged in them. As respects coffee, this is true of myself. That liquid is my favorite beverage in health. During indisposition the flavour of it is offensive to me, and continues so until the termination of my complaint, when my taste for it returns. For this there must be a cause, which doubtless consists in a changed condition of the ce- rebral system. 19* 222 ON TEMPERAMENT. manifested in the skin. Of every person of the Caucasian race the cutis vera is white; 1 might say equally so. Yet scarcely any two of them possess complexions of exactly the same shade. The reason is obvious. The matter of complexion, which is a secre- ted substance, and has its seat in the rete mucosum, differs in colour in different indi- viduals. Why?—Because the action of the skin, its secreting organ, is different; and that again can arise from nothing but difference of structure. Thus might I pass through the whole human system, and show, that wherev- er a marked difference exists between the cor- responding functions of different persons (and few phenomena connected with our race are more common) the diversity is to be ascribed to a like diversity in the structure of the or- gans by which the functions are performed. It is to be understood that I speak of the sys- tem in a healthy, condition. Yet the same is true also in disease. Sick or well, as al- ready intimated, organization gives us our character, and makes us what we are. ON TEMPERAMENT* 223 Is it our wish to extend our field of obser- vation, and add to our store of facts on this subject, by directing our attention to the in- ferior animals? There again similar phe- nomena present themselves to us from every quarter. We discover between animals of the same race innumerable differences, which can be referred to nothing but differences in organization. Even of vegetables the same may be safely affirmed. Among them also, as already mentioned, the same species are known to be marked by striking diversities in appearance and character. Nor can any thing produce them but similar diversities in organic structure. Differences in the phe- nomena and habitudes of vegetables will not be ascribed to difference of mind, a mode of solution which has been attempted in vain, with regard to animals. For the foregoing reasons, then, with ma- ny others similar in character, which it would be superfluous to adduce, I am compelled to believe, that, independently of all other cau- ses, differences in human temperament are 224 ON TEMPERAMENT. to be attributed, in part, to corresponding dif- ferences in the organization of certain por- tions, or the whole of the body. Other things being equal, in consequence of this source of influence alone, one person differs from ano- ther in many of the qualities of both person and intellect. He is more highly gifted, sprightly, and vigorous, or the reverse; or he is more courageous or timid, generous or sel- fish, according to his organization. But the second cause that was represent- ed to be instrumental in diversifying the hu- man temperaments is by far the most power- ful. It will be remembered to have been, "difference of size and vigour in certain rul- ing organs of the system." The organs allu- ded to are those contained in the three great cavities of the body; the chylopoetic, situa- ted in the abdomen, and including the stom- ach and intestines, with the liver, pancreas, mesentery, and lacteals; those of sanguifica- tion and circulation, situated in the thorax, and consisting of the lungs, heart, and blood vessels; and the brain, with its appendages, ON TEMPERAMENT. 225 the spinal cord and nerves. These three groups (for the brain is multiplex as well as the other two) are not only the ruling organs in the person of man; connected with the hard and soft parts that enclose them, they constitute the person. The upper and low- er extremities are but appendages; important and necessary, it must be acknowledged; but still appendages. The individual can exist and be a human being without them. Nor have they any influence in imparting consti- tutional character to their possessors. Stand- ing only in the capacity of subordinates to the controlling organs, they are not only nour- ished and put in motion by them; they la- bour mechanically for their uses, and serve as instruments to execute their purposes. They are composed of the extreme ends of the organized matter of the system, consti- tute only its out-works, and possess but little influence over its central parts. This repre- sentation rests on evidence that may be term- ed demonstrative. Many persons destitute of the upper or lower extremities, or both,* 226 ON TEMPERAMENT. have strong characters and well marked tem- peraments. But the extremities, if depriv- ed of the influence of any one group of the ruling organs, are converted not only into use- less but lifeless masses. Of the skin, mus- cles, and bones, which compose the head, neck, and trunk of the body, the same is true. Of themselves they possess no character, and can therefore bestow none. They also are but appendages to the organs they cover, af- fording them a secure lodgement and protec- tion from external injuries, and aiding them in the performance of some of their functions. And from this alone is their importance de- rived. Were it possible for them to exist apart from the viscera they contain, their grade of being would be below that of many vegetables. Most fatal diseases, moreover, have their original seat in the viscera of one of the three great cavities of the body, and no disease originating elsewhere can become fa- tal, until, by sympathy or metastasis, some of those parts are deeply affected. To enlight- ened physiologists this statement presents but *>N TEMPERAMENT. 227 a series of familiar truths. To the groups of organs exclusively, then, I repeat, contained in the rJdomen, the thorax, and the cranium, must we look as the main source of human character. And that character is different according to the predominance, in different individuals, of one group or another, or of any two of them. An equilibrium between the three groups constitutes another variety, by bestowing on character a corresponding equi- librium. Let the word temperament be sub- stituted for "character," and what is true of the latter will be so of the former. As alrea- dy mentioned, the organs referred to will be its source; and the differences in their pre- dominance will give diversity to it. To remove as far as possible obscurity and uncertainty from the remarks I have to offer, it is requisite that I should be more explicit, with regard to the functions of the three groups of organs that have been said to con- stitute the human person. The digestive ap- paratus prepares, from the alimentary mat- ter received into the stomach, chyle destined 228 ON TEMPERYMENT. to be first converted into blood, and in that form to convey nourishment and life to the different parts of the body. And in propor- tion to the power and activity of this appara- tus is the amount of chyle it forms out of a given quantity of food. It may be worthy of remark, that, as relates to strength and vig- our of action, there exists usually an adjusted balance between the chylopoetic organs and those of nutrition and secretion; the two lat- ter appropriating to the uses of the system and removing out of it, what the former prepare to be introduced into it. Were the case oth- erwise, perpetual derangement of some sort would prevail. Moderate deviations from this balance may exist, without producing fa- tal injury; and it will appear hereafter that this is the case under some of the tempera- ments. The chief function of the lungs is to form arterial blood out of a mixture of ve- nous blood, chyle and lymph. In the pro- cess of arterialization, the blood receives an additional supply of life, to compensate its loss of that attribute in its round of circula- ON TEMPERAMENT. 229 tion; so that the arterial is more highly vital than the venous. The more powerful the lungs are, the more vigorous will be their ac- tion, and the greater its effect. The function of the heart is to circulate the blood, a process in which its mode of action is purely mechan- ical, while its spring is vital. In perform- ing this function it throws the venous blood into the lungs, to be arteriuiized, and the ar- terial into all other parts of the body, to nour- ish and vivify them. l*i pi\;;»ortion to its power also is the vigour and efficiency of its action. Between its strength and that of the arteries a correspondence exists, else the har- mony of the system is broken. The cere- bral system, including the nerves, has been said to be multiplex. Considered in mass, its function is twofold; the production of feel- ing, and that of intellect, the latter embra- cing voluntary motion. Involuntary motion both perceptible and imperceptible also de- pends on it. To each different sort of feel- ing, as well as of intellection, a subordinate portion of brain is appropriated, in the char- 20 230 ON TEMPERAMENT. acter of a specific organ; precisely as, in eve- ry other part of the body, each function is performed by a peculiar apparatus prepared for the purpose. I need scarcely add, that, conformably to what is true of the other or- gans of the system, the vigour and efficiency of the action of the brain is in proportion to its power. Two points vitally important to this discus- sion are now to be considered. On what does the power of the three groups of gov- erning organs depend? and how can their actual possession of power be dicovered ? To these questions the answers are obvious. Other things being equal, the power of the organs is in proportion to their size; and their size is known by that of the cases in which they are contained. In plainer terms; the size of the brain is known by that of the head; the size of the lungs and heart by that of the chest; and the size of the digestive ap- paratus by that of the abdomen; I mean when the parietes of the latter cavity are not preternaturally distended by fat. ON TEMPERAMENT. 