army medical library FOUNDED 1836 WASHINGTON, D.C MEDICAL INQUIRIES AND OBSERVATIONS. ga^ag^ffgj!^ MEDICAL INQUIRIES AND OBSERVATIONS. IS' benjamin rush, m. d. professor or CHEMISTRY in the UNIVERSITY OB PENNSYLVANIA. PHILADELPHIA: PRINTED AND SOLD BY PR ICHARD & HALL, IN MARKET STREET NEAR FRONT STJllEET. M.DCC.LXXXIX, l?t T O JOHN REDMAN, M. D. TWO reafons have determined me to infcribe to you, the following Inquiries and Ob" fervations. They are the fruits of Jludies which hegan under your direction; and they require the protection of a refpeBable medical name. TO whom can they look up for thai proteBion withfo much propriety, as to the Pre-* sident of the college of physicians of Philadelphia ? WITH Jincere wijhes that your old age may long continue to be as honourable, ai your life has been ufeful, I am, With great refpetl, Your offeBionatefriend, BENJAMIN RUSH. fcftjanuaiy, J78g» ?il CONTENTS. I. AN inquiry into the natural hi/lory, of medicine among the Indians of North-America, and a compa- rative view of their difeafes and remedies with thoft of civilized nations. Page 9* II. An account of the climate of Pennfylvania, and its influence upon the human body. Page 57. III. An account of the bilious remitting fever, as it ap- peared in Philadelphia, in thefummer and autumn of the year 1780. Page 89. IV. An account ofthefcarlatina anginofa, as it appeared in Philadelphia, inthe years 1783 W1784. Page 101. V. Additional obfervations upon thefcarlatina anginofa. Page 109. VI. An inquiry into the caufe and cure of the cholera infantum. Page 112. VII. Obfervations on the cynanche trachealis. Page 120. VIII. An account of the effects of bliflers and bleeding in the cure ofobftinate intermitting fevers. Page 126. IX. An account of the diforder occafioned by drinking cold water in warm weather, and the method of cu- ring it. Page 129. X. An account of the efficacy of common fait in the, cure of hcemoptyfis. Page 133. XI. Free thoughts upon the caufe and cure of the pul- monary confumption. Page 137. yiu CONTENTS. XII. Obfervations upon worms in the alimentary ca- nal, and upon anthelmintic medicines. Page 150. XIII. An account of the external ufe of arfenic in the cure of cancers. Page 153. XIV. Obfervations upon the caufe and cure of the teta - nus. Page 169. XV. Additional obfervations on the tetanus and hy- drophobia. Page 177. XVI. The refult of obfervations made upon the difeafes which occurred in the military hofpitals of the United States, during the late war. Page 180. XVII. An account of the influence of the military and political events of the American revolution upon the human body. Page 186.. XVIII. An inquiry into the relation of tafles and ali- ments to each other; and into the influence of this re- lation upon health and pleafnre. Page 197. £j" The Reader is requeued to corre£t the following Errata.—In page 60, line 28, inftead of its ividth, read, the width of the river, p. 62 1. 18 and 19, inftead of difference ofifenfition between youth and old age, ivitb r.fbeel to beat and cold, read, the difference ofcloathing and fenfadon be-.- tween old age and youth in winter and fummer. p. 6j, 1. 29, after till, read. the water, inftead of it. p. 94, 1. 18, inftead aijpoonfuls, read, fpoonsful. p. 110,1.26, inftead of uafic.u bors, read, a few hours, p. 122 1. 11 in- ftead oiparoxyfms, read, continuance. In the fame p. 1. 12, inftead of They a-e, read, The fpafmodic is. p. 130, 1. 19, inftead of afphvxi, read, af- phyxia. p. 138, 1. 9, dele by ; and in 1. 10, add a comma inftead of a pe- riod ; after court!:, read all, inftead of All. p. 192, 1. n, inftead of de- Jlroying, read, diftreffing ; and in 1. 16, after occafioned, add, in part. p. 201, 1. 1, in fome of the copies, inftead of /'.-, read, lie. A n INQUIRY INTO THE NATURAL HISTORY OF MEDICINE AMONG THE INDIANS OF NORTH-AMERICA, COMPARATIVE VIEW OF THEIR DISEASES AND REMEDIES, WITH THOSE OF CIVILIZED NATIONS. Read before the American Philosophical Society, held at Philadelphia, on the 4th of February, 1774. GENTLEMEN*, I RISE with peculiar diffidence to addrefs you upon this occafion, when I refleft upon the entertain- ment you propofed to yourfelves from the eloquence of that learned member, Mr. Charles Thompson, whom your fuffrages appointed to this honor after the delivery of the laft anniverfary oration- Unhappily for the interefts of literature, his want of health has not permitted him to comply with ycur appointment. I beg therefore that you would forget for a while, the abilities neceflary to execute this talk with propriety, and liften with candor, to the efforts of a member, whofe attachment to the fociety, was the only qualifi- cation that entitled him to the honor of your choice. B The * This Inojjiry was the fubjecT: of an Anniverfary Oration, Tho ftyle of an oration is therefore preferved in many parts of it. 10 INQUIRY INTO THE NATURAL HISTORY The fubjeft I have chofen for this evening's enter- tainment, is " An inquiry into the natural hiftory of " medicine among the Indians in North-America, and " a comparative view of their difeafes and remedies, " with thofe of civilized nations." You will readily anticipate the difficulty of doing juftice to this fubjecL How fhall we diftinguifh between the original difeafes of the Indians and thofe contracted from their inter- courfe with the Europeans ? By what arts fhall we perfuade them to difcover their remedies ? And laftly, how fhall we come at the knowledge of fafts in that cloud of errors, in which the credulity of the Europe- ans, and the fuperftition of the Indians, have involved both their difeafes and remedies ? Thefe difficulties ferve to increafe the importance of our fubjeft. If I fhould not be able to folve them, perhaps 1 may lead the way to more fuccefsful endeavors for that purpofe. I shall firft limit the tribes of Indians who are to be the objefts of this inquiry,, to thofe who inhabit that part of North-America which extends from the 30th to the 60th degree of latitude. When we exclude the Efquimaux, who inhabit the fhores of Hudfon's bay, we fhall find a general refemblance in the color, man- ners, and flate of fociety, among all the tribes of In- dians who inhabit that extenfive tracl: of country. Civilian? have divided nations into favage, bar- barous, and civilized. The favage, live byfifhing and hunting. The barbarous, by palturage or cattle; and the civilized by agriculture. Each of thefe is connect- ed together in fuch a manner that the whole appear to form different parts of a circle. Even the manners of themoft civilized nations partake of thofe of the favage. It would feem as if liberty and indolenGe were the highefl OF MEDICINE AMONG THE INDIANS. 11 higheft purfuits of man; and thefe are enjoyed in their greateft perfeftion by favages, or in the pra&ice of cufloms which refemble thofe of favages. The Indians of North-America partake chiefly of the manners of favages. In the earlieft accounts we have of them, we find them cultivating a fpot of ground. The maize is an original grain among them. The different difhes of it which are in ufe among the white people flill retain Indian names. It will be unneceflary to fhow that the Indians live in a ftate of fociety adapted to all the exigencies of their mode ot life. Thofe who look for the fimplicity and perfe&ion of the ftate of nature, muft feek it in fyftems, as abfurd in philofophy, as they are delightful in poetry. Before we attempt to afcertain the number or hiftory of the difeafes of the Indians, it will be necef- fary to inquire into thofe cuftoms among them which we know influence difeafes. For this purpofe I (hall, Firft, Mention a few fafls which relate to the birth and treatment of their children. Secondly, I fhall fpeak of their diet. Thirdly, Of the cuftoms peculiar to each of the fexes. And, Fourthly, "Of thofe cuftoms which are common to diem both*. I. Of * Many of the facts contained in the Natural Hiftory of Medicine among the Indians in this Inquiry, are taken from La Hontan and Charlevoix's hiftoriet 13 INQUIRY INTO THE NATURAL HISTORY I. Of the birth and treatment of their children. Much of the future health of the body depends up- on its original ftamina. A child born of healthy pa- rents always brings into the world a fyftem formed by nature to refill the caufes of difeafes. The treatment of children among the Indians, tends to fecure this hereditary firmnefs of conftitution. Their firft food is their mother's milk. To harden them againft the ac- tion of heat and cold (the natural enemies of health and life among the Indians) they are plunged every day in cold water. In order to facilitate their being moved from place to place, and at the fame time, to preferve their fhape, they are tied to a board, where they lie on their backs for fix, ten, or eighteen months. A child generally fucks its mother till it is two years old, and fometimes longer. It is eafy to conceive how much vigor their bodies muft acquire from this fimple, but wholefome nourifhment. The appetite we fometimes obferve in children for flefh, is altogether artificial. The peculiar irritability of the fyftem in infancy, for- bids ftimulafing aliment of all kinds. Nature never calls for animal food till fhe has provided the child with thofe teeth which are neceffary to divide it. I fhall not undertake to determine how far the wholefome qua- lity of the mother's milk is increafed by her refufing the embraces of her hufband, during the time of giv- ing fuck. II. The hiftories of Canada; but the moft material of them are taken from perfons who had lived, or travelled among the Indians. The author acknowledges himfelf indebted in a particular manner to Mr. Edward Hand, furgeon in the 18th regiment, afterwards brigadier-general in the army of the United States, who during feveral years refidence at Fort Pitt, directed his inquiries into their cuftoms, difeafes, and remedies, with a fuccefc that e» *qu*t honor to his ingenuity and diligence. Of MEDICINE AMONG THE INDIANS. 13 II. The diet of the Indians is of a mixed nature, being partly animal and partly vegetable; their animals are wild, and. therefore eafy of digeftion. As the In- dians are naturally more difpofed to the indolent em- ployment of fifhing than hunting in fummer, fo we find them living more upon filh than land animals, in that feafon of the year. Their vegetables confift of roots and fruits, mild in themfelves, or capable of being made fo by the aftion of fire. Although the interior parts of our continent abound with fait fprings, yet I cannot find that the Indians ufed fait in their diet, till they were inftrufted to do fo by the Europeans. The fmall quantity of fixed alkali contained in the afhes on which they roafted their meat, could not add much to its ftimulating quality. They preferve their meat from putrefa&ion, by cutting it into fmall pieces, and ex- pofing it in fummer to the fun, and in winter to the froft. In the one cafe its moifture is diffipated, and in the other fo frozen, that it cannot undergo the putrefactive procefs. In dreffing their meat, they are careful to preferve its juices. They generally prefeT it in the form of foups. Hence we find, that among them, the ufe of the fpoon preceded that of the knife and fork. They take the fame pains to preferve the juice of their meat when they roaft it, by turning it often. The efficacy of this animal juice in diffolving meat in the ftomach, has not been equalled by any oF thofe fauces or liquors, which modern luxury has mix- ed with it for that purpofe. The Indians have no fet time for eating, but obey fTre o-entle appetites of nature as often as they call them. After whole days fpent in the chafe or in war, they often commit thofe exceffes in eatfng, to which long abftinence cannot fail of prompting them. It is com- mon 14 INQUIRY INTO THE NATURAL HISTORY mon to fee them fpend three or four hours in fatisfyirig their hunger. This is occafioned not more by the quantity they eat, than by the pains they take in maf- ticating it. III. We come now to fpeak of thofe cuftoms which are peculiar to the fexes. And, firft, of thofe which belong to the women. They are doomed by their hufbands to fuch domeftic labor as gives a firmnefs to their bodies, bordering upon the mafculine. Their menfes feldom begin to flow before they are eighteen or twenty years of age, and generally ceafe before they are forty. They have them in fmall quantities, but at regular intervals. They feldom marry till they are above twenty. The conftitution has now acquired a vigor, which enables it the better to fupport the con- vulfions of childbearing. This cuftom likewife guards againft a premature old age. Doftor Bancroft afcribes the haggard looks—the loofe hanging breafts—and the prominent bellies of the Indian women at Guiana, en- tirely to their bearing children too early*. Where marriages are unfruitful (which is feldom the cafe) a feparation is obtained by means of an eafy divorce; fo that they are unacquainted with the difquietudes which fometimes arife from barrennefs. During pregnancy, the women are exempted from the more laborious parts of their duty : hence mifcarriages rarely happen a- mong them. Nature is their only midwife. Their labors are fhort, and accompanied with little pain. Each woman is delivered in a private cabbin, without fo much as one of her own fex to attend her. After waffl- ing herfelf in cold water, fhe returns in a few days to ber ufual employments; fo that fhe knows nothing of thofe accidents which arife from the careleffnefs or ill manage- * Natural hiftory of Guiana, OF MEDICINE AMONG THE INDIANS. t$ management of midwives, or thofe weakneffes which arife from a month's confinement in a warm room. It is remarkable that there is hardly a period in the in- terval between the eruption and the ceafing of the menfes, in which they are not pregnant, or giving fuck. This is the moft natural ftate of the conftitu- tion during that interval; and hence we often find it connefted with the beft ftate of health in the women of civilized nations. The cuftoms peculiar to the Indian men, confift chiefly in thofe employments which are neceflary to preferve animal life, and to defend their nation. Thefe employments are hunting and war, each of which is conducted in a manner that tends to call forth every fibre into exercife, and to enfure them the poflefliort of the utmoft poflible health. In times of plenty and peace, we fee them fometimes riling from their be- loved indolence, and fhaking off its influence by the falutary exercifes of dancing and fwimming. The In- dian men feldom marry before they are thirty years of age : They no doubt derive confiderable vigor from this cuftom; for while they are fecured by it from the enervating effefts of the premature dalliance of love, they may enfure more certain fruitfulnefs to their wives, and entail more certain health upon their children. Tacitus defcribes the fame cuftom among the Germans, and attributes to it the fame good effe&s. " Sera juvenum venus, eoque inexhaufta pubertas ; " nee virgines feftinantur ; eadem juventa, fimilis " proceritas, pares validique mifcentur; ac robora " parentum liberi referunt*." Among * Csefar, in his hiftory of the Gallic war, gives the fame account of the ancient Germans. His words are : " Qui diutiffime impuberespermanferunt, maximam inter fuos fuunt laudem: hoc ali ftaturam, ali vires, nervofque confirmariputant." Lib. vi. xxi. \6 INQUIRY INTO THE NATURAL HISTORY Among the Indian men, it is deemed a mark of heroifm to bear the molt exquifite pain without com- plaining ; upon this account they early inure them- felves to burning part of their bodies with fire, or cutting them with (harp inftruments. No young man can be admitted to the honors of manhood or war, who has not acquitted himfelf well in thefe trials of patience and fortitude. It is eafy to conceive how much this contributes to give a tone to the nervous fyftem, which renders it lefs fubje£t to the occalional caufes of difeafes. IV. We come now to fpeak of thofe cuftoms which are common to both fexes : Thefe are PAINT- ING, and the ufe of the cold bath. The practice of anointing the body with oil is common to the fa- vages of all countries ; in warm climates it is faid to promote longevity, by checking exceflive perfpiration. The Indians generally ufe bears' greafe mixed with a clay, which bears the greateft refemblance to the co- lor of their fkins. This pigment ferves to leflen the fcnfibility of the extremities of the nerves ; it more- over fortifies them againft the afclion of thofe exha- lations, which we fhall mention hereafter, as a con- fiderable fource of their difeafes. The cold bath likewife fortifies the body, and renders it lefs fubje£i to thofe difeafes which arife from the extremes and viciflitudes of heat and cold. We fhall fpeak here* after of the Indian manner of ufing it. The ftate of fociety among the Indians excludes the influence of moll of thofe paflions which diforder the body. The turbulent effefts of anger are con- cealed in deep and lafting refentments. Envy and ambition are excluded by their equality of power and property. OF MEDICINE AMONG THE INDIANS. 