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          No. /f ^ /      ;
fgQxjOX ceo ?o ja x'.aGC|:i.':^ciagol(?r!^ 
 
 
      A DISSERTATION
                ON THE
        MUTUAL  INFLUENCE
                  OF

HABITS  AND   DISEASE.
             SUBMITTED AS AN

        INAUGURAL  THESIS,
           TO THE EXAMINATION OF THE

    REVEREND JOHN ANDREWS, D. D. PROVOST,
               (pro tempore),

                   THE
TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY
             OF PENNSYLVANIA,

        ON THE FIFTH DAY OF JUNE, 1804.

                   FOR
               THE DEGREE
                    OF
         DOCTOR OF MEDICINE.
    BY WILLIAM DARLINGTON, OF PENNSYLVANIA.
MEMBER OF THE AMERICAN LINNEAN AND PHILADELPHIA MEDICAL
                 SOCIETIES.                ''•.-«
Custom moulds        . ^»
To every clime the soft promethean clay.
                   ARMSTRONG.
          PHILADELPHIA:

PRINTED FOR THE AUTHOR, BY JOSEPH RAKESTRAW,
      NO. 95, NORTH THIRD STREET.

              "l804.' 
 
TO
DOCTOR JOHN VAUGHAN,
•s

 ^   •   WILMINGTON, DELAWARE,  ..
          *   V
THIS DISSERTATION IS INSCRIBED
      SMALL BUT GENUINE TRIBUTE OF RESPECT


FOR HIS TALENTS AS A MEDICAL PHILOSOPHER,


        ESTEEM FOR HIS WORTH AS A MAN,
GRATITUDE FOR THE KIND ATTENTION, AND VALUABLE

                   COUNSEL,
AS  PRECEPTOR,
SO OFTEN AND SO OBLIGINGLY CONFERRED UPON HIS SINCERE

         FRIEND AND AFFECTIONATE PUPIL,
THE AUTHOR. 
✓V

 
      DISSERTATION

               ON THE

    MUTUAL INFLUENCE
                OF

HABITS  AND  DISEASE.
" Man is a bundle of Habits."
  THE great and universal influence of custom,
or repetition of action, upon the operations of the
living body, has long been known and acknowledged
by the observant part of mankind ;  but the applica-
tion of this important principle to the prevention and
cure of diseases has been  too much neglected by
physicians.  The j ustly celebrated Doctor Darwin
has,  indeed, thrown great  light on the  subject of
associate motions,  and the diseases  of association;
but much remains  yet to be known respecting the
power of  disease in destroying  the habits of the
system, and also of the influence which the intro-
duction of new habits, or a recurrence to old ones,
where they have been violated, may have in removing
diseases.
  It is with a view  of turning the attention of
the accurate  observers in  medicine to  this inter-
esting subject,  that I  have  selected it as the object
of my inquiries in this inaugural Essay.  I am fully
sensible of the difficulties attending  a  thorough in-
vestigation of it, and  the necessity"of much more
experience than it was possible for me to possess,
to do  justice  to it:—But a desire of  seeing the
subject prosecuted by extensive and ingenious prac- 
6
titioners,  and of having the degree of its influence
ascertained, induced me to adopt it.
   The nature of the living body is such, that it can
accommodate  itself to a great variety of impressions
which were at first disagreeable, and even prejudicial
to it: A repetition of them, agreeably to one of the
laws of sensation, renders them less and less detri-
mental,  until they finally not only cease to be  dis-
agreeable, but become necessary  to the support of
health and life.;—When any habit has become thus
established,  the continuance of it may  be consider-
ed as a proof of health, and a violation as one of the
premonitory signs of disease.  Many peculiarities,
and unnatural operations often become habitual by
subjecting ourselves to the influence of custom, or
repetition of impression  and action,—as  is  finely
illustrated by the ingenious author of Zoonomia.
  Doctor Cull en  in his  Lectures on the Materia
Medica observes, that " both temperament  and
idiosyncrasy may be  variously affected by custom',
insomuch that by this any temperament may be cor-
rected, confirmed, obliterated, or even a new  one
induced."—Custom, he defines to be " the frequent
repetition of impressions on  the system.   Custom
is often confounded with habit.  Habit is only the
effect of custom,  as when frequent repetition of im-
pressions has given laws to the system."
  By this distinction  we may understand why, in
many instances,  customs  appear to be easily pre-
vented from taking effect,—-and also why many at-
tempts to introduce new habits, fail. The repetition
of impression is not continued long enough to give laws
to the system:—Hence we may perceive the propriety
and necessity  of long perseverance in difficult cases,
where we wish to induce a new action  that shall be
permanent.
   The explanation of the phenomena of habits is
founded principally upon the theory of the celebrated 
7
John  Hunter:  viz.—That  two  different  actions
cannot exist at the same  time  in the same part,  or
system  of the body;—and that  the  most powerful
exciting cause will always produce an action of its
own kind, to the extinction,  or removal of the one
previously existing.   The correctness of this theory
is so evident that it is  now generally admitted, and
taught in  the schools of medicine.
   The living body is endowed with a  certain  sus-
ceptibility,  or aptitude for action, upon the appli-
cation of stimuli, which is denominated excitability.
This excitability may be defined a  condition of the
system  which owes  its  existence   to  a particular
organization  of  matter.  With  this organization it
is capable of being excited into action when stimuli
are  applied ;  but it is entirely passive as  it respects
the  kind  of action into  which it may be  excited.
Every different stimulus  has the power of producing
an excitement peculiar to itself.*  The ever-varying
state of the system is owing to  the  great variety in
kind and force,  of the  exciting powers  applied.—
However, when  any particular  impression  is  con-
tinued for a considerable length of time, or repeat-
ed to a certain degree,  and is  of sufficient force to
produce its specific excitement, the previously exist-
ing  action  is destroyed,  and a new  one takes place
which will often become permanent, even if the cause
should  be  removed.