231 Does any one doubt whether the power of the organs I am considering depends on their size? Let him look through nature and his doubts will be removed. He will perceive that what I have said of them involves so much of a universal law, as to be true of all things of which we have any knowledge. There is reason to believe that an exception to it would be an anomaly in creation. Wheth- er the object examined be animate or inani- mate, other things being alike, its power and influence are in proportion to its magnitude. No matter how spacious and diversified the field we traverse in investigating this subject may be; the larger the more conclusive; for the same result presents itself in every stage of our inquiry, and from every quarter. The proposition is as self-evident, as that the whole is superior to a part. Is the sun the most powerful orb in the solar system, and does he control all the others? He is also the largest. Are the primary planets more powerful than their satellites, and do they govern them in their movements? They are likewise larger. 232 ON TEMPERAMFNT. Contracting the sphere of our observation, and taking a survey of things that are more fami- liar to us, we find that a large mountain has more influence in giving character to the re- gion around it then a small one. In that res- pect the Alps are more powerful than the Ap- ennines, and the Andes than the Allegany. Of rivers, lakes, and arms of the sea the same may be affirmed. The more spacious they are, and the larger the bodies of water they contain, the more powerful they are in their effects, and the more extensively they are felt. As re- spects all forms of living matter the same law prevails. Other things being equal, their magnitude and power are in proportion to each other. Shall we direct our attention, in this inquiry, to the trees of the forest? the larger will be found the more powerful. Shall we examine the inferior animals? There again, the condition of ceteris paribus being observed, size is an accurate measure of pow- er. Instances innumerable and familiar to every one might be given in proof of this. As relates to the human race the same may be ON TEMPERAMENT. 233 maintained. The large man surpasses the small one in power. To the different organs of the body the rule is no less applicable. A large bone is strong, a small one compara- tively weak; a large muscle possesses more power than a small one; and so does a large nerve. To adduce a few facts in proof of this latter position will tend to confirm my views, and may not, in other respects, be without interest. They shall be drawn chief- ly from the comparative strength of the exter- nal senses in different animals. In our examination of this subject we shall find, that in proportion to the strength and perfection of any sense is the size of the nerve on which it depends. Man possesses not only touch, properly so denominated, but the external sense of feeling generally, in a much higher degree than any of the inferior ani- mals. And,in precise correspondence to this greater strength of function, the nerves sub- servient to it are much larger than in those beings, in whose economy it is comparatively defective. Nor is this all. The keenness of the 20* •234 ON TEMPERAMENT sense of feeling is very different in different parts of the body of man; and in proportion to this difference is that of the size of the nerves which supply those parts. He posses- ses this sense in the highest perfection in his hands and fingers. And the reason of this is found in the magnitude of the nerves that run to those extremeties. Demoulins, a late writer on Comparative anatomy, tells us, that, " in the spinal nerves of man, the dorsal roots, or those belonging to sensation, in the nerves supplying the arm, have an excess of volume and of surface at least five times greater, both for each individual fibre, and for the bundle resulting from them, than the anterior roots, or those belonging to motion." And further, that "the roots of sensation in the spinal nerves going to the arm are about five times larger than the corresponding roots at other parts of the spinal cord, which are distributed to parts where touch is im- perfectly possessed." By way of additional illustration and proof of the proposition for which I am contending, I might further oh^ ON TEMPERAMENT. 235 serve, that in proportion as any species be- longing to the animal kingdom is more re- markable for strength of feeling or strength of voluntary motion, is the relative size of the nerves subservient to those two functions. The common belief is, that, in proportion to the size of their bodies, the nerves of the in- ferior animals are larger than those of man. This is true only of the nerves of motion; the reverse being true of those of sensation. The reason is plain. In proportion to their bulk, most of the inferior animals have more muscular strength than man; but they have less acuteness of feeling. The nerves of the iormer therefore are large in them, and those of the latter small Our cows, horses, and other domestic animals furnish ample proof of this. Their strength is great and their feel- ing comparatively dull. Corresponding to this, their motive nerves are large, and their sensitive ones small. It will be understood that I speak of the external sense of feeling alone, not of those of seeing, hearing, tasting, of smelling, some of which, in our domestic 236 ON TEMPERAMENT. animals, are exceedingly acute, and the nerves subservient to them large in proportion. The wings of bats and the tails of some species of monkeys are known to be remarkable for keenness of feeling; and their nerves of sen- sation are correspondingly large. The tail of the kangaroo has great muscular power; and its nerves of motion are unusually large. The trunk of the elephant is immensely pow- erful, as well as highly sensitive. In accor- dance with this is the size of its nerves; both sets having uncommon magnitude. To taste and smell similar remarks are applicable. In the African race those sen- ses are keener and stronger than in the Cau- casian. So is the sense of smell in the Ameri- can Indian. Of this difference the cause ex- ists in the different sizes of the olfactory and gustatory nerves. In the African, both those organs, and in the Indian, the former of them, have a much larger volume than in the Cau- casian. And where they receive the olfacto- ry and gustatory impressions, they are spread over a larger surface of mucous membrane. ON TEMPERAMENT. 237 Although the nose of the African is short, the entire region in him tributary to the sense of smelling, throughout which the olfactory nerves are exposed to the impression of odo- rous matter, is much more extensive than in the Caucasian. Of the North American In- dian the same is true. His olfactory region also is more extensive than that of the white man. Innumerable facts in the natural his- tory of the inferior animals are no less to my purpose. Of all the canine race the Grey- hound has the weakest sense of smell. He has also the smallest olfactory nerves. His slim muzzle testifies to the very limited space over which they are spread in his nares. In consequence of the imperfection of this sense in him, he pursues his prey entirely by his eye. In the fox-hound, and every other va=- riety, that follow their game by the scent, the nares are spacious and the olfactories large. The same is true not only of every sort of the dog kind, but of every species of inferior ani- mal, whose sense of smell is keen and strong. In most quadrupeds the sense of hearing 238 ON TEMPERAMENT. is keener than in man. This is owing to a threefold cause. The external ear is larger and better fitted to receive and concentrate the vibrations of the air which are tributary to sound; the portion of the internal ear over which the auditory nerve is spread is more extensive; and the nerve itself is larger. Facts in proof of these three positions may be derived from the size of the auditory nerves, and the structure and size of the ex- ternal and internal ears of sheep, cows, hor- ses, deer, and hares. Compared with the same parts in man, they are very large, and their forms are better suited to the purpose of hearing. Additional proof to the same ef- fect is derived from the large-eared bat, whose auditory nerve corresponds to the or- gan without, and whose sense of hearing is exquisitely acute. The importance of a large external ear is further confirmed by the bene- fit of an ear-trumpet to those whose hearing is impaired. It collects and throws into the internal ear a greater volume and force of vi- bratory movement than would otherwise en- ter it. ON TEMPERAMENT. 239 To vision the same principle is equally ap- plicable. The strength and acuteness of that sense also are in proportion to the size of the optic nerve, and the extent of the expansion of it, where it receives the impression of the rays of light. Proof of this might be drawn from a thousand quarters. But I shall refer chiefly to that afforded by birds of prey. In the eagle, the falcon, and the vulture, whose vision is almost incredibly distinct and pow- erful, the optic nerve is exceedingly large, and its expansion into retina uncommonly extensive. Their whole optical apparatus greatly exceeds in magnitude that of other birds, whose vision is less perfect. We learn from Demoulins that, "to effect the purpose of increasing the size of the optic nerve in these animals, without adding inju- riously to that of the eye itself, an admirable contrivance has been resorted to. Instead of forming a single membrane lining only the inner surface of the posterior chamber of the eye, as in man and animals of ordinary vis- ion, and consequently only equalling in ex- 210 ON TEMPERAMENT. tent the sphere of the eye, the retina in tfies* quick-sighted birds of prey is found to be composed of a great number of folds, each hanging loose in the eye, and augmenting, in an extraordinary degree, not only the extent of nervous surface, but the mass of nervous matter." Nor is it the optic nerve alone that is augmented in size in these birds of intense vision. The optical ganglion, or that portion of the brain to which the nerve is united is equally augmented. Thus, in the stryx flammea, or screeech-owl, whose sight is im- perfect, the two optical ganglions make about a twentieth part of the brain, while in the eagle they make a third part of it For this fact also I am indebted to Demoulins. Nor have I the least doubt that, in every case, where any nerve or set of nerves is peculiar- ly large, the portion of the brain to which they belong, and by which they are influenced and commanded, is correspondingly large. This I apprehend is as true of the cerebral portion controlling the nerves of voluntary motion, as of that which co-operates with the ON TEMPERAMENT. 