1? property. Nor is it neceflary that the perfections of the whole fex fliould be afcribed to one, to induce them to marry. " The weaknefs of love (fays Doc- " tor Adam Smith) which is fo much indulged in ages " of humanity and politenefs, is regarded among fa- " vages as the moil unpardonable effeminacy. A " young man would think himfelf difgraced forever, *' if he fhowed the leaft preference of one woman " above another, or did not exprefs the moft com- " plete indifference, both about the time when, and " the perfon to whom he was to be married."* Thus are they exempted from thofe violent or lafting dif- eafes, which accompany the feveral ftages of fuch paffions in both fexes among civilized nations. It is remarkable that there are no deformed In- dians. Some have fufpefted from this circumftance, that they put their deformed children to death; but nature here afts the part of an unnatural mother. The feverity of the Indian manners deftroys thenrr. From a review ot the cuftoms of the Indians, we need not be furprifed at the ftatelinefs, regularity of features, and dignity of afpecl: by which they are cha- racterized. Where we obferve thefe among our- felves, there is always a prefumption of their being accompanied with health, and a ftrong conftitution. Having finifhed our inquiry into the phyfical cuftoms of the Indians, we fhall proceed now to in- quire into their difeafes. C A CELE- * Theory of moral fentiments. + Since the intercourfe of the white people with the Indians, we findfome of them deformed in their limbs. This deformity, upon inquiry, appears to be produced by thofe accidents, quarrels, Sec. which have been introduced among them by fpirituous liquors. l8 INQUIRY INTO THE NATURAL HISTORY A celebrated profeffor of anatomy has afferted, that we could not tell by reafoning a priori, that the body was mortal, fo intimately woven with its tex- ture are the principles of life. Lord Bacon declares, that the only caufe of death which is natural to man, is that from old age ; and complains of the imper- fection of phyfic, in not being able to guard the prin- ciple of life, until the whole of the oil that feeds it is confurned. We cannot admit of this proposition of our noble philofopher. In the inventory of the grave in every country, we find more of the fpoils of youth and manhood than of age. This muft be attributed to moral as well as phyfical caufes. We need only recolletl the cuftom among the In- dians, of fleeping in the open air in a variable cli- mate—the alternate atlion of heat and cold upon their bodies, to which the warmth of their cabbins expofes them—their long marches—their exceflive exercife— their intemperance in eating, to which their long fall- ing, and their public feafts naturally prompt them ; and, laftly, the vicinity of their habitations to the banks of rivers, in order to difcover the empire of difeafes among them in every ftage of their lives. They have in vain attempted to elude the general laws of mortality, while their mode of life fubjefts them to thefe remote, but certain caufes of difeafes. From what we know of the aftion of thefe poten- tial nocentes upon the human body, it will hardly be neceflary to appeal to fafts to determine that fevers conftitute the only difeafes among the Indians. Thefe fevers are occafioned by the fenfible and infenftble qualities of the air. Thofe which are produced by cold, are of the inflammatory kind, fuch as pleurifies, peripneu. OF MEDICINE AMONG THE INDIANS. 19 peripnenmonies, and rheumatifms. Thofe which are produced by the infenfible qualities of the air, or by putrid exhalations, are intermitting, putrid, and in- flammatory, according as the exhalations are combined with more or lefs heat or cold. The dysentery (which is an Indian difeafe) comes under the clafs of fevers. It is the febris introverfa of Dr. Sydenham. The Indians are fubjeft to animal and vege- table poisons. The effects of thefe upon the body, are in fome degree analogous to the exhalations we have mentioned. When they do not bring on fudden death, they produce, according to their ma- lignity, either an inflammatory or putrid fever. The small pox and the venereal disease were communicated to the Indians in North-America by the Europeans. Nor can I find that they were ever fubjecl; to the scurvy. Whether this was ob- viated by their method of preferving their flelh, or by their mixing it at all times with vegetables, I fhall not undertake to determine. Doctor Maclurg afcribes to frefh meat an antifeptic quality*. The peculiar cuftoms and manners of life among the Indians, feem to have exempted them from thefe, as well as all other difeafes of the fluids. The leprofy, elephantiafis, fcurvy, and venereal difeafe, appear to be different modifications of the fame primary diforder. The fame caufes produce them in every age and country. They are diversified like plants by climate and nou- rilhment. They all fprung originally from a moift atmofphere and unwholefome diet: hence we read of their prevailing fo much in the middle centuries, when the * Experiments on the bile, and reflections on the biliary fecretion. 20 INQUIRY INTO THE NATURAL HISTORY the principal parts of Europe were overflowed with water, and the inhabitants lived entirely on fifh, and a few unwholefome vegetables. The abolition of the feudal fyftem in Europe by introducing freedom, in. troduced at the fame time agriculture ; which by mul- tiplying the fruits of the earth, leflened the confump- *:on of animal food, and thus put a flop to thefe dif- oru^rs. The elephantiafis is almoft unknown in Eu* rope. The leprofy is confined chiefly to the low countries of Africa. The plica polonica once fo common in Poland, is to be found only in books of medicine. The venereal difeafe will probably in a few years ceafe to be a tax upon unlawful embraces. The fmall pox is no longer a fatal diforder, when the body is prepared for its reception by a vegetable re- gimen. Even the plague itfelf is lofing its fling. It is hardly dreaded at this time in Turkey ; and its very exiftence is preferved there by the doftrine of fatalifm, which prevails among the inhabitants of that country. It may ferve as a new and powerful motive againft po- litical, flavery to perceive, that it is connected with thofe difeafes which moft deform and debafe the hu- man body. It may likewife ferve to enhance the blef- fings of liberty, to trace its effects, in eradicating fuch loathfome and deftruclive diforders*. I HAVE * Muratori, in his antiquities of Italy in the middle ages, defcribes the greateft part of Europe as overflowed with water. The writings of the hif- torians of thofe ages are full of the phyfical and political miferies which pre- vailed during thofe centuries. The whole of the difeafes we have mention- ed, raged at one time in all the countries of Europe. In the ninth century there were 19,000 hofpitals for lepers only, in Chriftendom. Lewis VIII. king of France, in the year 1227, bequeathed legacies to 2coo leprous hof- pitals in his own kingdom. The fame diet, and the fame dampnefs of foil and air, produced the fame effefts in South-America. The venereal difeafe probably made its appearance at the fame time, in South-America and Na- ples. Precis de l'hiftoire phyfique des terns, par M. Raymond. The le- profy and fcurvy ftill prevail in the northern parts of Europe, where the man- ner of living, among the inhabitants, ftill bears fome refemblance to that which OF MEDICINE AMONG THE INDIANS. SI I have heard of two or three cafes of the gout among the Indians, but it was only among thofe who had learned the ufe of rum frorrf the white people. A queftion naturally occurs here, and that is; why does not the gout appear more frequently among that clafs of people, who confume the greateft quantity of rum among ourfelves ? To this I anfwer, that the effects of this liquor upon thofe enfeebled people, are too fudden and violent, to admit of their being thrown upon the extremities; as we know them to be among the Indians. They appear only in vifceral obftru&i* ons, and a complicated train of chronic difeafes. Thus putrid miafmata are fometimes too ftrong to bring on a fever, but produce inftant debility and death. The gout is feldom heard of in Ruflia, Denmark, or Po- land. Is this occafioned by the vigor of conftitution peculiar to the inhabitants of thofe northern countries ? or is it caufed by their exceflive ufe of fpirituous liquors, which produce the fame chronic complaints among which prevailed in the middle centuries. Pontoppidan's natural hiftory of Norway. Between the years 1006 and 1680, we read of the plague being epidemic fifty-two times throughout all Europe. The fituation of Europe is well known during the fourteenth century : every country was in arms; agriculture was negleded; nouriftiment of all kinds was fcanty and un- wholefome ; no wonder, therefore, that we read of the plague being four- teen times epidemic in Europe during that period. In proportion as the na- tions of Europe have become civilized, and cultivated the earth, together with the arts of peace, this diforder has gradually mitigated. It prevailed only fix times in the fixteenth, and five times in the feventeenth centuries. It made its laft general appearance in the year 1680. It has occafionally vi- f)ted feveral cities in Europe within the laft century, but has raged with much lefs violence than formerly. It is highly probable its very exiftence would be deftroyed, could the inhabitants of Turkey (where it is at all times endemic) be prevailed upon to ufe the fame precautions to prevent itsfpread- ing, which have been found fuccefsful in other parts of Europe. The Bri- tifh, and other foreigners, who refide at Conftantinople, efcape the plague more by avoiding all intercourse with perfons, houfes, clothes, &c. infecled with the diforder, than by any peculiarities in their diet or manners. That the ufe of wine alone does not preferve them from the infection, we learn from the hiftory of the Armenians, who drink large quantities of wine; and yet, from their belief in the dodrine of fatalifm, perilb in the fame proportion as the Turks. 82 INQUIRY INTO THE NATURAL HISTORY among them, which we faid were common among the lower clafs of people in this country ? The fimilarity of their difeafes makes the laft of thefe fuppofitions the mod probable. The effetls of wine, like tyranny in a well formed government, are felt firft in the ex- tremities ; white fpirits, like a bold invader, feize at once upon the vitals of the conftitution. After much inquiry, I have not been able to find a fingle inftance of madness, melancholy, or fatuity among the Indians; nor can I find any ac- counts of difeafes from wo RMS among them. Worms are common.to moft animals ; they produce difeafes only in weak, or increafe them in ftrong conftitutions*. Hence they have no place in the nofological fyitems of phy fie. Nor does dentition appear to be a difor- der among the Indians. The facility with which the healthy children of healthy parents cut their teeth, among civilized nations, gives us reafon to conclude that the Indian children never fuffer from this quarter. The Indians appear moreover to be ftrangers to difeafes and pains in the teeth. The employments of the Indians fubjecl: them to many accidents; hence we fometimes read of wounds, fractures, and luxations among them. Having thus pointed out the natural difeafes of the Indians, and fhown what diforders are foreign to them; we may venture to conclude, that fevers, old * Indian children are not exempted from worms. It is common with the Indians, when a fever in their children is afcribed by the white people ta worms, (from their being difcharged occanonally in their ftoo's) to fay " the " fever makes the worms come, and not the worms the fever." OF MEDICINE AMONG THE INDIANS. 23 OLD age, casualties and war are the only na- tural outlets of human life. War is nothing but a diftemper ; it is founded in the imperfection ot politi- cal bodies, juft as fevers are founded on the weaknefs of the animal body.