.v;> j 11 :JF&>. SURGEON GENERAL'S OFFICE LIBRARY. Section, .xs~. JVo. WlUo ■M HP* ..-viOC*- v\-m> k *f»o • "• • . . or».^ * A PLAIN, '~£f ELEMENTARY EXPLANATION / O OF THE NATURE AND CURE OF DISEASE, PREDICATED UPON FACTS AND EXPERIENCE-, PRESENTING A VIEW OF THAT TRAIN OF THINKING WHICH LED TO THE INVENTION OF THE PATENT, PORTABLE WARM AND HOT BATH. WASHINGTON CITY:1 PRINTED BY ROGER C. WEIGHTMAN. ^ H ) 1814. District of Virginia, to toit: Be it remembered, that on the twenty-fifth day L. S. of January, in the thirty-eighth year of American in- dependence, Samuel K. Jennings of the said district, hath deposited in this office the title of a book, the right whereof he claims as author, in the words following, to wit: " A plain, elemen- " tary explanation of the nature and cure of disease, predicated up- " on facts and experience; presenting a view of that train of think- " ing which led to the invention of the patent, portable warm and " hot bath. By Samuel K. Jennings." In conformity to the act of the congress of the United States, entitled "An act for the en- couragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times therein mentioned;" and also to an act, entitled " An act supple- mentary to an act, entitled • An act for the encouragement of learn- ing, by securing the copies of maps, charts, and books, to the au- thors and proprietors of such copies during the times therein men- tioned; and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." WM. MARSHALL, Clerk of the district of Virginia. PREFACE. ABOUT ten years ago, I was convinced, that 'here was too much hypothetical reasoning incorpo- rated with every theory of fever of which I had any knowledge. They all too often failed to furnish such explanation, of the grades and states of disease, as I deemed necessary, to guard against mistake. Sensible of the high responsibilities of medical men, I entered upon a course of vigilant observation, in order to detect any important point at which our sci-< ence might be deficient. Two whole years were spent without gaining any considerable advantage. At length, however, several cases of fever occurred, of unusual type, difficult to manage, and attended with svmptoms which invited special attention to the sur- face of the patient. I formed several conjectural opinions, which afterwards were tested by addition- al experience, and corrected or established as facts directed. In the years of 1806-7, a similar fever prevailed, to an extent never before known in our section of the country. Several hundreds of the sick were committed to my management, affording me am- ple opportunity for repeating my observations. In the course of this labor, my inquiries began to as- sume a more systematic form; and ever since that period my opinions have been considerably guided * by the principles which I now hold to be true. For the space of seven years past, I have paid more at- tention to the surface, than any other physician of whose practice I have any knowledge, and have been in habits of making more than ordinary use of arti- ticial heat. The steam of boiling water has often Berved me a valuable purpose, when my patient could sit up to receive it. In cases of prostration, this, of course, became impracticable; and the moisture which this kind of steam universally produced, too much counteracted my intention, even when the con- dition of the patient was favorable. From time to time, therefore, different devices were tried for the production and application of heat, freed from this inconvenience, each of which was more or less bene- ficial, according to the facility and extent with which it could be accomplished. At length a perfect me- thod of applying dry heat, became to me a very great desideratum. Afterwards, I had the happiness to hit upon the gas of burning ardent spirit, and final- ly upon the invention of a portable apparatus for con- ducting it to my patient. During the whole course of this pursuit, I had no other design than that of improving my own practice. But the facility with which I have since been able to manage every grade of fever has been such, that I cannot reconcile it with my obligations to humani- ty, to withhold the result of my observations from the public. It is, therefore, submitted to the patro- nage of benevolent and intelligent citizens, as a sira- pie method of explaining disease to common appre- hension. It is laid at the feet of medical men, and claims no higher merit with them than that of a lit- tle appendix to their more profound researches. For myself, I feel no solicitude. Time and trial will ne- cessarily determine the fate of my work. As to the apparatus itself, considered as a conve- nient contrivance for administering a warm or hot bath, it needs no commendation. Every physician in town and country must know its worth. The difficulty and delay which attend any ordinary me- thod, heretofore discovered, are equally obvious. By this invention, every physician, and indeed every family, may be furnished with a convenient, elegant, and delightful method of applying heat. It may be put into operation in five minutes. It may be carried in a large pocket; it would scarcely in- commode a pair of saddle bags, in travelling. It does not weigh three pounds. It may be applied to a patient seated in a chair, or lying on a couch, sofa} cot, or bed. It is used without water. And it can be safely applied to patients in the most helpless con- dition. So far as I have been able to extend my inquiries, my system is original. Some experience, therefore, will be necessary to prepare the purchaser to derive those extensive advantages from its use, which will ultimately accrue to every one who will give it a fair and proper trial. Medical men will find but little difficulty to comprehend me at a single reading,— A 2 6 Others may find it expedient to devete sortie time and-application to the work. And where is the man who ought not to inform himself on the subject of his health? Let him avail himself of the advantage which is now offered him, and with the blessing of The Great Eternal, who holds the destinies of men, he will not be disappointed of his hopes. A PLAIN, ELEMENTARY EXPLANATION, $c. PART I. THAT peculiar energy, which supports vital motion in the living man, by some medical writers called sensorial fiower—by others excitability, is con- tinually expended, and therefore, of course, must be continually generated in the system. It is expended by all the motions and efforts of body and mind, exhibited in human life. The faithful laborer, and the diligent student, are equally sensible of the failure of their powers, through ar- duous and long continued application. It is expended by the systole and diastole* of the heart and arteries, and by all the variety of motions which support those numerous organs and functions, the description of which, would, itself, constitute a voluminous work. And it is highly probable that it is employed as an associate instrument, in the act of thinking, as well as a subordinate instrument, in the performance of muscular action—in the production of those motions of the body which are subservient to the will. An energy so essential to life, and so continually and copiously expended, must be perpetually sup- plied, or the system would perish, through its own necessary motions. * The two corresponding motions which receive and expel the blood. 8 Probably it is the grand function of the sensori- um* to maintain this energy. Possibly this organ should be considered a gland of superior dignity, whose office it is to secrete this astonishing power, and, through the mediifm of the nerves, to distribute it to its various destinations; or it may more proper- ly deserve the character of an electrical apparatus, which collects and diffuses vital power with instan- taneous velocity. But it is not material to my pur- pose to ascertain by what process it is accomplish- ed. I would insist upon the truth of this proposition only, that through the functions of the brain and nerves, there is a perpetual production or generation, andaperpetual effort for the diffusion of vital power, throughout all the parts of the system.f In making provision for bo ample a supply of this important principle, it is evident the author of na- ture had reference to an intended co-operauon of certain extraneous powers, which should afford the necessary pabulum,* and act as stimuli or exciting powers, upon the fibres, and vessels, and organs, of * The brain and its appendages. f Perhaps it might not be inconsistent with truth to say, that this excitability, or vital power, is scarcely distinct from life itself. Consequently, the quantity of this principle, present in the sys- tem of any man, might be called his stock in life. When health abounds, there is an ability in the sensorium to produce a sur- plus over and above the quantity necessary for the support of the organs and functions essential to life. This surplus furnishes a daily revenue, sufficient to meet any temperate expense of la- bor, thought, &c. If the expense exceeds the revenue, sleep becomes necessary to replenish the loss. In sleep, the act of vision, attentive hearing, and wasteful thought, are suspended; a proportionate saving is therefore brought to the system. Sleep, of course, is truly said to be " tired nature's sweet restorer.'3 i. Nourishment. 9 the system, so as to bring them into action, raise the action to its proper height, and maintain it through its destined period. These powers or stimuli, are ali- ments, heat, atmosphere, light, sounds, bodily exer- cise, thought, &c to which may be added, the pre- sence and motion of the blood in the heart and arte- ries, as also the several fluids, secreted and deposited in their various receptacles, or moving in their pas- sage through their appointed tubes. Through the influence of this vital power or ex- citability of the system, its vessels are susceptible of feeling the impression of the various stimuli which act upon them. And by a peculiar contractility,* with which it arms every fibre of the heart and ar- teries, veins, lymphatics, &c. all these vessels, in obedience to the powers of acting stimuli, perform their respective motions. Thus provision is made for the circulation of the blood, the secretion of lymph,t and the elimination of excrementitious mat- ter. The organic motion produced for these important purposes, is called excitement. If the quantity of vital power or excitability pro- duced in the system be natural, and the quantity of nourishment and stimuli in due proportion, excite- ment will be equable and healthful. In perfect health, therefore, excitement will be equable throughout all the vessels of the brain, of the lungs, of the liver and mesentry, of the stomach and intestines, &c. of the bones, of the muscles, and of the skin and cellular substance. In maintaining excitement, vital power is expend- ed; and the expenditure will be in proportion to the degree of excitement, for the time being. * A power or disposition to draw themselves into narrow limits. + A transparent animal fluid. 10 The application of preternatural stimuli will pro- duce more than ordinary excitement, and of course an extraordinary expenditure of vital power. The system, therefore, if long oppressed by the weight of preternatural stimuli, will necessarily sink into a state of indirect debility—a state in which there is a deficiency of vital power.* By the subduction of stimuli, excitement will be diminished, and, consequently, vital power will be , accumulated. The same effect roay be produced by the applica- tion of certain sedative agents, such as cold and fear. And whenever excitement is long reduced to a state below that which is natural, whether by the subduc- tion of stimuli, or by the application of a sedative agent, the system rises into a state of direct debility, a state in which vital flower is accumulated.^ These remarks, however, though certainly true, admit only of limited application. Although preternatural stimuli are calculated to produce extraordinary excitement, yet if applied in < a certain gradual manner, the system will acquire an habitual capacity to generate a commensurate por- tion of vital power, and by new modelling its move- ments, will assume a standing, analagous to that of natural excitement. This process is performed un- der the control of the same laws of the system by which it adapts itself to different climates, and in * A man staggering from the use of ardent spirit, or from chewing tobacco, furnishes an instance of this kind of debility. " He has been checking too heavily upon his stock in life. The same or a similar effect may be produced by a sickly atmosphere. And such is the state of things in most cases of sudden and dangerous fever—as the yellow fever, violent bilious fever of almost every grade, &c. f This is the condition of a man recently weakened by loss of blood; by the operation of a violent cathartic, or by excessive fasting. 11 every climate, to the diversity of seasons, modes of living, &c. which are found to prevail.* But when the stimulant agent is powerful, and is suddenly applied, or when applied a sufficient length of time, it may overwhelm the system with all its resources for adaptation, and raising the excite- ment too high, produce indirect debility. So, also, when there is a gradual subduction of stimuli, and the excitability is accumulated in a small degree only, the system, by its own powers of reaction, may raise its excitement, and find a natu- ral balance.f But a sudden and copious, or a fre- quently repeated subduction of stimuli, may produce a pernicious degree of direct debility. Whenever debility of either of these two descrip- tions prevails to a considerable extent, it places the system in a state liable to disease, and in this view, debility is well enough said to be the predisposing cause of fever. When vital power is sufficiently accumulated to place the system in a state liable to disease, for the sake of distinction, I will take the liberty to call it predisposition with accumulated power. And when the energies of life are sufficiently pros- trated to place the system in a state liable to disease, I shall call it predisposition with exhausted power. In abstracted speculations upon disease, we may lay down discriminations, and rigidly regard classical * By the same laws the system is saved from destruction, when men shamefully impose upon it those oppressive and poisonous stimulants, tobacco and ardent spirits. t The loss of a single meal, or of half a pound of blood, sel- dom much incommodes a man in pretty good health. 12 arrangement in all our disquisitions upon the sub- ject. But disease, in its actual assaults upon the sys- tem, is not always ushered in under the auspices of either of these predisposing circumstances, wholly abstract from the other. They are commonly blend- ed, and one or the other abounds, according to the nature of other co-operating powers, which are to be considered as remote causes of fever. Predisposition to disease, with accumulated pow- er, may be induced by too much sleep; by taking in suddenly too much nourishment, as is frequently done by eating and drinking at a feast; by taking too little exercise for the demands of the system, &c» The same or a similar state of things, may be effect- ed by the application of certain agents, which possess sedative powers. As such, I shall specially consider the passion of fear, and the negative agent cold. It is a fact well known to every man of observation, that fear, like cold, produces paleness of countenance, di- minution of strength, increased frequency of the pulse, and convulsive trembling of the muscles. But cold, more frequently than all other agents of this class, is the remote cause of predisposition to disease, with accumulated power. Predisposition with exhausted power, may be indu- ced by loss of sleep; by excessive labor; by a con- tinued habit of eating too much, or too little; or by eat- ing articles of diet too stimulant or indigestible in their nature; by violent anger; by grief; by disappoint- ed love; by intemperate indulgence in venery; by dai- ly dram drinking, or chewing or smoking tobacco; by stimulant gasses exhaled from marshes, &c; by whole regions of atmosphere, rendered more than ordina- rily stimulant, by unknown combinations; and by the agency of heat, in certain seasons and climates. 13 Cold and heat are necessarily and perpetually|oppo< 'ctl to each other. Heat, in a certain appropriate tem- perature^ the natural ally of life. Cold, on the contra- ry, is the universal companion of death. Without some degree of warmth, the vitality of the fibres can- not long be preserved. The motions essential to life, carinot be maintained without heat in a considerable degree. I feel myself at liberty, therefore, to speak of cold, in the sequel of this work, as the great enemy of human life, which is perpetually seeking for the extinction of the vital heat of every man; inasmuch as, in a comparative view of the temperature of the surrounding atmosphere, every man is daily more or less exposed to the sedative effects of this agent, Tis true, there are many days in midsummer, in which the degree of the atmosphere, approximates towards the point of blood heat. At night, however, the thermometer universally sinks, so as to fall con- siderably below that point. When the weather be- comes thus hot, the vessels on the surface are so highly excited by the heat of the day, that before the approach of night, the system is placed in a state of indirect debility.* The chilness of the night, there- fore, has an effect upon the vessels of the skin, though less in degree, yet similar to that which is produced by remaining too long in a moderately cold bath. The same influence repeated day after day, must at length bring about all the debilitating effects of cold. That sense ol heat which is fre- quently felt through the evening and early hours of a hot summer's night, affords no conclusive argu- ment against this position. If I am not misguided * As the system is prepared to generate a certain portion only of vital power, in a given time, to be equally distributed through- out all its parts, it therefore necessarily follows, that much ex- traordinary excitement on any one part, will tend to prostrate the whole. Thus, the heat of summer acts on the skin and lungs only, but the increased ^tion of the skin induces general de- bility. B i4 in my opinion upon the subject, the following consi- derations sufficiently explain the apparent difficulty. When we first rise in the morning, and with the skin uncovered, approach near to a good fire, it in- stantly produces a painful sense of heat. If we sus- tain the pain a few minutes, the excitement of the skin rises to a point at which that sensibility of heat is extinguished, and we can maintain the same dis- tance from the fire for some longer time, without in- convenience to our feelings. At length, however, the pain of heat will again become so intense, that we are compelled to take a greater distance. If the distance to which we remove, be just sufficient to relieve the pain, and is maintained firmly for a suffi- cient time, a free perspiration will ensue, and the sense of heat will again become oppressive, inso- much, that at length it will be insupportable. If we then retire almost without the reach of the heat of the fire, a sense of heat is still felt on the skin, and a profuse perspiration continues. Thus, the skin, heated by the atmosphere of a sum- mer's day, passes thiough all these changes, though in a more gradual manner; and in the evening, al- though the temperature of the atmosphere is lower, yet, in consequence of the intense action produced in the course of the clay, the excitement of the skin, through indirect debility, falls considerably below that which is natural; so that through the chilness of the evening, the absorbents of the surface are ren- dered weak, and the perspiration which continues, considerably imitates the sweat of death. In death the arterial action is weak, but as it stands associat- ed with the heart and central vessels, it is, therefore, stronger than the correspondent action of the ab- sorbents, which commence upon the surface: and as death commonly begins upon the absorbents, the 15 power by which the fluids are returned, is extin- guished before the impelling power of the artery subsides. The d)ing man, therefore, continues to sweat, until he expires. In a similar way, through indirect debility, in a hot summer's day, the absor- bents are so affected, that profuse sweating is in- duced: and through an increase of debility, con- sequent upon the chilness of the night, the same is increased. We have seen that in the morning, a moderate degree of heat produces a painful sensa- tion. In the morning the action of the vessels of the skin is weak, and therefore their sensibility to heat is increased.