  * To avoid circumlocution I shall employ the word excitability as expres-
sive of the system in a certain condition.  When I say a stimulus acts upon
the excitability and converts it into an excitement, I mean, that organized
matter, possessed of this property, is thrown into action When an impression
is made.  This condition of matter is common to all  bodies duly organized,
end the various phenomena of life are owing to the variety in organization,
and of stimulus applied.  Hence I infer that in the same system,  the variety
of excitement is owing to the various nature of the exciting powers.
  Although the system be passive  in  the abovementioned relation, yet 'it
cannot remain dormant, or inert.  If the more powerful of the usual stimuli
be abstracted, the aptitude increases so as to be acted upon by the weaker;
which cannot be all abstracted.  This being the case, it behoves all who
prize a healthy excitement to apply  such powers, and such only (as far as.
practicable) as are calculated to produce this, effect. 
8
   Some curious facts are related of the influence of
custom in giving laws to the operations of the sys-
tem,—as  of the Idiot of Stafford,  England, who,
being  accustomed to tell the hours of the  church
clock,  as it struck,  told them as exactly when it did
not strike, by its being out  of order.   There is also
a  story told by Montaigne,  of some  oxen that
were employed in  a machine for drawing  water,
who, after making three hundred turns, which was
the usual  number,  could not be stimulated  by any
whip nor goad  to proceed farther.
   By the light of this principle, I apprehend,  are the
habitual operations  of the body to be traced to their
source. By it we may learn  how the frequent and
regular application of the durable stimulus of aliment
is  capable of preserving the habit of healthy  excite-
ment,  in opposition to  those causes which  have  a
contrary tendency;  and to  which we are unavoid-
ably more or less exposed. The stimulus of aliment,
however, like many others,  is of such a nature that
it  cannot establish a habit which will continue after
the removal of the cause :—A constant and regular
application is necessary to the permanence  of the
effect:  hence any considerable  interruption  of the
process leaves  the excitability unemployed,—other
less favorable agents take effect, and  convert it into
an excitement of injurious tendency.
   The  influence of any habit with respect  to diet
on the  system is  very great, and  should never be
overlooked in the treatment of diseases ;  more espe-
cially in those of long standing, or of weak morbid
action,  such  as chronic dyspepsia.   L.  Cornaro,
who dieted himself very strictly, was possessed of
good health whilst he observed his regulations,  but
when he deviated  from his rules he found his health
and temper much affected :—Many other facts evince
a  similar  effect of  custom  in this respect;  where-
fore Professor  Rush,  among the prophylactics  of 
9
apoplexy, and some other forms of disease,  recom-
mends to avoid becoming habituated to any one kind
of diet,—for a change  would then  be dangerous;
and few people can avoid changing it in the course
of a life-time.
  This theory is equally applicable to the operations
of the mind,—or more properly speaking, of the
brain; for the mind is as  much an effect of the
operation of external  agents upon the brain,  as
vision is of the impression of the rays of light  upon
the retina.  The  knowledge of this unfolds to  us
the immense importance of my subject in relation
to morals;  and points out the necessity of an edu-
cation that will give permanence to  such habits of
thought (and consequently of action) as  are calcu-
lated to  promote  the happiness  of  man,  and the
welfare of society.
   The susceptibility of acquiring habits of thought
and action is  much greater in youth than  in  adult
age;  because the excitability at that period of life
has  not  been  acted upon  by  any  stimulus long
enough to establish its particular excitement,  or to
give a lasting  and definite  mode of action to the
system;  and therefore, the new impression has no
old established habit to overcome.   It is similar to
the taking of a new country, or one inhabited only
by a few defenceless savages,  by a company of ad.
venturers,—they meet with  no obstacle in obtaining
possession, nor in establishing what form of govern-
ment they choose ;—but  if that country had been
long occupied by a brave and well-disciplined people,
the conquest would be extremely difficult, if not
impossible.  Hence it  becomes an  object  of  great
interest, both in a national and social point of view,
that the rising generation should be subjected, as
far as  possible,  to such impressions as  are adapted
                        B 
10
to produce  an habitual excitement of patriotic and
moral ideas.
  The influence of  habit upon the mind was long
since known, and expressed in the following just
and interesting admonition:  " Train  up a child in
the way that he should walk,  and when he is old he
will not depart from  it."
  A healthy, or rational state  of mind, depends upon
correct perception, association, comparison, and in-
duction, or inference from propositions :—But our
perceptions may be correct, and yet from a too great
frequency of heterogeneous impressions, the habitual
trains of thought, or operations of the  brain will be
interrupted;  and hence we  may understand  why
booksellers, reviewers,  and all those whose occupa-
tions  subject them to great variety and dissimilarity
of mental exertion,  are so apt to become maniacal
upon  the least predisposition*.   From their dis-
tracted and  unconnected state of mind,  they might
be said  (if  the expression were allowable)  to be
habitually destitute of habit in their operations.   The
probable means of restoring a regular train of thought
will be hinted at hereafter.
  There is  also a derangement in mental operation
which is induced by too exclusive an application of
any particular impression which is calculated to ex-
cite wrong ideas. This is most frequently occasioned
by great distress, or mistaken notions of religion.—
In these cases, such a despotic habit of action is
established  in the brain,  that most others are ex-
cluded ; and therefore the patients are for ever dwell-
ing upon one theme.
  Absence of mind, as it is called, is to be explained
upon  the same principle.   It  is a continued and
exclusive excitement of the  brain which cannot be
overcome by the usual impressions upon the senses;

             *' Professor- Rush's M.  S-. Lectures* 
11
hence some of the  greatest personages, those who
have prosecuted abstruse inquiries with the greatest
euccess, have been most subject to it.
  Having premised  thus much concerning the na-
ture of habits, and the principles by which I conceive
they are to be explained, I shall next proceed to con-
sider  the  influence which  disease exerts  over the
more remarkable habitual operations of the system,
and to notice the practical inferences which are to be
made from an attention to it.


INFLUENCE OF  DISEASE UPON HABITS.