—Providence in thefe difeafes feems to act like a mild legiflature, which mitigates the fe- verity of death, by inflicting it in a manner the leaft painful upon the whole, to the patient and the furvi- vors. Let us now inquire into the remedies of the In- dians. Thefe, like their difeafes, are fimple, and few in number. Among the firft of them we (hall men- tion the powers of nature. Fevers we faid for- merly, conftituted the chief of the difeafes among the Indians ; they are likewife, in the hands of nature, the principal inftruments to remove the evils which threaten her diflblution; but the event of thefe efforts of nature, no doubt, foon convinced the Indians of the danger of trufting her in all cafes; and hence in the earlieft accounts we have of their manners, we read of perfons who were intruded with the office of phy- ficians. It will be difficult to find out the exact order in which the Indian remedies were fuggelted by nature, or difcovered by art; nor will it be eafy to arrange them in proper order. I (hall however attempt it, by reducing them to NATURAL and artificial. O To theclafsof natural remedies belongs the Indian practice, of abltracting from their patients all kinds of ftimulating aliment. The compliance of the Indians with this dictate of nature, in the early ftage of a diforder, no doubt, prevents in many cafes, their being «4 INQUIRY INTO THE NATURAL HISTORY being obliged to ufe any other remedy. They follow nature ftill clofer, in allowing their patients to drink plentifully of cold water; this being the only liquor a patient calls for in a fever. Sweating is likewife a natural remedy. It was probably fuggefted by obferving fevers to be terminated by it. I fhall not inquire how far thefe fweats are effential to the crifis of a fever. The Indian mode of procuring this evacuation is as follows: the patient is -confined in a clofe tent, or wigwam, over a hole in the earth, in which a red hot ftone is placed; a quantity of water is thrown upon this ftone, which inftantly involves the patient in a cloud of vapor and fweat; in this fituation he rulhes out, and plunges himfelf into a river; from whence he retires to his bed. If the remedy has been ufed with fuccefs, he rifes from his bed in four and twenty hours, perfectly recovered from his indifpofition. This remedy is ufed not only to cure fevers, but to remove that uneafinefs which arifes from fatigue of body. ,A third natural remedy among the Indians, is PURGING. The fruits of the earth, the flelh of birds, and other animals feeding upon particular vegetables, and above all, the fpontaneous efforts of nature, early led the Indians to perceive the neceflity and advantages of this evacuation. Vomits conftitute their fourth natural remedy. They were probably like the former, fuggefted by na- ture, and accident. The ipecacuana is one of the many roots they employ for this purpofe. The OF MEDICINE AMONG THE INDIAN'S. 25 The artificial remedies made ufe of by the Indians, are bleeding, caustics, and astrin- gent medicines. They confine bleeding entirely to the part affected. To know that opening a vein in the arm, or foot, would relieve a pain in the head, or fide, fuppofes fome knowledge of the animal cecono- my, and therefore marks an advanced period in the hiftory of medicine. Sharp ftones and thorns are the inftruments they ufe to procure a difcharge of blood. We have an account of the Indians ufing fomething like a potential caustic, in obftinate pains. It confifts of a piece of rotten wood called punk, which they place upon the part affected, and afterwards fet it on fire; the fire gradually confumes the wood, and its allies burn a hole in the flelh. Th e undue efforts of nature, in thofe fevers which are connected with a diarrhoea, or dyfentery, together with thofe haemorrhages to which their mode of life expofed them, neceflarily led them to an early difco- very of fome astringent vegetables. I am uncertain whether the Indians rely upon aftringent, or any other vegetables, for the cure of the intermitting fever. This difeafe among them probably requires no other remedies than the cold bath, or cold air. Its greater obftinacy, as well as frequency among our- felves, muft be fought for in the greater feeblenefs of our conftitutions; and in that change which our coun- try has undergone, from meadows, mill-dams, and the cutting down of woods, whereby morbid exhala- tions have been multiplied, and their paffage rendered more free, through every part of the country. D This 2.6 inquiry into the natural history This is a fhort account of the remedies of the In- dians. If they are fimple, they are like their elo- quence, full of ftrength; if they are few in number, they are accommodated, as their languages are to their ideas, to the whole of their difeafes. We faid formerly that the Indians were fubject to accidents, fuch as wounds, fractures, and the like. In thefe cafes, nature performs the office of a furgeon. We may judge of her qualifications for this office, by obferving the marks of wounds, and fractures, which are fometimes difcovered on wild animals. But fur- ther, what is the practice of our modern furgeons in thefe cafes? Is it not to lay afideplafters and ointments, and truft the whole to nature? Thofe ulcers which re- quire the affiftance of mercury, bark, and a particular regimen, are unknown to the Indians. The hemorrhages which fometimes follow their wounds, are reftrained, by plunging themfelves into cold water, and thereby producing a conftriction upon the bleeding veflels. Their practice of attempting to recover drown- ed people, is irrational and unfuccefsful. It con- fifts in fufpending the patient by the heels, in order that the water may flow from his mouth. This prac- tice is founded on a belief, that the patient dies from fwallowing an exceflive quantity of water. But mo- dern obfervation teaches us, that drowned people die from another caufe. This difcovery has fuggefted a method of cure, directly oppofite to that in ufe among the Indians; and has fhewn us that the practice of fufpending by the heels, is hurtful. I DO OF MEDICINE AMONG THE INDIANS. 27 I DO not find that the Indians ever fuffer in their limbs from the action of cold upon them. Their mokafons*, by allowing their feet to move freely, and thereby promoting the circulation of the blood, defend their lower extremities in the day time, and their prac- tice of fleeping with their feet near a fire defends them from the morbid effeas of cold at night. In thofe cafes where the motion of their feet in their mokafons is not fufficient to keep them warm, they break the ice, and reftore their warmth by expofing them for a fhort time to the ftimulus of cold water. + We have heard much of their fpecific antidotes to the venereal disease. In the accounts of thefe antivenereal medicines, fome abatement fhould be made for that love of the marvellous, and of novelty, which are apt to creep into the writings of travellers and phyficians. How many medicines which were once thought infallible in this diforder, are now rejeft- ed from the materia medical I have found upon in- quiry, that the Indians always aflift their medicines in this difeafe, by a regimen which promotes perfpiration. Should we allow that mercury aBs as a fpecific in de- ftroying this diforder, it does not follow that it is proof againft the efficacy of medicines which aft more me- chanically upon the body. % There * Indian fhoes. , , , . .. + It was remarked in Canada, in the wmter of the year 1759, during the war before laft, that none of thofe foldiers who wore mokafons were froft- bitten, while few of thofe efcaped that were much expofed to the cold, who W°tl cannot help fufpefting the antivenereal qualities of the lobelia, ceano- thus and ranunculus, fpoken of by Mr. Kalm, in the memo,™ of the Swe- dilh academy. Mr. Hand informed me, that the Indians rely chiefly upon a Plentiful ufe of the decotY.ons of the pine-trees, aga.nft the venereal difeafe. He added moreover, thathe had often known this difeafe prove fatal to them. 28 inquiry into the natural history There cannot be a ftronger mark of the imper- fect; ftate of knowledge in medicine among the Indians, than their method of treating the small pox. We are told that they plunge themfelves in cold water in the beginning of the diforder, and that it generally proves fatal to them. Travellers fpeak in high terms of the Indian antidotes to poisons. We muft remember, that many things have been thought poifonous, which later experience hath proved to poffefs no unwholefome quality. Moreover, the uncertainty and variety in the operation of poifons, render it extremely difficult to fix the certainty of their antidotes, to them. How many fpecifics have derived their credit for prevent- ing the hydrophobia, from perfons being wounded by animals, who were not in a fituation to produce that diforder ! If we may judge of all the Indian antidotes to poifons, by thofe which have fallen into our hands, we have little reafon to afcribe much to them in any cafes whatever. I have heard of their performing feveral remark- able cures upon stiff joints, by an infufion of certain herbs in water. The mixture of feveral herbs together in this infufion calls in queftion the fpecific efficacy of each of them. I cannot help attributing the whole fuccefs of this remedy to the great heat of the water in which the herbs were boiled, and to its being applied for a long time to the part affected. We find the fame medicine to vary frequently in its fuc- cefs, according to its ftrength, or to the continuance of its application. De Haen attributes the good ef- fects of electricity, entirely to its being ufed for feve- ral months. I HAVE OF MEDICINE AMONG THE INDIANS. 29 I have met with one cafe upon record of their aiding nature in parturition. Captain Carver gives us an account of an Indian woman in a difficult labor, being fuddenly delivered in confequence of a general convulfion induced upon her fyftem, by {top- ping for a fhort time her mouth and nofe, fo as to ob- struct: her breathing. We are fometimes amufed with accounts of Indian remedies for the dropsy, epilepsy, colic, gra- vel and GOUT. If, with all the advantages which modern phyficians derive from their knowledge in ANATOMY, CHEMISTRY, BOTANY and PHILOSO-. PHY ; if, with the benefit of difcoveries communicat- ed from abroad, as well as handed down from our anceftors, by more certain methods than tradition, we are ftill ignorant of certain remedies for thefe difeafes ; what can we expect from the Indians, who are not only deprived of thefe advantages, but want our chief motive, the fenfe of the pain and danger of thofe dif- orders to prompt them to feek for fuch remedies to relieve them ? There cannot be a ftronger proof of their ignorance of proper remedies for new or difficult difeafes, than their having recourfe to enchantment But to be more particular ; I have taken pains to in- quire into the fuccefs of fome of thefe Indian fpecifics, and have never heard of one well attefted cafe of their efficacy. I believe they derive all their credit from our being ignorant of their compofition. The influ- ence of fecrecy is well known in eftablifliing the cre- dit of a medicine. The fal feignette was an infallible medicine for the intermitting fever, while the manu- factory of it was confined to an apothecary at Rochelle; but it loft its virtues as foon as it was found to be compofed of the acid of tartar and a foflil alkali. Dr. Ward's 30 INQUIRY INTO THE NATURAL HISTORY Ward's famous pill and drop ceafed to do wonders in fcrophulous cafes, as foon as he bequeathed to the world his receipts for making them. I foresee an objection to what has been faid con- cerning the remedies of the Indians, drawn from that knowledge which experience gives to a mind intent upon one fubject. We have heard much of the per- fection of their fenfes of feeing and hearing. An In- dian, we are told, will difcover not only a particular tribe of Indians by their footfteps, but the diftance of time in which they were made. In thofe branches of knowledge which relate to hunting and war, the In- dians have acquired a degree of perfection that has not been equalled by civilized nations. But we muft re- member, that medicine among them does not enjoy the like advantage with the arts of war and hunting, of being the chief object of their attention.- The phy- cian and the warrior are united in one character; to render him as able in the former, as he is in the latter profeflion, would require an entire abftra£tion from every other employment, and a familiarity with ex- ternal objects, which are incompatible with the wan- dering life of favages. Thus have we finilhed our inquiry into the dif- eafes and remedies of the Indians in North-America. We come now to inquire into the difeafes and re- medies of civilized nations. Nations differ in their degrees of civilization. We fhall felect one for the fubject of our inquiries which is moil familiar to us ; I mean the Britifh na- tion. Here we behold fubordination and clafles of mankind eftablifhed by government, commerce, ma- nufactures, OF MEDICINE AMONG THE INDIANS. 31 nufactures, and certain cuftoms common to moil of the civilized nations of Europe. We fhall trace the origin of their difeafes through their cuftoms, in the fame manner as we did thofe of the Indians. I. It will be fufficient to name the degrees of heat, the improper aliment, the tight drefles, and the pre- mature ftudies children are expofed to, in order to (how the ample fcope for difeafes, which is added to the original defect of ftamina they derive from their anceftors. II. Civilization rifes in its demands upon the health of women. Their falhions; their drefs and diet; their eager purfuits and ardent enjoyment of pleafure ; their indolence and undue evacuations in pregnancy; their cordials, hot regimen and neglect or ufe of art, in child-birth, are all fo many inlets to difeafes. Humanity would fain be filent, while philofophy calls upon us to mention the effects of interefted mar- riages, and of difappointments in love, increafed by that concealment which the tyranny of cuftom has impofed upon the fex*. Each of thefe exaggerates the natural, and increafes the number of artificial difeafes among women. III. The difeafes introduced by civilization extend themfelves through every clafs and profeflion among men. * " Married women are more healthy and long-lived than (ingle women. The'regifters, examined by Mr. Muret, confirm this obfervation; and (how particularly, that of equal numbers of fingle and married women between fifteen and twenty-five years of age, more of the former died than of the lat- ter, in the proportion of two to one : the confequencc, therefore, of follow- ing nature, muft be favourable to health amon^ the female (ex." Supple- ment to Price's Obfervations on ReverSpnary Payments, p. 357, 32 INQUIRY INTO THE NATURAL HISTORY men. How fatal are the effects of idlenefs and in- temperance among the rich, and of hard labor and penury among the poor ! What pallid looks are con- tracted by the votaries of fcience from hanging over the " fickly taper !" How many difeafes are entailed upon manufacturers, by the materials in which they work, and the pofture of their bodies ! What monk- ilh difeafes do we obferve from monkilh continence, and monkilh vices ! We pafs over the increafe of ac- cidents from building, failing, riding, and the like. War, as if too flow in deftroying the human fpecies, calls in a train of difeafes peculiar to civilized nations. What havoc have the corruption and monopoly of provifions, a damp foil, and an unwholefome fky, made in a few days in an army ! The atchievements of Britilh valor at the Havannah, in the laft war, were obtained at the expence of 9,000 men, 7,000 of whom perilhed with the Weft-India fever*. Even our mo- dern difcoveries in geography, by extending the em- pire ot commerce, have Hkewife extended the empire of difeafes. What defolation have the Eaft and Weft Indies made of Britifh fubjects! It has been found upon a nice calculation, that only ten of an hundred Europeans, live above feven years after they arrive in the ifland of Jamaica. IV. It would take up too much of our time to point out all the cuftoms both phyfical and moral, which * The modern writers upon the difeafes of armies, wonder that the Greek and Roman phyficians have left us nothing upon that fubjedt. But may not mojl of the difeafes of armies be produced by the different manner in which wars are carried on by modern nations? The difcoveries in geography, by ex- tending the field of war, expofe foldiers to many difeafes from long voyages, ar.d zfudden change of climate ; which were unknown to the armies of for- mer ages. Moreover, the form of the weapons, and the variety in the mi- liary exercifes of the Grecian and Roman armies, gave a vigor to the conftU tution, which can never be acquired by the ufe of mufkets and artillery. OF MEDICINE AMONG THE INDIANS. 