* So, also, after the vessels of the skin are indirectly weakened by the heat of the day, a sense of heat becomes more and more oppressive, as the debility increases, till at length the sensibility becomes so acute, that the heat of the circulating fluids brought to the surface, is painfully felt.f That * I think there is in the animal system of man. a peculiar ap- petency to heat, which physiologists have not sufficiently de- veloped. In pursuing this important subject, it will be found, that a certain degree of deficiency of heat, produces the kind of sensibility to its approach, which is here referred to. If, how- ever, the deficiency be extended to a certain further degree, it is followed by a remarkable insensibility to the impression of this agent, which is not easily corrected, but by an approach to the fire of considerable duration. Perhaps the greatest and most dangerous accumulations take place when the system becomes thus insensible to heat. •(■ This must be the true explanation of the inward heat and thirst, which attend cases of direct debility from hemorrage, or other causes. In further proof of this, in fevet of low type, when there is great deficiency of excitability, there is alway i less thirst than in cases v.heie the system has been reduced by evacuation. The insatiate thirst consequent upon loss of blood, or the operation of a violent dote of medicine, is increased by drinking cold water, because the sedative eifect of cold upon the fauces and esophagus, increases their sensibility to heat,and therefore the heat of the circulating blood and fluids of the parts is the more painfully felt. Thirst of this description is alvt ays most certainly corrected by hot and stimulant dr.nks. 16 it cannot be the heat of the surrounding-atmosphere of which we complain, is obvious, inasmuch as per- spiration is profuse, and must continually furnish water for evaporation. Besides, it appears on trial, that a man sweating under these circumstances, finds his skin cold to his own touch. The least de- gree of covering increases the distress, whilst an en- tire removal of covering affords very little relief. Evaporation on the surface, brings this very partial relief, which, in ordinary circumstances is all we are eble to find. Fanning is, therefore, grateful, as it hastens evaporation. But the moment the fan- ning is suspended, the sense of heat is increased, by the increased sensibility to heat which the fanning produces. Any degree of covering is calculated to retard an elimination of heat, and therefore becomes quite insupportable. In the midst of this inconve- nience, commonly ascribed to the heat of the sur- rounding atmosphere, an approach to the fire, for a sufficient length of time to rouse the action of the absorbent vessels up to a state of balance with that of the arteries, will correct the distress, and afford a practical argument in confirmation of the forego- ing observations. If such considerable effect can be produced by the agency of the heat of one day, and that too when the seasons regularly progress, what may we not ex- pect when the same effects are again and again re- peated, in the midst of vicissitudes of weather? And if the condition of the surface can so completely in- volve the whole mass of excitement, ought not me- dical men to pay more attention to this important membrane? It is obvious that the skin, which spreads so broad a surface open to the agency of the surrounding at- 17 mosphere, must, therefore, be equally liable also to1 come under the sedative power of cold. Destined to be the covering of the whole system, it is prepar- ed, in safety to its own existence, to undergo fre- quent alternations of increase and diminution of ex- citement. And-though at one time highly excited} at another subjected to long continued collapses of its vessels, and almost to entire privation of excite- ment, it nevertheless retains so much vitality as to escape gangrene. If, therefore, I repeat it, the heat of one summer's day can so increase the action of the vessels of the surface, as to bring the system in- to a state of indirect debility, ought we not to expect corresponding influences equally great lrom the se- dative power of cold? In fact, the one occurrence happens as frequently as the other, and both have been repeated from lime immemorial. The great advantages, however, which might have resulted in favor of medical science, from a due attention to these reciprocal vibrations of excitement, appear to have escaped the notice of those worthies who have contributed so much to the enlargement of her trea- sures. Engaged in deep researches after truth, observations upon the surface have been left for men of less ability. 1 have taken considerable pains to satisfy myself with respect to the probable proportion which the skin and cellular membrane bears to the remaining soft solids of the system. I have inquired of many respectable physicians. And I had the honor of a correspondence upon the subject, with the ever ve- nerable doctor Rush. I am, however, still left in uncertainty—Shall therefore satisfy myself, for the present, in the supposition, that the skin and cellu- lar membrane as spread over the surface, inmost 18 cases, may nearly, if not fully, amount to one fourth of the soft solids. In many fat persons it is certain- ly much greater. If, then, the sensorium continues its functions,, a$d produces such a quantity of vital power as is sufficient for the supply of the whole mass of the system, whilst at the same time, a pro- portion approximating towards one-fourth part of its destined expenditure, is suspended through the influence of cold on the surface, an accumulation of power must speedily be effected, to an amount suf- ficient to place the system in a state of predisposi- tion to disease. The weight of this consideration is much increased, by the great sensibility which is brought to the skin of most people through the warmth of their clothing, in almost every stage of life. Did mankind universally live in simple style, and from their birth put on no more than a single garment, it is probable, this membrane would as- sume an habitual power of resisting cold more effec- tually, or that the whole system would be adapted to such a state of things, in which the skin should re- quire a less portion of excitement, and of course have a less share in the formation of disease. But so long as men are raised effeminately, and the wea- ther is subject to vicissitudes of temperature, we may expect to find the skin deeply involved in eve- ry case of predisposition- The progress of the seasons may serve to regu<* late some further observations upon this subject.— During the severity of winter, most people defend themselves against cold by putting on the necessary additional clothing, and by having frequent re- course to good fires. The salubrious atmosphere of winter, supports a vigorous action, and the unifor- mity of the weather, give9 the system ample oppor- 19 tunity to avail itself of its powers for adaptation, which circumstances prove effectual to maintain a proper balance. Any momentary suspension of ex- citement, produced by the sudden application of in- tense cold, is followed by speedy reaction, inso- much that the pernicious effects of cold in the win- ter and spring seasons, are almost exclusively pro- duced in moderate weather, when the degree of cold is not sufficiently intense to compel the patient to have recourse to the fire, when the accumulation of vital power is not sufficiently sudden to induce an immediate reaction of the vessels of the surface. Intense cold, suddenly applied to any system, arm- ed with good stock of energy, produces an immedi- ate reaction, imitating the result of a stroke upon an elastic body; whereas moderate cold gradually applied, insidiously takes possession of the surface, and resists a return of excitement, until the vessels of the skin are too much debilitated for speedy re- action. During the time of this suspension, an ac- cumulation of vital power is generated in the sys- tem, which necessarily progresses towards a predis- position to disease, with accumulated power. This is the state of things in every case of fever in its simplest form; and such is most commonly the form of fever, as it occurs in the winter and spring seasons of the year. During these seasons, as above stated, health abounds. Vital power is daily gene- rated to an amount commensurate to the full de- mand of all the functions of the system. Hence it follows, that by such suspension of excitement upon the vessels of the surface, as is produced by expo- sure to cold, sometimes for one day only, an accu- mulation of excitability is induced, which subjects the system to an attack of pleurisy the succeeding night.* And this the more certainly happens, if the * If every branch of the blood vessels were, in every case, at all times armed with equal and well-poised tone, an instance of 20 exposure be immediately preceded by some great exertion, through which the energies of the system are for a short time considerably exhausted. By such exhaustion there is less power to maintain that grade of excitement on the surface, which is neces- sary for the resistance of the sedative effects of cold, and before the system can rally itself, the enemy takes possession of its outposts; and predisposition with accumulated power is induced. Here, then, we have a case, in which there is supposed to be present, a quantity of power more than sufficient for the performance of all the functions of life, whilst the vessels of the surface, perhaps nearly one-fourth of all the soft solids, are in a collapsed state, pre- inflammation would rarely occur But this is not the case. A large majority, male and female, through hereditary or accidental causes, have some one or more of their organs weaker than the rest. It therefore follows, that when fever is excited to a pow- erful height, or is a long time kept up, the weaker vessels are al- ways in danger.' If the impulse of the heart and arteries, is made with a power commensurate to the tone of the strongest vessels, the blood will inevitably be impelled into the weaker branches, with a force sufficient to expand them beyond their natural di- mensions. This expansion of the fibres, causes the pain, and the enlargement of the diameters of the capillary vessels, gives room for a misplacing of the red particles of the blood. Hence the extravasation of blood or serous fluid, which produces the cough in pleurisy. A simple fact will more fully explain the subject. Let a finger, for instance, receive a blow from a hammer,. so as to weaken its blood vessels. The artery which conveys the blood into the finger, continues its action as if no such accident had happened. The bruised vessels, not having their natural tone,, are expanded beyond their ordinary capacity. The enlargement of the vessels, which, in this case, is obvious to the sight, pro- duces the pain: and the swelling is increased at every pulsation of the artery, which is commonly said to throb. Except the caube of the weakness in the vessels only, something like this happens in every case of inflammatory fever, whether it be de- termined upon the brain, the lungs, the viscera, or muscles. The various changes which are effected upon the vessels and fluids, when the injury thus induced is cured by a resolution of the parts, do not necessarily claim my notice. 21 pared rather to resist, than to encourage a return of excitement. Ol course, by an effort for a restora- tion of a balance, the excitement of those vessels which are prepared for action, must necessarily be- come excessive. Anatomy has taught us, that the whole current of circulating blood, returning to the right auricle of the heart, is necessarily impelled into the pulmonary arteries, and returned again by the pulmonary veins to the left auricle, before it can possibly be circulated by the aorta, or great distri- buting artery, throughout the system. The surface being collapsed and languid, the pulmonary veins, probably by the laws of association, or sympathy, partake of the same languor, whilst the heart and pulmonary arteries are necessarily active, and ready to receive a determination of this accumulated power. In a few strokes of the heart, the pulmonary arte- ries so completely overwhelm the languid absorp- tion of the pulmonary veins, that an engorgement of the capillary branches necessarily ensues. By this engorgement the whole mass of excitement is retarded, and almost locked up in the lungs. Hence the chilly sensation which is felt at this stage of the disease. Whether animal heat depend upon the development of caloric* in the lungs, or whether it depend upon mechanical attrition, or whether it be the result of a chymical decomposition of the fluids, which is taking place in the glands and secretory vessels, or whether it be co-ordinate with excite- ment, and is a necessary result of the action of sti- * muli upon the fibres of the system—whether any or all of these considerations are involved in the production of animal heat, it must equally follow, that there is a deficiency of this principle in the system whenever there is a deficiency of excite- ■ Elementary heat in an abstracted form. 22 ment.* That there is a deficiency of excitement taken in the aggregate, is obvious. The skin is pale, cold, and"collapsed; the lips, and the skin around the mouth and eyes, are livid, and the pulse, though tense, is small and frequent. That there is an engorgement of the vessels of the lungs must al- so appear. There is felt a sense of fulness or tight- ness in the chest, respiration is quick and laborious, and, as before stated, the pulse is in a state which indicates it. Moreover, at the height of this strug- gle, the pain is first felt, and frequently more or less blood is expectorated. The chilly sensation, there- fore, may fairly be considered to be the effect of a positive deficiency of animal heat. The deficien- cy of heat necessarily follows a deficient quantity of excitement. And the excitement is deficient in con- sequence of a collapse of the vessels of the surface, co-operating with an engorgement of the pulmonary arteries. The convulsive shiverings are produced by a translation of vital power, from the blood vessels to the muscles. The great accumulation of excitability Which has raised this terrible storm, is now impetu- ously seeking an avenue for its expenditure. The system, defeated in its attempt to go off through the most direct and natural channel, that of ordinary ex- citement, to save itself from destruction, by an ac- cumulation of excitability, according to the princi- ples of Dr. Brown, has recourse to some other alternative. A determination is accordingly made upon the muscles, through the medium of Dr. Dar- ' win's Laws of Volition. The shivering, therefore, in- stead of being an alarming symptom, proves the * The heat which is felt on the surface of a patient, in a con- tinued or typhus state of fever] affords no argument against the truth of this conclusion. The apparent accumulation of heat, is the result of debility, in consequence of which the fluid necessa- ry for its evaporation is not supplied; which will more fully ap- pear in the sequel of this work. 23 presence of that power of adaptation, by which the : ystem avails itself of its alternative; and so far is it from being an unfriendly movement, that it is pro- bable no other, at this period, could prevent destruc- tion. Through this convulsive shivering of the muscles, there is brought about a very hasty expenditure of vital power. Any violent muscular exertion, con- tinued for a few minutes only, so exhausts this pow- er, that it becomes difficult for the system to main- tain the necessary motion of the heart and lungs:— and if the muscular struggle be continued too far, the blood vessels may be so completely disarmed of power, that they will fail to circulate the blood, and instantaneous death will be the consequence.—This is the state of things when a man, or any animal, through fear, runs himself to death. Pain, also, in a degree proportioned to its severity, expends this power; as will be more fully seen in another place. When, therefore, convulsive excitement, toge- ther with muscular shiverings and acute pain, have sufficiently exhausted the accumulation of vital pow- er, which in the predisposition seems to be concen- trated upon the heart and pulmonary arteries, the pulmonary veins are able to receive and give a free passage to the whole current of circulating blood, the chill subsides, and the hot stage of fever com- ' mences.* * The form of disease here described, is commonly called a pleurisy; but it is in reality an inflammation of the lungs. Indeed I doubt the existence of a pleurisy as an original affection. It is true, that by dissection, it is proved that the lungs sometimes ad- here to the pleura. It is most probable, nevertheless, that the lungs, when tumid by inflammation, are kept in contact with the pleura, until the adhesion iribrmed. From this view of the subject, it appears that in the chilly state of fever, in every case, the pulmona- ry vessels are in the greatest danger; as in that state, the lesion,* which produces the pain and consequent expectoration of blood, always takes place. And whether the morbid action proceed so far only as to effect a state of congestion, or whether the violence of the struggle be sufficient to rupture one or more vessels, it is the lesion exclusively, which properly constitutes an instance of inflammatory fever; for if the pain do not take place in time of the chill, it frequently happens that all the appearances of the chilly state of fever, and the consequent hot fit, pass away, without any considerable subsequent inconve- nience to the patient. It will also appear that the greater the stock of vital power present in the system, the more certain and powerful must be the chilly state of any case of fever which may occur: and in the converse, the greater the prostration of the system, the more cer- tainly such case of fever will be ushered in without a chill.f Thus we have seen, that in the simplest form of fever—that which occurs in the winter or spring seasons of the year, cold alone may be considered as the remote cause. If violent exertion be added, so as to exhaust the energies of the system, and render it less capable of resisting the sedative agency of cold, the case will be less simple in its appear- ances, more tedious in its progress, and more diffi- cult in its management: and this variation, with its concomitant circumstances, is entirely the effect of * Lesion, used by physicians:—-taken from the Latin word Icesum, to hurt,—an injury, implying more or less disorganiza- tion. f Many observations, made with much care and attention, justify me in asserting that this is a fact of great moment, in forming an estimate of the quantity of vital energy present in any given case. Uo a greater or more extensive collapse of the vessels of the surface. Having taken this brief view of fever, as it oc- curs in the most healthful seasons, I now proceed to consider its appearances when the seasons become sickly. I will first take up an ordinary intermittent; and shall consider it a fortunate occurrence, if it should be allowed, that I have discovered a key for unlock- ing the long hidden mysteries of a mode of disease, which has been thought almost or altogether unac- countable. In treating the progress and appearances of a sim- ple inflammatory fever, notice has been taken of the circumstances which occur in the chilly stage. The great doctor Rush has encouraged me to believe, that as well in medical inquiry as in religion, truth is a unit: and one of the settled rules for philosophising requires, that we should refer similar effects to simi- lar causes Am I not warranted then to believe, that an engorgement of the pulmonary artery, co-oper- ating with a collapsed state of the blood vessels on the surface, is equally the cause of the chilly state of fever in every ordinary case? That a collapsed state of the surface, is a univer- sal appearance in the commencement of fever, is confirmed, not by my observations only; it is known to every physician. Doctor Cullen has predicated his whole system of the theory and practice of phy- sic, upon the same fact. His opinions and doctrines upon the subject of spasm, are justly exceptionable. His facts, however, must be admitted; and whilst they afford conclusive evidence in my favor, they must continue to do honor to that accurate observer of nature, till disease shall cease to commit ravages upon the race of man. c 26 The primary, remote cause of this form of dis- ease, possibly, is the poisonous gas which exhales from marshes, which, in an indirect way, produces partial debility, or predisposition with exhausted power. But it is a fact, that in those regions where intermittents abound, whilst the days are commonly very warm, the nights are exceedingly cold for the season of the year. The atmosphere is daily heated by the rays of the sun, but the chilness of the wet earth, together with the exhalations proceeding from it, afford such a perfect conductor for the heat, that the sun is scarcely below the horizon before it va- nishes away. The heat of the day co-operating with the remote cause, the marsh miasma, raises the ac- tion of the system so high as to induce indirect de- bility. The vessels of the surface are therefore in- capable of maintaining a sufficient portion of excite- ment to resist the cold of the night. Each succeed- ing night more and more of the surface is brought into subjection to the sedative power of the enemy, till at length the outposts of the system are so com- pletely conquered, that though the excitement, con- sidered in the aggregate, is less than natural, yet it is confined to limits too narrow for the expenditure of the powers of the system. An accumulation of pow- er, a determination upon the lungs, and a consequent engorgement, ensues, and the appearances of a chill, as described in the foregoing disease, necessarily follow. In this case, however, no lesion takes place in the lungs. Possibly the tone of the pulmonary arte- ry may be stronger than in the former instance, but most probably the debility which has been previous- ly induced, is such, that the utmost effort of the sys- tem, is not sufficient to produce either a congestion or rupture of the vessels of the lungs. And in this particular alone, consists the difference between a paroxysmof an intermittent, and the first effort of in- flammatory fever. 27 It is true, a further difference may be marked, with reference to the remote causes of each. Cold alone produces the predisposition in the one case, leaving the system armed with the whole stock of healthful power. In the other, a debilitating agent, to a certain degree disarms the system of its powers, subjecting it to the morbid influence of cold, whilst the energies of life are too much exhausted to strug- gle with sufficient violence to produce lesion.* The periodical movements of an intermittent, still remain to be considered. If an adequate accumula- tion of power is generated by the suspension produ- ced by the cold of one night, to charge the system sufficiently for the production of a febrile storm each succeeding day, the fever will put on a quotidian form. If it require two nights for collecting the ne- cessary stock of power, the form will be that of a ter- tian. And if three nights be necessary for the pro- duction of a similar state of things, we shall have a quartan. If more than three be necessary for rais- ing the stock of power so high as to produce fever, it would seem that the accumulation of each night, is expended each succeeding day. Any other diversity, as to the severity of the at- tack; the duration of the chilly or hot stage; the dif- ficulty which may attend the cure, 8cc. must depend on the power of the primary, remote cause, and on the various temperaments of different patients. Thus it appears, that upor; principles of unity, there is no difficuiry in explaining the phenomena of the chilly state of fever, under whatsoever ordinary form it may appvar. And the same explanation will * The explanation here given of fever, as it graduates from pleu risy to intermittent, is continually exempli tied in the marshy coun- try near the sea-coast. One or the oiher of these two forms is generally prevalent, following the seasons according to the order here proposed. 