  The  approach of disease may very generally be
discerned by its causing a suspension, or sudden
violation of the accu, -omed operations of the body ;
and more especially in those who are subject to con-
spicuous or remarkable habits :—For example, in
those who are affected with  habitual  discharges from
the system; as the hemorrhoids,  issues,  chronic
diarrhea,  and others :—Or  in those who are accus-
tomed to the  use of tobacco,  or  other  powerful
stimuli.   Under the head  of habitual discharges
may be  considered the periodical  evacuation of the
catamenia ;  the state of which is at  all times an im-
portant  index  to the condition of  the  system, in
females.
  The suppression of those established evacuations,
is generally  considered as the cause of the diseases
which follow ; but it is only a symptom, or  necessary
consequence of the operation of a more powerful in-
citant than that by which they were  sustained,  pro-
ducing  a different  kind  of action.    Thus,  when
conception takes place, the menses  are suppressed,
because there  is a new excitement  induced by the
application  of a more  powerful stimulus j  and the 
12
previous excitement,  or  habit,  must  necessarily
cease*.
   This principle likewise  applies to the  suspension
of those habits which are  acquired by the frequent
application of stimulants ;—the remote and exciting
causes of disease produce a new action in the system,
and thereby obliterate the former one,—doing  away
the necessity, or appetite for the accustomed stimu-
lus. These effects so uniformly appear as harbingers
of disease,  that they ought always to give the alarm
when  observed.   There is also an inaptitude to the
usual actions: the excretions are affected, &c. &c.—
A long list  of premonitory signs of this nature,  is
given  by authors,  which indeed are generally so well
understood, that all we have to do is  to endeavor  to
make  a proper  use of them.   By a due attention  to
them we may often be able  to remove diseases whilst
in their forming stage, which would otherwise baffle
the skill of the ablest practioners.
              ...................... " For want of timely care,
           " Millions have died of medicable wounds."
                                   Armstrong.
When we have been exposed  to the  remote causes
of disease, and perceive their effects upon the habitual
operations of the body,  we  may consider them  as
the premonition of impending evil, and should take
measures accordingly.
  There are  two stages,  says Professor Rush,  in
which  diseases  may  be prevented, viz.  in the pre-

  * As disease is only a different excitement from that which  constitutes
health, or that by which all the functions of the body are performed with
ease and regularity, pregnancy may very preperly be considered as a diseased
state. (Vide Med. Repository, Hexade 1. Vol. vi. pages 31 and 150; where
Doctor Vaughan has ingeniously and ably proved that pregnancy is a form
of disease.) The violation of the menstrual habit is one of the first symptoms
of the disease,—and health cannot be said to be completely restored until
this habit re-appears, as it is essential to a perfect state of the female systein.
This does not take place upon delivery,—but the disease may, at this period,
be said to have come to a crisis; and lactation seems to be the most eligible
method of bringing the system gradually back to the healthy state of excite-
ment; when it again assumes that important habit. 
13
disposition and in the forming  stage.  Where the
system is predisposed to great morbid action,  such
remedies as lessen the action should  be used;  as
fasting, rest,  gentle cathartics,  or small bleedings;
and particular care should be taken to avoid irritat-
ing or exciting causes.   Where the  predisposition is
to weak morbid action, the use of gentle stimulants,
as the pediluvium, and warm teas, will  generally
remove it.
   Doctor Lockette, in his inaugural Dissertation
on the Warm Bath,  speaks highly of it as a prophy-
lactic; and it certainly has great efficacy in restoring
an equable and healthy excitement, when used during
the predisposition to,  or even in the forming stage
of many diseases.   The  value of warm  diluting
drinks, and gently stimulating vegetable infusions,
was frequently experienced by  my respected  Pre-
ceptor during the prevalence of the yellow fever in
Wilmington,  Delaware, in the autumn of 1802. By
the timely and judicious use of those simple reme-
dies, he evidently avoided the fatal epidemic, by
removing the predisposing debility, and preventing
the formation of disease, after the fatigue of profes-
sional duties had favored it.
   There is an account of  a comedian who lived to
near the age of 100 years, and was never sick during
that long period, in consequence of always going to
bed as soon as he found himself under the action of
the  predisposing cause, or in the  forming stage of
disease.   By  inducing a gentle diaphoresis in this
state, he restored that equilibrium, which a few days,
or perhaps  a few hours neglect, might have render-
ed a copious  depletion, and a tedious confinement
necessary to accomplish.
   The approach of the dysentery is almost always
 announced to the patient by a violation of the habitual
 operations of the bowels ; and, in this state, a gentle
 cathartic will generally prevent  the formation of the 
14
disease.  It was prevented in a company of soldiers
during the  revolutionary war,  by causing  them to
drink sea water freely, which operated as a purge *.
  In the forming stage of catarrh,  the free use of
diluting drinks, and an abstinence from, or sparing-
use of cordial and stimulating diet, will almost uni-
versally remove the disease. It is said the celebrated
David Garrick was in the practice of removing
catarrhal affections,  in this stage,  by eating  a salt
herring; the object,  and good effect of which was
the thirst it produced, thereby inducing him  to drink
largely of diluting liquids,  which gave the disease a
centrifugal direction,  and  restored an equable ex-
citement.    This disease being  one cause (and  a
very frequent cause) of consumption,  should  never
be neglected j\
  The accession of  mania is generally to  be fore-
seen by an obvious interruption of the habitual trains
of thought.   A diseased perception,  or  a derange-
ment of any of the  other operations of the mind, is
very quickly manifested,  either in conversation or in
actions ;—and when once observed, should be im-
mediately attended to.  In this early state, a proper
application  of physical and  metaphysical remedies
will often have the happy effect of checking  the pro-
gress, and preventing the formation of this deplorable
disease.  It is much easier to repair the mind when
but one pillar is deranged, than after the whole fabric
is demolished.
  As mental derangement, particularly that kind or
grade called  melancholy, or hypochondriasis, very
frequently  originates  from erroneous perception, we
need  not,  we  cannot in such cases,  expect a re-
turn of rationality until the perception be corrected :
ex. gr.  If a man admit the idea that he is composed
of glass, it will be impossible to convince him by
* Rush's M. S. Lectures.     t Ibid. 
15
any argument that there is no danger of accident from
blows or falls.—The idea of fragility will inevitably
be  associated  with  that  of  vitreous structure:
Therefore, to produce a radical cure, or to prevent
such cases from degenerating into confirmed habits
of wrong action in the brain,  we  should aim at re-
storing a correct perception as soon as it is observed
to be diseased.
   Erroneous  perceptions  very often require, and
are relieved by the application of such remedies as
alter the state of the system and organs of sense ;—■
but there are also wrong perceptions from the par-
tial subjection of objects to  the  inspection of the
senses.    Sometimes it  is  necessary that  several
of the senses should unite in their report of objects
to the sensorium,  in order to  produce a correct per-
ception ; hence, it would be proper in all cases where
we suspect this has not been  the fact, to call in the
aid of the other senses.  Many diseases of the mind
are rendered incurable, and many errors propagated
in society, by a neglect of this valuable, this essential
rule.
   Vice is a morbid excitement,  or operation of the
mind, or  brain,  which tends  to injurious conse-
quences  in society.   The  will,  or  perhaps more
properly, the capacity of volition, is acted upon by
morbid motives, and a new excitement of pernicious
tendency is the result.  If those motives be repeated
in their application to a certain degree, a vicious habit
of thought and action becomes established, and the
moral faculties are  impaired.   Here  we see the
necessity of a preponderance of such  motives  a»
excite to virtuous actions.
   It has been said that education is not sufficient to
establish habits of probity and rectitude which wiU
endure  through life,  because there  are  many in-
stances of parents of exemplary morals having chil-
dren of dissolute,  or exceptionable character:—But 
16
this assertion originated in an ignorance of the laws
of the mental economy.  It is true,  such cases are
often observable,—but the persons are constrained to
moral  acts  by parental authority,  and not suffered
to exercise their reason  on the subject.  No motives
are held out calculated to volunteer them  into good
actions.   The will is rather suppressed ;  and there-
fore,  agreeably to the laws of excitement, is more
readily excitable into wrong action, upon subsequent
exposure  to morbid motives.
        " For Virtue is the Child of Liberty,
        " And Happiness of Virtue ; nor can they
     "Be free to keep the path, who are not free to stray."
                                     Beattie.
  It is a mistaken  notion, both in domestic and
national governments, to make the dread of punish-
ment the inducement to upright conduct:—There
ought to  be motives  of such nature and force  ap-
plied,  as would ensure a  virtuous  volition j  and
this is just as practicable as it is to  ensure a healthy
excitement of body by a proper use of alimentary,
and other suitable stimuli.
  When a person of  virtuous  habits has  been ex-
posed to immoral  causes until they begin to  take
effect,  their influence may soon be perceived.  His
old habits will be violated by the formation of a new
excitement; or a different direction being given to
the will.  In the predisposition to, or in this form-
ing stage of vice, many persons by a proper manage-
ment,  might be arrested in their mischievous, and
often fatal career.  How many, in  this  stage of the
disease, have been converted to permanent rectitude,
by presenting motives to them of a more powerful
and salutary nature!
  The pathology of the mind presents a vast and
important field for observation; in which it is  the
peculiar province  of  physicians to display the true
principles by which the various phenomena are to 
17
be explained.   Volumes would be requisite to detail
and  apply  every  circumstance illustrative of this
beautiful theory of the mind,  as taught by the in-
genious Professor of the practice of physic in this
University ;—but the limits of this essay render it
necessary that I should dismiss the further consider-
ation of the  subject under this  head, and proceed
to consider the  influence which a repetition of im-
pressions may have in producing new habits of action,
and  thereby  removing previous actions of morbid
nature.                            .
INFLUENCE OF HABITS UPON DISEASE.

