A TREATISE ON THE SCARLATINA ANGINOSA, AND DYSENTERY; AND SKETCHES ON FEBRILE SPASM, AS PRODUCED BY PLOGISTON. By ISRAEL ALLEN, M. D. LEOMINSTER, (MASSACHUSETTS) Printed by CHARLES PRENTISS, FOR THE AUTHOR, & ROBERT B. THOMAS. 1796.  TO THE FRIENDLY PATRONAGE OF PHYSICIANS THE FOLLOWING OBSERVATIONS ARE Inscribed, BY THEIR MOST OBEDIENT AND HUMBLE SERVANT, THE AUTHOR. STERLING, October 1, 1796.  A TREATISE ON THE Scarlatina Anginosa, &c. The general Type of the Fever. To characterize this epidemic by any particular symptom or set of symptoms, would be difficult. In giving the history of the disease, it will be necessary to mark the different degrees of febrile heat, and general type; and notice the variety of symptoms under particular cases. In general, the presence of an inflamma- tory diathesis prevailed, but in various de- grees. A2 Excess (6) Excess of febrile Heat. IN cases of high excitement the patient is accompanied with many disagreeable sen- sations; as head and back ache, throat in- flamed and very painful, the tonsils tumefied, eyes inflamed, skin hot and itching to excess, nausea and vomiting; the whole vascular sys- tem greatly excited, and the action of the ex- treme vessels very much increased: all these symptoms, united, form an assemblage uncom- monly irritating and distressing. These symptoms generally terminated at the completion of five days; but if the disease anticipated a crisis only, the symptoms on the sixth would go on increasing; but showing signs of crisis; as a partial moistness on the skin, turbid urine, &c. and a final solution and relaxation appeared evident at the com- pletion of the seventh; at which period, the body became sweaty and moist, the urine pre- cipitated a sediment, the tongue cleaned par- tially, and there was a more free discharge of canker from the throat, than had happened before (7) before. A lively delirium, quick pulse, hoarse- ness, an apparent atony, vomiting, sometimes purging, large discharge from the tonsils, were all attending symptoms; but a perfect crisis constantly happened to those under this form of disease. The patient being freed from the violence of excitement, generally remained several days, very sleepy, feeble and deranged. Defect of febrile Heat. AS it is of importance in practice to dis- tinguish the different degrees of febrile heat; so in this diathesis it is necessary to mark the different stages of disease. Two periods are peculiarly dangerous, viz. the time of acces- sion and recession of eruption. The danger at the beginning of disease evidently arises from want of action or mobility in the ex- treme vessels, and an obstinate spasm; there- by occasioning local determinations to the brain and lungs; this defect of reaction, and the danger, are greatly increased by the coin- cidence (8) cidence of cold, being received just at the time of accession, and a constitution favoring fe- brile spasms and spasmodic affections. The patient, very soon after being seized, becomes stupid, has a small and frequent pulse, obscure heat, sometimes vomits and purges insensibly, the eye fixed and glassy, the respiration soon becomes anxious and difficult, the tonsils mild- ly inflamed, scene small inflammatory pimples in the throat, and imperfect eruption on the neck and stomach. With these alarming symptoms, the patient generally dies within the first twenty four hours, unless means are employed sufficient to excite and increase the mobility on, and determination to, the surface of the body. Many livid spots have appear- ed on those who have died in this stage of disease; which some have thought were from a broken and dissolved state of the blood; but I apprehend the appearance was from an in- flammatory diathesis, determined to the skin, and violent febrile spasm. Patients that have been relieved under symptoms (9) symptoms like the preceeding, and a final so- lution of disease, obtained, have (on taking cold) been seized with a secondary fever, and blood taken away has constantly appeared sizy and inflammatory, which it would not in so short a period, had it been broken and dis- solved before. Recession and imperfect Crisis. THE period next to be noticed is that which follows the recession of the eruption. This period, in this form of the disease, the practitioner ought to keep in view; and is between the fifth and eighth day. In this stage and form, prognostic is dangerous. The patient has no unfavorable symptom, the sau- ces are moderately inflamed, the heat equal and mild—no derangement of the intellectual functions; finally, every symptom promises safety to those unacquainted with the com- plaint; when, unexpectedly, the patient be- comes (10) comes insensible, the eyes inflamed, an acri- monious saliva discharges from the mouth, an acrid mucus from the nose, very eroding to the skin, and a sanies from the ears; the face, neck, hands, and feet bloated, the tonsilar and parotid glands tumid; the action of the heart and arteries feeble; the natural warmth, or vital energy perceptibly diminishing, and ev- ery morbid symptom tending to the fatal pe- riod; which, few cases excepted, is rarely more than forty hours from the change of symp- toms. All reasoning respecting this sudden change of symptoms, would be hypothetical; but, we may however conjecture, that the cause, or particular state of atmosphere, which originates the fever, is highly active and stim- ulant; and by reason of violent stricture, or exposure to cold air, determines to the sensu- ous part of the brain. And, considering the supersicies is an expansion of blood vessels and nerves, and greatly inflamed and irrita- ted, may it not be also supposed that the plex- us choroides, and pia mater, are inflamed early in the disease; and in the second stage, the (11) the medullary substance is inflamed and intire- ly disorganized? Local inflamations of mem- braneous parts, we are assured, are not attend- ed with high excitement. Whether the change arises from the cause suggested, or from an absorption of acrimony from the glands, is not known. I have never observed, even in one in- stance, any local determination under the first form of disease, where the crisis was com- plete, except what was common to both, a foreness and swelling of the joints. But when the tongue retained its cast, the surface con- tinued dry, and other symptoms of doubtful crisis, till after the seventh day, a recession followed, and a particular determination was evident. In one instance, it evidently deter- mined to the brain, and produced symptoms of an hydrocephelus internus, as might plain- ly be traced, by the dilated pupil and