28 apply as well to autumnal as to vernal intermit tents.* The same principles will apply in an explanation of every grade of remittent fever. There must be a difference, however, in the power of the remote cause by which each grade is produced. For if the degree of debility which is previously induced, were no greater in the one than the other, similar causes will produce similar effects. But as the heat of sum- mer progresses, the volume of poisonous gas is ex- tended, and its violence increased. The system in the mean time, exerts itself in its powers of adaptation, and from time to time spins out its strength, strug- gling to be able to meet the increasing mandates of the stimuli which act upon it, just as a man can com- pel his animal system to adjust itself to the pressure of a daily increased dram of ardent spirits, till, at length, through the co-operation of some additional stimulant, casually or artificially applied, or through the exhaustion consequent upon some extraordinary exercise or labor, or, finally, through some unusuaj * It is possible, indeed it is probable, that after frequent occur- rences of the paroxysm, from the cause as above stated, the ordi- nary laws of association may claim a place in maintaining those oscillatory movements of the system, which are sometimes ex- tended through man}* months, It is also possible, that a torpor of some of the viscera, according to doctor Darwin's opinion, may sometimes be the cause of an accumulation of energy, and produce, or hold a share in producing and maintaining, a similar mode of fever. The pressure made upon the large blood ves- sels, by the weight or distension of an extensive abscess, may sometimes occasion similar appearances So, also, in inflamma- tory affections of the liver, mesentery, or uterus, there is such an introversion of excitement, and such an extensive retardation of action, as always produce chilly sensations. But none of these instances furnish any sufficient objection to the mode of explana- tion which is here given. 29 change in the temperature of the weather, a collapse takes possession of the outposts of the system. The excitement retires to limits narrow in proportion to the existing debility, and the excitability of the cen- tral vessels which remain in action, is elevated suffi- ciently for the production of fever. But, because of the exhausted state of the sensorium, the effort is seldom strong enough to produce a perfect ague in the commencement; and not many distinct appear- ances of chill are observed in the succeeding exacer- bations. It would seem that the stimulant or hurtful agent, which produces the exhaustion of vital power, con- tinues to act upon the system day and night, and that, at the close of the first and every succeeding struggle or paroxysm, the predisposing circumstances of the case are becoming more and more aggravated, and that through the daily increase of exhaustion, the system is less able to impel the blood into the pul- monary vessels, with the force which is necessary to- produce the chilly state of fever. I have stated'that the hurtful, remote cause, is to be considered as con- tinuing its agency upon the system, day and night. This continual pressure, together with the ordinary stimulants which prevail more in the day than in the night, causes an increase of excitement about mid- day. As the day declines, the subduction of stimuli, and the progressive exhaustion of the energies of life, cause the action to abate. The sedative power of the temperature of the night, which* is always comparatively cold, again brings about the same train of things, which, at first, constitutes the predis- position, and again arms the system for a paroxysm of fever. In consequence of the accumulation for the night, the pleasant stimuli of the morning, produce comfortable sensations to the patient, as if he were approximating towards a balance of excitement, and for a very short space there seems to be an obvious 30 amendment. But as the day advances, the remote, hurtful agent, together with the ordinary stimuli of the day, again unite their powers, over-rule the ex- citement, and drive the sinking system through the same routine of motions, which constitutes an exa- cerbation of fever.* The difference, therefore, which obtains in an or- dinary intermittent and remittent form offevei, ap- pears to be this:—in an intermittent, the system taken in the aggregate, is partially exhausted by the remote cause, yet, through the great disparity of temperature between the day and night, in regions where intermittents abound, a state of predis- position is formed, whilst there still remains suf- cient power to produce an effort, not far in- ferior in force to that which constitutes simple inflammatory fever. In a remittent, the system tak- en in the aggregate, is much more exhausted, whilst through the lesser disparity of temperature between the day and the night, the system is able to maintain an approximation toward a balance of ex- citement, till the collapse takes a more extensive possession of the vessels on the surface. And when the moving vessels are sufficiently charged for rai- sing a fever, the system is too much exhausted to as- sume movements, as nearly imitating those which constitute a simple inflammatory fever. It may probably be asked here, if the outposts of the System, in a remittent form of fever, are more completely in possession of the enemy, how happens it, that the skin is often as hot or hotter than it is in an intermittent? I answer, that in every case where there is much prostration, the skin is so far depriv- * Exacerbation—paroxysm, are two technical terms; each of which signifies a fit of fever. u ed of excitement, that the moisture necessary for conducting off the heat which is eliminated from the system, is not supplied; and, as a bottle filled with boiling water, and kept properly dry, will retain its heat much longer than another which is continually moistened, though both are within the same tem- perature, so a fever with a dry skin, is always mark- ed with a preternatural heat. But it shall be found that although the surface is hot, the vessels of the skin and cellular membrane are collapsed, and therefore that the heat is not the result of an increase of action on the surface. Moreover, it is a fact, that by an ap- plication of cold water, by affusion, or by the means of a wet sponge, the accumulated heat may be speedily evaporated, and that it will require a length of time proportioned to the degree of exist- ing debility, before a similar accumulation will again be collected; consequently it cannot be the result of a preternatural heat at all. It is a mere retention of such portion of this principle as is necessarily eliminated so long as life can be preserved, although the quantity present in the system, taken in the ag- gregate, is less than natural. I am at liberty to as- sert,therefore, that with the exception of certain cases of simple inflammatory fever,* and those which par- ticularly concern the skin, as scarlet fever, measles, smallpox, &c the more feeble the excitement in fe- ver, until death commences, the hotter the skin will appear to be at certain intervals. * In cases attended with great depression of excitement, whether through an engorgement of the lungs, or brain, or mesentery, a state of things which occurs in the commence- ment of fever only, the'pulse is sometimes almost or altogether imperceptible, whilst the skin is quite cold and clammy. This appearance of course, for the time being, furnishes an instance of exception. Also, when the system has been worn down through an excessive action of the vessels of the skin, as m measles, &c. we would naturally expect the heat on the surface to be less than when the eruptive fever is at its height. With these exceptions, the principles above laid down, must be ad- mitted. 32 Fever, which in the commencement, may be con- sidered strictly remittent, if improperly managed or neglected, frequently degenerates into a continued form.* This change is wholly the result of increas- ing prostration. And if the remote cause be armed with sufficient power, and continue to act upon the system long enough to produce a certain degree of exhaustion, the mode of fever which takes place un- der such circumstances, will be continued from the beginning. In consequence of the great debility so gradually brought about in this case, a more exten- sive collapse of the extreme vessels takes place. The whole stock of moving power is contracted into narrower limits. The action of the vessels within those limits, is therefore perpetually more or less above par. But the great mass of collapsed ves- sels maintain a perpetual and effectual resistance against the feeble efforts of the system to recover its balance. And, in fact, this grade of fever might more properly be considered a state of great ex- haustion of vital energy, than that of febrile action at all. If the sensorium can maintain its functions, until the hurtful agent pass away, or, till by rest and ma- nagement, the necessary adaptations can be accom- plished, the patient recovers, but if the hurtful pow- er of the remote cause continue its pressure, until the sensorium is sufficiently exhausted, it necessarily terminates in death. * Is it not strange that physicians should for ages have wit- nessed the transition of disease out of one form into another, and yet doubt of its unity? And where can a physician be found who does not know that such transition can be produced by a single instance of ill-timed bloodletting, or, by the operaticn of onexathartic dose, if too severe for the condition of the patient? How then can he fail to see that the difference in the forms of fever, is the result of the difference in degree of strength, in dif- ferent seasons or different persons? *3 If the remote cause be more gradually applied, so as to give longer space, and of course more fully to exhaust the struggling powers of the system, a form of fever will ensue very similar to the foregoing, but with a more entire abandonment of the surface, assuming the shape and appearances which are commonly called typhus, which will be more or less gravid or mild, according to the power of the re- mote cause.—And if much improper evacuation be effected, there will speedily follow a subsultus ten- dinum, or a nervous twitching of the muscles.* Such is the gradation and appearances of disease, as it occurs under the influence of ordinary remote causes, throughout the course of the seasons. Some other modifications will be considered, each in its proper place. I have chosen to commence my explanations of fever, by a consideration of its appearances in the form of an ordinary pleurisy, because this is un- questionably the simplest form of disease; and be- cause, in my apprehension, it affords a key for an explanation of the chilly state of fever, in whatever season, or by whatever remote cause it may be pro- duced; and, if I mistake not, by this method an easy and natural explanation of disease, in any of its forms, is furnished. But this will more fully appear when I consider the method proper to be pursued for effecting a cure. Before I enter upon this part of my work, that I may be distinctly understood, it is necessary to give * This twitching of the muscles, will as certainly take place toward the close of a case of pleurisy, rendered fatal by ill- timed and excessive blood-letting, as in a case of typhus fevet regularly ushered in and protracted in the ordinary way. Is not this also an incontestable fact, proving the unity of diseases? 34 a brief exhibition of my view of the modus operandi, or the manner of operation of some of those medical agents which I have found to be most useful, and lay down some instructions, by which to predicate an appropriate intention in any given case. To prescribe judiciously, it is necessary, first, to fix upon some definite object which ought to be accom- plished, and then select such an article or prepara- tion of medicine, as is known most certainly and safely to produce the object proposed. For instance, it might be proper to know whether any case under consideration should be referred to the standard of predisposition with accumulated power, or the contrary. Then if the case occur in winter, or in a healthful season and region, if the patient have always enjoyed good health and vigor, and if he were suddenly affected with chill and lan- guor, with dull heavy pain in the back, and limbs, &c. there would be very little hazard in venturing upon an opinion, that such a case should be considered an instance of "predisposition with accumulated power." To judge still more accurately of the probable quantity of accumulation present, inquiry should be made respecting the temperature of the weather; the duration and circumstances of the exposure; the quantity of clothing; and the various artificial means which may have been used to counteract the influ- ence of cold. The patient's skin should be carefully inspected, in order to judge of the probable extent of the collapse which may have taken place.* And spe- * In making the investigation here proposed, I never fail to pay as much regard to the state of the veins, as they present themselves to the eye, as I do to the state of the artery, for de- termining its force, &x. In cases of obstinate collapse, the veins cannot be filled by tying on a ligature in the way it is done in or- 35 eial attention should be paid to the state of the pulse, to judge of the quantity of excitement present in the system, and of the probable degree of power, which is likely to be exerted for the restoration of a balance. In a case of this description, it is obvious, that the intention ought to be in some way, as expeditiously as possible, to restore a return of excitement to the surface, so as effectually to drive the enemy from his possessions, and then extinguish any remaining accumulation of vital power, which might be found afterwards to prevail. If the case occur in a sickly season, or in any place where some alarming fever for the time being pre- vails; if the patient have gradually declined, so as to have been lingering under a sense of weakness, for a considerable time before the symptoms became se- rious, and especially if there have been a daily dis- position to be near the fire, or within the influence of the rays of the sun, it may be safely concluded that this is a case of predisposition with exhausted power. In order to judge of the degree of debility pfesent, and of the extent of the collapse which may have taken place, all the foregoing inquiries ought to be made, and an accurate attention should be paid to the state of the pulse, that any change which may be expected, may be properly understood. In a case of this description, it must be obvious, that the first intention should be to regain possession of the outposts of the system, and in some way to hold them till the necessary strength can be reco- vered, and healthful excitement established. dinary blood letting. An accurate attention to the skm is ear- nesdy recommended. A nice observer will discover a diversity of texture and appearance incident to this membrane, infinitely surpassing ordinary apprehension on the subject. 36 If the case under consideration should have pass- ed beyond the stage of predisposition, and the fever have actually formed, some additional circumstances come into view. In every case of fever with accumulated power, we necessarily have an instance in which the quantity of excitement rises above par, and the excess above that which is ordinary will be in proportion to the existing accumulation of excitability. If such excess be great, there may be danger of a pernicious lesion, or a destructive stretching or rending of some of the vessels important to life. And the degree of this dan- ger may be known, by the tension of the artery, the difficulty of respiration, and the severity of the pain. Such tremendous instances, in which the violence of excitement overwhelms the functions of life, in which the brain or lungs are so suppressed, that the patient becomes speedily insensible of his distress, are ex- ceptions which will require the immediate aid of a skilful practitioner. In a case like this, it is obvious, that the first inten- tion of the physician should be, to reduce the power of excitement with such expedition and decision, as may be necessary to prevent threatened lesion, or if. lesion have already taken place, to prevent its further extension. The outposts of the system in the mean time, should be carefully recovered and maintained, and any degree of accumulated vital power, should be speedily extinguished. Again, if fever with exhausted energy, have actu- ally taken place, it will be found, that by the agency of the remote cause, together with the exhaustion at- tendant upon feverish excitement,the systen is every moment more and more prostrated. Of course, it must follow, that the first intention, in such a case, 37 should be to correct the feverish excitement. But this is to be done in a way having a proper reference to the nature of the predisposition. By the suppo. sition of the case, the excitement of the vessels actu- ally in motion, is more or less excessive, because of its confinement to limits too narrow for the demands of existing vital power; whilst, at the same time, the quantity of power, taken in the aggregate, is less than natural. The intention, therefore, should be, first of all, carefully to correct the collapse of the surface, so as to afford the degree of expansion to excitement necessary for the complete expenditure of existing vital power, for the time being. And any subsequent assault from the enemy must be prevent- ed, till the necessary time shall be gained, to permit the system to adjust its functions to the circumstances of the season or climate, or till it shall acquire the necessary adaptation to bear the pressure of the re- mote cause. If a man, in habits of drinking ardent spirits, or one with a fat personage, or a healthy man, immedi- ately after great fatigue, should be so exposed to cold, as to bring on a state of predisposition, though in Ahe healthful season, his case will assume a mixed shape, in some degree imitating the form of fever as it occurs in the sickly season. The enemy will be found to have taken deep possession of the outposts of the system, and reaction will be considerably languid. The fever, therefore, will assume the shape commonly called a bilious pleurisy, or some other form of bilious inflammatory fever. This fact affords another invincible argument in favor of the doctrine of unity of disease. Here the intention should be, first, to correct the collapse. This done, in most cases there will still D 38 remain some excess of excitement; this excess should be put down for the lime being, and the ne- cessary arrangements should be made to prevent any further attack from the enemy. Afterwards, still maintaining the surface, the excitement must be re- gulated Irom time to time, according to circumstan- ces. The bilious appearances in such a case, are the result of a powerful introversion of excitement, which commonly attends, producing more or less engorge- ment of the vessels of the liver, or mesentery. In such a case, the practice must necessarily be simi- lar to that which is required in common bilious fe- ver.__Not only ordinary cathartics will be requisite, but more or less repetition of such as are considera- bly drastic, will be found indispensable. A similar case may occur in the sickly season, when a man, armed with considerable vital power, comes under the influence of a sickly atmosphere, and by some excessive effort in labor, running, or riding on horseback, or by drinking ardent spirits, suddenly induces a sufficient degree of prostration to produce a fever. The fatigue, together with the power of the sickly agent, produces a sudden ex- haustion of vital power. But as the system has not long been laboring in her powers for adaptation, to adjust her movements to the sickly region, the sen- sorium is sufficiently active to produce an effort of considerable power. Hence, when the reaction or struggle for a restoration of a balance commences, appearances very similar to those which occur in a case of bilious pleurisy, frequently happen. In such a case, the intention should be similar, without re- gard to the season of the year. Whenever the ex- citement has abandoned the surface, it should be 39 made to return. Any excess of excitement should be put down. Any accumulation of excitability or vital power should be extinguished.* It sometimes happens, that in consequence of some peculiarity in the system, whether by heredi- tary or accidental causes, when a predisposition to disease is formed, a destructive determination to some one organ, or to some particular part of the sys- tem, is the result. In such a case, the intention, as it respects the general treatment, should always be the same as if no such determination had occurred. Some additional and subsequent intention, however, may be found necessary in order to perfect a cure. In a case of pleurisy, for instance: in addition to the ordinary remedies for reducing the violence of ex- citement, it is often necessary to draw a large blis- ter over the region of the pain. The intention is to raise an external irritation on the surface, suffi- cient to counteract the irritation, which is kept up by the internal injury sustained upon the vessels of the lungs. And sometimes it happens, that whilst there is a disposition in the system to determine its powers to some one weak point—there is a proportionate dis- position to abandon others. In every such case the intention should be to equalize excitement through- out all the vessels of the system. * Who that carefully considers the facts upon which this clause is predicated, can fail to perceive the strongest evidence in favor of the unity of disease? I should be ready to suspect a want of the necessary accuracy of observation m any man, who has not noticed the great similarity of appearances which occurs in these cases, though in seasons and under circumstances so dissimilar. 