  Proceeding upon the principle of the unity of
action  in the particular  systems of the  body, and
of removing one kind of action by exciting another,
we  may understand how a continuance, or repeti-
tion of those  impressions  which are  sufficiently
powerful to induce a new excitement, can eradicate
the original morbid action;  or,  in other words,
how habits of  wrong action may be removed by
producing those which are more favorable to a re-
turn of healthy excitement.
  In cases of wrong action induced by subjection
to new impressions, the first object in the treatment
is the removal of the cause;  and if the excitability
be  not too completely converted into the peculiar
excitement of the new stimulus,  the effect will soon
cease.—But if it have been so long applied that its
particular action is confirmed in the system, that
action  will continue, even  though the cause be re-
moved.  The system appears to  acquire an inde-
pendence from repetition, by which it can of itself
continue those actions that could only be produced 
18
 originally by the presence of the exciting  powers.
 When this is the case,  morbid excitement must be
 destroyed  by such  agents as will produce a new
 action.
   If the morbid action be violent, it  must be di-
 minished before a new  exciting power can be safely
 applied :—if it be more moderate,  but  of long con-
 tinuance, and deeply rooted in the system, it will
 often be necessary to take  an intermediate step, and
 eradicate  it by inducing another disease ; but one
 which will be afterwards much more easily removed.
 We have an instance of this in the treatment of old
 cases of syphilis,—we  destroy it by bringing on  a
 mercurial disease;  and when we have completely
 removed the syphilitic habit by introducing this new
 one,  such applications are  used as are calculated to
 displace the latter,  by producing the excitement of
 health.  And lastly, when morbid action is feeble,
 and  not of long standing,  the diseased habit may
 often be destroyed by such exciting powers as are
 suitable to induce, directly, the action  of health.
   When any acute or recent  disease is occasioned
 by an excess of those agents which are adapted to
 the support  of health and  life, it may  be removed
 merely by  restoring an equilibrium of excitement
 in the different systems of the body;—but where
 causes are applied which produce a pernicious ex-
 citement in every  degree  of  force (provided they
 take effect at all), the case  is widely different.  No
 man ever cured syphilis by simply equalizing the
 excitement:—It must be destroyed by  such reme-
 dies  as  have the power of producing  a new  and
 different action.
   It is upon those  principles,  which were first sys-
tematized by the ingenious Hunter, that we pro-
pose to explain the action  cf  habits upon disease ;
or rather,  the influence  of  one kind of action upon 
19  r-
another;—for an  acquired habit  is nothing  but a
different action rendered permanent by repetition.
   To remove an established excitement of evil ten-
dency,  often requires the aid  of extensive observa-
tion, and acute reasoning.  There  is a certain  grade
in the  force  of  every particular excitement,  above
which  it is not safe to attempt a change by the  im-
mediate application of  different  exciting powers;
hence  it is generally necessary in the  beginning of
diseases to diminish  the excitement of the system
by depletion,  before we can administer such  reme-
dies as are suited to restore healthy  action, with
advantage.
   The  neglect  of a  due degree  of this has been
the cause  of much mischief in the practice  of phy-
sic.  It is a truly important part of the treatment;
and to the illustrious Professor Rush are we indebt-
ed for  much light  and information on this  subject.
By attending to the circumstance, we may be en-
abled to introduce  new habits of action upon rational
principles, instead of groping in empirical darkness.
   In our  regard of the effects of custom, in  the
management of  diseases, we should never lose sight
of those habits which are induced by the revolutions
of the celestial bodies, by the return of the seasons,
and our connections with mankind ; more especially
the connections  of friends  and relations*,  neither
should we overlook those laws of the system which
have been occasioned  by any particular mode  of
living;  whether of dress, diet, drinks,  &x.—nor
of those  established  by  any  particular  medicine,
whether it  have disagreeable or salutary  effects.
They all  have  their  influence, which by attention
may be converted  into  use, but by neglect are al-
ways liable to counteract our endeavours.
* Doctor Cullen. 
  We see somewhat to this purpose in intermittent
fever; the  disease appears to be sustained by the
united influence of the remote cause, and the diurn-
al revolution of the earth.  It has been  supposed
that medicines given just before the expected parox-
ysm would have  most effect in preventing it,  by
exciting a  different action;  but Professor Barton
informs us,* that he has often found the paroxysm
aggravated by this practice;  and that he  has had
most  success in the treatment by applying the rem-
edies  immediately after the paroxysm, or for a con-
siderable time previous to the expected period of
the next one; unless there were danger of the sue,
ceeding one proving fatal; which is sometimes the
case.
  This would certainly seem the most rational prac-
tice ;  for in this case, there  is but the influence  of
the remote cause to counteract, and therefore a new
action would be much easier excited by the stimulus
applied,  than when  it had  to combat the above-
mentioned  additional force.   To prevent  relapse,
the application should be continued until  the new-
action be established.
  The unmanagable disease of epilepsy appears  to
be  often rendered habitual in the  system by the
influence of the periodical revolutions of the globe.
The scientific Professor of materia medica relates a
case in  his lectures, which was originally brought
on  by fright, but which became periodical; recur-
ring daily about the  same hour.  He removed the
disease by exciting an action,  previous  to the ex-
pected paroxysm,   which was superior to the accus-
tomed epileptic action.
  The cure of intermittent diseases, or those which
occur at stated times, is most commonly effected by
some  of the more powerful incitant,  or tonic medi-
* M. S. Lectures. 
21
cines;—but to show that there  is nothing  specific
or exclusive  in their operation  upon  the diseased
action,  we need only mention  the  fact,  that  they
have all been occasionally removed by exciting  a
superior action of a different kind, without,the ex-
hibition of any thing internally.
   Intermitting fever has frequently been cured by
violent emotions of mind, or great bodily exertion ;
or, which is perhaps more effectual, by the united
exertions of body and mind.  Doctor Cull en pre-
vented  several paroxysms of epilepsy in a girl by
threatening her with punishment if  she had  any
more.
   It is certainly our duty to remove diseases by
those powers which will produce a healthy excite-
ment, or one the most  favorable to health:—Yet
the above, and many other facts evidently  show, that
it is not any particular remedy alone,  which  will
destroy  an existing  morbid  action ;  but that any
cause will do it which is sufficiently powerful  to
produce  a  new excitement.—Therefore,  the  best
medicine  is that which will produce  the best new ac-
 tion.
   The influence of custom in rendering motions  or
 operations periodical, was well understood by Doctor
 Cullen :—" An  instance of this," observes  that
 great man,  " we have in sleep, which is commonly
 said to be owing  to the nervous power  being ex-
 hausted, the necessary consequence of which is sleep,
 i. e. a rest of the voluntary motions to favor the re-
 cruit of that power: But if this were the case, the
 return of sleep should be at different times, accord-
 ing as the causes which diminish the nervous  influ-
 ence operate more or less powerfully ; whereas the
 case is quite otherwise,  these returns of  sleep being
 quite regular."
   This law of habit might be applied with great ad-
 vantage, in conjunction with other  means, in cases 
22
 of morbid or preternatural wakefulness ;  by favoring
 a regular periodical return of sleep, this distressing
 affection would probably be  often relieved,  where
 it now resists the operation  of the  most  valuable
 soporific medicines, promiscuously given.
   Any habits of patients respecting sleep, should at
 the same time be always attended  to; for instance,
 if they have been accustomed  to sleep in the neigh-
 borhood of a great noise,  the continuance of that
 noise will be necessary to the production of sleep in
 them, however it might prevent it in  others.
   The same principle has been applied by Doctor
 Darwin and others, to  the regulation of the  alvine
 excretions.   A regular stated time  of evacuation, or
 even an attempt at evacuation, has been found effec-
 tual in obviating and removing a constipation of the
 bowels.
   *' Custom, or repetition, gives  strength to mo-
 tion."   "  This,"  says Doctor Cullen,  " is of
 considerable importance  in the practice of physic,
.though but too  little regarded :  for the recovery of
 weak people, in a great measure depends upon the
 use of exercise suited to their  strength, or  rather
 within it, frequently repeated and gradually increas-
 ed."
   Doctor Rush has amply illustrated this principle
 by his own  practice in the Pennsylvania hospital, in
 the  treatment of rheumatalgia  and paralytic  cases.
 Many of the  patients affected with those disorders,
 have recovered  their wonted strength, by beginning
 to lift small weights, and repeating the exercise every
 day, gradually increasing them.
   As disease is a habit of wrong action, so I  would
 reverse  it,  and say that  all habits of injurious tend-
 ency are diseases; and  of course require medical
 treatment.   The management of them all  requires 
23
a knowledge of the laws of the animal economy:
otherwise the practice  will be  empirical,  and the
success fortuitous.
   The habit, or disease of drunkenness is a truly per-
nicious one ; and the treatment of it proportionally
difficult and critical.  The  cure  is becoming  daily
an object of more solicitude and importance, and to
accomplish  this radically, is the province of the ob-
serving physician.   It  has been  treated  suc-
cessfully.—And were those principles, before
laid down,  properly enforced in practice, I have no
doubt but we should frequently arrive at this grand
desideratum.
  When the use of an active or diffusible stimulus has
become so habitual as to render it a necessary support
of animal life, it is in vain to attempt the disuse of it,
without at the same time substituting an equivalent.
 If this be neglected, the system languishes from de-
fect of its accustomed support,  and a train of symp-
toms ensue which are generally disagreeable in pro-
portion to the power,  or previous  continuance, of
the  stimulus omitted.   It is from  this  cause that
 we see so many fruitless efforts at reformation among
the  unhappy votaries of Bacchus.   How often have
the  unfortunate subjects of the habit of intoxication,
 upon seeing its  fatality, resolved, and pledged them-
 selves to abjure  it for ever!   But, alas!  fromLan
 ignorance of the laws of organic life, they have
         " Resolv'd, and re-resolv'd—yet died the saine."