241 ner ves of sensation. True; most of the nerves of voluntary motion come from the spinal cord. But no matter; they derive their ef- ficiency from some portion of the brain. And when they themselves are unusually large, so, I feel persuaded, is the cerebral por- tion which gives them their energy. That fitness and harmony which every where pre- vail, and constitute much of the wisdom as well as of the beauty of creation, warrant me in asserting that it must be so. I doubt not that, by means of anatomical researches, that which I offer as matter of opinion now, will become history hereafter. That it may pro- duce its full effect, it appears indispensable that a large nervous apparatus should be con- nected with a large cerebral one. In as much, then, as, other things being equal, size gives power to every thing else, we are not only justified in believing; on grounds of analogy we are compelled to be- lieve, that the same is true of the organs con- tained in the cranium, the thorax, and the abdomen. When they are in a sound and 21 242 ON TEMPERAMENT. natural condition, their size also is the meas- ure of their power. Were not this the case, they would be either altogether abnormal, or subject to laws that govern no other kind of matter, whether organic or inorganic, of which, we have any knowledge. But the po- sition I am contending for is not to be regar- ded as a mere inference in a process of rea- soning. It will appear hereafter that it is a positive fact, which observation has discov- ered, and continues to confirm. I have alleged that the size of the three groups of ruling organs may be ascertained by that of the cases in which they are con- tained. Nor do I perceive on what ground any one, who is even moderately acquainted with the structure of the human body, can controvert the belief, or cherish the slightest doubt on the subject of it. In healthy per- sons (and my remarks relate only to such) the size of the brain is necessarily known by that of the head. As the viscus completely fills the cranium, the case cannot be other- wise. Although the bones of the head and ON TEMPERAMENT. 243 the soft parts that cover them are thicker in some individuals than in others, the differ- ence is so small as not materially to affect the result. The chest is filled by the lungs, heart, and large blood-vessels. Its measure, therefore, cannot fail to be the measure of them. Any deviation from exactness in this, that may be produced by varieties in the thickness of the skin, muscles, and other parts, is of no moment. Of the chylopoetic viscera the same is true. They also fill ex- actly the cavity prepared for them. The size of the abdomen, therefore, affords a knowl- edge of their size sufficiently accurate for all practical purposes. By a mere inspection of the person of man, then, the absolute meas- ure of the groups of organs I am considering, as well as their magnitude in relation to each other, can be fairly ascertained. And it will appear on examination, as already stated, that the predominance in size and energy of any one or two of them, always imparts a corresponding diversity to the human char- acter. Does the brain predominate? the in- 244 ON TEMPERAMENT. dividual to whom it belongs is more remarka- ble for the vigour of his intellect or feeling, or both, than for any other constitutional quality. These modes of mental manifesta- tion constitute the natural functions of the brain; and when of an order unusually high, they give a peculiarity of character to the whole system. The person thus endowed feels more keenly, thinks more strongly, is more eager in pursuit of knowledge, and at- tains it with more facility. His relish for pleasure is also inordinately keen, and he pur- sues it at times with burnmg ardour. Such was the constitutional character of Mr Fox, and also of our distinguished countryman the late Mr 3ayard. I need scarcely add, that this predominance of sensibility and mental action must necessarily modify the diseases the individual may sustain. But of this I shall speak hereafter. Do the lungs, heart, and blood vessels predominate? A larger volume of highly arterialized blood is formed, and thrown more forcibly and in greater quantities throughout the system. From the ON TEMPERAMENT. 245 abundance of that fluid, and the superior size of the vessels conveying it, those parts of the body nourished by the red blood will be com- paratively most copiously supplied. But it is more especially the muscles that are thus nourished. They will be therefore large and powerful. Hence persons with broad and full chests have well developed and vigorous muscles. In proportion to their size their animal strength is necessarily great. Nor can such constitutional peculiarities fail to be productive of peculiarities in disease. Do the chylopoetic viscera predominate? The amount of chyle formed is very large in pro- portion to the quantity of food eaten. But the lungs, heart, and blood-vessels being com- paratively small, neither is sanguification abundant and perfect nor circulation vigo- rous. The blood is not either highly arteri- alized or animalized. Its amount of red glo- bules is small, and it circulates feebly through vessels of a limited size. The consequence is, that the muscles receive less red blood, and are less fully nourished; the system at large 21* 216 ON TEMPERAMENT. is not so highly endued with life, and the soft parts generally have a lower tone. The in- dividual thus marked is less robust and vigo- rous than one whose system is supplied abun- dantly with highly arterialized blood, and less intellectual and sprightly than those whose brain predominates. It is almost need- less to say, that, under such circumstances, disease must be modified in conformity to the constitution. From the preceding views it clearly ap- pears, that the comparative standing of indi- vidual man, as relates to his race, is gradu- ated by the predominance of his leading or- gans. Do his abdominal viscera preponde- rate? He has much of the animal in him, and his grade is low. Are his thoracic vis- cera most highly developed ? His qualities are of a superior order; but he still partakes too much of the animal. Does his cerebral system predominate; and is it well develop- ed in all its parts? He rises above the sphere of animal nature, and stands high in that of humanity. He is formed for an intellectual ON TEMPERAMENT. 217 and moral being, with no more of animality in his constitution, than is necessary to give him practical energy of character. This subject may be further illustrated by a reference to some of the animals below us. The worm commonly denominated a grub is but little else than a mass of abdominal matter. It is therefore one of the humblest and grossest of worms. The insect has also a largo abdomen, with a very small chest, and a smaller head. Hence, though superi- or to the grub, it is low in the scale of animal nature. Reptiles and fish are more elevated, because their abdominal viscera preponde- rate less. But still they do preponderate •, and therefore the rank of the animals is hum- ble. In the hog the abdominal viscera are most strongly developed, and hence his stand- ing among quadrupeds is low. The same is true of the bear and the ox, and also of the sheep and the goat, but in an inferior degree. The horse, especially the barb and the race horse, furnish no bad specimens of the mix- ed or balanced temperament. When the 248 ON TEMPERAMENT. latter is undergoing preparation for the course, the object of his keeper is to make the tho- racic temperament preponderate as much as possible, for the time, in order to increase his vigour and endurance; in the language of the turf, to give him more strength and "bet- ter bottom." The war-horse approaches the thoracic temperament. In the canine race, more especially in the Grey-hound, the tho- racic viscera hold the ascendency. Hence the muscular power of the dog is greater, and his grade among quadrupeds higher than those of most of the preceding animals. The same is true of the wolf, the panther, and the tiger. In some dogs there is a considerable cerebral developement; but it is never large enough to counterbalance the thoracic. Of all animals, the lion affords the most finished specimen of thoracic preponderance. In proportion to his size, his lungs and heart, es- pecially the latter, are immensely large. And his muscular power corresponds to them. The magnitude of his heart is generally con- sidered the cause of his boldness. Hence a ON TEMPERAMENT 249 very courageous man is said to have a great heart, or to be lion-hearted. All this is popular error. The heart is but a muscle; and, in man, has no more connexion with courage than the gastrocnemii muscles; nor, in the lion, than the muscles that move his tail. Courage is exclusively a cerebral attri- bute, and has its seat in an organ specifically appropriated to it. In none of the inferior animals does the brain preponderate. That preponderance belongs to humanity, and, as already mentioned, indicates its highest grade. Of all the beings below us, some of the ape tribe have the highest cerebral da- velopment. And they approach nearest to man in their degree of intellect. This is fur- ther proof, that, other things being alike, the brain gives the measure of mental power. I have lately seen a publication, in which it is gravely asserted, that the large ourang-ou- tang catches crabs with a stick, and makes a rude basket of osiers to contain them. Not- witstanding the well known sagacity of that animal, this statement savours strongly of the "tale of a traveller." 250 ON TEMPERAMENT. Such are the principles on which the pre- sent inquiry rests, accompanied by the fullest illustration that the extent of this essay per- mits me to give them. In their application to man, they appear to throw new and valua- ble light on the human temperaments. They profess to substitute fact for assertion, and reason for conjecture, and to render intelligi- ble that which has been heretofore buried in the mysteries of the schools. Their chief value seems to consist in their offering a rea- son, easily understood, for the various sorts and degrees of health enjoyed by different individuals, as well as for the modifications of the diseases they suffer, and thus expound- ing in some degree the philosophy of their nature. If they do this, I need scarcely add, that their usefulness will be great. In that case, they also indicate a process, by which the balance of the human system may be bet- ter preserved than it has hitherto been, and likewise more easily restored when derang- ed. Their importance therefore in practical medicine cannot be held doubtful. Heretor ON TEMPERAMENT. 