40 In every case of disease, so long as there is suffi- cient energy to sustain the shock necessarily atten- dant upon it, one leading intention should be, to re- move all feculent matter, as often as it accumulates sufficiently to irritate the system The skin and mouth should therefore be carefully and frequently washed; and the bowels should be aided with ap- propriate cathartics. After disease has progressed so far that the sys- tem is much enfeebled in its powers and move- ments, it frequently becomes necessary to afford the aid of some artificial stimulant. In such case, the intention should always be, to institute an artificial balance of excitement, upon a grade commensurate to the several peculiarities of the case; endeavour- ing to maintain the artificial arrangement in a state as nearly analagous to that of health, as circum- stances will admit, till, by suitable nourishment and sufficient time, real health may be recovered. Each of these various intentions should be pursued as often as the existing state of things makes it necessary and proper, without regard to the name or duration of the disease. Remedies, or medical agents, are useful and valua- ble, therefore, just so far only as they can be depend- ed upon with certainty for the accomplishment of any proper intention. I shall consider those proposed, in connexion with such practical observations as may enable the reader definitively to judge wherefore, when, and how far, each of them should be employed. 41 I shall not regularly pursue the classification com- monly observed by writers on materia medica, but introduce each article in that form and order in which it is present before my own mind. 1. Blood-letting is a remedy by which excite- ment is completely placed within the control of art.* I have considered the blood as one of the natural sti- muli upon which life depends. By loss of blood, therefore, excitement is reduced, in proportion to the quantity lost, except only in certain cases of depres- sion, in which through an engorgement of some im- portant branch of the blood-vessels, excitement is confined. In such a case, loss of blood to a certain extent, may be followed by an immediate increase of excitement. But when there is no such depression, it must universally follow, that by loss of blood, excitement for the time being, will be diminished. Therefore, when excitement runs so high, as to pro- duce lesion, or threaten to produce it, and especial- ly when, through the violence of the assault, time is not allowed for the trial of other alternatives, blood- letting should be employed. And upon the same intention it may be repeated as often as the case may require. When there is good reason to believe that the en- ergies of the .system are sufficiently active to raise a speedy and effectual reaction, then as a copious blood- letting produces great momentary suspension of ex- citement__by this suspension, excitability is accumu- lated, and the system is charged for an effort by which it finds an immediate balance, or an approxi- mation towards a balance of excitement. This is * It is a remarkable fact, that blood drawn from a patient im- mediately after the operation of my hot bath, is universally florid —m appearance just as if it had flowed from an artery. This is given as a hint for physiologists. d2 42 often effectually done in the time of the predisposi- tion, or early stages of fever.* Also, when there is a morbid generation of vital power, or when there is an obstinate inflammatory determination to some particular organ, or part of the system, it may be frequently repeated for the pur- pose of producing and maintaining a state of debili- ty, till, by time and management, the morbid action may be made to subside, and a complete balance can be established. One of three intentions, therefore, ought to direct the use of the lancet. To reduce excitement in or- derto guard against threatened lesion; indirectly to produce a new action through the accumulation of vital power; or to induce a certain degree of direct debility, in order to render the system more manage- able, that is, more susceptible of any counteracting impression which may be intended. I must not fail to add, that although a copious blood-letting taken from a large orifice, has the most effectual tendency for the moment to induce an ac- cumulation, yet it must follow, that by loss of blood, in the end, there will be a commensurate loss of vi- tal power. Whatever excitability or vital power is, it is in some way generated in the system. And if the sys- tem be robbed of its most essential nourishment, it must fail to generate this power in natural quantity. * The blood glows on the surface after such an instance of blood-letting, by the same laws which produce that effect after using the cold bath in an appropriate way. And here let me remark, that the success which frequently follows this decisive method of employing blood letting, when properly timed, has con- tributed very much toward the great popularity of this remedy. It should be remembered, however, that when the same thing is attempted upon a case which is not in an appropriate condition, the most alarming and destructive consequences frequently take place: hence this practice m unskilful hands, is, of all others, the most dangerous. 43 And, therefore, although debility induced by blood letting, comparatively speaking, is always of a direct kind, yet it would be absurd to suppose that a con- tinued accumulation of vital power would follow great and repeated losses of blood. When great losses have been sustained, such management will be re- quisite as has a tendency to replenish the loss; at the same time that artificial stimulants are used, to sup- ply the place of a natural one, so important as the blood. For although the system is truly said to be in a state of accumulated power, and therefore to need the balancing influence of an appropriate stimulant, yet opiates, ardent spirits, and the like, must not be relied on without the addition of suitable nourishment, otherwise the system will sink into a state of indirect debility, and that of the most dangerous kind. Un- der such circumstances, therefore, whether brought about by accident, or by sudden or long continued hemorrhage, wine, soup, sago, and the like, ought always to be used, at proper intervals, between the repetitions of the necessary opiate doses. 2. Puking is a remedy which reduces morbid ex- citement, and has a very strong tendency in many cases, by the storm which it raises, to balance the motions of the system. It may be used to evacuate the stomach, when, at the same time, there is good reason to suppose there is a morbid accumulation of vital power. In fact, when there is much exhaustion of vital power, emetics fail to produce their intended effect. On the contrary, they increase the debility of the intestines, and are followed by colliquative diarrhoea. In most cases where blood-letting is proper, an emetic* might immediately follow the loss of blood * Emetic medicines are such as excite vomiting. Ipecacuana, perhaps, is the best article of this class. To be given in doses from 5 to 30 grains. Mr. Finlev, representative in the lower house of congress informed me, that he had very often treated 44 with advantage. By the bleeding, there it brought about a diminution of excitement, of course an ac- cumulation of vital power. The circumstances which make blood-letting necessary, commonly forbid the use of ordinary stimulants, which might otherwise be employed for preventing any morbid accumula- tion. By the painful nausea and convulsive motion of the stomach and abdominal muscles, the desired expenditure may be frequently and safely produced.' One of three intentions, therefore, ought, in every case, to preside over the administration of an emetic. Either to shock the system, with design to overwhelm any morbid action present; to evacuate the stomach; or to extinguish any morbid degree of vital power, from time to time generated in the system. 3. Cathartic remedies* should be used with an intention to evacuate the intestines. And as there are in use various articles, of different powers, some one should be chosen, or such a combination of two or more, whose known powers may most accurately meet the intention. In robust cases, with violent morbid excitement, some drastic dose should be pre- ferred, as jalap and calomel. If any degree of en- gorgement is justly suspected to have taken place in the liver, or mesentery, a dose or two of articles still more powerful maybe profitably used; as aloes, gamboge, and calomel, combined. Afterwards, in ordinary cases, castor-oil or rheubarb, with salts, al- ternated with doses of calomel, may answer the in- tended purpose. If the case be chronic, alkalinef medicines may be combined or interspersed with other cathartic medicines. If the bowels are infla- med, or the patient much exhausted, olive oil, cold pleurisies with great success in this way; and that he had never known an emetic, given immediately after blood-letting, to fail in producing an excellent effect. * Cathartics are purging articles. f Alkaline medicines, such as salt of worm wood, salt of tar- tar, salt of amber, soda, &c. •to drawn castor oil, manna, cream of tartar, Rochelle salts, tamarinds, or magnesia, &c. ought to be pre- ferred. In cases of infants, rheubarb, with magnesia, warmed with a little essential oil of anise, or when this might be too stimulant, a little olive oil, orman- na, oran infusion of rose leaves. In the progress of fever, it is necessary to pay strict attention to the state of the bowels. Irritating mat- ter, retained in the alimentary canal, might keep up a feverish action when every other arrangement has been made favorable for a cure. 4. Diaphoretics, or sweating medicines, ought to be used when the intention is to restore excite- ment to the surface, and when the system at the same time can safely be placed under the influence of an artificial stimulant. Perspiration can be induced when the system is in two different states. In a state of direct debility through loss of blood, or through the sedative agency of cold; if not too long continued, certain gently stimulant means, especially when aided by heat,will excite the system, producing an increase of arterial action, which will ultimately extend its influence to the extremities of the capil- lary vessels.—The arterial action thus artificially raised, will necessarily for a lime transcend the action of the veins. During the continuance of this want of balance, extraordinary moisture will be exuded— that is, perspiration will be produced. Again, if the energies of the system are entire, and the organization of its vital parts is sound, by the agency of similar means, with the aid of some additional heat, a profuse sweating may be effected upon the principles laid down in the foregoing re- marks upon the influence of the heat of a summer's day upon the surface. By the power of the preter- 46 natural stimulant used for the purpose, indirect de- bility is induced. But as the heart and arteries are held under the influence of this artificial agent, the failure of power will first be perceived in the absor- bent system. A sweat induced in this way, some- times produces morbid effects; and when there is any considerable degree of fever, it is unfafe. If congestions have been previously formed, they are rendered more extensive and obstinate; and in many instances incurable. It is frequently thought the patient is injured by subsequent cold. But, in truth, the intended remedy, in almost every instance, is properly chargeable with the mischief. The ex- haustion of vital power, through the stimulant agen- cy of the means employed, and the loss of circulat- ing fluid, through the profuse perspiration which is induced, may co-operate, so as to prostrate the sys- tem as low as an excessive loss of blood would have done, leaving the system in a state of predisposition with exhausted power. Diaphoretic medicines," therefore, ought to be used with circumspection, when the intention is to raise excitement on the one hand, and deplete the fluids of the system on the other, so as to institute and establish a new ac- tion. If this intention be judiciously managed in the forming stage of disease, it is frequently effec- tual in correcting the morbid action at once. Very great accuracy of judgment, however, is necessary to guard against mistake. And, therefore, heavy sweats ought never to be given in this way, except by the hand of experience. 5. Antimonial preparations* have commonly been considered as important diaphoretic agents. * Antimonial wine, tartar emetic, are the two most commonly in use. 47 For many years I have not used them with any such intention. In my opinion they are valuable, chiefly on account of their efficacy in extinguishing the vital power of the system. Hence it is, that they are always most useful in those cases of fever which are marked with sufficient energy. For the same reason they are always pernicious when there is great prostration; and, instead of inducing any thing like a diaphoresis, they are followed by colliquative diarrhoea. Whenever they produce diaphoretic effects, it is done in the following manner :—The sudden extinction of vital power on the stomach pro- duces general debility; the action of the absorbents on the surface first begin to languish; the arterial action therefore overruns that of the veins, produ- cing diaphoresis. 6. Mercury is become a very fashionable medi- cine. In the form of calomel, it is a valuable cathar- tic, when the intention is to evacuate the bowels and at the same time produce an increased discharge of bile—an effect which, in ordinary cases, so uniformly attends the use of this article, that it might almost claim the dignity of a specific. But it so imperiously extinguishes vital power, that in every case of great prostration it is utterly inadmissi- ble- In that grade of fever in which the energies of life are exhausted down to the state of typhus, a single dose of this agent has. in many instances, pro- duced an unconquerable colliquative diarrhoea. When there is a disposition in the system to direct a morbid determination upon the liver or mesentery, well regulated repetitions of calomel will be found highly important. By procuring an extinction of energy on those parts, for a sufficient length of time, aiding the intention by blood-letting, and other ca- 4S thartic doses, when necessary, such morbid determi- nation is most effectually corrected* And this will.ther more certainly be done when the repetitions are made once every sixth hour, which is about the pe- riod during which calomel maintains its stimulant power. All cathartic and emetic agents extinguish excitability. Those most drastic and violent, proba- bly possess this extinguishing posver in the greatest degree. In cases of bilious pleurisy, and ordinary bilious fever, in which there is need of disarming the sys- tern of that portion of power which is exerted in maintaining a morbid determination upon the liver and other viscera, large doses of calomel, daily repeat- ed, have often .been found highly important, if not in- dispensable. In these cases, also, if an appropriate dose were repeated once every sixth hour, the in- tention would be more speedily and effectually ac- complished. The same mode of administering this remedy would also be found most effectual in that form of located disease which is commonly called bilious colic.—And here it should be remembered, that aged persons, and such as are prematurely worn out by imtemperance, as well as all those who are prostrated by disease, have too little vital energy re- maining to bear the exhausting powers of large doses of calomel. For want of this precaution life might be lostby a single dose. 7. A salivation produced by the use of mer- cury, is deemed an important remedy in the cure of disease in some of its forms, especially those which affect the glands of the system. The mode of its operation in thi> respect, may therefore deserve re- mark.—When the system is permanently placed under the power of this agent, its first effects upon 49 the blood-vessels are obviously inflammatory, inso- much, that in many cases the intention would be defeated if the inflammatory appearances were not put down by blood-letting. It would seem that it in- duces a peculiar disease upon the blood-vessels, which probably acts wi^h equal power upon every branch of the arterial system, beginning at the cen- tre and progressing towards the surface, compelling the action to assume an equable determination upon every part of the system. FromAhis mode of oper- ation, results that astonishing power which mercury sometimes displays in breaking a morbid deter- mination of excitement. It would seem, also, that the irritation which is first excited in the arte- ry, continues to progress, till, by the ordinary com- munication, it passes over to the vein and produces an increased action in the secretory vessels. And this effeet, in order of time, takes place after the arterial action has in some degree subsided, so that the arterial action is diminished, at the same time that the action of the absorbents is increased. And in this state ot things, the deobstruent* effects of mercury, probably are accomplished. The saliva- ry glands, as well as the whole mass of glandular vessels, are equally roused into increased action; but as the secretion which is accomplished by those glands, is destined for the lubrication of the mouth, this obvious circumstance, I think has induced a belief that mercury is armed with a specific power of producing salivation. If this view of the subject be correct, then it will follow, that some appearance of salivation is neces- sary to prove that the glandular system is suffi- ciently roused to meet the intention; and that the * De"bsb' that an external application of an appropriate portion will afford the most natural aid in this situation. h> proof of this, it is always agrt?able to the patient. Having tried the experiment an hundred limes over, without meeting with one exception, I assert, that in every case of fever with exhausted energy, and in all cases of direct debility, artificial heat, in an appropriate degree, brings pleasurable sensation to the patient, and may be so managed as to produce cordial effects. In all cases of debility, whether directly or indirectly induced, there is a prevailing inclination to an introversion of excitement. Heat applied to the skin, most effectually counteracts this tendency, and promotes a centrifugal determination. When the surface is abandoned through want of excitement, the skin collapses, and seems to lose its natural elasticity. Heat artificially applied, cor- rects this inconvenience. In some instances it may seem at the first to produce a transient effect only; but by careful and well timed repetitions, it will at length become durable. The system artificially re- plenished with this principle, is presently enabled to generate a more competent supply for itself. But as an excessive portion of wine, or any other cordial, stimulates too much, and induces a morbid degree of indirect debility; so also an excessive application of heat, will produce similar effects. In all such cases, therefore, special regard should be had to the feelings of the patient. There are some remarkable and important advan- tages attending the use of this cordial, which no other can possibly claim. In every case, where pro- perly used, it produces a full effect, without impos- ing any improper stress upon the central vessels. So that in securing the most pleasant diffusion of excitement, it offers no injury to any of the organs of life; ordinary cordials, on the contrary, are de- pendant upon the struggle which they may excite 57 in the heart and central vessels, for any and every centrifugal tflVct wmch they may produce. Again, at the same time that heat, by its stimu- lant power, invites excitement to the surface, it sof- tens and expands the skin, in a way preparatory to receive the returning blood. Ordinary cordials must accomplish the effect, by compelling the feeble sys- tem, if indeed it can be done, to assume an action sufficient not only to resume all those branches which it had abandoned because it was not able to maintain them, but also to overcome all the resist- ance of an almost lifeless collapse of the vessels on the surface, possibly one-fourth part of the system. It is true, that heretofore insuperable difficulties attended the use of this agent in many cases. But, by the aid of my portable apparatus, every difficulty is now perfectly corrected, and the application of heat can be made with such precision, as fitly to meet the most accurate intention. I have said, that " in maintaining excitement, vi- tal power is expended"—and, of course, that " ex- traordinary excitement must produce a preternatu= ral extinction of vital power." In any case of pre- disposition with accumulated power, therefore, it must be a very important acquisition to have a re- medy at hand, by which such expenditure can be speedily and safely accomplished. Heat is this agent. By raising an intense degree of excitement on the surface, every necessary effect can be pro- duced with the utmost safety. This is sufficiently evinced by the foregoing remarks upon the influence of heat in a summer's day. I have said that pain also has a considerable effect in expending vital power. By exciting as much heat on the surface as can be borne, the pain, to- gether with the concomitant increase of excite- ment in the vessels of the skin, will certainly and safely correct most instances of predisposition with 58 accumulated power. The skin is not easily injured in this way, and the strong determination to the surface, which is secured by this method, most ef- fectually guards the system after the process is end- ed. Other powerful remedies when once administer- ed, are gone beyond the reach of control, and must have their full effect, whether judiciously or inju- diciously administered. But if too much heat has been employed, it is perfectly within our reach to check its influence, by an immediate application of cold. Besides, if it should be found that the blood- vessels are too much excited, blood-letting will safe- ly correct this effect. Again, in cases of gout, rheumatism, spasm, co- lic, &c. when there is a morbid determination or lo- cation of excitement, heat affords a safe agent by which to correct the determination of power, and maintain a sufficient degree of excitement on the surface, till the system can recover a balance. After debility has long prevailed in the system, by whatever cause it may have been induced, the collapse of the vessels of the surface becomes so obstinately fixed, that in many cases, no agent here- tofore known, has proved sufficiently powerful to ef. feet its correction. In obstinate,bowel complaints, for instance, the skin is universally dry and hard, as if its vessels, which in their natural state must ne- cessarily be tubular, had shrivelled and become im- pervious. The skin, therefore, loses its elastic feel—becomes habitually and obstinately pale, and through its privation of circulating blood, is disarm- ed of its power to resist the cold. Heat promises much in such a case. When things have remained a long time in this condition, another additional mischief is done. As the system, in its astonishing powers for adaptation, can effect the return of the whole stream of arterial b9 blood, sent into an amputated limb, though robbed of all its ramifications below the point of amputa- tion; as it can enlarge the lesser branches of the artery, when, by the operation for an aneurism, one of its principal trunks is divided, and a part of it re- moved; so also the arterial blood, destined for the support of the surface, will ultimately find a return by a shorter passage, and the skin will be left never to be recovered, but by some extraordinary agent. Heat must unquestionably afford the best aid for the correction of this untoward condition of things. It may perhaps be feared, that a frequent use of heat, the only remedy upon which any rational cal- culation for a correction of this error can be made, may induce debility. My experience warrants the assertion, that the contrary is true. An excessive perspiration induced in this way, as well as in any other, might have this effect, but an appropriate ap- plication always invigorates, increasing hilarity. The bath produces no loss of vital fluid, and there- fore any moderate degree of debility is quickly re- covered. A pleasant expansion is given to the vessels of the surface, and by heat they are stimulated into increased action. The circulating blood is invited from the centre to the skin. The intestines, therefore, by being partially deprived of excitement, are, for a time, relaxed'—But when the bathing is ended the blood returns to its natural equilibrium, without any subsequent inconvenience. It should be remembered, however, that when there is an extensive congestion, the vessels invol- ved in the centre of such an almost lifeless mass, must be very partially supplied with excitement. A suspension, or a great diminution of action, therefore, whether produced by blood-letting or by abstraction, might induce a speedy gangrene. 