33 which influence difeafes among both fexes-. The for- mer have engendered the feeds of difeafes in the human body itfelf; hence the origin of catarrhs, jail and miliary fevers, with a long train of contagious dif- orders, which compofe fo great a part of our books of medicine. The latter likewife have a largefhare in producing difeafes. I am not one of thofe modem philofophers, who derive the vices of mankind from the influence of civilization ; but I am fafe in affert- ing, that their number and malignity increafe with the refinements of polifhed life. To prove this, we need only furvey a fcene too familiar to affect us: it is a bedlam ; which injuftice, inhumanity, avarice, pride, vanitv, and ambition, have filled with inhabitants. THUS have we briefly pointed out the cuftoms which influence the difeafes of civilized nations. It remains now that we take notice of their difeafes. Without naming the many new fevers, fluxes, haemorr- hages, fwellings from water, wind, flelh, fat, pus and blood ; -foulneffes on the Ikin from cancers, leprofy, yaws, poxes, and itch; and laftly, the gout, the hyfteria, and the hypochondriafis, in all their variety of known and unknown fhapes ; I fhall fum up all that is ne- ceflary upon this fubject, by adding, that the number of difeafes which belong to civilized nations, accord- ing to Doctor Cullen's nofology, amounts to 1387 ; the fingle clafs of nervous difeafes form 612 of this number. Before we proceed to fpeak of the remedies of civilized nations, we fhall examine into the abilities of nature in curing their difeafes. We found her active and fuccefsful in curing the difeafes of the In- dians. Is her ftrength, wifdom, or benignty, equal to E the 54 INQUIRY INTO THE NATURAL HISTORV the increafe of thofe dangers which threaten her dif- folution among civilized nations ? In order to anfwer this queftion, it will be neceflary to explain the mean- ing of the term nature. By nature, in the prefent cafe, I underftand nothing but phyfical necejjity. This at once excludes every thing like intelligence from her operations: thefe are all performed in obedience to the fame laws which govern vegetation in plants and the inteftine motions of fbflils*. They are as truly mechanical as the laws of gravitation, electricity, or magnetifm. A fhip when laid oh her broadfide by a wave, or a fudden blaft of wind, rifes by the fimple laws of her mecha- nifm; but fuppofe this fhip to be attacked by fire, or a water-fpout, we are not to call in queftion the fkill of the Ihip-builder, if fhe is confirmed by the one, or funk by the other. In like manner, the Author of nature hath furnilhed the body with powers to pre- ferve itfelf from its natural enemies ; but when it is attacked by thofe civil foes which are bred by the pe- culiar cuftoms of civilization, it refembles a company of Indians, armed with bows and arrows, againft the complicated and deadly machinery of fire-arms. To place this fubject in a proper light* we fhall deliver a hiftory of the operations of nature in a few of the difeafes of civilized nations. I. There, are cafes in which nature is ftill fuc- cefsful in curing difeafes. In fevers fhe ftill deprives us of our appetite for animal food, and imparts to us a defire for cool air and cold ^water. In of medicine AMONG THE INDIANS. 25 In haemorrhages fhe produces a faintinefs, which ©ccafions a coagulum in the open veffels ; fo lhat the further paffage of blood through them is obftructed. In wounds of the flefli and bones, (he difcharges foreign matter by exciting an inflammation, and fup- plies the wafte of both with new flefli and bone. II. There are cafes where the efforts of nature are too feeble to do fervice, as in putrid and nervous fevers. III. There are cafes where the efforts of nattire are over-proportioned to the ftrength of the difeafe, as in the cholera morbus and dyfentery. IV. There are cafes where nature is idle, as in the atonic ftages of the gout, the cancer, the epilepfy, the mania, the venereal difeafe, the apoplexy, and the tetanus*. V. There are cafes in which nature does mifchief. "She waftes herfelf with an unneceffary fever in a dropfy and confumption. She throws a plethora upon the brain and lungs. She ends a pleurify and peripneu- mony in a vomica, or empyema. She creates an un- natural appetite for food in the hypochondriac difor- der. And laftly, fhe drives the melancholy patient to folitude, where, by brooding over the fubject of his infanity, he increafes his difeafe. We are accuftomed to hear of the falutary kind- nefs of nature in alarming us with pain, to prompt us to feek for a remedy. But, VI. There * Hoffman de hypothefium medicarum damno, feci. xv. 36 INQUIRY INTO THE NATURAL HISTORY VI. There are cafes in which the refufes to fend this harbinger of the evils which threaten her, as in the aneurifm, fcirrhus, and ftone in the bladder. VII. There are cafes where the pain is not pro- portioned to the danger, as in the tetanus, conlump- tion, and dropfy of the head. And, VIII. There are cafes where the pain is over- proportioned to the danger, as in the paronychia and tooth-ach. This is a fhort account of the operations of na- ture, in the difeafes of civilized nations. A lunatic might as well plead againft the fequeftration of his eftate, becaufe he once enjoyed the full exercife of his reafon, or becaufe he ftill had lucid intervals, as nature be exempted from the charges we have brought againft her. But this fubject will receive ftrength from confi- dering the remedies of civilized nations. All the products of the vegetable, foflil, and animal kingdoms, tortured by heat and mixture into an almoft infinite variety of forms ; bleeding, cupping, artificial drains by fetons, iffues and blifters ; exercife, active and paflive ; voyages and journies ; baths, warm and cold; waters faline, aerial and mineral ; food by weight and meafure ; the royal touch ; enchantment; miracles ; in a word, the combined difcoveries of natural hiftory and philofophy, united into a fyftem of materia medica, all fhow, that although phyficians are in fpeculation the fervants, yet in practice they are the mafters of nature. The whole of their remedies feem contrived on OF MEDICINE AMONG THE INDIANS. 37 on purpofe to aroufe, aflift, reftrain, and controul her operations. There are fome truths like certain liquors, which require ftrong heads to bear them. I feel myfelf pro- tected from the prejudices of vulgar minds, when I reflect that I am delivering thefe fentiments in a fociety of philofophers. Let us now take a comparative view of the difeafes and remedies of the Indians, with thofe of ci- vilized nations. We fhall begin with their difeafes. In our account of the difeafes of the Indians we beheld death executing his commiflion, it is true; but then his dart was hid in a mantle, under which he conceal- ed his fhape. But among civilized nations we behold him multiplying his weapons in proportion to the num- ber of organs and functions in the body; and point- ing each of them in fuch a manner, as to render his meffengers more terrible than himfelf. We faid formerly that fevers conftituted the chief difeafes of the Indians. According to Doctor Syden- ham's computation, above 66,000 out of 100,000 died of fevers in London about 100 years ago; but fevers now conftitute but a little more than one-tenth part of the difeafes of that city. Out of 21,780 perfons who died in London between December 1770 and Decem- ber 1771, only 2273 died of fimple fevers. I have more than once heard Doctor Huck complain, that he could find no marks of epidemic fevers in London as defcribed by Doctor Sydenham. London has under- gone a revolution in its manners and cuftoms fince Doctor Sydenham's time. New difeafes, the offspring of 38 INQUIRY INTO THE NATURAL HISTORY of luxury, have fupplanted fevers; and the few that are left, appear fo complicated with other difeafes, that their connection can no longer be discovered with an epidemic conftitution of the year. The pleurify and peripneumony, thofe inflammatory fevers of ftrong conftitutions, are now loft in catarrhs, or colds; which inftead of challenging the powers of nature or art to a fair combat, infenfibly undermine the conftitution, and bring on an incurable confumption. Out of 22,434 wno ^ied between December 1769 and the fame month in 1770, 4594 periflied with that Britifk diforder. Our countryman, Doctor Maclurg, has ventured to foretel that the gout will be loft in a few years, in a train of hypochondriac, hyfteric and bili- ous diforders. In like manner, may we not look for a feafon when fevers, the natural difeafes of the hu- man body, will be loft in an inundation of artificial difeafes, brought on by the modifh practices of mo- dern civilization ? It may notbe improper to compare the prognosis of the Indians, in difeafes, with that of civilized na- tions, before we take a comparative view of their re- medies. The Indians are faid to be fuccefsful in predicting the events of difeafes. While difeafes are fimple, the marks which diftinguifh them, or characterize their feveral ftages, are generally uniform and obvious to the moft indifferent obferver. Thefe marks afford fo much certainty, that the Indians fometimes kill their phyficians for a falfe prognofis, charging the death of the patient to their careleflhefs, or ignorance. They eftimate the danger of their patients by their degrees o£ appetite; while an Indian is able to eat, he is looked upon OF MEDICINE AMONG THE INDIANS. 39 upon as free from danger. But when we confider the number and variety in the figns of difeafes, among ci- vilized nations, together with the ftiortnefs of life, the fallacy of memory, and the uncertainty of obfervation; where (hall we find a phyfician willing to rilk his re- putation, much lefs his life, upon the prediction of the event of our acute difeafes ? We can derive no ad- vantage from the fimple fign, by which the Indians eftimate the danger of their patients; for we daily fee a want of appetite for food in difeafes which are attend- ed with no danger; and we fometimes obferve an un- ufual degree of this appetite to precede the agonies of death. I honor the name of Hippocrates: But forgive me ye votaries of antiquity, if I attempt to pluck a few grey hairs from his venerable head. I was once an idolater at his altar, nor did I turn apoftate from his worlhip, till I was taught, that not a tenth part of his prognoftics correfponded with modern ex- perience, or obfervation. The pulfe* urine, and fweats, from which the principal figns of life and death have been taken, are fo variable in moil of the acute difeafes of civilized nations, that the wifeft phyficians have in fome meafure excluded the prognofis from being a part of their profeflion. I am here infenfibly led to make an apology for the instability of the theories and practice of phyfic The theory of phyfic is founded upon the laws of the animal ceconomy. Thefe (unlike the laws of the mind, or the common * Doctor Cullen ufed to inform his pupils, that after forty yean experi- ence, he could find no relation between his obfervations on the pulfe, and thofe made by Dodor Solano. The climate and cuftoms of the people in Spain being fo different from the climate and cuftoms of the prefent inhabi- tants of Britain, may account for the diverfity of their obfervations. Doclor Heberden's remarks upon the pulfe, in the fecond volume of the Medical Tranfadtions, are calculated to mow how little the iflue of difeafes can be learned from it. 40 INQUIRY INTO THE NATURAL HISTORY common laws of matter) do not appear at once, but are gradually brought to light by the phaenomena of difeafes. The fuccefs of nature, in curing the fimple difeafes of Saxony, laid the foundation for the an i m a medica of Doctor Stahl. The endemics of Hol- land* led Doctor Boerhaave to feek for the caufes of all difeafes in the fluids. And the univerfal pre- valence of the difeafes of the nerves, in Great-Bri- tain, led Doctor Cullen to difcover their peculiar laws, and to found a system upon them; a fyftem, which will probably laft till fome new difeafes are let loofe upon the human fpecies, which fhall unfold other laws of the animal ceconomy. It is in confequence of this fluctuation in the prin- ciples and practice of phyfic, being fo neceffarily con- nected with the changes in the cuftoms of civilized na- tions, that old and young phyficians fo often difagree in their opinions and practices. And it is by attending to the conftant changes in thefe cuftoms of civilized na- tions, that thofe phyficians have generally become the moft eminent, who have fooneft emancipated them- felves from the tyranny of the fchools of phyfic; and have occasionally accommodated their principles and practice to the changes in difeafest. This variety in difeafes, * " The fcurvy is very frequent in Holland; arid draws its origin partly from their ftrong food, fea-fifh, and fmoaked flefh, and partly from their denfe and moift air, together with their bad water." Hoffman on Endemi- al Diftempers. " We are now in North-Holland ; and I have never feen, among fo few people, fo many infecled with the leprofy as here. They fay the reafon is, becaufe they eat fo much fifti." Howell's Familiar Letters. + We may leam from thefe obfervations, the great impropriety of thofe Egyptian laws which oblige phyficians to adopt, in all cafes, the prefcripti- ons which had been colle&ed, and approved of, by the phyficians of former ages. Every change in the cuftoms of civilized nations, produces a change in their difeafes, which calls for a change in their remedies. What havoc would plentiful bleeding, purging, and (mail beer, ibrmerly ufed with fo much OF MEDICINE AMONG THE INDIANS. 4I difeafes, which is produced by the changes in the cuf- toms of civilized nations, will enable us to account for many of the contradictions which are to be found in authors of equal candor and abilities, who have writ- ten upon the materia medica. In forming a comparative view of the remedies of the Indians, with thofe of civilized nations, we fhall remark, that the want of fuccefs in a medicine is oc- cafioned by one of the following caufes. First, our ignorance of the diforder. Secondly, an ignorance of a fuitable remedy. Thirdly, a want of efficacy in the remedy. Considering the violence of the difeafes of the Indians, it is probable their want of fuccefs is always occafioned by a want of efficacy in their medicines. But the cafe is very different among civilized nations. Diflections daily convince us of our ignorance of the feats of difeafes, and caufe us to blufli at our prefcrip- tions. What certain or equal remedies have we found for the gout, the epilepfy, apoplexy, palfy, dropfy of the brain, cancer and confumption ? How often are we difappointed in our expectations from the moft certain and powerful of our remedies, by the negli- gence or obftinacy of our patients ! What mifchief have we not done under the belief of falfe facts (it I may be allowed the expreflion) and falfe theories! We have afliited in multiplying difeafes.—We have done more—we have increafed their mortality. F I SHALL much fuccefs by Dr. Sydenham in the cure of fevers, now make upon the en- feebled citizens of London ! The fevers of the fame, and of more fouthern latitudes, ftill admit of fuch antiphlogiftic remedies. In the room of thefe, bark, wine, and other cordial medicines, are jarefcribed in London in almoft eu m l°ngitude 75 ° 8' from Grepnwich, and fifty-five miles weft from the Atlantic ocean. It is fituated about four miles due north from the conflux of the rivers Delaware and Schuylkill. The buildings, which confift chiefly of brick, extend near- iy * The author is happy in being able to inform the public, that a corredt view of thefe mountains and rivers, with their heights, diftances and courfes, will be publiftied in a few months by Mr. Reading Howell, of the city of Philadelphia, in a large map of Pennfylvania. 