251 fore temperament has been regarded as a kind of entity, superadded to the systems of those who possess^it. But, by the principles here laid down, it is made to depend, like every other human attribute, on the condi- tion of some of the organs of the body. And this is the doctrine that must ultimately pre- vail, because it is true. Whatever we have, of a constitutional character, and whatever we are, in a constitutional point of view, is the product of organization. This is true, if any thing be so in the philosophy of man. Considered in relation to these principles, temperament may be divided into seven va- rieties. 1 The mixed or balanced, in which the ruling organs are in fair proportion to each other; 2 The encephalic; 3 The tho- racic ; 4 The abdominal; 5 The encephalo- thoracic; 6 The encephalo-abdominal; and 7 The thoracico-abdominal. Before enter- ing on the consideration of these varieties separately, it is necessary to observe, that they are not altogether permanent. They change, intermix, and are, in some cases, even 252 ON TEMPERVMENT. converted into each other, at different peri- ods of life, from infancy to old age. Some of these variations, connected with the cir- cumstances under which they occur, will be referred to hereafter. 1. The mixed or balanced variety. In this the name explains the temperament. The external marks of it are plain. They consist in a well adjusted proportion between the si- zes of the head, thorax, and abdomen. If the limbs are in harmony, the symmetry of the entire person is complete. Although individu- als, in whom this temperament prevails, are usually above the middle height, and well formed, they are not necessarily so. They may be of any stature, and any shape, straight or crooked, provided the three great cavities and their contents be accurately bal- anced. This is not the temperament of ei- ther early life or old age. It commences with manhood, and continues until the fortieth or forty-fifth year, and then passes into some- what of the abdominal. The Apollo Belvi- dere, by Phidias, is an exquisite specimen of ON TEMPERAMENT. 253 it. But some modern artists have violated it, in painting that statue, by making the chest and the head too large. Although the manifestation of strength, majesty, and intel- lect is heightened by this, the beauty of the youthful god is marred. The figure, though more imposing, has lost its charm. This temperament is much more com- mon in the United States and in France, than in Great Britain, or perhaps any other coun- try in Europe. It is also witnessed in many persons of the higher orders in Persia and Turkey. Those who possess it having no strong constitutional tendency to disease, un- less in cases of peculiar hereditary predispo- sition, experience good health, and enjoy ex- istence in an eminent degree. Being equal- ly free from apathy and excessive sensibility, they are strangers alike to the monotonous slumbers of some, and the stormy and tor- menting passions of others. Although their capabilities both mental and corporeal are sometimes great, they are in general better suited to action than deep deliberation. They 22 254 ON TEMPERAMENT. rarely attain the summit of renown, either as statesmen or orators, philosophers or warriors. They are not formed to lead the world, revo- lutionize nations, or, in any way, create a new era in human affairs. This temperament would seem to have constituted the proto- type of Homer's Patroclus and Paris, much more than of Hector and Achilles; yet the two latter were far more conformable to it than Ajax or Ulysses. The Euryalus of Dryden is a fine specimen of it. When com- plete, its three most prominent attributes are, manly elegance, personal activity, and bloom- ing healthfulness. As it does not create any permanent liability to disease, neither does it in any way peculiarly modify it. 2. The encephalic. In this variety the head is relatively large, but is not always equally developed in every part, a circum- stance which varies greatly, as will presently appear, the characters of those who possess the temperament. The development of the thorax and abdomen is moderate, the person lean, and the countenance expressive of in- ON TEMPERAMENT. 255 tense feeling and deep passion. In some indi- viduals, however, the countenance beams with intelligence, without much passion, while, in others, manifestations of powerful intellect and passion are united. The thora- cic and abdominal activity is never high; yet in many instances the personal hardihood and endurance are invincible. It is men of this temperament alone that can immor- talize themselves by great achievements, good or bad. All history and observation testify to this. Is the development very 'large in the moral and intellectual regions of the brain, and so moderate in the animal as to be held fully in check? The individual will distinguish himself by a dignified purity of deportment, and by the performance of great and good deeds. He may become illustrious as a moralist, a philosopher, a statesman, or a philanthropist; or he may unite these char- acters, and be celebrated in them all. Such were Zeno, Seneca, Sully, Walsingham, and Sir Walter Raleigh, all of whom had large moral and intellectual developments, and 256 ON TEMPERAMENT. controllable animal ones. Are the intellec- tual and animal compartments largely devel- oped, and the moral ones very limitted? The possessor of this temperament will distinguish himself by daring and memorable acts of vice. Such were Cataline, Pope Gregory VII, Richard III, and Louis XI. Aided by their powerful intellects, characters of this description perpetrate their crimes under plausible pretexts, that they may indulge their evil propensities in security, and with the greater effect. Are the animal and mere knowing compartments largely developed, and the moral and reflecting very slightly? As relates to vice and profligacy in their foul- est shapes, this is the worst of all tempera- ments. Nothing more prone to depravity can be imagined. The person possessed of it delights in some sort of animality alone; and if he ever engages in any thing higher or purer, it is for a sinister purpose, that he may return to his chosen indulgences in more security, or on a broader scale. But possessing great force of character, he is a ON TEMPERAMENT. 257 great animal, and commits corresponding enormities. In gratifying his propensities nothing moderate satisfies him. His crimes therefore are as great and destructive as his means can render them. He sleeps but to dream of evil, and wakes but to commit it. Such monsters were Nero, Caracalla, Pope Alexander VI, Pope Martin V, and many others, whose likenesses I possess, and whose detestable crimes make a part of history. Is the development very large and equally so in all the departments of the brain, animal, mor- al, and intellectual, giving to the head unusu- al size? The individual possessing it has a lofty and powerful character, is capable of attaining the highest renown, and making an impression, not to be erased, on the age and country in which he lives. His career may be occasionally stained by irregularities and checkered with clouds, but will be brilliant in the main. His designs are vast, because he feels his power, the instruments with which he works are men, and he wields them in masses. The term little has no place in his 22* 258 ON TEMPERAMENT. vocabulary, nor its prototype in his thoughts. His aim is greatness of some kind—high achievement, or deep catastrophe. Such men were Pericles, Caesar, Henry IV, Napo- leon, Franklin and Hamilton. Each of these was alike ambitious, and aspired alike to the high and the great, but from different mo- tives, and in different ways. All men who have immortalized themselves by their pens, from the Great Stagirite to the Great Unknown, have been of this temperament. Satisfactory testimony to this effect is deriv- ed from the models we possess of the heads of Homer, Virgil, Cicero, Dante, Bacon, Shakspeare, Milton, Voltaire, Rousseau, and Johnson, and from the size and form of the heads of many writers who are still living. In fact, we may as well look for a giant in bodily strength without large muscles and bones, as for a mental giant without a large brain; as well for a Hercules with a slim per- son, as for a Socrates with a small head. This temperament is much more common among men than women, and in free coun- ON TEMPERAMENT. 259 tries than in those where despotism prevails. The reason of the latter fact is plain. The brain, like every other organ of the body, is enlarged by suitable exercise, and dwindles under inaction. But in nations as free as England and the United States have long been, and as France has been for a shorter period, it is exercised much more constant- ly and favourably, than it can be under a des- potic and jealous government, where even thinking freely is frowned on, and as far as possible prevented. In the free countries just mentioned, therefore, the encephalic pre- vails more extensively than in any others. It is also met with much more frequently in cities than in the country, among mechani- cians, artists, scientific, literary, and profes- sional men, and cultivated characters gener- ally, than among servants, day-labourers, and common operatives in husbandry. To speak in terms still more comprehensive, it belongs to those who pursue some occupation in which the intellect is exercised, much more than to those who work only with their muscles and 260 ON TEMPERAMENT. bones. Among tli ' l»:?er it is rarely if ever found. All correct observation testifies to this. So do the differ; m measures for hats, to suit different casts of customers, in the great hat-factories of London and Paris. In those establishments hats for adults are of three sizes. The first or lowest size is for servants, because their heads are small; the second for farmers and common mechanics; and the third and largest for men of intellect and mental cultivation. The reason of this is so obvious that it is needless to state it. The fact has been familiar to ha iters for cen- turies. The encephalic, in cases where it is the temperament of manhood, glides, in the de- cline of life, into the encephalo-ahdominal, which will be described hereafter. It is in consequence of this change in it giving more vigour to the chylopoetic organs, that indi- viduals frequently recover, about this period, from long-standing dyspepsia. When high- ly developed, it entails on those who possess it a liability greater than common to some ON TEMPERAMENT. 