60 When no better arrangements are provided, the bath may be administered to the patient byf support- ing the bed clothes with a staff or two of suitable length, or with a temporary frame, madot*o half hoops of a flour barrel, and a few laths, three or four feet long; taking care to spreala sheet^of paper over the frame, so as to detend the sheets from the severity of the heat at the mouth of the tube It is necessary to be circumspect during the process, to prevent the paper, or any part of the covering, . from falling in, so as to stop the free passage of the heat. Without this precaution, the condensation would become sufficiently great to scorch and injure 1 ^The most convenient and effectual method is, to have a substantial frame, so covered with plank as to supercede the necessity of using the paper, after the following form: _ , ,. Half a circle of twenty or twenty four inches di- ameter, made of oak, or some other strong plank, , inch thick—for explanation, say one halt oi the rim of a wheel. If one inch by one inch and a halt, it will be strong enough. This will make the end ot the frame, which is to stride across the body ot the patient a little above the waist. A half circular plank of fifteen or eighteen inches diameter, will make the foot end of the frame. A thm plank, say three eighths of an inch thick, three feet and a halt or four feet long, and nine inches wide, should cover the frame on its uppermost side, and a lath or two , of similar length, should secure each of its sides. A hole three and a half inches in diameter, should be made in the middle of the foot-piece for the in- troduction of the tube. With this as a model, eve- ry man may exercise his own ingenuity, and vary his frame so as to suit any particular case. The patient should be stripped of all clothing, except his linen, which, after the bath goes into 61 operation, he may draw up to his chin. The frame is to be laid over him in bed, and a sufficient weight of bed-clothes should be used so as lo confine the heat properly. A sheet, and three or four blankets, or other covering to that amount, is about the pro- per quantity for the winter season; a blanket less will serve for the summer. By this arrangement the bath is most conveniently administered. It is applied at the feet of the patient, which is most proper in all ordinary cases, and the gas has a free opportunity to diffuse itself all round the body of the patient. The weight of the bed-clothes being properly sustained by the frame, he can turn him- self over at pleasure, which will give him the ad- vantage of warming first one side and then the other, as it may be most agreeable to his feelings. For grown patients, I commonly use the largest cup, and very often the largest and the least both at once. Complaints should always be met at their first appearances, before the energies of the patient are exhausted by disease. In the commencement of sickness, the bath may always be used with de- cision. It may be very hot, so as to produce a pro- fuse sweating. But it is not necessary to continue the application longer than is sufficient to produce a complete state of perspiration. It should be re- membered, however, that in cases of very robust patients, it is commonly safest lo take some blood before the bath is applied. It sometimes happens in recent cases of pain in the breast or bowels, in which the propriety of blood-letting may be doubtful, that the bath produces partial sweating and temporary ease, but presently the perspiration suddenly dries up, and the pain in- creases. This circumstance will at once determine the necessity of blood letting, which, in such an in- stance, will be found more effectual after the bath r than it would have been if performed prior to its application. In some instances, also, when the bath is ad- ministered to patients inclined to be feverish, when blood-letting has not been premised, and especially when too small a cup has been used, or the bath continued a little too long, an uncomfortable rest- lessness is felt. This circumstance, as well as a head- ache, if they continue any length of time after the bath, should be relieved by an appropriate loss of blood; also, some agreeable cathartic dose should be immediately taken. In cases where it maybe used with great decision, it commonly produces some throbbing of the head. When this appearance is considerable, the process may be discoutinued, and if blood-letting is not ne- cessary, the throbbing will quickly subside, leaving no inconvenience to the patient. In delicate cases, however, it ought not to be pushed up to this pitch; the fire should be lighted up and extinguished, al- ternately, as it may be found agreeable to the patient. When the bath is to be a long time continued, as in cases of feeble and very old persons, the smallest cup ought to be used. And in most instances it ought to be repeated once every sixth hour, some- times once every third hour. Meanwhile, the pa- tient should be supported by nourishment and cor- dials. Sometimes it may be beneficial to move the appa- ratus from the feet to the side of the patient, and so on alternately, as the judgment of the practitioner will quickly discover. In cases of long standing debility, it sometimes happens that the bath is scarcely put into operation, before the patient feels distressing sickness, threat- ening danger of fainting. When this happens, let the fire be extinguished, and give the patient a glass of wine and water, and when sufficiently refreshed, 05 rekindle the bath. After a day or two, more intense heat and greater duration of its application will be borne with less anxiety. In such delicate cases it fre- quently is necessary to use laudanum, as well as the wine and water. Say ten, fifteen, twenty, or thirty drops, to be given at the close of the process. The durable, stimulant power of the opium, prevents that collapse of the surface, which ought carefully lo be opposed in every case. By well timed repeti- tions of this course, vigor will be regained, and health recovered. In almost every serious case of any standing, it is necessary, after the bath, to use jugs, or bottles, filled with boiling water, or hot bricks, to aid the feeble excitement of the surface, that it may retain the advantages gained by the bath. It is worthy of remark, that there is no danger of taking cold, especially in recent cases. The gas which is used, is as much freed from moisture as at- mospheric air, insomuch, that it will dry a damp sheet. Besides, in all the instances in which it has been used, I have not known one, by which the pa- tient found any ill effect in that way. Indeed, if such a thing should happen, another application, and a little care, would perfectly correct every inconve- nience. 64 PART II. HAVING taken a view of such medical agents as more particularly concern my work, I now proceed to give some additional practical observations, in a review of the same grades which are laid down in the foregoing explanations. And first, inflammatory fever is ushered in by a predisposition with accumulated power. It occurs in the healthful season. And cold alone, or cold combined with fatigue, may almost exclusively be considered as the remote cause. In this, and indeed in every case, it must be the most desirable object to avoid the predisposition. For this end, it is necessary to guard against too much exposure to the weather, especially if damp and moderately cold. But if such expo- sure is inevitable, the system should be supported by a comfortable meal. And for a day or two, ci- der, wine, and ardent spirits, should not be used, ex- cept by such as are in daily habits of using them;* and at night, before going to rest, special care should be taken to secure an effectual warmth at the fire. If, however, ordinary measures fail to produce a glowing excitement on the surface, or if an unusual length of time is required to become warm in bed, on a nice inspection it shall be found that a collapse of the skin has already taken place. The roots of the hairs will be elevated in a way resem- bling the skin of a goose plucked of its feathers and a ligature tied on the arm, as in ordinary blood-let- ting, will not distend the veins. These appearances universally indicate a forming predisposition. If a stretching, yawning, and chilness, with a dull or heavy aching in the loins and limbs attend, the * A very pernicious habit this, which ought to be abandoned. 65 predisposition may be considered to be complete, and without the interference of art, a fever may be confidently expected. To correct this state of things, let the patient re- tire to bed, and receive an intensely hot bath. The pain of heat, and the increase of excitement upon the surface/, in most instances, will sufficiently extinguish the accumulation of vital power to restore a balance. It sometimes happens, however, in making this ap- plication, that although a favorable determination is given, to the excitement, yet, in consequence of the great accumulation of power, too much stress is im- posed upon some one weak point. In most instances, the brain,through the delicacy of its organization, is first sensible of this kind of increased action. If, therefore, the bathing produce considerable head- ache, whether a perspiration is readily induced or not, blood-letting ought to be performed without de- lay.* And at the close of the process, some suitable cathartic should be administered, as jalap and cal- omel in robust cases, or calomel, in-a moderate por- tion, followed by some agreeable cathartic dose, in cases which are more delicate.f Sometimes too, when the accumulation is very ,great, a single course of treatment is not sufficient completely to remove the predisposition—when this is the case, more or less of the symptoms stated above, will still be felt the next one or two succeeding days, and will mark the necessity of continuing the prac- tice with more or less decision and repetition, as the case may require. * It is commonly prudent, in robust cases, to let blood about the time the bath is fairly getting into operation . f In robust cases, say calomel, 10 grs. jalap,15 to 30 grs.—In delicate cases, calomel, 4 to 10 grs. and oil, or some other suit- able article, three hours afterwards. T % 66 These instructions respecting the correction ot the predisposition, are the more important, because it is within the reach of the most ordinary capacity to un- derstand-and execute all that is necessary, for pre- venting an attack of simple inflammatory fever. Whereas, after the fever is formed, it may sometimes Tequire the most accurate judgment to manage the patient in safety. To the people at large, the supe- rio rimportanceof my system will be evident, chiefly in this, and this chiefly concerns the public Who, in his senses, will suffer a painful course of sickness to come upon him when it may so pleasantly and cer- tainly be prevented. OF PLEURISY. If, however, through neglect or accident, the fe- ver should be formed, the symptoms heretofore de- scribed, as marking the state of predisposition, will be more evident. The chilness will increase, and be attended with a pain in the back and limbs, and with difficult and" quick respiration, thirst, &c; and if these appearances are not immediately corrected, a pungent pain commonly will strike the breast. At this stage of fever, blood letting is a practice perfectly philosophic, and ought to be repeated as of- ten as the pain returns. In performing this practice, however, if the veins do not fill on tying on the liga- ture, the patient should first be placed in bed, and the bath put into operation. When the veins begin to fill, blood may be let, until the pain abates, and the bathing may be continued until a free perspiration is induced. Some suitable cathartic, as in the pre- disposition,may be administered, and ihe patient may take half an ounce of cooling solution once every third hour.* Early the next morning, the bath may * As a cooling solution, take salt petre, 40 to 60 grains; cream of tartar, 60 to 90 grains; tartar emetic, 3 to 6 grains, water o»e pint: a table-s-poon full is the ordinary dose. 67 be again put into operation, and the cooling solutioi. maybe continued. And as often as the fever rises and the pain returns, the same treatment may be re- peated, with some diminution in extent and severity, according to the abatement of the disease. Where this mode of practice is judiciously employed, the most satisfactory result will rapidly take place. I have frequently cured a forming pleurisy by a sin- gle course, that is, in twenty-four hours. In applying the bath in any recent case, and es- pecially in cases of pleurisy, and other forms of in- flammatory fever, I use two cups. The largest and the least. The largest is kept continually burning, and the least is introduced and removed alternately, according to the degree of intensity and continuance of the heat which the patient can conveniently bear. This method secures greater decision in the cure; perspiration is more speedily and safely induced; and the centrifugal determination is more permanent af- ter the process is ended. The more violent the attack, and the greater the pain, the more speedy and intense should be the ap- plication of the bath; and the cure will be the more speedy and decisive. There is much more danger in a temperate than in a violent hot bath. In deci- sion, therefore, nothing is to be feared. By blood letting, febrile action is subdued for the time being. By pain of heat, and increase of excite- ment on the surface, the system is safely and plea- santly disarmed of its accumulated power. By the operation of a cathartic, and the subsequent use of the cooling solution, the heart and central vessels, are continually disarmed of any rising excess of vi- tal power; and by maintaining a balance of excite- ment from the commencement of the cure, the ne- cessity of blistering is avoided. It the disease is not obviously corrected by this method, in two or three days, it may be* concluded 68 with certainty that the case is really bad; that the lungs are much injured; and that severe blistering and''accurate management are necessary. In this event, the blister which may be applied, should be made to abstract from the internal irritation, to an extent commensurate with the severity of the dis- ease; if a grown person, say eight by ten, or ten by twelve inches square. And whether the case should assume such serious appearances or not, the same course of treatment should be continued, taking care, from time to time, to adjust the quantity of blood to be lost, and the ex- tent and severity of the bath, to the strength of the patient. The ordinary practice in this grade of disease is, to let blood without taking an adequate measure to disarm the system of its accumulated power. It fol- lows, therefore, that after a little, she rallies herself, and a second or third, sometimes a fourth bleeding, is found necessary in the course of the first twenty- four hours. The cause which makes such repetition necessary, is obvious. Almost an entire dependence is placed upon the loss of blood, for performing two intentions, each of which necessarily implies an op- posite principle: the one, that of putting down the morbid excitement; and the other, that of disarm- ing the system of its accumulated power. As if the principle, " that by a subduction of stimuli, vital pow- er or excitability is accumulated," were entirely for- gotten. A fortunate circumstance, however, has saved the lives of thousands, who otherwise must have perished, through the destructive tendency of such absurd practice. A blistering point is discovered! Happy discovery. Let me inquire, therefore, what it is that constitutes the blistering point? 69 By the loss of blood, as often as the energies of the system are sufficiently rallied to produce a pa- roxysm of fever, the action of the healthful vessels is reduced, so that, for the time, the power with which they propel the blood into the weakened branches, is not sufficient to increase the disease. The injured vessels, therefore, have an opportunity given them to be at ease, and appearances seem very flattering. After four or five days, and sooner if the blood-letting be too much extended, those happy effects, which at first accompany the loss of blood, are no longer pro- duced- For the moment it may reduce the action, but, presently, every ill appearance recurs; the pulse contracts its diameter, and becomes more frequent; the tongue become dry; the skin sallow; the extre- mities hard, dry, and hot; thirst increases; expecto- riation is more scant and difficult; and the patient grows more and more restless. To me the cause of all these distressing appearances is plain. A state of things similar to the predisposition, is artificially induced. By every repetition of blood-letting, the action of the system is reduced more and more be- low par, till at length a collapse takes place to such an extent, that nothing short of an application to the skin, of sufficient power to produce and maintain a very considerable centrifugal determination, can pos- sibly save the patient. When this stage of things is obviously threatened, the practitioner has arrived at the blistering point. A point at which he ought ne- ver to arrive if he can possibly avoid it; inasmuch as it universally implies a loss of the balance of excite- ment. Not that I would be understood to say, blis- ters are useless, and may be wholly laid aside; but they should be wholly confined to an intention, either to correctt a very obstinate morbid determination, or to abstract from great irritation. And if the system be properly managed from the commencement, the blistering point wiil not be found necessary, except only for one of those two purposes. 70 Management, similar to that above advised for the cure of pleurisy, with some additional considerations, will be proper in every form of inflammatory fever. When I say similar management, 1 mean to be un- derstood, to advise consistently with the great fun- damental principle, "the unity of disease." And time and practice will establish its truth. I know how many difficulties I have to encounter on account of opposing prejudice. Many want to see a definite account given of every mode of disease, each with a separate and appropriate name. They are delighted with the exhibition of a farrago of re- medies, the mere recollection of whose names would make a pack horse of one's memory. Let my sys- tem be fairly and properly tried, and I believe this error will be corrected. With a little variation in extent and severity, and with some reference to the seat of the pain, it may be repeated,—similar ma- nagement will succeed in every possible mode of re- cent disease. INFLAMMATION OF THE BRAIN. Phrenitis, or inflammation of the brain,is inflam- matory fever, in which the morbid determination of excitement is turned upon the head. The peculiar symptoms attending it, are [a violent pain of that part; an inability to bear light or noise; great rest- lessness; and commonly a small, tense pulse, though sometimes the pulse is full and strong. In other re- spects the appearances are the same as those above described. I might add, however, that it is frequent- ly attended with very obstinate costiveness, as if the sensorium had forgotten the intestines, and neglect- ed to furnish them any portion of excitability. For in some cases, the most violent cathartic medicines are used in vain. In this case, blood should be let freely, and as of- 71 ten as the violence of the symptoms make it neces- sary. * Measures should be taken for maintaining the surface, as in pleurisy, observing to defend the head with cold applications, as frequently and as exten- sively as it may be found agreeable to the patient, es- pecially during every application of the bath. Dras- tic cathartics should be daily administered. And in cases of great violence, the intestines should be con- tinually under their influence for two or more days.* The feet of the patient should be kept carefully warm, and if the pain be obstinate, a large blister should be drawn upon the back of the neck. Light should be excluded, and silence constantly observed. As in pleurisy, so also in this mode of fever; if the veins do not fill on tying on the ligature, let the bath be applied before any very decisive blood-letting is performed. INFLAMMATION" OF THE LIVER. Hepatitis, that is, an inflammation of the liver, may be known by a dull pain in the right side, under the short ribs, extending into the right shoulder; some- times affecting both sides, and felt in both shoulders, with great costiveness and dejection of spirits. Other appearances are such as attend simple inflammatory fever, except that the pulse is commonly less tense, and the appearances generally less violent. In this case the treatment will also be similar.