60 ACCOUNT OF THE CLIMATE ly three miles north and fouth along the Delaware, and above half a mile due weft towards the Schuylkill, to which river the limits of the city extend ; the whole including a diftance of two miles from the Delaware. The land near the rivers, between the city and the con- flux of the rivers, is in general low, moift, and fub- ject to be overflowed. The greateft part of it is mea- dow ground. The land to the northward and weft- ward, in the vicinity of the city, is high, and in ge- neral well cultivated. Before the year 1778 the ground between the prefent improvements of the city, and the river Schuylkill, was covered with woods. Thefe, together with large tracts of wood to the northward of the city, were cut down during the winter the Britilh army had poffeflion of Philadelphia. I fhall hereafter mention the influence which the cutting down of thefe woods, and the fubfequent cultivation of the grounds in the neighbourhood of the city, have had upon the health of its inhabitants. The mean height of the ground on which the city ftands, is about forty feet above the river Delaware. One of the longeft and moft populous ftreets in the city, rifes only a few feet above the river. The air at the north is much purer than at the fouth end of the city ; hence the lamps exhibit a fainter flame in its fouthern than its northern parts. The tide of the Delaware feldom rifes more than fix feet. It flows four miles in an hour. Its width near the city is about a mile. The city, with the adjoining diftricts of South- wark and the Northern Liberties, contain between 40 and 50,000 inhabitants. From OF PENNSYLVANIA. 6l From the accounts which have been handed dpwn to us by our anceftors, there is reafon to believe that the climate of Pennfylvania has undergone a material change. Thunder and lightning are lefs frequent, and the cold of our winters and heat of our fummers are lefs uniform, than they were forty or fifty years ago. Nor is this all. The fprings are much colder, and the autumns more temperate than formerly, infomuch that cattle are not houfed fo foon by one month as they were in former years. Within the laft eight years, there have been fome exceptions to part of thefe ob- fervations. The winter of the year 1779, 80, was uniformly and uncommonly cold. The river Dela- ware was frozen near three months during this winter, and public roads for waggons and fleighs connected the city of Philadelphia in many places with the Jer- fey fhore. The thicknefs of the ice in the river near the city, was from fixteen to nineteen inches, and the depth of the froft in the ground was from four'to five feet, according to the expofure of the ground and the quality of the foil. This extraordinary depth of the froft in the earth, compared with its depth in more northern and colder countries, is occafioned by the long delay of fnow, which leaves the earth without a covering during the laft autumnal and the firft winter months. Many plants were deftroyed by the intenfe- nefs of the cold during this winter. The ears of horn- ed cattle and the feet of hogs expofed to the air, were froft-bitten ; fquirrels perifhed in their holes, and par- tridges were often found dead in the neighbourhood of farm-houfes. The mercury in January flood for feveral hours at 5 ° below o, in Farenheit's thermo- meter ; and during the whole of this month, (except on one day) it never rofe in the. city of Philadelphia to the freezing point. The 62 ACCOUNT OF THE CLIMATE The cold in the winter of the year 1783, 4, was as intenfe but not fo fteady, as it was in the winter that has been defcribed. It differed from it materially in one particular, viz. there was a thaw in the month of January which opened all our rivers for a few days. The fummer which fucceeded the winter of 1779, 80, was uniformly warm. The mercury in the ther- mometer, during this fummer, flood on one day (the 15th of Auguft) at 95°, and fluctuated between 93 ° and 80 ° for many weeks. The thermometer, in every reference that has been, or fhall be made to it, flood in the fhade in the open air. 1 know it has been faid by many old people, that the winteis in Pennfylvania are lefs cold, and the fummers lefs warm, than they were forty or fifty years ago. The want of thermometrical obfervations before and during thofe years, renders it difficult to decide this queftion. Perhaps the difference of fenfation be- tween youth and old age, with refpect to heat and cold, may have laid the foundation of this opinion. I fuf- pect the mean temperature of the air in Pennfylvania has not altered, but that the principal change in our climate confifts in the heat and cold being lefs con- fined than formerly to their natural feafons. I adopt the opinion of factor Williamfon* reflecting the di- minution of the cold in the fouthern, being occafioncd by the cultivation of the northern parts of Europe ; but no fuch cultivation has taken place in the coun- tries which lie to the north-weft of Pennfylvania, nor do the partial and imperfect improvements which have been made in the north-weft parts of the ftate, ap- pear to be fufficient to leffen the cold, even in the city * American Philofophical Tranfa&ions, vol. I. OF PENNSYLVANIA. 63 city of Philadelphia. I have been able to collect no facts, which difpofe me to believe that the winters were colder before the year 1740, than they have been fince. In the memorable winter of 1739, 40, the Delaware was croffed on the ice in fleighs on the 5th of March, old ftyle, and did not open till the 13th of the fame month. The ground was covered during this winter with a deep fnow, and the rays of the fun were con- ftantly obfcured by a mill, which hung in the upper regions of the air. In the winter of 1779, 80, the river was navigable on the 4th of March ; the depth of the fnow was moderate, and the gloominefs of the cold was fometimes fufpended for a few days by a cheerful fun. From thefe facts, it is probable the winter of 1739, 4°> was co^er tnan tne winter of 1779, 80. Having premifed thefe general remarks, I pro- ceed to obferve, that there are feldom more than twen- ty or thirty days in fummer or winter in Pennfylvania in which the mercury rifes above 80 ° in the former, or falls below 30 ° in the latter feafon. Some old peo- ple have remarked that the number of extremely cold and warm days in fucceflive fummers and winters, bears an exact proportion to each other. This was ftrittly true in the years 1787 and 1788. The warmeft part of the day in fummer is at two, in ordinary, and at three o'clock in the afternoon in extremely warm weather. From thefe hours the heat gradually diminifhes till the enfuing morning. The cooleft part of the four and twenty hours is at the break of day. There are feldom more than three or four nights in a fummer, in which the heat of the air is nearly the fame as in the preceding day. After the warmell 64 ACCOUNT OF THE CLIMATE warmeft days, the evenings are generally agreeable, and often delightful. The higher the mercury rifes in the day time, the lower it falls the fucceeding night. The mercury at 80 ° generally falls to 68°, while itdefcends, when at 60 ° only to 56 °. This difproportion be- tween the temperature of the day and night, in fum- mer, is always greateft in the month of Auguft. The dews at this time are heavy in proportion to the cool- nefs of the evening. They are fometimes fo confider- able as to wet the cloaths; and there are inftances in which marth-meadows, and even creeks which have been dry during the fummer, have been fupplied with their ufual waters from no other fource than the dews which have fallen in this month, or in the firft weeks of September. There is another circumftance connected with the one juft mentioned, which contributes very much to mitigate the heat of fummer, and that is, it feldom continues more than two or three days without being fucceeded with fliowers of rain, accompanied fome- times by thunder and lightning, and afterwards by a north-weft wind, which produces a coolnefs in the air that is highly invigorating and agreeable. The warmeft weather is generally in the month of July. But intenfely warm days are often felt in May, June, Auguft and September. In the annexed table of the weather for the year 1787, there is an exception to the firft of thefe remarks. It thews that the mean heat of Auguft was greater by a few degrees than that of July. The tranfitions from heat to cold are often very fudden, and fometimes to very diftant degrees. After % day OF PENNSYLVANIA. 65 a day in which the mercury has flood at 86° and even 90 ° , it fometimes falls in the courfe of a tingle night to the 65th, and even to the 60th degree, infomuch that fires have been found neceflary the enfuing morning, efpecially if the change in the temperature of the air has been accompanied by rain and a fouth-eaft wind. In a fummer month in the year 1775, the mercury was obferved to fall 20 ° in an hour and an half. There are few fummers in which fires are not agreeable du- ring fome parts of them. My ingenious friend Mr. David Rittenhoufe, whofe talent for accurate obferva- tion extends alike to all fubjects, informed me, that he had never paffed a fummer, during his refidence in the country, without difcovering froft in every month o£ the year, except July* Th e weather is equally variable in Pennfylvania du- ring the greateft part of the winter. The mercury fell from 370 to ^—° below o, in four and twenty hours, between the fourth and fifth of February 1788. In this feafon nature feems to play at crofs-purpofes. Heavy falls of fnow are often fucceeded in a few days by a general thaw, which frequently in a fhort time leaves rto veftige of the fnow. The rivers Delaware, Schuylkill and Sufquehannah have fometimes been frozen (fo as to bear horfes and carriages of all kinds) and thawed fo as to be paffable in boats, two or three times in the courfe of the fame winter. The ice is formed for the moft part in a gradual manner, and feldom till it has been previoufly chilled by a fall of fnow. Sometimes its production is more fudden. On the 31ft of December 1764, the Delaware was com- pletely fr- >zen over between ten o'clock at night and eight the next morning, fo as to bear the weight of a man. An unufual vapor like a fog was feen to rife I from 66 ACCOUNT OF THE CLIMATE from the water, in its paffage from a fluid to a folid ftate. This account of the variablenefs of the weather ii* winter, does not apply to every part of Pennfylvania. There is a line, about the 41 ° of the ftate, beyond which the winters are fteady and regular, infomuch that the earth there is feldom without a covering of fnow during the three winter months. In this line the cli- mate of Pennfylvania forms a union with the climate of the eaftern and northern ftates. The time in which froft and ice begin to fhew themfelves in the neighbourhood of Philadelphia, is generally abdtat the latter end of October or the be- ginning of November. But the intenfe cold feldom lets in till about the 20th or 25th of December ; hence the common faying, " as the day lengthens the cold " ftrengthens." The coldeft weather is commonly in January. The navigation of the river Delaware, after being frozen, is feldom practicable for large veffels, before the firft week in March. As in fummer there are often days in which fires are agreeable, fo there are fometimes days in winter in which they are difagreeable. Vegetation has been obferved in all the winter months. Garlic was tailed in butter in January 1781. The leaves of the wil- low, the bloffoms of the peach tree, and the flowers of the dandelion and the crocus, were all feen in Fe- bruary 1779 ; and I well recollect, about thirty-two years ago, to have feen an apple-orchard in full bloom, and fmall apples on many of the trees, in the month of December. A COLQ OF PENNSYLVANIA. 67 A COLD day in winter is often fucceeded by a mo- derate evening. The coldeft part of the four and twenty hours is generally at the break of day. In the moft intenfe cold which has been recorded in Philadelphia, within the laft twenty years, the mer- cury flood at 5 ° below o. But it appears from the accounts publiftied by Meflieurs Mafon and Dixon, in the 58th volume of the tranfactions of the Royal So- ciety of London, that the mercury flood at 22 ° be- low o on the 2d of January 1767, at Brandy wine, about thirty miles to the weftward of Philadelphia. They inform us, that on the firft of the fame month the mercury flood at 20 °, and on the day before at 7 ° below o. I have to lament that I am not able to procure any record of the temperature of the air in the fame year in Philadelphia. From the variety in the height and quality of the foil, and from the difference in the currents of winds and the quantity of rain and fnow which fall in different parts of the ftate, it is very probable this exceflive cold may not have extended thirty miles from the place where it was perceived. The greateft degree of heat upon record in Phila- delphia, is 950. Th e ftandard temperature of the air in the city of Philadelphia is ,52-j0, which is the temperature of our deepeft wells, as alfo the mean heat of our common fpring water. The fpring in Pennfylvania is generally lefs plea- fant, than in many other countries. In March the weather is ftormy, variable and cold. In April, and fometimes 68 ACCOUNT OF THE CLIMATE fometimes in the beginning of May, it is moift, and ac- companied by a degree of cold which has been called rawnefs, and which from its difagreeable effects upon the temper has been called fhtfrocco of this country. From the variable nature of the weather in the fpring, vegetation advances very differently in different years. The colder the fpring, the more favourable it proves to the fruits of the earth. The hopes of the farmer from his fruit-trees in a warm fpring are often blaft- ed by a froft in April and May. A fall of fnow is remembered with regret by many of them on the night between the third and fourth of May in the year 1774. The colder the winter, the greater delay we obferve in the return of the enfuing fpring' Sometimes the weather during the fpring months is cloudy and damp, attended occafionally with a gentle fall of rain referabling the fpray from a cataract of water. A day of this fpecies of weather is called, from its refem- blance to a damp day in Great-Britain, " an Englith day." This damp weather feldom continues more than three or four days. The month of May 1786, will Jong be remembered, for having furnifhed a very un- common inftance of the abfence of the fun for fourteen days, and of conftant damp or rainy weather. The month of June is the only month in the year which refembles a fpring month in the fouthern coun- tries of Europe. The weather is then generally tem- perate, the fky is ferene, and the verdure of the coun- try is univerfal and delightful. The autumn is the moft agreeable feafon in the year in Pennfylvania. The cool evenings and mornings, which generally begin about the firft week in Septem- ber, OF PENNSYLVANIA. 69 ber, are fucceeded by a moderate temperature of the air during the day. This fpecies of weather continues with an increafe of cold fcarcely perceptible, till the middle of October, when the autumm is clofed by rain, which fometimes falls in fuch quantities as to produce deftructive frethes in the rivers and creeks, and fome- times defcends in gentle fhowers, which continue with occafional interruptions by a few fair days, for two or three weeks. Thefe rains are the harbingers ot the winter, and the Indians have long ago taught the in- habitants of Pennfylvania, that the degrees of cold du- ring the winter, are in proportion to the quantity of rain which falls during the autumn*. From this account of the temperature of the air in Pennfylvania, it is evident that there are feldom more than four months in which the weather is agreeable without a fire. In winter, the winds generally come from the north- weft in fair, and from the north-eaft in wet weather. The north-weft winds are uncommonly dry as well as cold. It is in confequence of the violent action of thefe winds that trees have uniformly a thicker and more compact: bark on their northern, than on their fouthern expofures. Even brick houfes are affected by » I cannot help agreeing with Mr. Kirwan in one of his remarks upon the fcience of meteorology in the preface to his eftimate of the temperature of different latitudes. " This fcience (fays he) if brought to perfection, would enable us at leaft to forefee thofe changes in the weather which we could not prevent. Great as is the diftance between fuch knowledge, and our own prefent attainments, we have no reafon to think it above the level of the pow- ers of the human mind. The motions of the planets muft have appeared as perplexed and intricate to thofe who firft contemplated them; yet by perfe- veriag induftry, they are now known to the utmoft precifion. The prefent is (as the great Leibnitz expreffes it) in every cafe pregnant with the future, and the connexion muft be found by long and attentive obfervation." The influence which the perfection of this fcience muft have upon health, agriculture, navigation and commerce, is too obvious to be mentioned. 