 The abstraction of so powerful a stimulus leaves the
 system in a state of distressing languor and debility,
 in which it is not calculated to re-act under the pres-
 sure of business and domestic wants.  In this situa-
 tion they again have recourse to the insidious poison,
 in order to restore the pleasurable  excitement they
 have lost.  But it is  an error pregnant with every 
24
evil.   They restore an  excitement  which hurries
the body  to  dissolution.—They follow  a pleasure
which allures but to destroy.
   The disease of drunkenness is often kept up by
customs which might, with  a little  resolution, be
easily broken.   Many persons addicted to it,  only
get intoxicated at certain  times in the day, or among
certain companions,—others only at certain places of
resort, or  at  certain festivals,  &c.—and  some only
when they can procure their favorite potation *.
   By  observing those circumstances, we  may be
enabled to dissolve the charm by breaking a link  in
the chain of association, and substituting a new one
which will finally, with proper management,  estab-
lish a new habit.
   Even when repetition has  made the  stimulus ne-
cessary to  health, if the  patient be convinced of its
evil tendency, and resolved on reformation, we may
render his  determination effectual by inducing a new
action with a different stimulus ; and thus pave the
way for a radical cure.   If the habit have been  of
long standing, it may be proper first to  excite a new
disease, as was formerly mentioned.   The patient
may begin by only changing  the kind of  drink ; af-
terwards he may substitute a  powerful stimulus  of
a different  nature ;  as opium,  some  of  the metallic
preparations \,  or strong infusions of the vegetable
bitters and incitants.
   By  thus gradually effecting a revolution  in the
habits of the system, he may descend  by means of
tonics, and moderate stimulants, to a state of healthy
excitement.   Or if a continuance of some extraor-