— Bathe and bleed. But the blood letting will not be as frequently necessary. The same kind of drastic pills noticed in the preceding clause, will be highly useful, to be daily administered, as long as the vio- lence or obstinancy of the pain makes it necessary; * Aloes, 60 grains, gamboge, 20 grains, calomel, 20 grains. The whole may make 24 pills; 3 to 6 may be given once in 6 hours, according to the violence of the case. To be followed by a dose of oil, or some gentle cathartic, when discontinued^ 72 and a large blister should be applied over the region of the pain. At the close of a case of this sort, it is frequently useful to continue the bath twice or three times a week after the patient seems to be on the recovery; to be applied at night. The follow- ing morning, as much mercurial ointment as would be equal in bulk to an ordinary chesnut, may be rubbed upon the right side. In making this appli- cation, the patient should sit near to a good fire, and the friction should be pretty intense. After the operation, he should retire to bed; and rest till he is quite refreshed. This practice should be repeated every week, till all pain and soreness is removed out of the region of the liver. INFLAMMATION OF THE STOMACH, &C. In gastritis, or inflammation of the stomach, as also in enteritis, or inflammation of the bowels, the superior value of the hot bath will always be evinced. In these cases, the stomach commonly rejects every kind of medicine, whilst an alarming abandonment of the surface, and a corresponding violent introver- sion of excitement, are threatening speedy destruc- tion. That affection commonly called bilious colic, may properly be introduced here, as an instance of inflammation of the lower intestines, requiring simi- lar management. By the application of intense heat to the surface, together with a repetition of blood-letting, as often as the pain makes it necessa- ry, aiding the intention with appropriate doses of calomel, repeated every sixth hour, with mild in- jections at the close of each period, the cure will commonly be effected in a short time. If it should be protracted, however, and especially if the vomit- ing or pain should be obstinate, a large blister should be applied over the region of the stomach or ab- domen. 73 These reflections upon inflammatory fever, are predicated upon the supposition, that they occur as the primary affection, and, of course, as having been induced through a predisposition with accumulated power But it sometimes happens that similar ap- pearances take place, as symptoms of fever in differ- ent seasons of the year, whether ushered in with predisposition with exhausted or accumulated flow- er. It is therefore necessary, in every instance, to mark well the quantity of energy which may be present in the system, and to adjust the treatment accordingly. If the quantity of vital power be near. ly or quite entire, the treatment should always be decisive. If there be some degree of prostration, the management must be more delicate, as pros- tration is extended.* INTERBI1TTING FEVER. Intermitting fever probably has for its primary remote cause, marsh miasmata, which partially disarm the system. The disparity of temperature between the nights and the days; maybe a secondary remote cause, hastening the production of an accu- mulation of vital power Probably, vernal intermit- tents occur in some regions under the same cir- cumstances which produce violent pleurisies in others —So that, whatever other considerations might be associated with our views of an intermit- tent, cold has the most considerable agency in its production. * By using the necessary vigilance in blood-letting and other evacuations, it may be known whether the system generates vital power in ordinary quantity. Speedy and sprightly reaction after depletion, always indicates a goodly stock of vital power.— Depletion, followed by a languid pulsation, a collapsed surface, and emptiness of the veins, always evinces an exhausted state of the sensorium. a 7i< To prevent the formation of a predisposition to ague, therefore, good fires should be kept up every night throughout the whole year. The poor Afri- cans upon our southern rivers, reap the benefit of this precaution, whilst their masters suffer all the pains of annual intermittents.* If, however, such simple means fail to prevent the formation of the predisposition, the patient com- ing under its influence, will have an inclination to yawn and stretch; he will experience some aching in his back and limbs; his nails will put on a livid hue; and his skin and veins will exhibit appearances sufficiently indicative of that collapse which always attends the forming state of fever. He should then be immediately put lo bed, and receive a bath of sufficient extent to correct all these appearances. And this should be daily repeated, till such appear- ances cease to return. If, however, any of the pain- ful symptoms increase upon the use of the bath, the patient should be bled, and take a dose of jalap and calomel, or calomel alone; and after the opera- tion is over, the bath should again be used, and re- peated as often as the case may require. When no sufficient defence is made for the cor- rection of the predisposition, and the fever is actu- ally formed, the time of its accession should be an- ticipated by the use of the bath, an hour or two be- fore the commencement of the ague, to be managed as above advised. In this form of fever, there is a daily production of the predisposing circumstances; and, therefore, a proper use of the bath in the time of the intermission, will have an effect similar to an effort to prevent an attack in the first instance of predisposition. * Some masters escape, not by the kindly influence of culina- ry fire, but through the deadly agency of ardent spirits. The effect for the moment is similar. But oh! their end! their dread- ful end! 75 To correct the chilly state, when actually com- menced, the bath should be put into operation; and so soon as the surface is sufficiently heated to gain the advantage which may be derived to the pulmo- nary veins through the laws of association, blood may be drawn from the arm.* By a diminution of the volume of blood returning to the heart, together with the sudden debility which this practice brings to the heart itself, the impulse of blood into the pul- monary artery is diminished, at the same time that the action of the pulmonary vein is increased. A free circulation through the lungs is produced, and the chill immediately passes away. If the bath and cathartic medicines fail, wine and bark,* in the usual way, may be used in time of the intermission, which, under such circumstances, will almost universally succeed. REMITTENT FEVER. Remittent fever perhaps occupies an interme- diate grade, between simple inflammatory and con- tinued fever. The predisposition is induced by the heat and poisonous gasses prevalent in the sum- mer. These, as remote agents, cause debility. Cold induces a collapse on the surface—and that ac- cumulation of power is thrown upon the central ves- * It is not necessary to let blood in every case of ague. And if no painful symptom is produced by the operation of the bath, the blood-letting maybe omitted f Perhaps the following is the best general method of taking this article:—bark, 1 ounce; cream of tartar, 1 ounce; powdered cloves, 1 dram and a half, ground together, and divided into eight doses. Four doses a day, to be taken in time of the inter- mission. If the fever should continue obstinate after the bath and bark, as advised, I should draw a large blister, repeat the bath, and advise the daily use of good fires. If the liver seem to be involved, I should use calomel and mercurial ointment, as advised under the head of hepatics, or inliammation of the liver. 76 sels, by which the storm of fever is raised. The more sudden it is brought about, and the more ro- bust the patient, the nearer the appearances will be assimilated to simple inflammatory fever, and the contrary. The predisposition to this grade of fever, may be prevented by avoiding all excess of labor, diet, loss of sleep, &c, and by warming at the fire every morn- ing and evening. After the predisposition is form- ed, or the fever has actually commenced, the same principles and precautions are to be observed which Jhave been stated above—remembering only, that as there is greater prostration, less depletion can be safely borne than in inflammatory fever. And that the degree of decision should be regulated by the violence of the symptoms in every case. For the cure, bleed and bathe—or bathe and bleed—or bathe only; according to the urgency of the case, and the state of the surface. Then give calomel and jalap, or calomel followed by a dose of oil,* every day, if necessary, till the symptoms abate. Afterwards, use the bath in the morning, and a gen- tle cathartic in the course of the day, lor two or three days, gradually laying aside the practice as the symptoms disappear.! CONTINUED FEVER. Continued fever is ushered in by a predisposition which differs from that of a remittent fever in no- thing, except only, that the exhaustion of vital power is greater. The same management, there- fore, will be proper to prevent the predisposition, and the treatment may be similar for curing the * When oil is offensive, any other gentle dose may be preferred. f If the symptoms seem obstinate, a blister should be drawn upon the region of the stomach. If a grown person, say & by 10 inches in size. 77 fever when formed, remembering only, that there is less necessity of blood-letting in this, than in the former case—and that drastic cathartics, for the same reason, are not to be as frequently used.* Thirty drops of the spirit of nitre, diluted with a little cold water, may be given once every second hour; and plentiful dilution, such as chicken water, table tea, apple water, toast and water, Sec. may be constantly used at discretion. In this grade of fever, the bath should be used every morning and evening, but not often with an intention to produce a profuse sweat. A very gentle but free perspiration is all that is necessary. In remittent and continued fevers, it sometimes happens that determinations take place, threatening injury to some of the vital organs.. If this should happen, and continue after using the bath a few times, a large blister should be drawn, for the rea- sons heretofore stated. TYPHUS OR NERVOUS FEVER. Typhus fever is the most distinct exhibition of disease consequent upon a predisposition with ex- hausted power. In this form of fever, debility so prevails, and the abandonment of the surface is so complete, that the skin is almost left without a sup- ply of blood. The eyelids of the patient are not suf- ficiently expanded to cover the eyes—the skin ap- pears to cleave fast to the bones of the sternum or breast, and the surface, generally, is dry and husky. The narrow limits to which the feeble excitement is reduced, are scarcely sufficient to expend the * In this, and some instances towards the close of remittent fever, the following is a proper cathartic dose:—rhubarb, 25 or 30 grains; manna, 2 drams; Rochelle or glauber salts, 2 drams. The whole for one dose, for a grown person, to be dissolved in a little hot water. g2 78 slow production of vital power, and determinations upon the muscles, evinced in nervous twitchings, or wild mental effort, in form of a delirium, are employ- ed by the system to maintain an equilibrium. 1 he heat which is collected and retained on the surface, is accounted for in a preceding part of this work. This grade of disease may have for its remote cause, the pernicious gasses exhaled from a cellar or prison—or some region of atmosphere more ex- panded sometimes limited lo a family or neighbor- hood—sometimes spread over an extensive section of country. It may also be produced by loss of sleep, by excessive indulgence, by unwholesome or insuf- ficient diet, Sec. &c The predisposition is attended by unaccountable debility, great propensity to sleep, giddiness of the head, and an unusual inclination to be near the fire. As the case progresses, some pain is telt in the back part of the head and neck, aching in the loins and limbs, &c &c which gradually increase, till the disease is completely formed. When 'practicable, the remote cause ought to be avoided:__when this cannot be done, the patient should avoid fatigue. Sometimes rest and compo- sure for a sufficient length of time, will completely correct the predisposition. But a moderate use of the bath, for a day or two, or more, every morning and evening, would contribute much towards the certainty of the effect. After the fever is formed, first administer a mo- derate bath, then an emetic, followed by a gentle ca- thartic* Afterwards, a daily repetition of the bath when necessary, morning and evening: during the in- tervals between the repetitions of the bath, the sur- face should be defended by the application of jugs fill- * For the emefc, give 5, 10, or 15 grains of Ipecacuanha- For the cathartic, give the dose advised in a note under the ac- count of continued fever. 79 led with boiling water, or hot bricks, frequently renew- ed to prevent a declension of the warmth,which should be kept up so as to avoid a repetition of the collapse. An occasional repetition of a suitable cathartic, cor- dial drinks, as panada, chicken broth, wine and wa- ter, and to quench thirst, a little of the spirit of nitre, as before advised. In this, and in every grade of fever where depletion is not necessary, a large blister drawn on the region of the stomach frequent- ly contributes to hasten recovery. Having thus given a general view of disease, to- gelher with some instructions, for the formaiion of a proper intention, in attempting its cure; having said a few things respecting the mode of operation of some articles of medicine, and specified a simple me- thod of applying them in the cure of fever, I shall now drop some remarks upon a few particular cases. YELLOW FEVER. Yellow fever is a high grade of morbid excite- ment, consequent upon some poisonous agent, sud- denly produced, and acting upon persons with good stock of vital power. After the necessary depletion, the hot bath has been found beneficial, and I would expect great advantages from it if administered upon the principles which I recommend. GOUT AND RHEUMATISM. Gout and rheumatism are the result of morbid de- terminations upon the joints or muscles, or fascia, or sheaths of the muscles, or tendons. The bath, with or without depletion, according to the state of ex- citement, will always afford relief. It should be used so far and repeated so often as may be necessa- ry to secure and maintain a determination ot ex- citement upon the surface. If the appearances should be obstinate and inflam« matory, after using the bath decisively, as advised in 80 pleurisy, the patient may be bled. The bowels should be regulated as in every other form of disease; and if necessary, the following liniment should be applied to the parts most effected, viz.: Take spirit of wine, or high proof spirit of any kind, one quart; spirit of turpentine, one pint; cay- enne, or red pepper, half an ounce, or an ounce; and camphire, half an ounce. Shake up the preparation when used. Cotton or flannel cloths of suitable size, may be moistened with the liniment, and applied at discretion.* , If the case be obstinately painful, notwithstanding ' the bath and liniment, I should suspect the seat of the pain to be in the nerves, and would have recourse to stramonium, as follows: take of the ripe seeds twenty-four grains, finely powdered; gum arabic, also powdered, 24 grains; make the whole into 24 pills—two or three to be given night and morning for a week; and afterwards to be repeated and sus- pended at discretion. After placing the system un- der the agency of this article a week or two, try the bath and liniment, as before, and, finally, draw a very large blister upon the part affected. CROUP OR HIVES. In this disease Dr- Rush makes two important distinctions. The first is attended with spasm and a dry cough. The second is without spasm; and the patient under its influence, is able to cough up a considerable quantity of phlegm. The spasmodic croup comes on suddenly, and that generally in the night; has frequent and perfect intermissions of the symptoms for hours, and even for days; the child will probably go to bed in good health, and in an hour or two wake in a fright, with his face * Bags of heated sand, moistened with salt water, is an excel- lent intermediate application. 81 much flushed, or even of a purple color. He will be unable to describe what he feels; will breathe with much labour, and with a peculiar, convulsive motion of hia belly; his breathing will also be very quick, at- tended with a sound as if he were threatened with a speedy suffocation; the terror of the child increases his disorder, and he will cling to the nurse; and if not speedily relieved by coughing, belching, sneez- ing, vomiting, or purging, the suffocation will in- crease, and the child will die. It is remarkable that the cough in this disease very much resembles in sound the barking of a young dog. For the cure, give the hot bath. If the difficulty of breathing, a flushing of the face, with pain in coughing, continue, after a decisive bath- ing, the patient should be bled, and if necessary the bleeding shouldbe repeated. If the symptoms con- tinue after the bleeding, repeat.the bath. Then, if necessary, give 5 or 6 grains of ipecacuanha, with 2, 3, or 4 grains of calomel or turpeth mineral, or a tea- spoonful of antimonial wine; or, if it can be pro- cured, ten grains of powdered seneka, sometimes called rattlesnake root. Either of these doses may be mixed up in honey, and should be repeated every 20 or 30 minutes, till it produces the intended effect. Calomel, 3 to 6 grains, with julep, 8 to 10 or 12 grains, maybe used as a cathartic. The second distinction is attended with symp- toms very similar to those of the first, but may be known by its coming on gradually, and that common- ly in the day time; by its continuing and frequently increasing for several days without any remarkable remission or even abatement of the symptoms; by the elischarge of phlegm from the windpipe in cough- ing, as also by the appearance of slime in the stools. Apply the bath—bleed and puke in this case as in the first distinction. As a purge, calomel only shouldbe used. Great reliance should be placed upon this medicine. A 82 large dose should be giten as soon as the disease discovers itself; six grains to a child four years old. Afterwards, smaller doses should be given every day, so long as any of the symptoms continue. From two to four grains might answer this inteniion. CHOLERA MORBUS, OR PURGING AND VOMITING. This disease makes its appearance in warm cli- mates, as early in the season as April and May; but in colder climates not tili the middle of June or first of July. Children are subject to it from one or two weeks tili two years old. It sometimes begins with a diarrhoea, which will continue for several days without any other complaint; but most commonly violent vomiting andpurging, and high fever, attend. The matter discharged from the stomach and bowels, is yellow or green, and the stools are sometimes slimy and mixed with blood, without any appearance of bile; sometimes too, the stools are thin as water; worms are frequently void- ed, whether the evacuations be bilious or not: the pa- tient seems to suffer much pain; draws up his feet, and is never easy in one posture, his pulse is weak and quick, his head very warm, white his hands and feet are cold; the fever remits and returns with greater violence every evening; his head is some- times so much affected, that he not only becomes delirious, but will rave and try to scratch or bite his parents or nurse; his belly and sometimes his face and limbs swell; he has great thirst in every stage; his eyes, appear languid and hollow, and he sleeps with them half closed; so great is the insensibility of his eyes that flies liglt upon them while open, and do not excite the least motion in the eyelids. Sometimes vomiting continues without the purg- ing, but more commonly the purging remains with- out the vomiting, through the whole course of the disease. 83 The stools are sometimes large, emitting a very disagreeable smell; at other times there are scanty stools without smell, and like the food or drink taken in by the child. This disease is sometimes fatal in a few days, and in some cases even in twenty-four hours. Much depends on the state of the weather; one cool day frequently abates its violence. The time of its duration varies exceedingly, from a few days to six weeks or two months. When it is of long standing and tending to death,, there is commonly great wasting of the patient's flesh, his bones will some- times come through the skin. Towards the close of the disease, there appear purple spots on the skin, with hiccup, convulsions, ghastly countenance, and sore mouth. When these last appearances come on, the case has generally become incurable. On its first appearance apply the hot bath morning and evening, for two days; afterwards, if necessary, keep jugs or bricks properly heated to the patient, during the evening, and through the night and morning. In the meantime, give a puke to evacuate the bile from the stomach; this may be done by a dose of ipecacuanha or tartar emetic, and it should be repeated as often as there is vomiting of bile, in every stage of the disease. The bowels should be purged with manna, castor- oil, or magnesia- Rhubarb is not a proper remedy till the fever is in some considerable degree subdued. If, however, the puking and purging have continu- ed, till there is good reason to believe that the of- fending matter has been thrown off by the natural efforts, the pukes and purges must be omitted, and instead of them, a few drops of the tincture of opi- um may be given in a chalk julep. Say, prepared . chalk or crabs' claws, eight grains to twenty; tincture of opium, half a drop to three or four; cinnamon water, or peppermint tea, at discretion; syrup, as 84 much aa may be sufficient to make it pleasant, to be given every three, four, or six hours. Some- times a few drops of spirits of hartshorn, will be a useful addition to the above julep. Blister might be applied to the region of the stomach. Mint and mallows' teas, or blackberry briar-root, infused in cold water; a decoction of shavings of hartshorn, or a so- lution of gum arabic, or the pith of sassafras wood, steeped in warm water, with the addition of a little mint or cinnamon; either of these articles may be prepared and used as. a drink to compose the stomach or bowels Glysters made of flaxseed tea, or of mutton broth, or of starch dissolved in water; either of these, with the addition of a few drops of tincture of opium, may be frequently in- jected. Plaisters of Venice treacle, where it can be had, or flannels wetted with a strong infusion of bitter herbs, in warm spirits, or Madeira wine, might be applied to the stomach; or what might be still more convenient, a cloth, folded so as to be two or three inches square, might be wetted with the tinc- ture of opium and applied as before; or the lini- ment advised in rheumatism, may be used at discre- tion. As soon as the violent symptoms are subdu- ed, give bark in the form of a decoction, or in sub- stance, to which may be added a little nutmeg; or if bark be offensive to the patient, use port wine or claret in its stead.