70 ACCOUNT OF THE CLIMATE by the force and drynefs of thefe north-weft winds: hence it is much more difficult to demolifh the north- ern than the fouthern walls of an ©Id brick houfe. This fact was communicated to me by an eminent bricklayer in the city of Philadelphia. The winds in fair weather in the fpring, and in wavm weather in the fummer, blow from the fouth- weft and from weft-north-weft. The raw air before mentioned, comes from the north-eaft. The fouth- weft winds likewife ufually bring with them thofe thow- ers of rain in the fpring and fummer, which refreth the earth. They moreover moderate the heat of the weather, provided they are fucceeded by a north-weft wind. Now and then fhowers of rain come from the weft-north-weft. There is a common fact connected with the ac- count of the ufual winds in Pennfylvania, which it may not be improper to mention in this place. While the clouds are feen flying from the fouth-weft, the feud, as it is called, or a light vapor, is feen at the fame time flying below the clouds from the north-eaft. The moifture of the air is much greater than for- merly, occafioned probably by the exhalations which in former years fell in the form of fnow, now descend- ing in the form of rain. The depth of the fnow is fometimes between two and three feet, but in general it feldom exceeds between fix and nine inches. Hail frequently defcends with fnow in winter. Once in four or five years large and heavy fhowers of hail fall in the fpring and fummer. They generally run in narrow veins (as they are called) of thirty or forty OF PENNSYLVANIA. 7* forty miles in length, and two or three miles in breadth. The heavieft fhower of hail that is remembered in Phi- ladelphia, did not extend in breadth more than half a mile north and fouth. Some of the ftones weighed half an ounce. The windows of many houfes were broken by them. This fhower fell in May 1783. From fudden changes in the air, rain and fnow often fall together, forming what is commonly called fleet. In the uncultivated parts of the ftate, the fnow fometimes lies on the ground till the firft week in April. The backwardnefs of the fpring has been afcrib- ed to the paffage «f the air over the undiflblved beds of fnow and ice which ufually remain, after the winter months are paft, on the njrth-weft grounds and wa- ters of the ftate, and of the adjacent country. The diffolution of the ice and fnow in the fpring, is fometimes fo fudden as to fwell the creeks and ri- vers in every part of the ftate to fuch a degree, as not only to lay wafte the hopes of the hufbandman from the produce of his lands, but in fome inftances to fweep his barns, ftables, and even his dwelling houfe into their currents*. The wind during a general thaw, comes from the fouth-weft or fouth-eaft. Triv * The following account of the thaw of the river Sufquehannah, in ths fpring of 1784, was publifhed by the author in the Columbian Magazine for November 1786. It may ferve to illuftrate a fact related formerly in th; hiftory of the winters in Pennfylvania, as well as to exhibit an extraordinary inftance of the deftructive effects of a fudden thaw. "THE winter of 1783,4, was uncommonly cold, infomuch that tKr mercury in Farenheit's thermometer flood feveral times at 5 degrees below c. The fnows were frequent; and, in many places, from two to three feet dsep, during the greateft part of the winter. All the rivers in Pennfylvania were frozen, fo as to bear waggons and flads with rmmejife weights. In the 72 ACCOUNT OF THE CLIMATE The air, when dry in Pennfylvania, has a peculiar elafticity, which renders the heat and cold lefs infup- portable than the fame degrees of both are in moifter countries. It is in thofe cafes only when fummer fhowers are not fucceeded by north-weft winds, that the heat of the air becomes oppreflive and diftrefling, from beinp- combined with moifture. ~ ° x ROM month of January a thaw came on fuddenly, which opened our rivers fo as to fet the ice a-driving, to ufe the phrafe of the country. In the courfe of one night, during the thaw, the wind fhifted fuddenly to the north-weft, and the weather became intenfely cold. The ice, which had floated the day before, was fuddenly obftrudted ; and in the river Sufquehannah, the obftrudtiona were formed in thofe places where the water was moft (hallow, or where it had been accuftomed to fall. This river is feveral hundred miles in lengthj and from half a mile to a mile and an half in breadth, and winds through a hilly, and in many places a fertile and highly cultivated country. It has as yet a moft difficult communication with our bayfc and the fea, occafioned by the number and height of the falls which occur near the mouth of the river. The ice in many places, efpecially where there were falls, formed a kind of dam, of a moft ftupendous height. About the middle of March our Weather moderated, and a thaw became general. The eftefts of it were remarkable in all our rivers; but in none fo much as in the river I have mentioned. I lhail therefore endeavour in a few words to defcribe them. Unfortunately the dams of ice did not give way all at once, nor thofe which lay neareft to the mouth of the river, firft. While the upper dams were fet a-floatby the warm weather, the lower ones, which were the krgeft, and in which, of courfe, the ice was moft impacted, remained fixed. In confequence of this, the river rofe in a few hours, in many places, above 3o feet; rolling upon it* furfaee large lumps of ice, from 10 to 40 cubic feet in fize. The effects of this fudden inundation were terrible. Whole farms were laid under water. Barns—ftables^-horfes—cattle—fences—mills oi every kind, and in one inftance, a large ftone houfe, 40 by 30 feet, were carried(down the ftream. Large trees were torn up by the roots—feveral fmall iflands covered with woods, were fwept away, and not a veftige of them was left behind. On the barns which preferved their fhape, in fome inftances, for many mile* were to be feen living fowls; and, in one dwelling, a candle was feen to burn for fome time, after it was fwept from its foundation. Where the fhore was level, the lumps of ice, and the ruins of houfes and farms, were thrown a quarter of a mile from the ordinary height of the river. In fome inftances, farms were ruined by the mould being fwept from them by the cakes of ice, or by depofitions of fand; while others were enriched by large depofitions of mud. The damage, upon the whole, done to the ftate of Pennfylvania b/ this frefh, was very great. In moft places it happened in the day time, or the confequences muft have been fatal to many thoufands. " I know of but one ufe that can be derived from recording the hiftory of this inundation. In cafe of fimilur obftruftions of rivers, from caufes fuch as have been defcribed, the terrible effects of their being fet in motion by means of a general thaw, may in part be obviated, by removing fuch things out of the courfe of the water and ice, as are within oti: ;>o.\ -r; particular!? cattle, hay, grain, fences, ar.i farming uteufih. of all kind. ' OF PENNSYLVANIA. 73 From tradition, as well as living obfervation, it is evident, that the waters in many of the creeks in Pennfylvania have diminifhed confiderdbly within the Jaft fifty years. Hence many mills, erected upon large and deep ftreams of water, now ftand idle in dry wea- ther; and many creeks, once navigable in large boats, are now impaffable, even in canoes. This diminution of the waters has been afcribed to the application of a part of them to the purpofe of making meadows. The mean elevation of the barometer in Philadel- phia, is about 30 inches. The variations in the baro- ■ meter are very inconfiderable in the greateft changes of the weather, which occur in the city of Philadelphia. During the violent and deftructive ftorm which blew From the fouth-weft on the 11th of November 1788, it fuddenly fell from 30 to 29 tV. Mr. Rittenhoufe in- forms me, that long and faithful obfervations have fatisfied him, that the alterations in the height of the mercury in the barometer do not precede but always fucceed changes in the weather. It falls with the fouth and fouth-weft, and rifes with the north and north-weft winds. Th e quantity of water which falls in rain and fnow, one year with another, amounts to from 24 to 36 inches. But to complete the account of variable qualities in the climate, it will be neceflary to add, that our fummers and autumns are fometimes marked by a deficiency, or , by an excejive quantity of rain. The fummer and au- tumn of 1782 were uncommonly dry. Near two months elapfed without a fingle fhower of rain. There were only two fhowers in the whole months of Septem- ber and Oftober. In confcquence of this dry wea- ther, there was no fecond crop of hay. The Indian K corn 7\ ACCOUNT OF THE CLIMATE corn failed of its increafe in many places, and was cut down for food for cattle. Trees newly planted, died. The pafture fields not only loft their verdure, but threw up fmall clouds of duft when agitated by the feet of men, or beafts. Cattle in fome inftanccs were driven many miles to be watered, every morning and evening*. The earth became fo inflammable in fome places, as to burn above a foot below its furfaee. A complete confumption of the turf by an accidental fire kindled in the adjoining ftate of New-Jerfey, fpread terror and diftrefs through a large tract of country. Crabs which never forfake fait or brackifh water, were caught more than a mile above the city of Philadelphia, in the river Delaware, which is 60 miles above the places in which they are ufually found. Springs of water and large creeks were dried up in many parts of the ftate. Rocks appeared in the river Schuylkill which had never been obferved before, by the oldeft perfons then alive. On one of them were cut the figures 1701. The atmofphere, duringp art of this dry weather, was often filled, efpecially in the mornings, with a thin miftt, which while it deceived with the expectation of rain, ferved the valuable purpofe of abating the heat of the fun. I am forry that I am not able to furnifh the mean heat of each of the fummer months. My notes of the weather enable me to add nothing further upon this fubject, than that the fummer was " uncommon- ly cool." The * It was remark:d during this dry weather, that the fheep were uncom- monly fat, and their flefh well tafted, while all the other domeftic animals languifhed from the want of grafs and water. + A fimilar m'ft was obferved in France by Doctor Franklin, in the fum- mer of 1782. The winter whkh fucceeded it, was uncommonly cold ia France, as well as in Pennfylvania. OF PENNSYLVANIA. 7$ The fummer of the year 1788 afforded a remark- able itiltance of excefs in the quantity of rain, which fometimes falls in Pennfylvania. Thirteen days are marked with rain in July in the records of the weather kept at Spring-Mill. There fell on the 18th and 19th of Auguft feven inches of rain in the city of Philadelphia. The wheat fuffered greatly by the conftant rains of July in the eaftcrn and middle parts of the ftate. So un- productive a harveft in grain, from wet weather, had not been known, it is faid, in the courfe of the laft 70 years. The heat of the air during thefe fummer months was very moderate. Its mean temperature at Spring- Mill was 67,8 in June, 74,7 in Julv, and. only 70,6 in Auguft. Ir is fome confutation to a citizen of Pennfylvania, in recording facts which feem to militate againft our climate, to reflect, that the difference of the weather in different parts of the ftate at the fame feafon, is.hap- pily accommodated to promote an increafe of the fame objects of agriculture; and hence a deficiency of crops has never been known in any one year throughout the whole ftate. The aurora borealis and meteors are feen occafion- ally in Pennfylvania. In the prefent imperfect ftate of our knowledge of their influence upon the human body, it will be foreign to the defign of this hiftory of our climate to defcribe them. Storms and hurricanes are not unknown in Penn- fylvania. They occur once in four or five years, but they are moft frequent and deftructive in the autumn. They are generally accompanied by rain. Trees are toixi up by the roots, and the rivers and creeks are fometimes j6 ACCOUNT OF THE CLIMATE fometimes 'fwelled fo fuddenly as to do confiderable damage to the adjoining farms. The wind, during thefe ftorms, generally blows from the fouth-eaft and fouth-weft. In the ftorms which occurred in Septem- ber 1769, and in the fame month of the year 1785, the wind veered round contrary to its ufual courfe, and blew from the north. After what has been faid, the character of the climate of Pennfylvania may be fummed up in a few words. There are no two fucceflive years alike. Even the fame fucceflive feafons and months differ from each other every year. Perhaps there is but one fteady trait in the character of our climate, and that is, it is uniform- ly variable. To furnifh the reader with a fuccin£t view of the weather in Pennfylvania, that includes all the articles that have been mentioned, I fhall here fubjoin a table containing the refult of meteorological obfervations made near the river Schuylkill, for one year, in the neighbourhood of Philadelphia, by an ingenious French gentleman*, who divides his time between rural em- ployments and ufeful philofophical purfuits. This table is extracted from the Columbian magazine for Febru- ary 1788. The height of Spring-Mill above the city of Philadelphia, is fuppofed to be about 70 feet * Mr. Legeaux. METEORO- METEOROLOGICAL OBSERVATIONS, made at SPRING-MILL, 13 Miles NNW of Philadelphia. Refult of the Year" 1787." January February March April May June July Auguft September October November December THERMOMETER. of Farenheit, mean degree D. tV 0 3$ 1 33 8 45 1 S4 3 bi 2 70 7 72 2 74 5 b4 7 5' 1 45 34 1 de Reaumur, degres moyens 1 4 8 5 8 9 9 '3 17 2 17 9 H BAROME- TER. mean height in. pts.yV 29 9 9 29 9 9 29 9 7 29 9 6 29 9 2 29 8 2 29 9 10 29 10 6 29 10 4 29 11 9 29 11 1 19__7 7 10 Feb. greateft D. of cold. 1 10 Feb. D. du plus gr. froid. 8 Mar. great- eft elevation. 30 10 3 Jul) r.reateft D. of heat. 96 I Variation. 91 1 3 July plus G. D. de chaud. 28 5 Variation. 40 5 2 Febr. leaft elevation 29 Variation. 1 10 Temperature. S3 5 Temperature. 9 6 Mean elevat. 29 9 9 < < Variable ftill. N E W Still, s w Still, WSW WNW W. WSWvari. W WNW WNW variable Still, variable WNW WNW -DA YS- o 7 3 6 3 14 9 5 u 6 4' 5 73 »7 WATER of R A I N and snow, in.pts.TV 3 10 10 3 7 3 242 1 2 13 411 4 1 10 4 3 l II 5 * 3 278 7 10 2 6 10 9 WEATHER. Fair, ftill, cold, and fnow. Fair, overcaft. Fair, windy. Fair, and very dry. Foggy, cold and wet. Very fair and growing weather. Fair and overcaft. Very fair and cloudy. Fair weather. Foggy, fair and dry weather. Very fair. Very fair and very dry. 32 8 14 TEMPERATURE Of ..THE YEAR 1787, Very fair, dry, abundant in every thing, and healthy. 