261 diseases, and produces peculiarities in others. From the facility with which preternatural excitement, with its concomitants, may be produced in the brain, it is the temperament most subject to great and frequent irregulari- ty of spirits, melancholy, and mental derange- ment. It creates also a stronger tendency than any other temperament to phrenitis, and delirium in fever. These are the complaints more especially of the prime of manhood. In the decline of life, and in old age, the lia- bility of those whose cephalic development is very large is to apoplexy and palsy. From the strong tendency of the brain to overwork and exhaust itself, it is the organ most serious- ly endangered under this temperament. But the lungs and chylopoetic viscera are also en- dangered. Does the brain, by its own la- bours, expend too great an amount of vital energy? In doing this it robs the thoracic and abdominal viscera of a part of what they should receive, and thus enfeebles them. Hence the liability of those, whose systems are thus unbalanced, to pulmonary consump- 262 ON TEMPERAMENT. tion and dyspepsia, more especially the lat- ter. Torpor, or some other kind of chronic derangement of the chylopoetic organs, is al- most a habitual concomitant of the encepha- lic temperament. It necessarily therefore predisposes, in a certain degree, to fevers arising from gastric irritation, and to consti- pation of the bowels. When more than usu- ally developed in infants it produces a ten- dency to hydrocephalus internus, and some- times to convulsions. The latter predisposi- tion continues in some instances until the pe- riod of puberty. Caesar, whose developments were strongly encephalic, was always sub- ject to epileptic convulsions, except when un- der the excitement of military enterprise. It is persons possessing this temperament that suffer most from repeated paroxysms of high- wrought passion, and intemperance in the use of intoxicating drink. Such practices, if persevered in, produce at length a constant irritation, amounting perhaps to subacute in- flammation of the brain and spinal cord, which not only destroys comfort and useful- ON TEMPERAMENT. 263 ness, but terminates in unappeasable fretful- ness, tremors, startings, and lancinating pains in all parts of the body, amounting in the whole to one of the most deplorable forms of human wretchedness. This is not the temperament of robust health. 3. The thoracic. Under this variety the head is small, usually round, and covered with thick curling hair, the abdomen of limit- ed dimensions, the chest spacious and pow- erful, and the muscles swelling and firm. Whether fair and ruddy or otherwise, the complexion is strong. Respiration is full and deep, and the action of the heart regular and vigorous; and the pulse has great volume. Like the result, in every other kind of inordi- nate vital action, the animal temperature is high. This temperament, in which neither feeling nor intellect prevails, begins to show itself about puberty, and continues until the decline of life, when it undergoes a change. The Fernesian Hercules is the beau ideal of it. This shows that it was known to the an- cient Greeks, who were probably indebted 264 ON TEMPERAMENT. for their acquaintance with it to observations made on the persons of their wrestlers. In modern times it is strongly developed in box- ers and porters, and sufficiently so in bakers, wood-choppers, operative agriculturists, and others who have been habituated to labour from their boyhood. I have observed no lit- tle of it among the London boatmen, the oc- cupation of whose life is to ply the oar, a mode of exercise well calculated to develop the chest, together with the muscles of the upper extremities. I have seen good speci- mens of it also in the African race. The thoracic temperament never occurs in women. It belongs to men alone, and fits them peculiarly for labour, fatigue, and deeds of strength. It qualifies them to obey rather than to command; to be efficient soldiers or sailors rather than accomplished officers. So robust and firm is the constitution, and so sound the health of those who possess it, that it can scarcely be said to predispose to dis- ease. The complaints that occur under it are inflammatory, assuming the fonn of pleu- ON TEMPERAMENT. 265 risy, peripneumony, carditis or some other affection of the heart, and rheumatism, but rarely attacking the abdominal viscera or the brain. They are usually moreover produc- ed by indiscreet exposure, violent exercise, or some sort of excess, which the individual fearlessly incurs, from a belief that his hardi- ness will prevent it from injuring him. In treating them, a liberal employment of the lancet is requisite. Unless the brain suffer from mechanical violence, or some over- whelming animal passion, neither madness, epilepsy, nor any other form of cerebral de- rangement is much to be dreaded by those possessed of this temperament. Their lia- bility to tetanus from punctured or lacerated wounds forms no exception to this. In that affection the cerebral system suffers by sym- pathy with the part originally injured. 4. The abdominal. This temperament is easily recognised by the character it imparts to the person and intellect. The pelvis is broad in proportion to the shoulders and tho- rax, the abdomen large and prominent, and 23 266 ON TEMPERVMENT. the adipose matter abundant, filling up the interstices of the muscles, and often forming a layer between them and the skin, in conse- quence of which the limbs are round and smooth and soft to the touch. . In such con- stitutions, ecchymosis succeeds, with unusual readiness, to slight contusions. Circulation in the skin being feeble, the complexion may be fair and delicate, but never very ruddy or strong. The size of the head is limited, the intellect moderate, the eye deficient in lustre and the countenance in expression, and the movements heavy and seldom graceful. The abdominal viscera seem to draw every thing into the vortex of their action. The amount of vitality isevidently below its common meas- ure in the human system, and, in some instan- ces, the flesh seems to hang as a load on the spirit. It is to be understood that I am speaking of the phenomena of this tempera- ment, when it is highly finished. In a mode- rate condition of it the manifestations of it are weaker. The animal appetite for food predominates, Yet the individual neither OS TEMPERAMENT. 267 eats voraciously nor much at once. His de- light is to eat frequently and slowly, in con- sequence of the pleasure it affords him, and then while away his time until the next meal. Without intending to make a degrading com- parison, but merely to illustrate my views, I might correcdy say, that his deportment, in this respect, resembles that of the hog. He eats, sits or lies down to slumber, and rises at the call of appetite to eat again. His secre- tions, except that of adipose substance, and perhaps also of mucus, are scanty. In a par- ticular manner he perspires very moderately. His skin has a temperature unusually low, and never throws out on any part of it a heavy growth of hair. The hair covering the head is fine, soft, and strflght, and rarely very dark coloured. The only organs of the body that act vigorously are the chylopoetic and nutri- tive, especially those that form fat. The muscles being defective in vitality and tensi- ty, as well as in size, their strength is never great Individuals possessing this tempera- ment have neither enthusiasm nor a spirit of 268 ON TEMPERAMENT. enterprise, and are equally deficient in every other ingredient of greatness. Although suf- ficiently healthy, under common circumstan- ces, they are easily broken down by labour and hardship. Hence they make indifferent soldiers and sailors. Their diseases are those of torpor and depression, rather than of high excitement. If fever attack their brain, it is more likely to produce delirium mite than delerium ferox. Their want of vital vigour renders it difficult to cure their febrile com- plaints; difficult I mean to eradicate them completely. For in proportion to the vitality of the system is its susceptibility towards me- dicinal agents, and its own curative action under the existence of disease. Hence the liability of febrile patiWts, having the tem- perament I am considering, to obstructions producing dropsy, enlargement of the lym- phatic glands and other parts,cutaneous erup- tions which terminate at times in indolent and obstinate ulcers, and other chronic affections difficult to be removed. In no case does the system work vigorously. Owing moreover ON TEMPERAMENT. 269 to the abundant production of chyle, united to a limited excretory discharge, this tem- perament predisposes to a degree of obesity and vascular fulness, which sometimes ter- minates in hemorrhagy or apoplexy. Does an acute affection attack the thoracic visce- ra? It is much more likely to be peripneu- monia notha than peripneumonia or pleuri- tis vera. And unless it be skilfully treated, hydrothorax, asthma, or some other chronic complaint will more probably follow it. It has been already stated that, at an ad- vanced period of life, the encephalic passes, in part, into the abdominal temperament. On that occurrence the abdomen absorbs and concentrates much of what remains of vital energy, its contents are enlarged, the brain, in common with the nerves and muscles, lo- ses not only its vigour but somewhat of its size, and the individual exhibits no small share of the mental dulness and imbecility, with which the temperament is associated in cases where it is original. This change oc- curs much more certainly and in a higher de- 23* 270 ON TEMPERAMENT. greein men of the encephalic temperament. who. after a life of great activity, become in- dolent. The vital energy which had been previously expended in cerebral and muscu- lar exercise, concentres now in the abdo- minal viscera, strengthens their functions, and adds to their size. In those who perse- vere in their active habits, whether of mus- cle or brain, the change is much less striking. Voltaire, Priestley, Jefferson, and the late Dr. Rush were instances of this. Their mental activity continued until the close of their lives, and their change toward the abdomi- nal temperament was very slight. Voltaire's leanness has been attributed to his excessive potation of strong coffee. This is a mis- take. It was the result of his indulgence in strong thought. Napoleon drank more strong coffee than he did, and became fat on it; but he was not so morbidly encephalic. Hard-working men, who continue their la- bours until an advanced age, never exhibit the temperament I am considering. The reason is plain. They expend in muscular ON TEMPERAMENT. 