other symptoms corresponding. In another in- stance, to the intestines, followed by dysente- ric discharges. And in a third to the lungs and (12) and bronchia with symptoms of synanche trachealis. A fourth determination, and which is common in an obscure crisis, is to the par- otid glands, which continue a long time in- durated, after the ulcerations on the tonsils, uvula, and mouth are abated and healed. Secondary Fever. ANOTHER characteristic in this disease, is an aptitude remaining to febrile heat. Cold air, wet cloths, rooms, linen or shoes, quick- ly renew the inflammatory diathesis. Those in a state of convalesence, must cautiously avoid any exposure for ten or twelve days at least, after the crisis. Wine, spirits or tonic medicines, must be administered with caution. The fever that follows is very inflammatory, and renews all the preceeding symptoms, ex- cept the ulceration of the throat. A boy who had the complaint, with the usual symp- toms, except the eruption, grew tired of con- finement, (13) finement, escaped to the; barn; the following evening, a delirium and febrile paroxysms, great heat and effloresence succeeded; the ton- sils inflamed, greatly, but without canker. The fever raged five days, when a favorable crisis appeared. General Remarks. SOME peculiarities characterize this dis- ease, which are not observed in any other eruptive disorder. I could never be satisfied whether it was contagious or not. At one time, when it entered a family, one only would have it; at another, two; at another, all. At one time, it appeared to follow in a week or less, after being exposed; and at another, not till after four or five; and many had it with- out ever being in any way near an infected person. The effloresence on the skin is not a certain symptom of disease; neither is can- ker; and many had neither an eruption, can- B ker, (14) ker, nor fever; a sore throat only; at the same time and same family of which three died; a circumstance, that it was the same disorder. In one instance it appeared local, as no other symptom happened, but inflamed tonsils, which continued seven days, attended with a large effusion of saliva, the quantity of three pints or more in twenty four hours; a circum- stance, likewise, that it was not a common sy- nanche, four others of the same family, the following week, were violently attacked with the disease. A free discharge from the throat was a sign of safety, and the reverse, when it could not be promoted. An absorption was succeeded with tumefaction in the glands, ulcerations in the nose and ears, an obscure heat and debility. I have never observed any general tendency to putrescency. The ulcers in the sauces were deep and very offen- sive, before the crisis; especially, when the patient had been neglected or taken tonic medicines too freely. Cold and heat were equally to be avoided; heat increased the restlessness, anxiety, and febrile irritation, cold (15) cold gave a sensation equally unpleasant. Cold and hot drinks had the same effect as the temperature of air. Those with an excess of diathesis, parted with their hair and nails; those with less excitement, the scarf skin only. Those under the highest excitement were the most debilitated, and remained convalescents the longest. An absorption to the glands in many cases was more troublesome. Many, under a mild diathesis, had as perfect a crisis, which was as distinctly to be traced, as those under the highest. From the 1st of March, 1795, to April 18, 1796, one hundred and fifty persons, mostly children, had the disease in this place; and eight of those died, viz. One on the 21st day, emaciated with constant heat, large ulce- rations and abscesses in the inferior part of the throat, aphtheous mouth, and general ac- rimony of the fluids. Two on the 9th, from imperfect crisis, and an inflammatory deter- mination to the brain. One in twenty four hours, from violent febrile stricture, on the surface, (16) surface, and a determination to the lungs and bronchia. One on the fifth, an infant, with spasms, and dyspnoca, at the recession of eruption. Two on the 7th, from cold, after an apparent crisis; the natural and vital heat being repelled; the contractile power of the fibres being feeble, a general atony and tume- faction succeeded. One by local affection of fever exerted on the intestines. Indications. ALL that medical aid can do, is to obviate the morbid tendencies, or local determina- tions to important and vital parts. Heat, the only known stimulus in nature, when an ex- cess is received into the system, by the lungs, from the atmosphere, or by absorption, or in contagious principles in the air, or be detain- ed by cold, and an excess is accumulated, in- creases the contractility of the muscular fibres of the heart, and the surface of the body. The (17) The increased action of the heart increases the velocity of the fluids, and while the re- sistance on the surface continues, a febrile ef- fort commences, and continues, till the action of the heart overcomes the resistance, and an exhalation of heated fluids takes place; or the resistance called reaction repels the heated fluids to the brain or some vital part, and des- troys its mechanism. The indications are two, viz. Remove the cause, excess of stimuli, and obviate the fatal tendencies. The peculiar tendency of erup- tive fevers is to the surface. The scarlatina exerts its influence on the tender surface of the sauces. Many writers have supposed the particular determination and inflammation there, producing ulcerations, were the most dangerous symptoms in the disorder. Debil- itating the vessels of the throat, while the spasm continues, by poultices externally ap- plied, hot fumigations, and relaxing gargar- isms, augment the suffusion and inflammation B2 there (18) there. The indication to obviate the morbid tendency, is to repel the heat and check the violent action of the inflamed vessels by as- tringents, early in the disease; and after the parts are greatly swelled, stimulants to obvi- ate loss of tone in the vessels. Method of Cure. AN emetic in the beginning generally relieved the patient of many painful sensa- tions, as nausea, pain in the throat, headache, &c. Immediately after the operation, I or- dered the sauces to be garbled, with a solution of sugar of lead, alternating every three hours with a solution of salt, water and vinegar; at the same time directed the external parts of the throat to be bathed with the same solu- tions. The determination to the surface, the next indication, was promoted by internal and external means. A febrifuge medicine, com- posed of nitre camphire and golden sulphur of (19) of antimony, was given every three hours, alternated, saline julep, and tincture of opium, sufficient to take off an excess of irritation. The bowels regulated with glauber salts and castor oil, or rheubarb and salt of worm- wood; a gentle operation only, being necessa- ry. Bathing the legs in warm water, poul- tices to the feet and blisters favored the indi- cation.