78 ACCOUNT OP THE CLIMATE It is worthy'of notice, how near the mean heat of the year, and of the month of April, in two fucceflive years, are to each other in the fame place. The mean heat of April 1787 was 54 ° 3, that of April 1788 was 52 ° 2. By the table of the mean heat of each month in the year, it appeals that the mean heat of 1787 was5a°5 at Spring-Mill. The following accounts of the climates of Pekin and Madrid, which lie within a few minutes of the'fame latitude as Philadelphia, may ferve to fhew how much climates are altered by local and relative circumftances. The account of the temperature of the air at Pekin, will ferve further to fhew, that with all the advanta- ges of the higheil degrees of cultivation which have taken place in China, the winters are colder, and the fummers warmer there than in Pennfylvania, princi- pally from a caufe which will probably operate upon the winters of Pennfylvania for many centuries to come, viz. the vicinity of an uncultivated north-weft country. 0 " Pekin, lat. 390 54', long. 1160 29' W. "By five years obfervations its annual mean tempe- rature was found to be 55 ° ,5. July - - 84 °,8 Auguft « .- 83 September - 63 October ^2 November - 41 December - - 27 " The temperature of the Atlantic under this paral- lel is 62, but the llandard of this part of the globe is the January February - March April - May - - June - - 20 ,73 - 32 - 48 - 59 - 72 - 83,75 OF PENNSYLVANIA. 79 the North Pacific, which is here 4 or 5 degrees colder than the Atlantic. The Yellow Sea is the neareft to Pekin, being about 200 miles ditlant from it; but it is itfelf cooled by the mountainous country *of Co- rea, which interpofes between it and the ocean, for a confiderable part of its extent. Befides, all the nor- thern parts of China (in which Pekin lies) muft be cooled by the vicinity of the mountains of Chinefe Tartary, among which the cold is faid to be exceffive, " The greateft cold ufually experienced during this period, was 5 °, the greateft heat, 98 ° : on the 25th of July 1773, the heat arofe to 1080 and 1100; a N. E. or N. W. wind produces the greateft cold, a S. or S. W. or S. E. the greateft heat*." " Madrid, lat. 400 25'long. 30 20'E. " The ufual heat in fummer is faid to be from 75 to 85 ° ; even at night it feldom falls below 70 ° ; the mean height of the barometer is 27,96. It feems to be about 1900 feet above the level of the feat." The above accounts are extracted from Mr. Kir- wan's ufeful and elaborate eftimate of the temperature of different latitudes. The hiftory which has been given of iheclimate of Pennfylvania, is confined chiefly to the country on the eaft fide of the Allegany mountain. On the weft fide of this mountain, the climate differs materially from that of the fouth-eaftern parts of the ftate in the tem- peratuDe of the air, in the effects of the winds upon the weather, ** " 6 Mem. Scav. Etrang. p 528." i " Mem. Par. 1777, p. 146." 80 ACCOUNT OF THE CLIMATE and in the quantity of rain and fnow, which falls every year. The winter' feldom breaks up on the mountains before the 25th of March. A fall of fnow was once perceived upon it, which meafured an inch and an half on the 11th day of June. The trees which grow upon it are fmall, and Indian corn is with difficulty brought to maturity even at the foot of the eaft fide of it. The fouth-weft winds on the weft fide of the mountain are accompanied by cold and rain. The foil is rich, confifting of near a foot in many places of black mould. The roads in this country are muddy in winter, but feldom dufty in fummer. The arrange- ment of the ftrata of the earth on the weft fide, differs materially from their arrangement on the eaft fide of the mountain. " The country, (fays Mr. Rittenhoufe in a " letter to a friend in Philadelphia*) when viewed " from the weftern ridge of the Allegany, appears to " be one vaft, extended plain. All the various ftrata " of ftone feem to lie undifturbed in the fituation in " which they were firft formed, and the layers of ftane, " fand, clay, and coal, are nearly horizontal." The temperature of the air on the weft is feldom fo hot, or fo cold, as on the eaft fide of the mountain. By comparing the ftate of a thermometer examined by Doctor Bedford at Pittfburgh, 284 miles from Philadel- phia, it appears that the weather was not fo cold by twelve degrees in that town, as it was in Philadelphia, on the 5th of February 1788. To thew the differencebetween the weather at Spring- Mill and in Pittlburgh, I fhall here fubjoin an account of it, in both places, the firft taken by Mr. Legeaux, and the other by Doctor Bedford. This account is un- fortunately * Columbian Magazine for October 1786 OF PENNSYLVANIA* 8l fortunately confined only to the firft fifteen days in April 1788; but it affords a good fpecimen of the dif- ference of the weather, ort the two fides of the moun- tain, in every month of the year. It is remarkable that in five days out of feven, the rain which fell, was on the fame days in both places. L METEORO- METEOROLOGICAL OBSERVATIONS, rmde at SPRING-MILL, 13 Miles NNW of Philadelphia. Month of April ,,*« ■C THERMOMETER. BAROME- 0 (— —D A Y S-----, WATER r: 0 TER. J 0 0 0^ 0 O Of RAIN H of de J Q < 2 c » ET D1 n WEATHER. J3 Farenheit, Reaumur, mean height ' 3 3 3 3 and snow, O mean degree degres moyens 0 a 5> Q 1 D. T'o O D-. To O in.pts. TV as ft. in.pts. ^ 58 I 11 6 29 10 5 W Overcaft, fair. 2 46 9 6 6 30 1 Calm. Overcaft and windy. 3 4° 3 3 7 30 3 Changeable. 1 1 '5 Overcaft, rainy. 4 51 3 8 6 29 11 7 SW Overcaft. ? 5' 1 8 5 3° 7 E Overcaft, fair. 6 55 7 10 5 29 11 7 Calm. 1 1 3 Overcaft, rainy. 7 5i 3 8 6 30 2 N E 1 a 7 Overcaft, rainy. 8 42 1 4 5 29 11 E 1 1 4 Rainy, 9 63 5 H 29 8 W Overcaft, windy. 10 46 7 - 6 5 29 10 W 11 53 « 9 7 30 2 W Very fair. 12 4+ 5 S 5 29 IO Calm. 1 1 11 Overcaft, rainy. '3 60 5 12 7 29 IO 3 s vv Very fair. £5_ 50 2 El'tOR( Vi.o= 8 1 n 6 5iCAL7o iJSKF 29 9 E 1 _29___7___7_ S W_ j 1VATK)NS~^ade_aT PITTSBUR~GH~,_ 284 Miles from 1 14 2 13 Philadelphia. Fair* overcaft, rainy. Tossy, rainy. Month of April, )788~_ 1 2 4° 42 s vv N EbN 1 | Cloudy. Clear. 3 43 S E I 1 Cloudy. Cle?-. 4 64 Calm. 5 6 7 8 9 10 11 80 5* 48 66 5° 60 62 S EbS S W NEbN S EbS N WbN s VV Calm, - 1 ] 1 1 1 Cloudy. Cloudy. Cloudy. Cloudy. Cloudy. Cloudy, with wind. Clear. 1*1 67 f Cloudv, with wind. \\*U= I i- v;'.:7.Vi,i«.| Clesr. OP PENNSYLVANIA. 83 From a review of all the facts which have been mentioned, it appears that the climate of Pennfylvania is a compound of moft of the climates in the world. Here we have the moiflure of Britain in the fpring, the heat of Africa in fummer, the temperature of Italy in June, the iky of Egypt in the autumn, the cold and fnows of Norway, and the ice of Holland in the winter, the tempefts (in a certain degree) of the Weft-Indies in every feafon, and the variable winds and weather o£ Great-Britain in every month of the year. From this hiftory of the climate of Pennfylvania, it is eafy to afcertain what degrees of health, and what dif- eafes prevail in the ftate. As we have the climates, fowe have the health, and the acute difeafes, of all the coun-' tries that have been mentioned. Without attempting to enumerate the difeafes, I fhall only add a few words upon the time and manner in which they are produced. I. It appears from the teftimonies of many aged perfons, that pleurifies and inflammatory diforders of all kinds, are lefs frequent now than they were forty and fifty years ago. II. It is a well known fact, that intermitting and bilious fevers have increafed in Pennfylvania in pro- portion as the country has been cleared of its wood, in many parts of the ftate. III. It is equally certain that thefe fevers have lef- fened, or difappeared, in proportion as the country has been cultivated. IV. Heavy rains and frefhes in the fpring feldom produce fevers, unlefs they are fucceeded by unfeafon- ably warm weather. V. Heavy 84 ACCOUNT OF THE CLIMATE V. Heavy rains, or froft, in the autumn, alike check the progrefs of fevers in Pennfylvania. VI. The fame ftate of the atmofphere, whether cold or warm, moift or dry, continued for a long time without any material changes, is always healthy. Acute and inflammatory fevers were in vain looked for in the cold winter of 1779, 80. The dry fummer of 1782, and the wet fummer of 1788, were likewife un- commonly healthy in the city of Philadelphia. Thefe fafts extend only to thofe difeafes which depend upon the fenfible qualities of the air. Difeafes from mi- afmata and contagion, are lefs influenced by the uni- formity of the weather. The autumn of 1780 was, Very fickly in Philadelphia, from the peculiar fituati- on of the grounds in the neighbourhood of the city, while the country was ujicommpnly healthy. The dry fummer arid autumn of 1782 were uncommonly fickly in the country, from the extenfive fources of morbid exhalations which were left by the diminution of the waters in the creeks, arid rivers. The city of Philadel- phia owed its peculiar healthinefs during thefe two fe?.- fons, to its being nearly furrounded by tide water. VII. Diseases are often generated'in one feafon and produced in another. Hence we frequently obferve fevers of different kinds to follow every fpecies of th,e weather that was mentioned in the laft obfervation. VIII. The fevers which accompany, or follow a warm fummer, are bilious and remitting. In propor- tion as the cool weather advances, they put on the type of Doftor Cullen's typhus mitior. After a very cold winter, I have twice feen pleurifies in the fpring, accompanied by the fymptoms of the bilious fever. In one, OF PENNSYLVANIA. *5 one of thofe epidemics, the pulfe, on the fifth day, in feveral cafes, became irregular, and flopped after every third or fourth ftroke. This complication of typhus with fynocha, is not peculiar to Pennfylvania. I have been informed that fevers of even a putrid kind frequently fucceed long and cold winters in Ruffia and Sweden. They have been afcribed, by a Ruffian phy- fician, to extreme cold producing the fame fedative jeffe&s as extreme heat upon the human body. IX. The exceffive heat in Pennfylvania has fome- times proved fatal to perfons who have been much ex- pofed to it. Its morbid effe&s difcover themfelves by a difficulty of breathing, a general langour, and in fome inftances, by a numbnefs and an immobility of the extremities. The exceffive cold in Pennfylvania has more frequently proved fatal, but it has been chiet- ly to thofe perfons who have fought a defence from it, by targe draughts of fpirituous liquors. Its operation in bringing on fleepinefs previous to death, is well known. On the 5th of February 1788, many people were af- fefted by the cold. It produced a pain in the head; and in one inftance, a ficknefs at the ftomach, and a vomiting appeared to be the confequence of it. I have frequently obferved that a greater number of old peo- ple die, during the continuance of extreme cold, and warm weather, than in the fame number of days, in moderate weather. X. May and June are ufually the healthieft months m the year. XI. The influence of the winds upon health, depends very much upon the nature of the country over which they pafs. Winds which pafs over mill-dams and marlhes in Auguft and.September, generally carry with them the feeds of fevers. XII. The 86 ACCOUNT OF THE CLIMATE XII. The country in the neighbourhood of Phila- delphia is much more fickly than the central parts ot the city, after the 20th of Auguft. XIII. The night-air is always unwholefome from the 20th of Auguft, efpecially during the paffive ftate of the fyftem in fleep. The frequent and fudden changes oi the air from heat to cold, (exclufive of its infenfible qualities) render it unfafe at any time to fleep with open windows. XIV. Philadelphia became unufually fickly alter the year 1778, during the late war, in confequence ot the meadows being overflowed to the fouthward of the city, and of the cutting down of the trees by the Britifh army, which formerly fheltered the city from the exhalations of the grounds to the north and north-weft. From the repairs of the banks of the meadows, which exclude tides and freflies ; from the cultivation of the grounds to the weftward of the city, which were for- merly covered with filth, or with ftagnating waters; and laftly, from the more regular cleaning of the ftreets, and the cnclofure of a large and offenfive canal which crofted two of the principal ftreets near the centre of the city, Philadelphia, from having been formerly the moft fickly, has become one of the healthieft cities in the United States. XV. Valetudinarians always enjoy the moft health in Pennfylvania in the fummer and winter months. The fpring, in a particular manner, is very unfavourable to them. I shall conclude the account of the influence of the climate of Pennfylvania upon the human body, with the following obfervations. 1. The OF PENNSYLVANIA. %7 i. The fenfations of heat and cold are influenced fo much by outward circumftances, that we often mif- take the degrees of them, by neglecting to ufe fuch conveniencies as are calculated to obviate the effects of their excefs. A native of Jamaica often complains lefs of the heat, and a native of Canada of the cold, in their refpe&ive countries, than they do under cer- tain circumftances in Pennfylvania. Even a Pennfyl- vanian frequently complains lefs of the heat in Ja- maica, and of the cold in Canada, than in his native ftate. The reafon of this is plain. In countries where heat and cold are intenfe and regular, the inhabitants guard themfelves by accommodating their houfes and drefles to each of them. The inftability and lhort du- ration of excefiive heat and cold in Pennfylvania, have unfortunately led its inhabitants, in many inftances, to neglect adopting cuftoms, which are ufed in hot and cold countries to guard againft them. Where houfes are built with a fouthern or fouth-weftern front expo- fure, and where other accommodations to the climate are obferved in their conftruaion, the difagreeable ex- ceires of heat and cold are rendered much lefs percepr tible in Pennfvlvania. Perhaps the application of the principles of philofophy and tafte to the conftrufctton of our houfes within the laft thirty or forty years, may be another reafon why fome old people have fuppofed that the degrees of heat and cold are lefs in Pennfyl- vania than they were in former years. 