271 action that degree of vital energy, which the abdominal viscera require to render them powerful. Let them decline a laborious life and live comfortably, and they will then be- come fat. Why? Because the energy, which had been previously wasted by the muscles, centres now in the chylopoetic viscera and nutritive organs, and gives them vigour. The abdominal temperament prevails more in Holland and the Netherlands, than ih any other portion of Europe. It is also more fre- quently met with in England and Germany, than in France or the United States. The diseases of those who possess it seldom re- quire the bold and vigorous use of the lancet. Being slow in their progress, they allow the physician time in his contest with them, and usually yield to secretory remedies. Suitable exercise does much toward their removal. 5. The encephalo-thoracic. This tem- perament is a type of power both bodily and mental. Its compound name expresses ful- ly the external appearances that mark it, as well as the attributes that always accompany 272 ON TEMPERAMENT. them. With an abdomen of moderate di- mensions, the head of the individual who possesses it is large and vigorous to conceive and direct, and his chest and muscles power- ful to execute, and hardy to endure. It is the temperament of masculine and compre- hensive thought and strong propensity, united to energetic action, rather than of seclusion and profound meditation. As in all other cases,'the character is varied in it according to the portion of the brain that is most large- ly developed. He to whom it belongs feels himself in his proper sphere when he is among men, and is well fitted to act his part in times of tumult and scenes of difficulty. Is his brain large in each of its compartments? If an occasion present itself, he not only min- gles in the moral storm, but aspires to direct it. In case of his becoming a warrior, his genius and sword are alike formidable. In battle, previously to the invention of fire- arms, such a man was the terror of his ene- mies and the hope of his friends. Ulysses, as sketched by Homer, is as fairly the beau ON TEMPERAMENT. 273 ideal of this temperament, as Hercules is of the thoracic. That chieftain was alike wise to counsel, intrepid to dare, and powerful to perform. Plato, so called from the uncom- mon breadth of his chest, who had also a ve- ry large head, is another excellent model of the same. Even in times of peace the cor- poreal attributes of a man of this description add to his influence. Jupiter, the emblem of wisdom and power, as represented by the an- cient statuaries, with an imWhse head and trunk, and arms of matchless strength, is as finished a specimen of the encephalo-tho- racic temperament, as Apollo is of the mixed. From what has been said of the encepha- lic and thoracic temperaments, separately considered, the tendencies of this to disease, as well as the diseases when they occur, must be so obvious as to render it needless for me to specify them. The temperament being mixed, so must be its maladies; and they must correspond to it. Their usual seat are the brain and thoracic organs; and they are of high excitement. In the treatment of them the employment of the lancet must be bold. 274 OJS TEMPERAMENT. I cannot refer to any place where this tem- perament prevails much more than in others. I have seen it most frequently in the moun- tain region of the United States. Among the people of Great Britain and Ireland it is of- tener found than among those of France. It is a sort of sporadic variety, which occurs occasionally in every country peopled by Caucasians, but is not perhaps endemic in any of them. It probably never appears, in full developq|£$, in individuals belonging to any of the other races of man. In an ad- vanced age it makes an approach toward the mixed temperament, and produces an en- largement of the abdominal viscera. 6. The encephalo-abdominal. Here a- gain the name bespeaks sufficiently the de- velopment, form, and character of those who possess the temperament The head and abdomen are comparatively large, the tho- rax small, and the shoulders narrow. Hence the sensibility is keen, and the intellect, if not powerful, active and respectable. For the reasons given, when the abdominal tempera- ON TEMPERAMENT. 275 ment was considered, the limbs and person, under the present one, are round and smooth, agd the flesh is soft; but, owing to the influ- ence of a well developed brain, and nerves that correspond to it, the movements are sprightly and the air graceful. Though rare- ly powerful, the character is attractive. This is the temperament of childhood and wo- man, much more than of adult life and man. Fine genius, but elegant and playful, rather than strong and brilliant, is often connected with it. It is females, in whom the encepha- lie development is larger than usual, that pos- sess minds truly masculine. This temperament, in a certain degree of development, is more common than either of the others. It prevails in every country peo- pled by the Caucasian race. As already sta- ted, it belongs to women* and children^ and * The strength of the abdominal temperament, in females, is increased by pregnancy. Hence the well known fact, that the predisposition in them to pulmonary consumption and other thoracic affections is weakened, and the com- plaints themselves .often suspended, during the period of gestation. 276 ON TEMPERAMENT. also to the advanced life of those, whose tem- perament during manhood was the encepha- lic. Like its constitution and character, its complaints are mixed, partaking of those of the two simple temperaments of which it is composed. Owing probably to the delicacy of the organization of the nerves and brain, and the high degree of life possessed by those parts, the amount of sensibility, under this temperament, is often more than in propor- tion to the extent of cerebral development. Such cases are easily explicable. In giving strength of function to the brain, higher in- tensity stands in lieu of greater extensity; a phenomenon of which no one versed in physiology can be ignorant. Under this tem- perament, diseases, originally abdominal, have an unusual tendency to attack the brain. Hence the frequency of puerperal madness, and the uncommon liability of women to suf- fer delirium in cases of peritonitis. For the same reason hysteria is almost exclusively a female complaint. Its origin is abdominal; and it falls on the brain and spinal cord by ©N TEMPERAMENT. 277 metastasis or sympathy. In the treatment of most diseases connected with this tempera- ment, free secretion from the viscera of the abdomen is peculiarly useful. The liberal employment of the lancet and of leeches is likewise often indispensable. 7. The thoracico-abdominal. In this temperament the head is comparatively small, and the thorax and abdomen large, with a corresponding size of the muscles and bones, and much adipose substance. It is the tem- perament of mere animal strength and pa- tient endurance, without any of the elevated, sprightly, or attractive qualities of human na- ture. It forms good labourers and fatigue- men, but is entirely unfit for those whose province is to meditate, plan, and direct. It comports well enough with the character of soldiers of a certain description, but is alto- gether out of harmony with that of an officer. It is, I think, more favourable to health than any of the other temperaments, except per- haps the mixed. If those who possess it have weak intellects, their passions are usu- 24 278 ON TEMPERAMENT. ally moderate, and rarely hurry them into pernicious excesses. The tenor of their lives is but little interrupted by either irregu- larity or disease. Hence they retain their vigour uncommonly well, and are often day- labourers and industrious husbandmen at an advanced age. True; their appetite for food is strong; but they are not prone to an exces- sive indulgence of it; I mean at a single meal. Like those possessed of the abdomi- nal temperament, they eat often rather than superabundantly at once. Besides, such is the strength of their chylopoetic viscera, that they subdue and digest, without sustaining any injury, as much food as would produce disease in those of different constitutions. Nor are they so much endangered by vascu- lar fulness as persons of the simple abdomi- nal temperament. The reason of this is plain. Their blood vessels are larger, and their ex- cretions more copious, especially those by the skin and the organ of respiration. From the warmth of their constitutions, owing to an abundance of well arterialized blood, and a ON TEMPERAMENT. 279 concomitant vigorous circulation, they per- spire freely, and secrete and exhale copious- ly from the lungs. This temperament is rarely found among women, and is not very common among men. I have not often seen it in natives of the United States. In Ger- many and England it is more frequently met with. It is said to prevail more in Asia and Africa than in Europe or America. On this point my information does not authorize me to speak confidently. Considerations how- ever are not wanting to render the statement probable. Under this form of constitution idiotism, or an approximation to it, is not ve- ry unusual. I have already adverted to the fact, that, at certain periods of life, one temperament pas- ses into another, as the result of the natural changes which take place, in the progress of the growth and decay of the human body. This is true of every individual, but of some in a much more striking degree than of oth- ers. The subject is so interesting, and yet so little noticed, that it might seem to have 280 ON TEMPERAMENT. something of novelty in it I trust therefore that a succinct but general view of it will not be unacceptable to the reader. Like every thing else in nature, the sys- tem of man is never stationary. From birth to death it presents an uninterrupted succes- sion of changes; and death itself is but ano- ther change. Nor are these mutations alike in every part of the body, at the same time, being much greater in some organs than in others. Hence the balance of the system is perpetually varying, a circumstance tanta- mount to the interchange of temperament re- ferred to. During growth, those parts which are first and most wanted in the general econ- omy of the body increase most rapidly; and decay observes, in its progress, somewhat of