—As children cannot use the garga- risms, the nurse ought to touch the tonsils and other inflamed parts with a soft swab or arm- ed probe; wet with the astringent solusions. This course, varying, with the symptoms and indications, I continued till the fifth or sixth day, at which period the inflammation was at its acme. At this time I changed the course; ordered a strong solution of borax as a gargarism, in brandy and water, and gave spirit of nitre, camphire and opium, as a feb- rifuge. After the crisis, which may be ex- pected on the seventh, I have found a solu- tion of white vitriol in rosewater the best as- tringent to prevent a return of ulcerations and aphtha. Much caution and attention is now (20) now necessary. The nurse must constantly assist the patient, if a child, with the probe, to dis- engage and discharge the canker; and par- ticularly to press the tongue down, and exam- ine, and disengage that which lies lodged on the tonsils. Some patients have not swallow- ed during the night, from inattention of the watcher. I have been obliged to pass a large armed probe between the glands before the patient found relief. The teeth and lips are to be frequently washed; and the throat like- wise, before eating or drinking. At this pe- riod of disease the surface of the mouth and throat is tender, and dry; the patient can on- ly whisper. A spoonful of some oily medi- cine, after waking from sleep, is very useful indeed. In this stage, the bowels are to be opened, if necessary, and restrained if a di- arrhœa be urgent. The patient can neither bear evacuations nor tonics. A middle course is to be pursued, gently restoring and nourishing. Here, I would remark, that I have never ob- served any essential benefit, from any vegeta- ble astringent, nor from allum, gumkino, nor from (21) from marine acid. I would also inform my readers that I made trial of Dr. SIMS' medi- cine, recommended by Dr. BULFINCH, which is the vitriolic acid diluted with water, and think it the best astringent in use. The few cases which happened after I received his publication,do not allow me to recommend from much experience, but have no doubt of its efficacy in this and other inflammations of the throat. After I was acquainted with the medicine, I employed it with success; it is astringent, stimulant, and antiphlogistic; the last property perhaps is only local, and the effect of the astringent. The Dr. prepares in the following form: take oil of vitriol from one to two hundred drops, pro re nata, spirit of lavender eight drops, simple water eight ounces, united to- gether in a phial, which he directs to be given, a tea spoonful or more, every three hours, and used as a gargle till the fifth or sixth day. The Dr. cautions against using it too freely, left a stricture be induced on the lungs. The same (22) same caution is necessary in giving bark, while the arid skin and inflammation con- tinue. This he depended on for cure ex- cept necessary laxatives to regulate the bow- els. The indications in an obstinate spasm at the accession, are to increase action and mo- bility. The method, which has afforded the most certain relief is either partial or general fomentations; that which is the most conven- ient, is soaking cloths or flannel blankets in hot water, salt and water, or vinegar and spirit; and which must be applied over the whole surface, and often repeated, till action and reaction are increased. Internal stimu- lants and antispasmodics must be vigorously employed—as volatiles, musk, ether, cam- phire, infusions of saffron and snakeroot, &c. which may be given warm and often repeated. This course if taken early, before the respira- tion becomes difficult and laborious, has of- ten restored reason, and recalled to action the vital principle, which had been almost sus- pended (23) pended. As soon as the determination to the superficies is restored, the fever assumes its usual type. A large blister to the back part of the head is very beneficial, if applied at an early peri- od. Emetics are hurtful, not being sufficient to overcome the spasm; the nervous influence and mobility of the system being greatly de- ereased. Cathartics increase the symptoms, Bleeding, performed on a young man, by a physician greatly embarrassed with the situa- tion of his patient, gave no relief; he died in thirty six hours. Friction with moist hot cloths has been found very salutary. I would here beg leave to introduce an idea, whether some preparation of tobacco might not be useful in this stage and form of the disease, as well as in other spasmodic com- plaints. A respectable physician from Can- ada* informed me he had used an extract of tobacco * Dr. RAYMOND. (24) tobacco for the cure of colic, which had not failed in one instance in thirty years practice, if exhibited early in the complaint. The fol- lowing recipe is his form of preparing it. Take tobacco, senna, and anise seed, of each two ounces, boil them in water to the consist- ence of molasses, add cathartic species, suffi- cient to bring it to consistence for pills; as scammony, coloquintida, aloes, and rheubarb, equal parts. Two pills of common size were generally sufficient to case the pain, and operate as a gentle and safe purge, in an hour, or at least in the usual period. It cer- tainly has singular effects on the system; it discovers sedative effects without affecting the sensorium, or destroying the peristallic motion of the intestines. Dr. MAY, also, in an in- augural dissertation, has demonstrated from experience its antispasmodic power, in teta- mus, when opium failed. Patients in this form and state of disease, are so delirious and com- atose, I have never ventured to give opium; but on the Brunonian plan it certainly would be proper. Tobacco, having the antispas- modic (25) modic power, without the sedative, has the preference in many cases, and I have no doubt of its being useful in febrile spasm. Indications and Method in imperfect Crisis. WHEN the crisis is postponed, to the end of the 7th day, and no relaxation is obtained, with little discharge from the glands, skin dry, mouth aphtheous, any prognostic must be hazardous. A remission, however, takes place about the sixth day: but if no sweat