* At this stage, it will be proper to indulge the child in any particular article of strong food he may hap- pen to crave, as salted or dried fish, salt meat, but- ter, or rich gravies, and even the strongest cheese. In the recovering stage of the disease, it will be found very beneficial to carry the child out to breathe a fresh country air. * Peruvian bark, quilted between two pieces of cotton cam< brie, and made up in the form of a waistcoat, may be worn as an excellent remedy in the last stages of the disease. 85 In places where this complaint prevails, the following precautions will probably prevent it: The dress of children should be carefully accommo- dated to the state and changes of the weaiher, Salted meat should be daily but moderately used through the sickly season. Good, sound wine may be given them in portions adapted to their age, from a teaspoonful to half a wine glass full, at the dis- cretion of their parents,especially mornings and even- ings. Particular regard should be had to cleanli- ness, both with respect to their skin and clothing. Lastly, persons living in sickly towns, ought to be specially attentive lo all these precautions; and where it can be done, they should remove their children to the country before the sickly season. A well-timed bath will commonly prevent the.* disease from fixing itself, in almost every case. DYSENTERY, OR BLOODY FLUX. This disease is attended with frequent slimy or bloody stools, while at the same time the usual con- tents of the intestines are very commonly retain- ed, and with a violent griping and a painful or fre- quent urging to go to stool. It occurs in the same seasons with intermittent fevers, and like them, it follows long dry, long moist, and hot weather. Sometimes it comes on with cold shiverings and other marks of fever, and in some instances the fever attending is very violent and inflammatory. Sometimes, though not so frequently, a diarrhcea is the first symptom. There is commonly a loss of ap- petite, frequent sickness, nausea, and vomiting, which are considerably proportioned to the violence of the disease. In every case where there is violent fever, the danger is considerable. On the first appearance of this disease, apply the bath, and give a free dose of oil; then, if necessary, bleed, and' if the pains and other violent symptoms H 86 continue, the blood letting must be repeated every twelve or twenty four hours. Pukes are sometimes proper, but they should be used when there is great sickness at the stomach only, and if the marks of fever as above be present, a puke should not be administered till after one or more bleedings. Frequent cathartics, but they must be of the most gentle sort, as cream of tartar, purging salts, manna, castor oil, &c; one of these should be used every day while the disease con- tinues. Let it be remembered that jalap and rhu- barb are not proper in this complaint. Glysters of flaxseed tea, or mutton broth, with a little tincture of opium, should be injected three or four times for every twenty-four hours. If there be great heat and pain in the bowels, cold water might be injected in the form of a glyster; and in- deed it could do no injury if there were no very in- flammatory symptoms. Opium. A dose of the tincture, or a pill of the solid opium, should be given every night; and after sufficient evacuations, it might be used every six or eight hours, if necessary. Cooling drinks. Whey, flaxseed tea, camomile tea not too strong, mallows' tea, mullen tea, and barley-water, are all proper for this purpose. And if there be much fever, cold water is a very proper drink. A decoction of gum arabic, or shavings of harts- horn, with spices; mutton suet boiled in milk; a de- coction of blackberry roots; or a gruel made of a little flour prepared according to doctor Buchan, viz.: take a few handfulls of fine flour, tie it up in a linen cloth, and boil it in a pot for six hours, till it becomes as hard as starch, afterwards grate it and make it into gruel. Either of these will be very useful when the patient is much spent. Blisters may be applied to the abdomen, wrists, and ankles, 87 but not commonly until after the fifth day. In the close of the disease, port wine, Maderia, or sherry wines are proper. Where the fever intermits, and especially where it assumes the shape of the third day fever and ague, the bark is a very proper remedy, to be given chiefly in the fore' part of the day.* During the whole course which may be required to effect a cure, it is proper to use the bath daily, and to maintain its effects by the aid of jugs filled with boiling water, or hot bricks, frequently renewed. But if the bath be properly used in the first appear- ance of the disease, little else will be necessary in any ordinary case. Bowel complaints are commonly instances of in* troverted excitement. It is all important, therefore, in effecting their cure, to secure a return of the cir- culation to the surface. The bath will aid in the accomplishment of this intention in every case. It* decisive powers will be most certainly evinced in the first onset of the complaint. Yet it is equally im- portant in cases of standing, though it requires more additional aid: for instance, chronic diarrhoea, there- fore, which is always attended with a dry skin, will be the more certainly relieved by the aid of this re- medy. But in this case, during the intervals of bath- ing, the liniment recommended in rheumatic cases, should be freely and extensively used, and the fol- lowing bolus may be taken at discretion, viz.: take of gum camphire, 30 grains; opium 3 grains; vola- tile salt of hartshorn, 30 grains; ipecacuanha, 4grains; syrup, as much as is necessary to prepare the bolus: the whole to make six doses; one to be taken every sixth, eighth, or twelfth hour, according to circum- stances. In some instances it is every useful to draw a large blister on the abdomen, to be repeated as of- * Or apply the bark waistcoat, as advised in a note under page 84. 88 ten as it heals, till the disease becomes completely manageable without it. Sometimes, too, it is high- ly useful to the patient, to precede the hot bath by a general washing of the skin with a cloth wetted with soap-suds or proof spirit. There is no danger of taking cold from this practice if the patent bath be immediately employed. Colics may be the effect of inflammatory action, or of spasm. In either case the bath will afford re- lief. In the one, aided by blood-letting it diffuses excitement, and lessens the force of the determina- tion—in the other, it extinguishes the accumulation of vital power, upon which the spasm or cramp de- pends. After an attack of colic, some appropriate cathartic ought to be used in almost every case. FEMALE COMPLAINTS, &C When certain peculiar appearances come on too slowly, attended with pain, Sec., the bath should be used at night, to be aided by the following dose:— gum camphire, 10 grs., gum arabic, 30 grs,, loaf su- gar at discretion, cinnamon water, or fennel-seed lea, sufficient to dilute the whole. This may.be re- peated every hour, till it procures ease to the pa- tient. If, by alternate exposure to heat and cold, or by any other accidental means, these appearances cease improperly, there will be a sensible fulness, or increased motion of the blood, producing a swim- ming, and dull, heavy pain of the head, which is increased on stooping down; a redness; a fulness, with a sense of weight across the eyes; an aversion to motion; an unusual sense of weakness and heavi- ness of all the limbs, and sometimes a bleeding at the nose, fcc* m; Where these, or most of these symptoms occur, iet blood from the foot, ten or twelve ounces, to be repeated as occasion may require. Give a hot bath on going to bed; followed by a glass of wine — Then give a portion of calomel and aloes, three grains each. Syrup of some kind may be added so as to form it into a pill or two, or so much as to make it of the consistence of honey. Continue the bath, and calomel and aloes, for three successive nights. During the recess of the complaint, the patient should avoid exposure to wet and cold weather. And at the next period proceed through the same course, viz.: bleed, bathe, and give calomel and aloes for three successive nights. There is a variation of this complaint not so sud- denly induced as the former, and most commonly incident to those who live in indolence. The symp- toms are great paleness or rather yellowness and bloating of the face, shortness of breath, loathing of food, indigestion, disposition to eat chalk or marie, great weakness, quick and weak pulse, swelling of the feet and ankles, and, in some instances, a bloating of the whole body. For the cure in such a case, give a hot bath at night, as before, and one dose of aloes and calomel. Repeat the bath two or three times a week. Give one or two grains of calomel every second or third night, for fifteen or twenty days. Bitters of camo- mile and orange-peel steeped in boiling water, may be used at discretion. Afterwards, use the tincture of steel, or take rust of iron prepared, one ounce; gum myrrh, one ounce;* nutmegs, No. 2, or cinnamon, half an ounce. The whole to be finely powdered, carefully mixed, * If the gum myrrh be offensive, it may be omitted, regulat- ing the dose accordingly. H % 90 and kept in a close vessel. If rust of iron cannot be had, the salt of steel will answer, using half the quantity. Of this preparation, if made with the rust of iron, six or eight grains may be taken from four to six times a day. If prepared with the salt of steel, three grains will be the dose. The por- tion of either ought to be varied according to cir- cumstances. It excites a little sickness of the stomach. But if a puking or too violent sickness be excited, the dose may be lessened. On the other hand, if no considerable effects are observed, it may be enlarged. Regular exercise; as friction with a flesh-brush, or flannel; riding in a carriage, or on horseback, &c. Sometimes rhubarb, five grains, united with opium, half a grain, given every night when great costiveness does not forbid their use Flesh diet with wine and water when no fever exists. And when the patient begins to regain strength and color, at every appearance of the pains, 8cg. use the hot bath, to be followed by a dose of cam- phire, as above, or a teaspoonful of paregoric. Again: these peculiarities sometimes come on too often for the strength of the patient. This most frequently happens to women of a soft, delicate ha- bit; to such as use tea and coffee too freely, and who do not take sufficient exercise. It is sometimes brought on by excessive fatigue, and this may hap- pen to those who are temperate and industrious. In either case, its approach may be known by a pain in the loins and hips. Observe this symptom carefully, and on its first approach let the patient take a hot bath, to be fol- lowed immediately by a dose of opium, or lauda- num. If opium, say from one to three grains. If yl laudanum, from 25 to 50 drops; and, if necessary, re- peat the same every sixth or eighth hour. If excessive labor be the cause of the disease, rest, of course, is indispensable for effecting a cure. If both these fail, it will commonly be necessary to let a little blood. Where too strong motion of the arteries can be ascertained as the cause, it may be entirely remov- ed by gentle bleeding and purging, occasionally re- peated. If much weakness, paleness, and a disposition to bloat attend, give half a grain of opium every 6 hours, and at intervals of three or four hours, give twelve or fifteen grains of an equal mixture of allum and gum kino, to which may be added, a drop or two of the oil of cinnamon. Nauseate the stomach with small doses, from one to five grains of ipecacuanha. Apply blisters to the abdomen and extremities. If none of these things succeed, a gentle course of mercurial salivation ought to be tried; intersper- sing the same practice above advised at proper in- tervals. Sometimes a particular appearance of a whitish complexion, Sec. &c. presents itself instead of the natural one, and is very troublesome. For the cure in this case, give wine and iron— using the bath two or three times a week. It is somelimes of service to use a mixture of turpen- tine with honey; each in equal quantity, a tea- spoonful the dose—to be taken three or four times a day. Wash the parts with milk and water; and use the following injection:—take white vitriol, 60 grains; sugar of lead, 60 grains; the whites of two eggs; beat them together, adding water, gradually, till it amounts to six gills: boil and strain, and it is ready for use. This injection might be prepared with or with- out the addition of lead. That which is most effec- tual of course will be preferred. 92 In violent floodings, under whatever circumstan- ces induced, with or without the aid of blood letting. or opium, as the case may require, the bath will be found an invaluable remedy. Upon the principles of unity of disease, a morbid determination of the blood to the parts concerned, with an associate abandonment of the surface, is the disease. The intention for effecting a cure, must therefore be ob- vious to common sense. Great sickness of the stomach and vomiting are very common complaints in the early stages of preg- nancy. In some instances the vomiting continues through the whole course of gestation, and in others disappears after some weeks, but to return again to- wards its close; when violent, in a case where there is a full habit of body, it is often necessary to let blood, from eight to ten ounces, from the arm. After the bleeding, and in cases where through the weakness of the patient no blood can be spared, the vomiting may be removed by some of the following remedies: 1. Magnesia, two teaspconfuls in a cup of pepper- mint tea,to be repeated every one, two, or three hours. 2. Salt of tartar, 20 grains, lime juice or good vin- egar, half an ounce, spring water, one and a half ounces, common syrup a spoonful: to be speedily mixed, and to be taken in a state of effervescence* It may be repeated once in three or four hours if ne- cessary; or dilute half an ounce of muriatic acid with a quart of water; a tablespoonful may be taken three or four times a day, in half a gill of any agreeable drink, sweetened at discretion. 3. Or an infusion of columbo or camomile, with orange peel, in boiling water. The columbo is thought most effectual. It may be so managed, as to take from ten to twenty grains for every two or three hours if necessary. 4. Or where the vomiting is excessive, opium from half a grain to a grain, to be repeated every one or two hours till the complaint abates. 93 Some one or more of these remedies, aided by the use of the bath morning and evening, for a day or two, will seldom fail to afford relief. If the case be violent, the patient should remain in bed, and hot jugs and bricks should be employ- ed to maintain the advantages gained by the bath. Some women are also frequently subject to heart- burn. If the complaint be violent, nothing perhaps is better than a small dose of ipecacuanha, so as to procure a motion or two. After the puke use the following preparation: Magnesia and spirits of sal ammoniac, or spirits of hartshorn, of each, the eighth of an ounce; cin- namon water, or a strong infusion of cinnamon, three-eighths ot an ounce; pure spring water, five ounces. Of this, two or three table spoonfuls to the dose, as often as the heartburn is distressing. If, however, this complaint is the consequence o'f ajoss of digestive power, the strength of the stomach must be restored by the use of some bitter infusion, as orange peel, camomile, columbo, bark, Sec. Dilute muriatic acid; and, finally, some preparation of steel, with exercise, might also be employed. In this also the bath should be occasionally used. Tooth ache is a very distressing symptom, and may be removed in most instances by the use of the hot bath only. PILES. Most fleshy persons, and more commonly those who lead sedentary lives, are subject to the distres- sing complaint called piles. If the attack be of the more moderate kind, a gentle dose of cream of tar- tar and flower of sulphur combined, will afford con- 94 siderable relief. Cold applications of any kind, as of cloth wetted in cold water or spirit and water, would answer the purpose. Also, the following oint- ment: take the yolk of one egg, tincture of opium ©r laudanum, three teaspocnfuls; neatsfoot or other oil, one table spoonful, to be mixed and applied. Let the tincture and the yolk of the egg be first mix- ed together, and afterwards the oil may be added. This ointment gives relief when much disposed to itch. If they protrude outwards, press them between the thumb and finger, and at the same time anoint and put them up carefully. Those subject to this complaint ought to lie down upon their backs for a few minules after every evacuation. An occasional use of the bath will invite the cir- culation to the surface, and very much aid the cure. An ointment impregnated with the virtues of the leaves of stramonium, Jamestown weed, is highly re- commended. A diarrhoea is sometimes very troublesome, and injurious to pregnant women. If attended with fe- ver, let blood from the arm, from six to ten, or fif- teen ounces, according to circumstances, and apply the bath. After the blood-letting and bath, a dose of oil, or the following, viz.: rhubarb, 25 grains; manna\ oz.; Rochelle salt, | oz.; dissolved in half a gill, or a gill of hot water; the whole for one dose. Should there be sickness at the stomach after all these, a dose of ipecacuanha, 15 or 20 grains. When the necessary evacuations are procured, take gum arabic, 1 ounce; prepared chalk, 1 ounce; magnesia, 2 or 3 drams; powdered opium, 10 grains; oil of cinnamon, 15 drops; loaf sugar at discretion; water, one pint; a table spoonful the dose; to be repeated three or four 95 times a day, or oftener at discretion. In the mean time, the starch glyster with tincture of opium, or a glyster made of boiled flour or of mutton broth with the same tincture, may be thrown up every three or four hours if necessary. Sometimes blistering the wrists and ankles is found beneficial after the feverish symptoms are subdued. Bathing the feet frequently in hot water, might also be tried. A painful inclination, and an irresistible straining to urinate, at the same time, effecting very inconsi- derable discharges, mark the disease called stragnu* ry. In such a case, apply the bath.* If necessary let blood. Then, as a cathartic dose, give manna, one ounce, dissolved in hot water, to which add sweet oil, one ounce, to be repeated at discretion. As of- ten as necessary repeat this practice, aiding the in- tention with frequent injections of warm milk and water. The patient may also use 30 or 40 drops of spirits of nitre, every hour, in a little barley water, or melon-seed tea; and after the necessary evacuations, a dose of laudanum may be taken sufficiently large to procure ease. Sometimes a strange distention of the veins of the legs takes place in the last months of gestation. To those who may never have seen such a case, it might give considerable alarm; but it is not followed by any immediate danger. A disagreeable numbness commonly attends it, and the distorted veins elevate * Between the repetitions of the bath, jugs filled with boiling water, or hot bricks wrapped in moistened cloths, may be appli- ed to the seat of the pain. 96 the skin, producing great unevenness. The proper remedies here, are small, frequent blood-letting and gentle purging. Also the bath once or twice a week, confining the application to the lower extre- mities. Cramp also occurs chiefly during the last months. For the cure, keep the bowels gently open. If it attend a full habit, bleed. If it should come on in the night, jump out of the bed and stand upon the feet till it goes off. Sometimes grasping a cane, or bedpost, or a roll of sulphur in the hand, affords relief. In this case the bath would afford the most certain cure. Puerperal or child bed fever, may take place in twenty or thirty hours after delivery; and sometimes it happens after as many weeks. It commonly begins with a chill, attended with a nausea at the stomach, pain in the head, loss of strength, and restlessness. The skin is sometimes dry, at other times partially or unusually moist. The tongue is dry, and sometimes covered with a black crust. "The pulse varies, being in some cases weak and small, and in others full and tense. Wan- dering pains are felt in the abdomen, and some- . times in the sides, resembling pleurisy. In some oases they extend to the shoulder blade, to the short ribs, liver, and spleen, then descend to the bladder and lower intestines. The pain becomes so acute in some instances, that the patient cannot bear the weight of the bed clothes. The face has a sorrow- ful appearance, and every word and action will more or less express her sufferings both of body and 97 mind. Sometimes the abdomen is enlarged as m pregnancy. Pains are felt in the back and hips, the legs swell, and at length the breathing becomes dif- ficult. So great the loss of strength as to be unable to turn in bed. Vomiting and diarrhoea, and some- times a stubborn costiveness take place. The lochia are sometimes suppressed, at other times they con- tinue throughout the disease, and when the inflam- mation is confined to the uterus, this must be a fa- vorable circumstance. Urine is scanty, frequently evacuated, and turbid. Spots appear on the joints. It continues from three to five days, and sometimes in the country, to ten, fifteen, and twenty. Although the appearances vary in different patients, yet by this catalogue of symptoms, the puerperal fever may be known. On the first appearance of the at- tack give a hot bath, and if necessary, bleed more or less, according to the violence of the attack. Then a mild vomit of fifteen grains of ipecacuanha, with one quarter or one half grain of tartarized antimony should be given; and after a gentle eva- cuation downwards, ahot bath and opiate at night.