a reversed order. Parts' decline in vigour earlier or later, according as their functions are more or less indispensable to animal ex- istence ; those least necessary decaying first. At birth, the head and abdomen being dis- proportionately large, and the thorax narrow, the temperament of the infant is the encepha- ON TEMPERAMENT. $8l lo-abdominal. But it is the animal organs of the brain alone that are largely developed, the knowing, moral, and reflecting ones being yet small. Hence the character of the indi- vidual is also animal. The appetite is keen, the functions of digestion, assimilation, and nutrition vigorous, and the sensibility great It will be understood that I allude to mere animal sensibility, not to that of a higher or- der. Knowledge therefore is very limited; and there is an entire destitution of reflec- tion and moral sentiment. The complaints of this period are cephalic and abdominal. being very rarely seated in the thorax. Until the commencement of puberty, the head continuing to grow, while the abdomen becomes comparatively smaller, the change of temperament is toward the encephalic. The enlargement of the brain, however, dur- ing this period, arises chiefly from the growth of the knowing organs, the moral and reflect- ing ones increasing much less rapidly. The child now seeks the elements of knowledge -with great ardour, and attains them with ease; 24* 282 ON TEMPERAMENT. but he is less attentive to the relations of things, and less fitted to acquire a knowledge of them. Nor is he yet a moral agent. His animal sensibility is still great, and shows it- self in frequent bursts of passion. His com- plaints lose somewhat of their abdominal character, and become gradually more ence- phalic. At puberty the development of the moral and reflecting organs, together with that of the amatory one, takes place, and the chest and its contents are expanded in every direc- tion. In the female the capacity of the pel- vis and the bulk of its organs are also enlarg- ed. But the abdomen loses still more in its comparative size. This change is toward the encephalo-thoracic temperament. It is now that the thirst for enterprise and exploit is awakened, military life is perhaps strongly coveted, the passions become more storm), the youth who was lately devoted to study, and perhaps fond of tranquility, is now burn- ing for action; and a leading object of his ambition is to become a favourite of the fair, ON TEMPERAMENT. 283 Moral sentiment and the reflecting faculties are now possessed by him; but they are still liable to be occasionally overruled by animal propensity. His diseases are thoracic and cephalic. Madness, Peripneumony, hemop- thisis, and pulmonary consumption make a part of them. Before puberty these com- plaints are very rare. This state of things lasts from the fourteenth or fifteenth to the twenty-fourth or twenty-fifth year of life, or a little longer. Young manhood has now arrived, and its temperament is an approach toward the "mixed." The several parts of the body are becoming as well balanced as they will ever be, and so is the cast of character which ac- companies them. The system now attains its perfection, and is comparatively settled and stable in its economy. The changes it sustains are much less striking than they had been at any previous period; and its diseases are less frequent and numerous, and less con- fined to any given part. They are the pre- vailing diseases of the community, and not 284 ON TEMPERAMENT. such as arise from any constitutional pecu- liarity. Under suitable precautions, this is the healthiest term of life; and it extends to the fortieth or forty-fifth year. It includes therefore not only the beginning, but the ma- turity of manhood. Uniting with it a few of the last and ripest years of juvenescence, it is dien, in the fullest meaning of the terms, the period of high enterprise, daring, and ef- ficiency. If man is ever to become great, manifestations to that effect have been made by the time he has attained his twentieth or twenty-first year; and from that epoch his Character is rapidly developed. Creation is comparatively new to him. He has hitherto met with no obstacle to depress his spirit, or abate his ardour. His ambition for attain- ment and exploit is therefore eager and un- limited, he is untrammeled by prejudice, his hopes are buoyant and his perseverance stea- dy, and his faculties, fresh and vigorous, are capable of exerting themselves to the extent of their nature. The exceptions to this state- ment, if any exist, are very few. A long cata- ON TEMPERAMENT. 285 logue of names, which adom history, might be readily cited in proof of it. Such are those of Cyrus, Xenophon, Phocion, Alexan- der, Scipio, Caesar, Lorenzo de Medicis, Turenne, Pope, Dryden, Voltaire, Pitt, Fox, Napoleon, Washington, Jefferson, Hamilton, Byron, and hundreds of others well known to fame. All these were becoming illustri- ous by or before their twenty-first year. Nor is the rule less applicable to philosophers, than to statesmen, poets, and military com- manders. No error is more obvious, and few more pernicious, than that which attaches great- ness and practical power only to the meridi- an and the decline of life. It often excludes young men from places, which they would not only fill with lustre, but which they are alone fitted to fill. For there are stations of high importance to the welfare of man, to which the fixed and unbending habits of age, and even of ripe manhood, are not well suit- ed. Dark and flowing locks are no more emblems of the want of wisdom andefficien- 286 ON TEMPERAMENT. cy, than gray hairs or baldness are of the pos- session of them. Society has suffered so se- verely from the contrary belief, that it is time it were discarded, and reason and experience introduced into its place. True wisdom can be no more measured by years than by gallons. It is the offspring of genius, trained by observation and sober reflection. Nor, when genius is of a high order, and of the requisite cast, is it necessary that the train- ing should be very protracted. Wisdom then would seem to be instinctive. About the fortieth or forty-fifth year of life, another constitutional change takes place, in which the prevailing temperament assumes gradually somewhat of the abdominal. A weakness of the digestive organs, which had previously prevailed, now disappears, and the general health is improved; a greater fulness and rotundity of the abdomen follow, and the keenness of feeling and the activity of talent, more especially the brilliancy of ima- gination, begin to abate. Man descends gradually though perceptibly from the point ON TEMPERAMENT* 28* of elevation he had antecedently maintained. In very advanced years, the abdominal tem- perament is complete, and the individual has sunk to a monument of animality. It appears, then, that every one, who at- tains longevity, partakes, in the progress of growth and decline, of five temperaments; the purely abdominal, which prevails before birth; the encephalo-abdominal, which ex- ists at birth, and for some years afterwards; the encephalo-thoracic; the mixed; and the abdominal of real senility, which differs some- what from that of the foetus in utero. Thus passes the circle of life, beginning with the abdominal temperament of the foetal state, and terminating in that of extreme old age. Such, in brief, are the views I have enter- tained and taught for several years, respecting the foundation of human temperament, and the causes that diversify it If they are cor- rect, time will ratify them, and further obser- vation fill up the outline I have endeavoured to sketch. In that case, like all other truths, they will prove useful. But should they be 288 ON TEMPERAMENT. found erroneous, they will only share the fait of the thousand perishable fancies that have preceded them, and no one will regret their subversion less than myself. My attachment is to facts, not to hypotheses, however ingen- ious or splendid they may be, or by whomso- ever erected. As relates however to the views I have just delivered, I may be permit- ted to observe, that they are not built on any thing imaginary. They do not rest on vis- ionary conceits respecting humours or their conditions, or respecting any properties of matter, that have no existence. They have a tangible basis that can be approached and examined. The size, both absolute and rela- tive, of the ruling organs of the body can be readily ascertained. So can the constitu- tional characters of individuals. And if, in the same persons, certain modifications of the organs and their relations be found always to coexist with certain corresponding modifica- tions of character, the ground of belief will be very strong, that they are connected with each other as cause and effect. The entire ON TEMPERAMENT. 289 subject, therefore, is free from abstraction, and open to observation, and can be settled as easily as any other in medicine. A few practical remarks, which seem warranted by the views that have been given, shall close this essay. According to the representation made of them, all the temperaments, except the "mix- ed," are so many predispositions to disease; some of them indeed much weaker than oth- ers; but still predispositions. When diey are so strong as seriously to endnnger health, can they, by any process within the reach of human means, be so changed, as to come nearer a mutual balance, and be less dan- gerous?—I think they can, provided the ef- fort be commenced at the proper period, skil- fully conducted, and duly persevered in. As in every other case, the remedy, as well as the mode of administering it, must be suited to the character of the evil to be removed. A thorough knowledge of the subject, there- fore, and judicious management are essential to success. • 25 290 ON TEMPERAMENT. Does it appear, from the size of his head, the precocity of his intellect, and the slen- derness of his frame, that a boy possesses the encephalic temperament in a dangerous degree? Let an attempt be made to change it, as far as possible, into the encephalo-tho- racic. Nor are the principles that are to govern the effort obscure. The boy is high- ly sensitive and passionate, inclined to be in- ordinately sedentary, and to over-exercise his brain in pursuit of knowledge. Let him be kept as tranquil as practicable, by a careful avoidance of all causes that might excite feel- ing into passion, and let his daily occupations be such as may exercise his brain less and his muscles more. Let him be less of a stu- dent and more of a labourer. In a particular manner, let him spend a considerable portion of his time in some amusement or occupa- tion that will give full exercise to the mus- cles of his arms, shoulders, and chest. This will exercise, at the same time, his lungs and heart, and will tend to give expansion and strength to the whole. The pulmonary sys- ON TEMPERAMENT. 