appear, nor other marks of solution, we may prepare for difficulty. If low delirium, stu- por and mental derangements, come on, we may suspect an absorption of acrimonious fluid has determined to the brain; and in every instance I have seen it has been fatal, whether to the brain, intestines or pleura. In one case only, where the crisis was put off till the tenth, no local inflammation followed. C From (26) From the seventh to the tenth I gave ton- ic and stimulant medicines, as bark and snake- root, sirup, balsam, and spirit of lavender, spirit and water more freely; than before; sus- pecting that debility was the cause of the fe- ver's being protracted. On the evening of the 10th, applied two large blisters in addition to others, and gave an emetic; a general sweat and usual signs of crisis were obtained. A tumefaction, in the cellular substance, appear- ed in about a week, which I apprehended was the effect of the tonics; but it might be from absorption. I gave an emetic arid cathartic, and an infusion of tincture of snakeroot, Guaiacum, saffron, and Peruvian bark; which obviated the atony and swelling in a week or thereabouts. One determination from imperfect crisis remains to be mentioned, which is to the pa- rotid glands. These cases before the period of recession, appear under the slightest form of the disease; every symptom favorable, and the patient unwilling to be confined. An enlargement (27) enlargement of the glands, obscure heat, ul- cerous throat, gums, lips and tongue; pulse quick, countenance pale, general state enfee- bled. These cases are commonly attended with worms. The indications are many; as, emetics, cathartics, blisters, sudorifics, friction, and tonics after the heat has subsi- ded. The heat continues a sort night or more, and the debility for a long time. The real and essential indication is to invigorate the system; but I have not found it possi- ble, while the febrile and foul habit contin- ued. All cases of this description terminated favorably at last. Indications in a Secondary Fever. ANY exposure to cold air, damp rooms, &c. exposes the patient, to an inflammatory fever. The (28) The course to be pursued is antiphlogistic, as, bleeding, puking, purging, blistering, &c. which may be employed, according to the age and particular state of the patient. A crisis is generally obtained ahout the fifth day. Observations on the Dys- entery. SINCE the commencement of the year, the following disorders have been epidemical in this place, viz, the chicken pox, the hoop- ing cough, the scarlatina anginosa, and the dysentery. The latter of these began in au- gust, after four weeks of very hot, and dry weather. The cause of this fever is a precipitation of the fixed air, from an excess of phlogiston in the surrounding atmosphere.* The heat being * The exhalations from dried brooks, &c. being water decompounded, and arising from putrifying animals and (29) being particularly exerted on the intestines, produces an increased exhalation, and dis- charge, and an immediate tendency to mortifi- cation, especially in young children.† The symptoms at the accession are, head- ache, vomiting, thirst, alternations of heat and cold: these are followed with severe gripings and dysenteric discharges. In the economy of animal life there is a constant tendency to pu- trefaction, which is increased with the heat and moisture of the atmosphere. The prin- ciple of vitality which put the machinery in motion, and has influence in continuing life, in every inspiration, becomes, when increased to excess, the principle of dissolution. Every fever vegetables, are very noxious and produce the worst kind of dysentery. † The abdominal viscera and muscles corrupt the soonest of all parts of the body after death, and the quick putrefac- tion here may reasonably be ascribed to the putrid steams of the fœces. (HUNTER.) C2 (30) fever is attended with danger, and those in particular, in which the heated perspiratory fluid is locally seated on a vital part. Those which arise from atmospherical heat and con- tagious exhalations, discover a rapid tendency to putrescency. The cure of dysentery, being a local in- flammation, and arising from heated and con- tagious air, must always be doubtful and un- certain. The indications are to take off the spasm on the surface, and moderate the heat, irrita- tion, and stricture on the intestines. For tak- ing off the febrile stricture, electricity has been recommended and employed with suc- cess; but as this cannot be always conveni- ent, the surface may be relaxed, and the oscil- latory motion of the nerves on the skin in- creased by friction and warm bathing, daily repeated, till the stricture on the surface and spasms of the bowels, give way. At (31) At the accession, gentle emetics are much to be depended on, both in respect to the stomach and the febrile state. Laxative purges,* demulcents, and aces- cents are to be employed till the inflamma- tory symptoms subside. As a laxative, a so- lution of Glauber's salts, and tartar emetic may be useful; or when that cannot be re- tained on the stomach, an infusion of rheu- barb, English saffron, and gum Arabic; or sal rupellensis, being more agreeable, to some, and * I am informed by a practitioner in Pennsylvania, that the may-apple is a very valuable cathartic in dysentery and colic. It is a plant about two feet high, grows spontaneously in the woods in Pennsylvania, New York, on Mohawk river, and upper Canada. The leaves resemble those of coltsfoot, or wild grapes the apple is of the size and color of a lemon, of an odorous smell and not unpleasant taste; the root con- tains a large quantity of mucilage, and when boiled to an extract, becomes a gentle, but certain purgative, operating without giving pain or irritation. This plant I take to be the same that Dr. MORSE calls mallow-indian physic, (Spirœa trifoliata) page 172, edition of 1793. I hope to cultivate the plant in my garden the ensuing summer. (32) and equally useful; with the addition of cas- tor oil to either of the foregoing forms, it necessary. As a laxative, on those days the purging medicine is not employed, either ipecacuanha, waxed glass of antimony, or to- bacco, may be given in small doses and at proper intervals; the latter is very useful eith- er in powder, or extract. As an antiseptic; an infusion of columba or golden thread root;* the latter, I think, is to be preferred. To finish the course for the day, a dose of the- baic tincture may be given at bed time, if the spasms, tenesmus and discharges are severe; which is to be preceeded by warm bathing and the application of a dry warm flannel