  * Rush's M. S. Lectures.
  f How would a salivation do, where other circumstances do not  forbid ?
There is no process which has a greater effect in revolutionizing the system.
  Sine.-- writing the above, I have been informed by Professor Rush that it
was tried with success upon a gentleman in Virginia.  Blisters, he likewise
informs me, have been known to suspend this destructive habit. 
25
dinary stimulus be requisite, he can use such as will
prove least detrimental.
   My friend Doctor Gideon Jaqjjes  informed me
of a case much to my present purpose, which came
under his own care.   He removed this destructive
habit in an elderly man,  by exciting a new action
with other stimuli;  which supported the system at
the same time that they produced this effect.  The
principal substitutes  on which he relied, were opium
and seneka snake root,  gradually diminishing the
dose.
   It is said that the celebrated Doctor Johnson in-
tirely conquered  a propensity  for drinking ardent
spirits, by the free use of strong tea.  This,  and
other powerful vegetable infusions, might probably
be often substituted  with advantage for the  lethean
draught.
   Drunkenness has frequently been cured by exciting
disgust, shame, and other new actions.  Religious
impressions have often removed the habit likewise.
These facts prove in this case, what was formerly
proved by great exertion, or emotion, when  con-
sidering  periodical  diseases.   There  is  nothing
peculiar or exclusive in the  operation of the above-
mentioned remedies  on the habit of intoxication :—
any  application sufficiently  powerful,  will support
animal life in the place of the vinous stimulus;  but
those ought to  be chosen which produce the best
excitement:  and  when  the cure is attempted by
moral  or religious impressions, they ought always
to be aided by the proper physical remedies ; other-
wise the chance of a radical and permanent restora-
tion will be much less.
  All other pernicious habits,  as the excessive use
of opium,  tobacco, &c. are  to be treated upon the
same plan.   A substitute must be used to support
animal life ; and if the excitability be not too much
                         D 
26
destroyed  by  the long  use  of the stimulus,'  the
system may be gradually brought back to the healthy
state. But if the habit have been of such long stand-
ing as to induce a permanent exhaustion of excita-
bility,—or, in other words,  if the impression have
been so powerful, and so durable, as to derange that
exquisite  organization which renders the body cap-
able of re-action when the usual stimuli are applied,
and if this derangement be lasting, it will be neces-
sary to continue the use of the substitute *. There-
fore,  all  that  we can expect in this  case,   is  to
remove one evil by submitting to what with a healthy
person would be another;  but which previous cir-
cumstances have here  rendered  necessary, and of
course, comparatively salutary.
  There is an account of some Turks,  who,  being
at sea,  had used  all  their opium,  which from habit
had become  an  essential support  of life :  In  this
dilemma they sustained themselves,  at the expence
of conscience, by drinking wine which they had on
board.
  As different stimuli produce different actions, and
as they possess different powers of acting upon the
excitability,  it shows the propriety of being provided
with a variety of stimulating agents, as recommended
by Professor  Barton.   They might probably be
tried  with advantage in cases of great exhaustion of
excitability; for  it has been found  that medicines
of  apparently  less active powers, will  sometimes
effect a cure, where  more potent ones have failed.