291 tern may be further strengthened by the prac- tice, judiciously regulated, of singing, decla- mation, and playing on the flute, clarinet, of some other wind instrument of music. The mode adopted by Demosthenes to give strength to his lungs is known to every rea- der of Grecian history. The late Professor Rush stated in his lectures, a short time be- fore his death, that, in a long life of medical observation, he had never known pulmonary consumption to occur in a teacher of a sing- ing school, an auction-crier, a watchman who called the hours of the night, or an oyster- man, who proclaimed his vocation through the streets. But these exercises must be skilfully apportioned to the strength and con- dition of the organs which they are intended to invigorate. It is a well known principle, in the econo- my of living matter, that organs duly exercis- ed grow more rapidly, attain a greater bulk, and are more hardy and vigorous than those that are allowed to rest. They attract a por- tion of blood, and appropriate to themselves 292 ON TEMPERAMENT. a quantity of nourishment, that would other- wise go to augment the growth and add to the vigour of the quiescent organs. By the process indicated, then, the chest will be en- larged, and, instead of a dangerous encepha- lic, the temperament may be changed into a safe degree of the encephalo-thoracic. As constipation of the bowels usually attends such cases, and aids in directing the blood toward the brain, the means of removing it should never be neglected. If the end can be attained by diet and regimen, instead of me- dicinal articles, so much the better. But in relation to this point, different individuals will require different modes of treatment; and a knowledge of different cases can alone sug- gest the necessary variations. Nothing can be more erroneous, or more certainly injuri- ous, than for a person, whose temperament is dangerously encephalic, to pursue a seden- tary and studious, or an indolent life. Either will entail on him disease and wretchedness. Be his standing and condition what they may, he had better be a ploughman, a car- ON TEMPERAMENT. 293 penter, or a blacksmith. Frederick III had I probably in view some one possessing a high- ly finished encephalic temperament, when he declared that "man is better fitted to be a > postillion than a philosopher." It should * never be forgotten that, to prove effectual, the mutative process should be commenced early in life, and persevered in until man- p hood. It is only when the individual is young and flexible, that his constitution can be changed by training. It is the twig and the sapling that can be bent, and made to as- sume the desired form; the full grown tree resists. As already stated, however, there are particular periods in the life of man, when nature herself changes, to a certain extent, one form of temperament into another. Those are therefore the points of time, at which artificial efforts to the same effect will * more certainly avail. Hence they should be always selected as the most suitable occa- sions for energetic action. At puberty the change which nature makes is more particu- larly toward the thoracic temperament; she 25* 294 ON TEMPERAMENT. makes also a slighter one toward the ence- phalic. At this period therefore let art assist her, in the attainment of one or the other, as the case may require, and the probability of success will be the greater. Is the abdominal temperament to be chang- ed? Let the effort be to convert it into the "mixed." Nor is the process best calculated to effect this either obscure or doubtful. Ex- cite and exercise, in the requisite degree, the brain and muscles, especially the muscles of the upper extremities and the chest, and the work is done. It must be recollected that in every case where the muscles of voluntary motion are sufficiently exercised, so are the lungs and heart. The same means therefore tend to enlare and strengthen the whole. Does a desire exist, on account of the dan- gerous smallness of the chest, to alter the en- cephalo-abdominal temperament? Train. by the proper excitement and exercise, the thorax, heart and lungs. Nor let it be forgot- ten, that an essential part of this process con- sists in respiring free and wholesome air. To ON TEMPERAMENT. 295 resort daily therefore to the hill-top and the mountain, and spend as much time as may be convenient in those elevated situations, is a salutary practice. The exercise of ascend- ing them will cooperate with their wholsome atmosphere, in producing the wished-for change in the system. Is the thoracico-ab- dominal temperament to be modified and im- proved? Exercise the brain judiciously, so as to render it constantly a centre of flux- ion, and, as far as is practicable, the end will be attained. In fine, give exercise to the part deficient in size and vigour, and rest to that whose growth is exuberant, and nothing further can be done to equalize temperament and secure health. Even when the differ- ent compartments of the brain are dispropor- tioned to each other, this process, skilfully performed, can do much to produce an equi- librium and improve character. T>oe\ the mixed temperament prevail ? but is it accom- panied by inordinate general debility, with- out any apparent local complaint? The remedies consist in nourishing diet easy of 296 ON TEMPERAMENT. digestion, well regulated exercise, and the breathing of a pure and wholesome atmos- phere. To these add, suitable clothing, from six to eight hours' sleep, between nine or ten o'clock at night, and five or six in the mor- ning, on a hair matress rather than a feather- bed, and a due governance of the passions, and the constitution will be invigorated. If the principles contended for in this essay are true, the deductions from them are of high interest, and their practical applica- tion peculiarly important. As respects both physical and moral evil, man holds under his own control much more of his destiny than he is generally believed to do. He can so alter and rectify an unbalanced condition of his system, as to escape a large share of both, to which he would otherwise be subject. For a want of the requisite balance between the different compartments of the brain predispo- ses as certainly to eccentricity, immorality, and vice, as a similar want between the other parts of the body does to disease. And, in both cases, education, wisely planned and ON TEMPERAMENT. 291 skilfully conducted, can do much to remedy the evil. But not such education as now prevails. If that prevents some evils and removes others, it produces, in many instan- ces, an equal number. The reason is plain. Its plan is bad, and its execution no better. Nor can it be amended, in any respect, until it shall be placed under the direction of those who have a competent knowledge of human nature. Education, correctly interpreted, is the proper training of the entire person; the exciting, developing, and strengthening, by suitable exercise, every organ belonging to the body. By such a scheme of discipline alone can man be raised to the efficiency and perfection of which he is susceptible. Let the intellectual and moral compartments of his brain be duly exercised, each according to its nature, and they will acquire such de- velopment and vigour as to control his ani- mal. This will render him enlightened and virtuous. But never can the cause of either knowledge, or virtue, or religion be promo- ted, by punishment, denunciation, or terror. 4 298 ON TEMPERAMENT. Yet these means, cruel in their nature, and degrading and deleterious in their effects, are extensively employed. Let the other or- gans of man's body be trained with judg- ment and skill, and the process will exempt him from many diseases, and confer on him a degree of muscular energy, sufficient for his wants or reasonable wishes, and far beyond what he would otherwise possess. For the attainment of an end so peculiarly desirable, the means are equally simple and obvious. Place the business of education, where it ought to be, among the most honor- able and profitable employments, and the work will be done. Talents of the highest order, united to the requisite knowledge, and all other suitable qualifications, will then be engaged in it, and the issue will soon appear in a striking improvement of the educated portion of the human race. Teachers of this description will not submit to be control- led by authority because it is ancient. They will not conform to it unless it is sound. Nor, to determine this point, will they look to usa- ON TEMPERAMENT. 299 ges or listen to dogmas transmitted to us from times of ignorance and superstition. They will examine human nature, under the bright- er lights which now surround us; and to that alone will they accommodate their schemes of instruction. They will study first the con- stitution of man as it is; and having attain- ed a competent knowledge of that, they will then commence, under correct views, and with suitable arrangements, the great work of regulating, changing, and improving it. The scheme for effecting this will be devised and conducted in strict conformity to the laws which govern it physically, morally, and in- tellectually, giving to the higher a due as- cendency over the lower; not in obedience to practices derived from ignorant and semi- barbarous times, nor to the mistaken conceits or superficial notions of incompetent teach- ers. It is because the process is not un- derstood, that the plans"of education are now so numerous, different, and even opposite. All men possess the same faculties, although in different degrees. Human nature is there- 300 ON TMEPERAMENT. fore one; and so, in its principles, will be the true system of training and instruction, as soon as it shall be established. With the re- quisite modifications, as to form, extent, and administration, it will be adapted alike to all persons, and all purposes. Such, I repeat, is the issue, to which the principles maintained in this essay, provided they be true, are calculated to lead. Persuaded therefore that they are so, I submit them to the public, with a hope that they will be useful. THE END. I i 1 LIBRARY OF MEDICINE ■■»: NLM032776289