to the bowels and stomach. The most use- ful demulcents, are gum Arabic, isinglass, and sweet elm bark;† the latter of these, being put into cold water, becomes an exceeding agree- able demulcent, and gentle laxative. Allow- ing, in every stage all kinds of vegetables, and ripe fruits, which contain subacid or sac- charine * Nigella. † Ulmus Americanus. (33) charine qualities, as apples, pairs, mush and water melons, &c. and even onions and cab- bage, have been found safe and salutary. All cool and acescent drinks, as imperial, whey, buttermilk, cold water, apple water, barley water, brandy and water, &c. &c. The diet, chocolate, coffee, tea, milk, rice, &c. I have always observed children at the breast, bear the disease better than those who are weaned, which induced me to direct milk; and as ma- ny cannot bear it in its original state, cream, water and loaf sugar boiled, make a useful substitute. In the second period of disease, after the inflammatory and putrescent symptoms are obviated, astringents, tonics, demulcents, and animal food are to be employed; and through every stage I have experienced great benefit from exercise in the open air every fair day; and for children, gestation on a horse or in a carriage, if it can be supported, is very salu- tary. I have seen children recovered, by ex- ercise in the last stages of weakness; even af- ter (34) ter aphthae* and other marks of putrescency had appeared. Ventiducts may be kept open, into the apartment of the sick during the night and day; frequently washing the sick with cold vinegar or spirit and water. As a preventive to this distressing disease, I know of no one thing which would be so useful as cold bathing. Many children fall victims to the heat of summer, who might be saved by cool purges and bathing, especially those lately weaned, who are very liable to the complaint. And it is to be regretted there are so few baths in this country, convenient for adults—especially in seaport and other large towns, where the quantity of air is greatly diminished. Should health and plea- sure appear object sufficient to arrest public or private attention, it is hoped houses will be erected both elegant and useful; and for- eigners * Dr. SIMMS' medicine is a useful garganism,a nd an- tiseptic in this stage of the disorder. (35) eigners no longer complain of our inattention to an excercise so agreeable and healthful. A Review of Practice. THE pathology I have given of the Scar- latina Anginosa may appear to some very in- accurate; but not more so than the disease it- self. It appeared in various characters; but I have attempted carefully to mark its varie- ties, and various tendencies—and as it discov- ered an inflammatory irritation, but in diffe- rent degrees, I have partly adopted the anti- phlogistic course. As the complaint was sta- tionary thro the summer, and operated mostly in autumn and winter; I have found the bark and other tonics increase the heat and canker in the throat, and general stricture and dry- ness on the surface. What has been the type of the fever in the adjacent towns I have not been informed, only from common report. To prevent a violent effusion on the tonsils and contiguous parts by astringents, and ob- D tain (36) tain a crisis as early as possible, have appeared the chief indications. In 1786, the Dysentery followed the Scarlatina Anginosa, as an epi- demic, and many perished. The disease in many cases was not under the control of med- icine. In the present year it has appeared in the general character, and in a mild form, proving fatal but in few instances. The gen- eral method, as has been suggested, has been the most successful in its preceeding and pres- ent appearance. An Apology. THE acknowledged sentiment that the medical art has been improved by practical observations of physicians; and a compliance with the request of the Massachusetts Medical Society to practitioners in general, to make ob- servations on epidemics in particular, will, I hope, be an apology for the foregoing obser- vations. (37) Medical Sketches, &c. Heat the Principle of An- imation, &c. THAT principle which chymists and philosophers have demonstrated to exist in all bodies, is, doubtless, the only vivifying principle in the universe. This fluid has re- ceived various names according as it was com- bined with other elements, as electricity com- bined and existing in air, phlogiston, or in- flammable matter in oil and other inflamma- ble (38) ble bodies, fire, heat, &c. as an element or principle of matter.* We perceive this principle to act nearly alike on animal and vegetable bodies. It re- animates infects and other animal bodies, when life has been suspended through the in- fluence of cold, and vegetation lives again on the return of heat. Vegetation cannot exist without the influence of the other known elements of matter, as earth, air, and water. In the animal economy without this all vivi- fying and supporting fluid, and a constant supply of food, containing a portion of these, he fails, sickens and dies. By the union of these the air becomes the principle of vitali- ty, or the breath of life. Salubrious or fixed air, we may suppose, is a compound, acting on our bodies by cer- tain * Chymists have demonstrated this principle of phlogiston to be a component part of all bodies, and only a secondary principle, and to distinguish it from pure, unmixed fire, call it fire fixed or compounded with other elements. (39) tain laws we do not comprehend; and is con- stantly received into the lungs and instanta- neously decompounded, and those parts nec- essary for life are absorbed, and the remain- der exhaled as useless and even deleterious.* The universal, or vitriolic acid, which philosophers have demonstrated to exist in the air, which is a saline or earthy substance, heat and water, are components of this animating fluid. Its mode of supporting life we do not understand. We * It has been found by Dr. HALE, that a person in health destroys two gallons of air in two minutes and an half; so as to render it unfit for respiration. (HALE'S Statical Essays.) Dr. Percival has discovered that air which animals have breathed is in all respects the same with air in which animals have putrefied. The original quantity is diminish- ed in both cases, which is owing to the precipitation of the fixed air it contained. D2 (40) We may suppose a certain proportion of each necessary to compose this fluid. And also this principle has influence in continuing the power of cohesion in animated bodies. The cause of putrefaction is an excess of heat, for bodies in a putrefactive fermentation have an increased action, heat and agitation, which decompounds the different elements and par- ticles which compose the body. The principle of phlogiston also exists in the various kinds of sustenance, in a fixed state, as in wine, oil, spices, and animal food, and in different degrees, as is evident from the strength obtained from animal, and the debility, from vegetable food. This compound is not only the vital prin- ciple of life, it is also the nervous energy, the cause of all sensation and muscular motion.