 - * The susceptibility of action from the application of any stimulus being
destroyed, in great measure, by the excessive use of that  particular agent,
may we not  plausibly infer, that die reason why small-pox and meazles
can only be communicated once to the system, is because the morbid stimulus
which produces them destroys, permanently, the excitability ; or that peculiar
organization which is essential to the production of such an action ?__The
action of those contagions is so effectual, and of such specific nature, that the
system is no longer excitable by them.
 l 
27
   This circumstance may lead us to understand why
a stimulus which could remove a tenacious habit of
action,  may have its action removed in turn  by a
cause seemingly weaker than itself, one which could
not destroy the first action ; as  is seen to be the case
in the treatment of syphilis.
   After continued use has rendered tobacco a ne-
cessary stimulus,  it is not uncommon for  those  so
accustomed to it,  to vary the form of using it with-
out any inconvenience.   Those who chew can leave
it off, provided they supply the defect by smoking or
snuffing.  But I have also known persons long habi-
tuated  to chewing tobacco, to substitute  ginsengs
and other vegetable stimuli, with complete  success ;
thereby obviating  the disagreeable  effects of  the
former.
   These  facts likewise show the practicability of
changing  any particular habit, when attention is paid
to the state of the system,  and a new one at  the same
timj introduced.   This must be done; for one habit
can only be destroyed by the introduction of another.
  In the treatment of mania, as of all other forms of
disease, it is necessary to attend to the state of the
system.   If the action of the sanguiferous system be
violent in  this disease,  depletion is just as  requisite
as it is in a pleurisy ; and in mania from physical,
or mechanical causes, the  cure  is almost as easy.
But  where  there is a  morbid  excitement of lomr
standing in the brain, induced by causes which acted
directly upon the senses,  or where false associations
have become  established,  the  management of  the
system  generally,  can only be  considered as a  pre-
paratory step towards a cure.  Physical remedies,
strictly  speaking, can only act indirectly on  mania
from what  are called  mental causes : and hence,
as those remedies  are principally trusted  to in all
cases,  we may understand why mania from mental 
28
causes has been found more difficult to cure.   Be-
sides, in this species of mania, the causes very often
continue to act while the remedies are using.
   The senses, like so many great rivers, expose the
brain to the invasion  of every inimical idea;  and
therefore while those sources of  wrong action are
unattended to, physical remedies  may often be used
in vain.  It is frequently in our  power to exclude
some of the most unfriendly causes; and the chan-
nels which admit  the  enemy, are  always open to
convey the well-disposed.
   It is the business of the practitioner  to attend to
this, and to prevent the operation  of morbid causes,
as far as possible,  by removing those which can be
removed, and making such impressions as are suited
to introduce rational trains of thought.
   Where the excitement is not violent, or when it
has been sufficiently reduced, we may gradually at-
tempt to produce a new action by other causes.  If
the mind be exclusively occupied  with  one  theme,
as is most commonly  the case in hypochondriacal
affections, the brain should  be subjected to the va-
rious impressions  which are afforded by agreeable
society, and travelling.   If  it be  void of connected
operation,  a cause  should  be applied which  will
produce  a regular excitement; and continued, or
repeated until this excitement be  established.
   We have many  instances of the efficacy of this
practice.  A lady  was maniacal at all times, except
when she played at cards; her friends observing this,
played with her by turns, until her brain had recov-
ered its healthy action so completely that she did not
relapse afterwards.
   A judge  was  perfectly rational whilst  on  the
bench;  but as soon as he left it he became derang-
ed*.  In this  case  the  pressure of business pro-
                * Rush's M. S. Lecturer. 
29
duced a  rational excitement which overcame the
previous wrong  action;  but it was  not continu-
ed long enough  to become permanent.   Could he
have  been occupied in this 'way a sufficient length
of time,  no  doubt he would have been perfectly
cured ,  as in the case  of the lady.
   The good effects of business closely followed, or
any continued impression of salutary nature,  in re-
storing a  regular train of thought, have often  been
experienced: and it  is to be wished  that more at-
tention was paid to those remedies which act direct-
ly upon the  brain.  By observing that operation of
the deranged mind which is most allied to rational-
ity,  and supporting it as long as possible  by  the
proper impressions, either conversation,  objects, or
both,—it is more than probable, we might  often
accelerate the recovery of maniacal patients;
               ......................." For the attentive mind,
           " By this harmonious action on her powers,
           " Becomes herself harmonious."
                               Akenside.
   Vicious habits are to be treated upon the  same
principle.  If the patient have not been so long sub-
ject to the impression  of morbid motives as to im-
pair the moral faculties,  the disease will disappear
upon simply withdrawing the cause.   But if a habit
of thought and  action, which  is of injurious ten-
dency to  society, be establised,  the mere abstraction
of the cause will not be sufficient.   The diseased
action will  continue,  independently of the original
cause ;—and hence we often see persons in this con-
dition commit  vicious  acts without  any apparent
motive ;  or at least, from motives which would have
no effect  on others.  In this  case a change is only
to be effected by the application of causes which are
sufficiently powerful to excite a new action ; and on
the  nature of that cause depends the  nature  of the
action produced. 
30
  If the vicious excitement be violent, it must  be
reduced before salutary impressions can take effect.
This fact has received a negative proof from the ex-
perience of all ages,  by the vain attempts which
have been made to induce a healthy action, in such
cases, by the violent  remedy of ignominious punish-
ments inflicted  in public.   Such  treatment, instead
of exciting the  desired action, generally renders the
case desperate.   Like ardent spirit in  an  inflamma-
tory fever, it hurries  the system on to a  state  of
gangrene and death.
  But  the propriety and utility  of the abovemen-
tioned practice has received positive and ample proof,
from the successful management of those dangerous
cases,  in  the new jail  in the city of Philadelphia.
This valuable institution is in reality an hospital for
diseased morals.  If the action be too great to ad-
mit of the immediate application  of salutary causes,
it is reduced by putting the patient in the solitary
cells;—and no treatment has ever been found  to
produce a state of mind so favorable for the intro-
duction of  a new and healthy  excitement.  This
being premised, motives are then applied  which are
calculated to restore industry and integrity;  and
they are  continued until it is believed the habit  is
established.
  This method of treatment has  been  found so ef-
fectual, that numbers have been discharged com-
pletely cured.   They have returned to society with
the  character of honesty and  sobriety, which they
have ever after retained.
  It may be said that many have relapsed; but no
more happens here than is often  seen  to take place
in mania,  and intermittent fever.  It weighs nothing
against the principle.  If the remedy had been ap-
plied  sufficiently  long, the cure would have been
perfect. 
31
  That accurate delineator of the human mind, the
immortal Shakespeare, was well apprized of the
great influence of custom upon our actions; as is
evinced by the following lines :....
          " Assume a virtue if you have it not.
          " That monster, custom, who all sense doth eat,
          " Of habits devil,  is angel still in this j
          " That to the use of actions fair and good
          " He likewise gives a frock or livery,
          " That aptly is put on; Refrain to night;
          " And that shall lend a kind of easiness
          " To the next abstinence; the next more easy ;
          " For use can almost change the stamp of nature
          " And either master the devil or throw him out
          " With wondrous  potency.".....

   Religious impressions exert great influence upon
the  immoral form  of disease.   The morbid excite-
ment is subdued, or  diminished by the terror  of
future punishment;  and a virtuous action produced
by the  pleasing prospect  which  is held out,  of
the enjoyment of everlasting happiness.   What has
been said will point out the propriety,  when a re-
formation is attempted, of first depicting the evils
resulting  from  a  destructive  career, and then  to
pourtray the motives to upright conduct in all their
alluring beauties.


      RECURRENCE TO  OLD  HABITS.