—. Glysters, fomentations, and an opening draught of senna, manna, and cream of tartar combined, may be daily repeated. If there be frequent or involun- tary stools, glysters of chicken water, or flour and water boiled to a proper consistence, or flaxseed tea, ought to be often repeated. Then an infusion of columbo root or flowers of camomile may be used, as also the starch glyster, with the addition of fifty drops of the tincture of opium; also, spirits of nitre one quarter of an ounce, clean water, one half pint, and white sugar at discretion—of this mixture give two spoonfuls every hour. She should breathe pure air, and strict regard should be had to cleanli- ness. Rest must be secured, and silence carefully preserved. The bath should be daily repeated once or oftener, and jugs filled with hot water should be used during the interval. I 98 All women are alarmed at the time of the final cessation of certain appearances, believing that some ill consequences may follow. The truth is, that scarce one of a great number of women, suffer more than temporary inconvenience. It must be acknowledged, however, that if there be a disposition to disease in the constitution, it will proceed more rapidly when these cease, by being deprived of that local discharge by which they were before relieved. Many remedies have been advised to prevent, and correct the mischief, expected or supposed to exist. But the present mode of practice is, to bleed occa- sionally and give gentle cooling purges, as manna, cream of tartar or common purging salts, &c. avoid- ing all kinds of medicines and diet which are heat- ing. This practice is both rational and successful. I have found it a good way, to lessen the quantity of blood to be taken, in a gradual manner, so as to imi- tate as nearly as possible, the most regular cessation in the natural way. And as often as inconvenient symptoms are present or threaten an encroachment give a hot bath, to be followed by a dose of lauda- num in feeble cases, and by a dose of some pleasant cathartic the following day. In robust cases the laudanum may be omitted, and where it is pre- ferred, wine may be used instead of the opium. Measles is a disease of the skin. It occurs when the seasons are marked with more than ordinary cold. It the eruption is too slow in making its appear- ance, one application of the bath brings it forward. If the bath do not relieve all pain, bleed, and give a gentle cathartic. If the eruption recede premature- ly, another application will correct it. In other re- spects manage as in simple inflammatory fever. 99 Art can accomplish no more than three great and leading intentions. One is to diminish or put down excessive action. Another is to extinguish any ex- cess of vital power. The third is to support the sys- tem in any case of debility. A fourth might be ad- ded, as the result of a combination or modification of these, which is, to correct any morbid determination by equalizing excitement. The great utility of this powerful agent, must, therefore, be evident. And every physician jnust see, that it will admit of more universal application than blood-letting or any other individual remedy. Varying its degree and dura- tion, according to the demands of the intention, it will, therefore, be useful in colds, catarrhs, asthmas, pleurisies, 8ec; in cramps, spasms, colics, cholera- morbus, Sec; in nervous headache, and all nervous affections; in habitual paleness or sallowness of com- plexion; in female complaints of a certain descrip- tion; in scrofulous and other glandular and ulcerous affections; in excessive fatness, and in old age; in gout, rheumatism, and fever, Sec. Sec. In a word, it an excess or diminution of vital pow- er; if an increase or deficiency of action, with or without a morbid determination of excitability or ex,- citement, must be present, in every possible mode of disease, it necessarily follows, that disease itself is a unit; and, therefore, that there must be in nature, some great and universal agent, which may be so modified as to be appropriate in every case. Heat may be so used. The pain of heat on the surface can safely extinguish vital power, and thus indirect- ly diminish the force of excitement. In an agreea- ble temperature, it is an universal cordial; and it can be made to have a diffuse tendency, and thus correct any morbid determination. ADVERTISEMENT. The preliminary remarks of the following appen- dix, are not intended to be personal. They are pre- dicated upon general observation. Some facts, it is true, have occurred, which would justify particular notice. But I have not sought the names of hasty or inconsiderate men. Folly and vice, wherever found, should be exposed, for their correction. The author himself, may deserve an equal share. Honor to whom honor is due. I have given the names of a few, and I expect to add many worthies to my list be- fore my labors are ended. APPENDIX. Having fully ascertained by a very great number of experiments, carefully made under my own obser- vation, that a single decisive application of the pa- tent, portable warm and hot bath, will almost inva- riably be effectual for correcting predisposition to disease; that by the same method, recent disease, when actually formed, may be cured in the same de- cisive way; that the treatment thus far requires no considerable part of skill but the necessary decision; no caution but such as common sense will dictate; and that in the hands of physicians it places within ihe reach of the healing art, many cases of disease which for ages have been a reproach to the profes- sion. It, therefore, becomes a duty incumbent on me to take measures for bringing it into general use. Many difficulties oppose my purpose: but the neglect of a profitable establishment; absence from my family; labor, expense, Sec. would be deemed in- considerable, if I could be supported by the appro- bation of medical men—of that class of citizens, who ought, with open arms, to receive and with gladness give sanction to any discovery which promises so much for the alleviation of the sufferings of humani- ty. And it is truly a painful task to me to be under the necessity of exposing to the world, the various follies and passions which I am obliged to encoun- ter. It is well known to every man of observation, that the slow progress of improvement in the healing art, has had a peculiar effect upon many medical men. It has had injurious influence over the minds of some, who in every other respect deserve the high- est estimation. It has imperceptibly produced a \% 102 strong predisposition to look back for authority however dark and absurd, rather than range the works of creation, or make patient observation upon facts, in search after truth. In too many instances it has insidiously infused a spirit of pedantry into the minds of those who are truly learned—and by the superficial this weakness is carefully imitated, because they find it is easier to put on the air of mystery and importance than to trace that labyrinth of investigation, whose outermost courts they have never explored. Others may be found, who, with- out an intention to be arrogant, consider themselves the oracles of their day, to whom the people ought to look for instruction. Improvements in the art to which they can have no claim, must, therefore, eclipse their importance; and with their pride thus piqued, without waiting to reason upon the subject, all their feelings are concentrated in a fixed resolu- tion to put down the cause of their troubles. Such was the storm which was raised for the destruction of the great Sydenham of London! Such too the struggle intended to overturn the herculean labors of that great physician and philosopher who lately enlightened and graced the city of Philadelphia! Blinded interest too creeps in, and false fears of fu- ture loss are raised, so that every benevolent emotion is suppressed. Commiseration at human woe is no longer felt or felt in vain! This ruthless passion had rather witness destructive scenes of sickness, pain, and death, than hazard the possible loss of sor- did gain. Surroundedby this host of opposing pas- sions, 1 am nevertheless firmly supported by the re- flection, that truth is necessarily imperishable. It may be opposed and even suppressed for a season, but it will ultimately break forth in all its native splendor, and enlighten the world. Such was the fact in the memorable Wilberforce's motion before the parliament of England, to put an end to the 193 slave trade. " It fell dead from his lips." Sorr.- thirty years afterwards it was taken up and this odious trade in human souls forever abolished. I had flattered myself, that in a way undiscovered I should enlist a number of the faculty in my cause, before any thing like a new system should be sus- pected, and by this means secure the necessary sup- port. As every physician must know the impor- tance of heat in the cure of disease, and as all must have experienced the difficulties which attend its application in any ordinary way, I had no doubt that many would gladly avail themselves of the use of my apparatus. Could this plan have succeeded, they would have observed its effects, by which they would necessarily have been led to the adoption of those principles which I shall ultimately establish. I was the more ready to make calculations in this way, because I had already succeeded in securing the friendship of a few. But those suspicions, or opposi- tions, or jealousies which are common when any thing uew is offered, have been excited, and it follows, that the fate of my work must be determined by the or- dinary ordeal.* I cannot conceal a blush for such of the fraternity as have said, for charity requires that I should ad- mit that they believed as they said, " that warm water would do as well." Finding opposition likely to increase, I proceeded immediately to write a sketch of my system for publication, intending to make my appeal to those noble souls in the medi- * I have met with some physicians in every place through which I have travelled, who have treated me politely. Doctor Welford of Fredericksburg, doctor Johnson of Manchester, and doctor Ward of Norfolk, deserve my thanks. Doctor Selden, of Leesburg, the only "physician who has thought ii worth his pains to wait on me at my lodging for an explanation of my system, on taking his leave, in the most ingenuous man- ner, offered himself as a friendly agent for his town and neigh- borhood: others will hereafter be added, as they become ac- quainted with my work. 104 cal world, who are ready to see and embrace the truth, and to call to my aid scientific men of every order in society. By this plan I calculated on being able to proceed in despite of opposition. It has been attended with considerable success, and would of itself ultimately produce the effect. Afterwards, however, I resolved on another expedient. As speedily as possible a few copies of my elementary principles, which had now been hastily struck off, were sent to gentlemen members of congress. Hav- ing the advantage of a personal acquaintance with Thomas Gholson, esquire, I forwarded one specially to him, accompanied by a letter, signifying the good effect it would have in the cure of diseases incident to the army. Doctor James Tilton, physician and surgeon gene- ral of the armies of the United States, a man of much independent worth, happened to lodge in the same house with Mr. Gholson, and was immediately made acquainted with my views. In a few days the physician general obtained permission from the honorable John Armstrong, secretary of war, and I was invited to the seat of government. On my ar- rival I had the satisfaction to find that preparatory measures were already in train for the accomplish- ment of my wishes. The final arrangement and the result of the proceeding, will be seen in the se- quel. For this polite and highly respectable introduc- tion to the city, and the agreeable facility with which I was permitted to negotiate the contemplat- ed visit to the hospital at Norfolk, the honorable se- cretary of war and surgeon general, are entitled to my highest regard and most grateful acknowledg- ments. But they will receive a more lasting re- ward in the blessings which this system, aided by their patronage, will eventually secure to suc- ceeding generations. 10i» Washington City, April 7, 18]i. Dear sir, Conformably to the orders of the secretary of war, you will be pleased to accompany doctor Adam Hays, an hospital sur- geon, to Norfolk, in Virginia, and communicate to him and the surgeons generally, of that post, not only the principles of your newly invented bath, but the method of application; taking care not only to show the cases in which it may be applied to advan- tage, with the manner, duration, &c. but especially to guard them against the misapplication, so as not to bring an useful reme- dy into discredit. Agreeably to the secretary's order, your account for expenses, &.c may be presented at any time. I am, dear sir, very respectfully, Your most obedient servant, (Signed) JAMES TILTON, P. S. G. May 5,1814. This may certify, that, in obedience to an order of the hono- rable secretary of war, and in conformity to the instructions of the physician and surgeon general of the United States, doctor Samuel K. Jennings has accompanied me at the post of Nor- folk, Virginia, and satisfactorily demonstrated to me the princi- ples and mode of making the application of his newly invented method of curing disease in a summary way, by the means of his patent, portable warm and hot bath. (Signed) A. HAYS, hospital surgeon. Wilmington, f Delaware J July 16, 1814. Dear sir, Agreeably to your request, I have no hesitation in giving you my sense of the utility of your newly invented hot and warm bath, in the cure of diseases. I can only speak in general terms on a subject so novel; and, perhaps, the best method I can take for communicating my thoughts and reflections on the sub- ject, is, by recounting the measures taken by the hospital de- partment for the investigation of its usefulness. Conformably to an order from the secretary of war, I was di- rected to make the necessary arrangements for your admission to tke hospital at Norfolk. By the same order, I was directed to 106 send doctor Hays, an hospital, surgeon of great respectability, tu assist and be witness at the experiments. The doctor reported favorably, and in that correct manner which gratified the secre- tary of war, as well as myself. He particularly recommends it in regimental practice, "from the opportunity of meeting dis- ease in its early stages." He recommends it in fevers, languid excitement of the surface, and diseases produced by suppressed perspiration. The doctor made experiments on about thirty cases, very much to his satisfaction, but has not exhausted the subject.* I have seen the bath applied in a few instances; and have had it applied to my own person The ease and facility of the applica- tion, and the delightful sensations it affords, are greatly in favor of its general use. And when we consider the nervous and sen- sible quality of the skin, and the importance of this emunctory, a flood of argument must arise, for the application of remedies to the surface of the body. In the promised edition of your explanations, iSfc. besides the theory and direction for correct application, permit me to request that you will, by every possible precaution, guard us against the wrong application of so important a remedy. With great respect, I am dear sir, Your friend and humble servant, JAMES TILTON. Doctor S. K. Jennings, The following certificates, from doctors John I. Cabell, Gustavus A. Rose, and William Owens, and from the reverend Wm. S. Reid, and others, at hynchburgh, are highly important to my purpose. And whilst they do me credit they afford instances of candor and benevolence which will be duly appreciated. Jjynchburg, March 1,1814. Dear sir, I take a pleasure in informing you that for the last five or six weeks, I have applied your portable warm and hot bath * Of these thirty cases, some were recent instances of inflamma- tory fever—cured by one or two applications. Some were chronic, say typhus fever, from seven to twenty days standing—in these convalescence was produced, some in one, others in two and three, up to eight days. Some recent cases of dysentery, and in- flammatory rheumatism—cured by a single application. Some ladies' cases—in different circumstances—a change by one application. One a case of long standing, say three years, an irritation of the urethra—entirely relieved by two repetitions, &c. &cc. 107 with evident good effect, on a great number of my patients—In- deed I think it a most valuable acquisition to the catalogue of medical agents. The principles upon which it is used, only want to be known to bring it into esteem and general use. Out of the many cases to which I applied it, for brevity's sake I will select the two following: 1. A case of hepatic state of fever.—This was a lady, who, before I was called on, had been treated in the usual way by her attending physicians—bleeding, cathartics, a blister on the part affected, antimonial mixtures, &c. had been tried.—I found her with cold extremities and surface; fixed pain about the region of the liver, attended with' cough, general debility, and a feeble pulse. By the use of your bath, and a few small doses of calo- mel, with pectoral fibrifuges, she was soon restored to perfect health. 2. A case of inflammation of the stomach and bowels.—It was a desperate one.—This too was a female case, whom I found on visiting her, with cold extremities and surface, violent pain about the region of the stomach and upper bowels, with languor, faintness, and scarcely a perceivable pulse in the radial artery. In this situation she continued nearly two days, not- withstanding cordials, opiates, and cathartics, were administered, and a large blister was drawn upon the region of the stomach, and two upon the extremities. No passage could be procured, or general excitement raised on the surface. I applied your bath, and continued its application till a general diaphoresis was produced, and kept up for some hours, soon after which a pas- sage was effected by ordinary means. I then used it periodically, so as to keep up the excitement on the surface till the patient was relieved. I confidently believe that this woman would have died, had it not been for the aid of your bath. From yours respectfully, JOHN I. CABELL. Dear sir, Having used your " Portable Warm, and Hot Bath," with decisive advantage to several patients, I cannot but regret that any one should so far mistake your object as to suppose that you consider it a specific. Having for four years past received fre- quent communications from you, explanatory of your experiments and observations, upon the surface, and of the probable benefits to be derived from a more perfect method of applying heat, I am 108 -., duty bound to offer you my little influence in opposition to any such illiberal insinuation. I know that your invention is the result of much philosophical inquiry, and promises great pood to the community, as one powerful auxiliary in the cure of disease. And I know, moreover, that it may be so used, as, in many instances, pleasantly to supersede the use of other agents, which are loathsome in their administration, and. more or less, deleterious in their effects upon the system. Permit me to narrate the circumstances which attended a single case, which I treated upon your principles. It was an instance of a most painful dismenorrhagia,* protracted to the length of five days, with frequent faintings, and continued watchfulness. On the fifth day she became perfectly delirious, with a pulse beat- ing: 120 in the minute, and her extremities cold. At this stage I was called in. I immediately exhibited an anodyne, which was rejected. An attempt was then made to compose her stomach with cordials, intended to be preparatory for the trial of another opiate The attempt proved abortive. By this time three hours had passed away in painful anxiety, every moment hoping to see the stomach prepared to receive such agents as appeared to be necessary. Under these circumstances, I most willingly availed myself of the genial heat of your bath; first applying it to her low- er extremities; and so soon as her feet were well warmed, re- moving it to her stomach, where its powers were concentrated, until a general but moderate diaphoresis* was induced. Before the operation was ended, the delirium went off, and the patient diopped into a pleasant sleep and rested composedly for the space of two hours. . An opiate was then exhibited, which was retained by the sto- mach. Medicines, such as are ordinarily used in these cases, were afterwards advised, and the bath was repeated the follow- ing evening In ten minutes after the repetition ot the bath the patientbroke out uncommonly thick with the measles. I was informed that she had been exposed to the cold for 12 hours, about the time she expected to be in delicate health, and the immediate effect was such as I have described. Till convinc- ed by the fact, her friends were fully of opinion that she had the measles years ago. It is worthy of notice, that so com- pletely was the surface abandoned by the excitement, so complete- ly was the excitement locked up in the system, that she had none of the ordinary appearances which usher in the measles. N«i-. trtier high fever, cough, nor sore throat attended her case. There was indeed, an alarming deficiency of animal heat;—and I am * A disease peculiar to the mothers of mankind. | Sweating or perspiration. 109 confident without the influence of artificial heat, to that extent, and with that decision which your bath only could have fur- nished, this patient would have died, and no one would have suspected the true nature of the disease by which her dissolu- tion would have been effected. Agreeably to your request I will endeavor to procure a history of the case of Mrs. Darnell, the lady you visited at Mr. Jef- ferson's plantation in Bedford. I am yours, respectfully, GUSTAVUS A. ROSE. P. S. It is a certain fact, that