* “ Human * Wine, spirits and opium, contain a large share of this inflammable principle and increase the mobility of the ner- vous power to a certain point, beyond that, confusion of idea; carried farther, a disarrangement and disorganzation if the brain. (41) “Human life,” says a late writer,* “is an aggregate of at least three ingredients, per- ception, intelligence, and vegetation; and since man is declared to be a compound, the natural presumption is, that the life of this compound being is itself a compound. The mechanism of life, which is vegetative, is wholly of the body, and consists of a syme- try and sympathy of parts and a correspon- dence of motions, conducive by mechanical laws to the conservation of the whole.” The influence of air entering the pulmonary ves- sels, is mechanical, and when it is called the vital principle, refers to the mechanism of life, in that part which belongs to the body only. How far the vegetative life is influenced by heat and cold, I may now consider, as this only comes under the notice of the physician and physiologist. Philosophers assure us that whatever are the properties of heat, those of cold are direct- ly * Bishop HORSLEY; before the Humane Society, 1789. (42) ly opposite. Heat slows incessantly from the sun and is essentially fluid, and the principle of fluidity in other bodies. Cold is a priva- tion of heat, its qualities being different; while this condenses, that dilates. These two op- posite qualities seem to produce analogous effects when carried to a certain point; for cold condenses till after congelation, then like heat it expands the frozen substance. Physiologists have assigned various opera- tions or effects from the influence of cold— and when applied in certain states of the body becomes an astringent to the surface, contracts the exhaling vessels and retains the heat which ought to be carried off by perspiration. Various degrees have various operations ac- cording to former habits and particular states of the body at the time it is applied, &c. The influence of heat is also various, op- erating according to its duration, intensity, and alternation with cold and moisture. Its excess like cold becomes an astringent; con- tracts (43) tracts the surface and retains the perspiratory fluid. It has been proved that a hot room gives a cold, sooner than one of lower tem- perature; a cold being only the retention or accumulation of heat in the system.* It has been observed that heat is the prin- cipal mover in the mechanism of life, the principle of vegetative and animal motion— but it is at the same time acknowledged that an excess deranges and mechanically destroys the organization of the system.‡ The heat of the body may be increased to a certain degree without a fever's being present; but if carried beyond the point of evaporation, a febrile stricture takes place. In the * Dr. ALEXANDER has proved that a person may be too hot to sweat, and that there is a sweating point, and in any degree above or below, it cannot be obtained, till the heat is lowered by cold, or increased by heat. ‡ Animals, even those the most tenacious of life, and whose existence is found to depend the least on air, sooner expire in air made foul, than in vacuo. (LIND on fever.) (44) the vegetable economy, heat stops perspira- tion, equally as frost or cold.* Heat appli- ed to the body in any considerable degree, produces a febrile spasm, and a dangerous fever ensues; heat being received into the lungs and determined to the skin, inflames and irritates the nerves on the surface, and a stric- ture is induced. A modern pathologist,† supposes the proximate cause of fever is spasm, and the re- mote causes are sedative or debilitating pow- ers, &c. which acting on the primary organ, the brain, produce a dimimished energy; which has iufluence on the heart and arteries, by weakening their force and action. This and the vis medicatrix naturæ; § produce spasm and fever. The hypothesis is not easy to be com- prehended. * Plants sooner suffer and droop beneath the influence of noxious air, than in the want of this vivifying fluid. (LIND on fever.) † Dr. CULLEN. § It is hard to comprehend this power in the system, un- less it be reaction. (45) prehended. It is hard to conceive how mo- tion and vigor can be increased, when their cause is diminished; or how a diminished in- fluence can produce an increased action. The Doctor supposes the spasm &c. indirectly stimulate the heart and arteries, and thereby restore energy to the brain, which has influ- ence in obviating the atony and spasm on the surface. The influence of the nerves in the brain is continued by the constant supply of blood, of agreeable motion and temperature, and the blood flows consonantly to the energy the heart and the arteries receive from the nerves. Experience informs us that in almost every instance of debility, when the action of the heart is weak, the reaction is likewise; the resistence being in proportion to the dis- tending force. In cases of debility an equal balance is observed between the action and reaction, and an equal distribution of blood to the exterior vessels. Every paroxysm of fever increases debility in the various func- tions, (46) tions, and at the crisis the weakness is greater than at any preceeding period in disease. On the whole the effect cannot cease while the cause remains; neither can the same power produce vigor and weakness. An Hypothesis. MAY not febrile spasm arise from phlo- gistic heat? an excess being accumulated in the system, may it not inflame and excite the origin of the nerves in the brain, and be im- mediately communicated to those on the sur- face? Heat, cold, and moisture, equally con- tract the diameters of the exhaling vessels, and imprison the perspiratory fluid, which being phlogisticated air,* and highly stimulant, in- duces a febrile stricture. This * Heat, moisture, and stagnated air, and human efflu- via, such as sweat and perspiratory matter front the skin and lungs, are the grand promoters of putrefaction, (WHITE on puerpural fevers.) (47) This stimulant fluid inflames and con- tracts