   Where the confirmed habits of the  system are
not attended with much inconvenience,  it would be
better to endure them  than attempt a reformation;
and indeed under all circumstances they should be
borne with,  unless pains be taken to proceed upon
the same principles as above directed : for an omis-
sion of the accustomed stimulus has been known to
produce disagreeable,  and even fatal consequences. 
oJ.
   A  patient  of  Doctor  Hope  was  affected  with
vertigo, coma, &c. to an alarming degree, in conse-
quence of leaving off the use of snuff, through com-
plaisance to his wife :  The doctor, upon inquiry was
informed of the circumstance ; he advised the person
to return to his former habit, which intirely relieved
him.  The same remark applies  to habits acquired
by the repeated use of any other stimulus, or to any
habitual  discharge from  the system :  and when
guided by this principle, the treatment will be easy
to understand in all cases.
   The application  of preternatural  stimuli to the
healthy body  is at all  times  prejudicial, and often
dangerous.   They interrupt the  usual operations ;
and until the system accommodates itself to the force
of the impression,  its condition is more or less pre-
carious.   Resorting; to the  use of snuff has been
                 o
known to cause fatuity—and by leaving it off, health
was again restored.   This should teach  us to be
cautious how we attempt  innovations of this kind ;
and also to make inquiry in every case where such a
circumstance may be suspected.
  The re-appearance of those habits which were at-
tendant on the health of the patient, after they have
been  suspended by diseased  action,  is likewise a
matter of great importance, and should  never be
neglected, nor overlooked  by the practitioner who  is
ambitious to  make an early and correct prognosis.
  In all dangerous, or critical cases,  the friends  of
the patient demand and expect the opinion of the
physician  respecting the  event;  and much of his
reputation depends upon the correctness with which
jit is given.   By a nice observance of the healthy
habits as they return, he may be enabled to predict
a favorable issue, before the negligent attendant can
perceive any alteration.
   Sometimes, indeed, where  the disease has been
violent, and of considerable duration,  some of the 
33
more remarkable habits have been permanently de-
stroyed, as I have myself witnessed.  But otherwise
they are not; and in all cases, upon a favorable crisis,
it is the light of returning healthy operations which,
produces the dawn of convalescence.
  I  might here give a long list of the symptoms
which indicate a termination of diseases in health;
but  they are so amply detailed by authors, and so
judiciously commented upon by Professor Rush in
his lectures, that in me it  would be a work of super-
erogation.    Besides,  any  person  who  directs his
attention that way cannot  fail to observe them ; and
observing them,  he  will soon learn to make the pro-
per inference.
  There is an additional consideration attending an
observance of the first symptoms of convalescence,
which is of still greater importance ; and that is, the
more early use of restorative, or tonic remedies than
is frequently thought advisable by the generality of
practitioners.   It  is a  point  which requires  great
judgment, it  is  true, and mischief may often be
done by commencing the stimulating plan too soon;
but  I believe a proper attention to the above men*
tioned circumstances would obviate this evil in great
measure.
  That a neglect of them has produced evils on the
other hand, I have no doubt.   How many instances
are related of patients breaking over the rules of
regimen prescribed by  their  physicians, and in-
dulging their appetites in what was strictly forbidden,
not  only with impunity,  but with great advantage!
Almost every experienced nurse can  relate an in-
stance of such transgression,  whereby the patient
has evidently accelerated  his recovery.
  In those cases,  the habits of health have returned
unattended to by the physician, and the patient, by
obeying the early indications of convalescence, has
                        E 
34
rendered  his recovery  more  speedy than  it would
have  been by observing the formal regulations of
system,  under its present imperfections.   By dis-
regarding, or counteracting those indications, in the
infancy of their  return,  we  may often  retard  the
cure, if not prevent it altogether.
  The recovery  of convalescent  patients may be
much promoted by attending to the recommendation
of Professor Rush, of having every object removed
from their view which can tend to prolong  the dis-
ease by  association.   The  sight of old plaisters,
pill-boxes, remnants of  juleps,  &x.  exert a  very
unfavorable influence upon patients of  delicate con-
stitution, where   the  recovery  is  tedious.   They
should be taken away as soon as they can be dis-
pensed with; or if practicable, the patient should be
removed to another  room,  where objects will be
presented to him which are calculated to make him
forget his disease.
  The same observations may be extended to the
treatment of mental and moral diseases.  When the
maniac discovers the least sign of returning reason,
it  should  be  encouraged  and  assisted  by  every
humane  endeavor*:—And when the prodigal re-
traces with penitent steps the destructive path in
which he has strayed,  he should be received  with
open  arms, and  kindly  directed in the way that
leads to peace, prosperity,  and happiness.
  I have mentioned very  few of the instances in
which the  influence of custom is evinced ; but,  if
the explanation be correct,  they can all be under-
stood from what has been said ;  and may be turned
to our advantage  in the practice of physic.

  * This is of importance to attend to. Maniacal patients should be released
from chains and cells as soon as the case will admit of it.  Mania which
would otherwise have admitted of a cure, has, I believe, become habitual from
a continued impression of those objects which were applied during the vio-
lence of derangement. 
                       35

  I shall now conclude these desultory observations,
which I fear will suffer in the eye of the critic from
the uncouth form in which they make their appear.
ance :—But to close without a tribute of respect to
the illustrious Professors in this University,  would
be to suppress the warmest emotion of my heart.
   To all  of them  I am much indebted for their
personal kindness and attention.  They have indi-
vidually honored me  with that  regard  for my im-
provement which at once evinces the  patronizing
hand of liberal science,  and is calculated to  ensure
a grateful and permanent remembrance.
   The enlightened  Professor of Materia Medica, in
particular, has conferred obligations which  it will
ever be my duty and pride  to  acknowledge.   To
his polite  and friendly instruction I owe that taste
for the  study of nature,  from which I anticipate the
most rational and lasting pleasures  of  my life.   It
is his happy attribute to fascinate his pupils with the
sciences he so ably teaches.
   It is  high time for the haughty bigots of  the old
world to acknowledge and revere the scientific talents
of America.  No longer can it be said, to the reproach
of our country,  that all her productions are of an in*
ferior order.  As she has produced a Washington,
a Franklin, and  a Jefferson, to wrest and pre-
 serve  our rights  and liberties  from the  grasp of
transatlantic tyrants,—so  has she  given us  a Rit-
 tenhouse, a Rush, and a Barton,  to maintain
 our dignity and independence in the various branches
 of Philosophy, Medicine,  and Natural History.
TINTS. 
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