the solids, and rarefies the fluids, stim- ulates the heart and arteries, which increases the heat and stricture on the surface, and the febrile motions commence. Dr. RUSH * writes, that in the late fever at Philadelphia, the pulse was increased nearly twenty strokes in a minute, in those who had not a fever. A presumption, that the cause was a phlogistic atmosphere or an excess of stimuli, which corresponding with a particu- lar state of body, produced a febrile stricture. Another fact, favoring the supposition, is, that neither women, nor children, were so liable to the disease as men. The lax fibre of the former, not being so easily constricted as the latter, by the heated atmosphere. And I may remark further, that if real weakness, or diminished force, strength, or tone of the nerves, was the cause, why * See his letter to Dr. ROGERS. E was (48) was the debilitating course, such as large and repeated bleedings and other evacuations, so necessary and salutary? As he informs us he carried it to great excess before the corded pulse and other inflammatory symptoms could be obviated; and at the same time omitted all kinds of tonic or stimulant medicines. Febrile Symptoms. THE first febrile influence, it has been supposed, is on the brain; but from sympa- thy and a peculiar sensibility of the stomach, a perception, very unpleasant and disagreea- ble, is first noticed in that organ; it arises from excess of stimuli in the system, and be- gins to operate while the spasm is forming. The succeeding symptom is debility, which is a false perception; the whole vascu- lar system being in a state of febrile tension and spasm; which state produces a sensation of (49) of cold, which is not real, but apparent on- ly; for the sufferer is under more than usual heat except at the extremities.* The symp- tom following is increased heat; and the pa- roxysm which ensues, is a mechanical effort of the heart and arteries, and the expansive force of the rarefied air and fluids; and the febrile resistance on the surface; which effort is continued till a distribution is made to the surface, and a partial relaxation is obtained, and a portion of heat carried off by exhala- tion. Contagion is phlogistic air, arising from human or other putrifying bodies, being great- ly concentrated, and joined with acrimonious salts * By several experiments made by Dr. HOME, in the cold and even shivering fit of an intermittent, it appeared that the heat of the patient, by FARENHEITS' thermometer, was 104 degrees, whereas that of a person in health seldom exceeds 98. During the cold fit of an ague, the heat is considerably increased. (LIND'S Appendix.) (50) salts and oil of the putrifying substance; which violently stimulate the nervous system, and if received into the system, produce feb- rile spasm. It may be supposed that air de- compounded, or that has passed the lungs and bodies of animals, as that in jails, hospitals, &c. is not materially different from that ari- sing from dried brooks and stagnant water; the water, air, and acid, being seperated, its salubrity and vivifying power is destroyed. The excitement, which this imprisoned and contagious fluid gives to the system, is very great—as anxiety, nausea, horror, cold, shiv- ering, thirst, headache, delirium, and other preternatural irritations. Its activity with certain states of heat, has, likewise, immediate morbid effects on the flu- ids, by decompounding and destroying the globular system of the blood. Its stimulant qualities destroy the affinity of the various el- ements in compound, and break the union or relation each bore to the other. The putre- factive state commences, and the elements assume their original state. The (51) The intermitting fever is different from all others, and may be considered as an apti- tude or tendency to a febrile state. This fe- ver, only, is under the control of medicine, and if neglected, discovers a tendency to a remitting or continued fever. An apparent crisis suceeeds the paroxysm, as appears by the general relaxation and natural excretions from the surface. After a certain period or intermission of certain duration, according to the original type and tendency, the same phe- nomena are renewed. In the foregoing sketches it is supposed, that animal life has, in some respects, an analogy with vegetative, and that the influ- ence of heat and cold is analagous, that heat or phlogiston is the cause of spasm, when an excels is accumulated, and that this active principle decompounds the air, and other flu- ids. The hypothesis being admitted, still no new indications can be suggested, unless it should be, an admission of cold air and drink. These, it is acknowledged, are allowed by ev- E2 ery (52) ery practitioner of eminence; but I would ask with deference to those of more experi- ence and information, whether cold bathing and air, &c. might not be as safe and useful, in some fevers of this climate, as in those of Jamaica? Which practice Dr. JACKSON strongly recommends, from much experience, both in the West-Indies and England. No- sologists have multiplied the names of fevers, designating according to the local determina- tion, or prevailing symptom, as putred, yel- low, nervous, &c. &c. yet we have reason to suppose the cause is essentially the same, but the tendency different. I conclude by introducing an instance of the effect of cold in an inflammatory fever.— A person now living in this place was violent- ly attacked with a pleurisy, and almost from I the commencement became delirious; on the seventh day of disease, the watcher falling to sleep, the patient rose from bed and travelled into the garden adjoining the house; and be- ing entangled with potatoe vines, fell down and (53) lay some time, at least, till he became very cold; the watcher finding his patient gone; after considerable search with a light discov- ered him as related, perfectly restored to reason—was assisted back to bed—soon became warm and slept easily. His fever and adventure terminated together. A SUMMARY OF THE FOREGOING INDUCTIONS—WITH REMARKS. THE vegetative life of man requires a con- stant supply of air of certain temperature, and which supports life by respiration and evapor- ation from the surface; and that the cause of fever is an excess of this animating principle; and febrile spasm is an effect of its exciting power; and that this power or principle may be accumulated in the body from external cold, heat, or moisture, or be imbibed from contagious exhalations, arising from putrefy- ing animals or vegetables; which state never commences till the air is decompounded, and its (54) its salubrity destroyed, and that this heated fluid may be unequally distributed and deter- mined, and produce all the various phenomena in fevers; if to the brain and nervous system, a nervous—to the intestines, putrid and dysenter- ic—to the biliary system and liver, bilious and yellow fever, &c. &c. This electric principle may be locally exerted on a particular part, and produce great pain and irritation as soon as the spasm is formed, and evaporation ceas- es—as in rheumatism, felons, &c. The hy- pothesis is farther supported by the use of me- tallic points, lately introduced by Dr. PER- KINS, in curing local inflammations, &c. By these mineral conductors, the inflammable principle is attracted and carried off. Respect- able characters have given testimony of their utility.—However, we may suppose the heat cannot be conducted out of the body in any considerable degree, without some evacuation of the fluids; as by perspiration, bleeding, purging, &c. but we have unequivocal proof that the application of cold destroys and over- comes its stimulant power, as in burns, &c. also (55) also in fever's being relieved without any vi- sible evacuation—one instance in the memoirs of Baron TRENK, by drinking cold water. I have only to remark, that I have lately cured fevers, by warm bathing and cold drink, when the most celebrated febrifuges had failed. P. S. As a farther illustration that feb- rile stricture is the effect of heated air accu- mulated in the system from accidental causes; I here subjoin a few cases from Dr. JACKSON'S notes, on the use and safety of cold bathing. “As the cold bathing, which I have so strongly recommended in the cure of fevers, has an exterior appearance of being a rash and hazardous remedy, I shall relate some ca- ses which may enable the reader to judge more precisely of its real effects. “The first hints I had of this practice were accidental, and arose from a conversation I had with the master of a vessel, in which I went passenger. As he was talking one day of the state of the fleet, he mentioned acci- dentally, (56) dentally, that some men were sent aboard his ship ill of fevers; several of whom, jumped into the sea during the delirium which attend- ed the paroxsyms of disease. Some of them were drowned—but those who recovered from the waves, appeared to be greatly benefited by the ducking. I was resolved to bring it to the test of experiment, as soon as oppor- tunity should offer. A poor sailor was the first whose situation seemed to justify such a trial. He had been ill two days; the deliri- um ran high; his eyes were red and inflamed; his respiration was hurried; he was anxious and restless in a high degree, whilst together with those marks of excitement, he was occa- sionally languid and disposed to faint. His skin being dirty furnished an ostensible excuse for trying this remedy. But it was previously thought proper to draw some blood from the arm; which being done, some buckets of salt water were dashed on the shoulders. He was now laid in bed; a copious sweat ensued; suc- ceeded by a distinct remission, and a total change in the nature of the symptoms. The (57) The success I met with in this instance was more than I had expected; I was there- fore encouraged to try the same mode of bath- ing in a person who came under my care some weeks after, and who had been ill of a fever six or seven days. This patient had been bled and blistered;—emetics and cathartics had been likewise employed, and bark had been- given in the usual manner, for the three last days. The fever however, had now in a great manner lost its type. The man was low and languid; his eyes were dim; his vision indis- tinct; his pulse small and frequent, and, when the head was raised from the pillow, not to be felt. Though it did not appear that he could reasonably be expected to live long, I still wished to get him conveyed to the deck, that a trial might be made of the effect of cold bathing; but the situation was so tick- lish, that I felt some uneasiness in getting about it. At last he was lifted through the hatch way in a blanket, though I must confess that I was not without apprehensions that he might die under my hands. Some wine was then (58) then poured down his throat; and he was sprinkled with cold salt water as he lay upon the deck. Appearing to be somewhat invigorated by this process, he was raised up very gently, and several buckets of the sea water were dashed about his head and shoulders. He was then laid in bed; the pulse soon became large and full. I left him in a copious sweat and was agreeably surprised next day to find him fitting on the deck, to which he had walked on his own feet. Another instance, in which the effects of cold bathing were more decisive than in the former. A boy, aged fourteen, had been ill of a sever seven or eight days. Nothing had been omitted in point of treatment, which is usual to be done in similar cases. Bark and wine had been carried as far as could be ser- vicable, or even safe; yet death seemed to be approaching fast. The success of cold bath- ing, in some instances similar to the present, so far exceeded my expectation, that I was induced (59) induced to make trial of it, in the case before me, tho I was not without apprehensions that death might be the consequence of the attempt. The business, however was accom- plished without accident; and next day the boy was able, not only to fit up in bed, but even to walk over the floor. “After instances so unequivocal as the above, it would be superfluous to mention any others. I shall only add, that I, have tried the remedy in various situations, always with safety, generally with astonishing suc- cess; so that I cannot forbear recommend- ing it even at an early period, in fevers. It communicates tone and vigor to the powers of life, and diminishes irritability in a degree far superior to all other cordials or sedatives. “The bathing was managed in the fol- lowing manner: the water which was re- quired to be of a refreshing degree of cool- ness, was dashed by means of a bucket on F the (50) the head and shoulders. It was found, like- wise that its good effects were heightened, in some cases, by previous bleeding, and by the previous use of warm bathing.” ERRATA. Page. Line. 11 13 For cast, read coat. 12 11 For convalesence, read convalescence. 12 17 For preceed, read precede. 13 18 For effloresence, read efflorescence. 16 3 For dyspnoca, read dyspnœa. 19 2 After alternated, add with. 21 17 For eight, read eighty. 26 3 After sirup, add off. 26 14 For of tincture, read or tincture. 32 9 For columba, read columbo. 33 1 For mush, read musk.