2. The number, height, and vegetable produfti- ons of the mountains in Pennfylvania, afford a fa- vourable prognofis of the future healthinefs of th« ftate Exclufive of the beneficial efFefcrs of thefe moun- tains in producing falutary winds, and gentle rains. thcv will ferve as a perpetual and ine^uaulhble ilore- 83 ACCOUNT OF THE CLIMATE, &.C. houfe of that pure fpecies of air, which has of late been proved to conftitute the vital part of common air. 3. The variable nature of the climate of Pennfyl- vania does not render it necrffarily unhealthy. Doc- tor Huxham has taught us, that the healthieft feafons in Great-Britain have often been accompanied by the moft variable weather. His words upon this fubjeft convey a reafon for the fact. " When the conftitu- " tions of the year are frequently changing, fo thai " by the contrafl^ a fort of equilibrium is kept up,- " and health with it; and that efpecially if perfons are " careful to guard themfelves well againft thefe fudden " changes*." Perhaps no climate or country is un- healthy, where men acquire from experience, or tra- dition, the arts of accommodating themfelves to it. The hiftory of all the nations in the world, whether favage, barbarous, or civilized, previous to a mixture of their manners by an intercourfe with ftrangers^ feems to favour this opinion. The climate of China appears, in many particulars, to refemble that of Penn- fylvania. The Chinefe wear loofe garments of dif- ferent lengths, and increafe or diminifti the number of them, according to the frequent and fudden changes of their weather ; hence they have very few acute dif- eafes amongft them. Thofe inhabitants of Pennfylva- nia who have acquired the arts of conforming to the changes and extremes of our weather in drefs, diet, and manners, efcape moft of thofe acute difeafes which are occafioned by the fenfible qualities of the air; and faithful inquiries and obfervations have proved, that they attain to as great ages as the fame number of people in any part of the world. AN * Obfervations on the air and epidemic difeafes, v«l. I. p. - [ 89 ] A N ACCOUNT Bilious Remitting Fever, AS IT APPEARED IN PHILADELPHIA, IN THE SUMMER AND AUTUMN OF THE YEAR 1780. BEFORE I proceed to defcribe this fever, it will be neceflary to give a fhort account of the wea- ther, and of the difeafes which preceded it. The fpring of 1780 was dry and cool. A catarrh appeared among children between one year and feven years of age. It was accompanied by a defluxion from the eyes and nofe, and by a cough and dyfpncea, refem- bling, in fome inftances, the cynanche trachealis, and in others, a peripneumony. In fome cafes it was com- plicated with the fymptoms of a bilious remitting, and intermitting fever. The exacerbations of this feves were always attended by dyfpncea and cough. A few patients expectorated blood. Some had fwellings be- hind the ears, and others were affected with fmall ul- cers in the throat. I met with only one cafe of this fever in which the pulfe indicated bleeding. The reft yielded in a few days to emetics, blifters, and the bark, affilled by the ufual more fimple remedies in fuch diforders. M AN go ACCOUNT OF THE An intermittent prevailed among adults in the month of May. July and Auguft were uncommonly warm. The mercury flood on the 6th of Auguft at 94-5- °, on the 15th of the fame month at 95 °, and for feveral days afterwards at 90 °. Many labouring people periflied during this month by the heat, and by drinking, not only cold water, but cold liquors of feveral kinds, while they were under the violent impreffions of the heat. The vomiting and purging prevailed univerfally, during thefe two warm months, among the children, and with uncommon degrees of mortality. Children from one year to eight and nine years old were like- wife very generally affected by blotches and little boils, efpecially in their faces. An eruption on the fkin, called by the common people the prickly heat, was very common at this time among perfons of all ages. The winds during thefe months blew chiefly from the fouth, and fouth-weft. Of courfe they paffed over the land which lies between the city, and the conflux of the rivers Delaware and Schuylkill, the peculiar fituation of which, at that time, has been al- ready defcrrbed. The dock, and the ftreets of Philadelphia, fupplied the winds at this feafon, likewife, with a portion of their unwholefome exhalations*. The remitting fever made its firft appearance in July and Auguft, but its fymptoms were fo mild, and its * The mufquitoes were uncommonly numerous during the autumn. A Certain fign (fays Dr. Lind.) of an unwholefome atmofphere. BILIOUS REMITTING IEVER. $i its extent fo confined, that it excited no apprehenfions of its fubfequent more general prevalence throughout the city. On the 19th of Auguft the air became fuddenly very cool. Many hundred people in the city com- plained, the next day, of different degrees of in- difpofition, from a fenfe of laflitude, to a fever of the remitting type. This was the fignal of the epi- demic. The weather continued cool during the re- maining part of the month, and during the whole month of September. From the expofure of the dif- tricT of Southwark (which is often diftinguifhed by the name of the Hill) to the fouth-weft winds, the fever made its firft appearance in that appendage of the city. Scarcely a family, and in many families, fcarcely a member of them, efcaped it. From the Hill it gra- dually travelled along the Second-ftreet from the De- laware, improperly called Front-ftreet. For a while it was confined to this ftieet only, after it entered the city, and hence it was called by fome people the Front- flreet fever. It gradually fpread through other parts of the city, but with very different degrees of vio- lence. It prevailed but little in the Northern Liberties. It was fcarcely known beyond Fourth-ftreet from the Delaware. Intemperance in eating or drinking, ri- ding in the fun or rain, watching, fatigue, or even a fright, but more frequently cold, all ferved to excite the feeds of this fever into action, wherever they exifted. All ages, and both fexes were affected by this fever. Seven of the practitioners of phyfic were confined by it nearly at the fame time. The city, du- ring the prevalence of the fever, was filled with an unufual number of ftrangers, many of whom, pai ticu- 92 ACCOUNT OF THE laily of the Friends (whofe yearly meeting was held in the month of September) were affected by it. This fever generally came on with rigor, but fel- dom with a regular chilly fit, and often without any fenfation of cold. In fome perfons it was introduced by a flight fore throat, and in others, by a hoarfenefs which was miftaken for a common cold. A giddinefs in the head was the forerunner of the difeafe in fome people. This giddinefs attacked fo fuddenly, as to produce, in feveral inftances, a faintinefs, and even fymptoms of apoplexy. It was remarkable that all thofe perfons who were affected in this violent manner, recovered in two or three days. I met with one inftance of this fever attacking with coma, and another with convulfions, and with many inftances in which it was introduced by a delirium. The pains which accompanied this fever were ex- quifitely fevere in the head, back, and limbs. The pains in the head were fometimes in the back parts of it, and at other times they occupied only the eyeballs. In fome people, the pains were fo acute in their backs and hips, that they could not lie in bed. In others, the pains affected the neck and arms, fo as to pro- duce in one inftance a difficulty of moving the fingers of the right hand. They all complained more or lefs of a forenefs in the feats of thefe pains, particularly when they occupied the head and eyeballs. A few complained of their flefh being fore to the touch, in every part of the body. From thefe circumftances, the difeafe was fometimes believed to be a rheumatifm. But its more general name among all clafles of people wa*, the Break-bone fever. I MET BILIOUS REMITTING FEVER. 93 I met with one cafe of pain in the back, and ano- ther of an acute ear-ach, both of which returned pe- riodically every night, and without any fever. A nausea univerfally, and in fome inftances, a vomiting, accompanied by a difagreeable tafte in the mouth, attended this fever. The bowels were, in moft cafes, regular, except where the difeafe fell with its whole force upon them, producing a fymptomatic d) fentery*. The tongue was generally moift, and tinctured of a yellow color. The urine was high coloured, and in its ufual quantity in fevers. Th e fkin was generally moift, efpecially where the difeafe terminated on the third or fourth day. The pulfe was quick and full, but never hard in a fingle patient that came under my care, till the 28th of September. It was remankable, that little, and in fome inftances, no thirft attended this fever. A SCREATUS, or conftant hawking and fpitting, attended in many cafes through the whole difeafe, and was a favourable fymptom. There were generally remiffions in this fever every morning, and fometimes in the evening. The exacer- » A fymptomatic dyfentery frequently accompanies the autumnal fevers in Pennfylvania. In the hilly parts of the ftate, it has been remarked that it prevails chiefly on the high grounds ; while the remitting or intermitting feven prevail in the neighbourhood le/ow them. 94 ACCOUNT OF THE exacerbations were more fevere every other day, and two exacerbations were often obferved in one day. A rash often appeared on the third and fourth days, which proved favourable. This rath was ac- companied in fome cafes by a burning in the palms of the hands and foles of the feet. Many people at this time, who were not confined to their beds, and fome, who had no fever, had an efflorefcence on their fkins. In feveral perfons the force of the difeafe feemed to fall upon the face, producing fwellings under the jaw and in the ears, which in fome inftances terminat- ed in abfceffes. When the fever did not terminate on the third or fourth day, it frequently ran on to the eleventh, four- teenth, and even twentieth days, affuming in its pro- grefs, according to its duration, the ufual fymptoms of the typhus gravior, or mitior, of Doctor Cullen. In fome cafes, the difcharge of a few fpoonfuls of blood from the nofe accompanied a folution of the fever on the third or fourth day ; while in others, a profufe haemorrhage from the nofe, mouth, and bowels, on the tenth and eleventh days, preceded a fatal iffue of the difeafe. Several cafes came under my care, in which the fever was fucceeded by a jaundice. The difeafe terminated in fome cafes without fweat- ing, or a fediment in the urine ; nor did I find fuch patients more difpofed to relapfe than others, pro- vided they took a fufficient quantity of the bark. About BILIOUS REMITTING FEVER. 95 About the beginning of October the weather be- came cool, accompanied by rain and an eafterly wind. This cool and wet weather continued for four days. The mercury in the thermometer fell to 60 °, and fires became agreeable. From this time the fever evidently declined, or was accompanied with inflammatory fymp- toms. On the 16th of Oaober, I met with a cafe of inflammatory angina; and on the next day I vi- fited a patient who had a complication of the bilious fever with a pleurify, and whofe blood difcovered ftrong marks of the prefence of the inflammatory di- athefis. His ftools were of a green and black color. On the third day of his diforder the ralh appeared on his fkin, and on the fourth, in confequence of a fecond bleeding, his fever terminated with the com- mon fymptoms of a crifis. During the latter end of October, and the firft weeks in November, the mercury in the thermome- ter fluctuated between 50 ° and 60 °. Pleurifies and inflammatory difeafes of all kinds now made their ap- pearance. They were more numerous and more acute, than in this ftage of the autumn, in former years. I met with one cafe of pleurify in November, which did not yield to lefs than four plentiful bleedings. I shall now add a fhort account of the method I purfued in the treatment of this fever. I generally began by giving a gentle vomit of tartar emetic. This medicine, if given while the fe- ver was in its forming ftate, frequently produced an immediate cure ; and if given after its formation, on the firft day, feldom failed of producing a crifis on the third or fourth day. The vomit always difcharg- ed 96 ACCOUNT OF THE cd more or lefs bile. If a naufea, or an ineffectual attempt to vomit continued after the exhibition of the tartar emetic, I gave a fecond dofe of it, with the happieft effects. If the vomit failed of opening the bowels, I gave gentle dofes of falts and cream of tartar*, or of the butter-nut pillt, fo as to procure two or three plentiful flools. The matter difcharged from the bowels was of a highly bilious nature. It was fometimes fo acrid as to excoriate the rectum, and fo offenfive, as to occafion, in fome cafes, ficknefs and faintinefs both in the patients and in their attendants. In every in- ftance the patients found relief by thefe evacuations, cfpecially from the pains in the head and limbs. In thofe cafes, where the prejudices of the pati- ents againft an emetic, or where an advanced ftate of pregnancy, or an habitual predifpofition tohcematemefis occurred, I difcharged the bile entirely by means of the lenient purges that have been mentioned. In this practice I had the example of Doctor Cleghorn, who prefcribed purges with great fuccefs in a fever of the fame fpecies in Minorca, with that which has been de- scribed ;£. Doctor Lining prefcribed purges with equal fuccefs in an autumnal pleurify in South-Caro- lina, which I take to be a fpecies of a bilious remit- tent, accompanied by an inflammatory affeclion of the breaft. After * i have always found that cream of tartar renders the purging neutral fait* lefs difagreeable to the tafte and ftomach ; but accident has lately taught me, th :t the juice of two limes or of one lemon, with about half an ounce of loaf fugar added to fix drachms of glauber or epfom fait, in half a pint of boiling \,„:r.r, form a mixture that is nearly as pleafant as ftrong beveridge. + This pill is made from an cxtraft of a ftrong decodtion of the inner bark. of the white walnut-tree. £ The t.rtlana ii.tirpof.ta remiflione tantum, of Dr. Cullen, BILIOUS REMITTING FEVER. 97 After evacuating the contents of the ftomach and bowels, I gave fmall dofes of tartar emetic mixed with Glauber's fait. This medicine excited ageneral perfpira- tion. It likewife kept the bowels gently open, by which means the bile was difcharged as fall as it was accumulated. I constantly recommended to my patients, in this ftage of the diforder, to lie in bed. This favoured the eruption of the ralh, and the folution of the difeafe by perfpiration. Perfons who ftruggled againft the fever by fitting up, or who attempted to lhake it off by labor or exercife, either funk under it, or had a flow recovery. A clergyman of a refpectable character from the country, who was attacked by the difeafe in the city, returned home, from a defire of being attended by his own family, and died in a few days afterwards. This is only one, of many cafes, in which I have ob- ferved travelling, even in the eafieft carriages, to prove fatal in fevers after they were formed, or after the firft fymptoms had fhewn themfelves. The quickeft and moft effectual way of conquering a fever, in moft cafes, is, by an early fubmiflion to it. The drinks I recommended to my patients were fage and baum teas, apple* and tamarind water, weak punch, lemonade, and wine whey. I found obvious advantages in many cafes, from the ufe of pediluvia, every night. In every cafe, I found my patients refrefhed and relieved, by frequent changes of their linen. N On * That apple-water is moft agreeable which is made by pouring boiling water upon flices of raw applts. It is more lively than that which is made by pouring the water on roafted apples. 98 ACCOUNT OF THE On the third or fourth day, in the forenoon, the pains in the head and back generally abated, with a fweat which was diffufed over the whole body. The pulfe at this time remained quick and weak. This was, however, no objection to the ufe of the bark, a few dofes of which immediately abated hs quicknefs, and prevented a return of the fever. If the fever continued beyond the third or fourth day without an intermiffion, I always had recourfe to blifters. Thofe which were applied to the neck, and behind the ears, produced the moft immediate good effects. They feldom failed of producing an inter- miffion in the fever, the day after they were applied. Where delirium or coma attended, I applied the blif- ter to the neck on thefrft day of the diforder. A worthy family in this city will always afcribe the life of a promifing boy of ten years old, to the early ap- plication of a blifter to the neck, in this fever. Where the fever did not yield to blifters, and affumed the fymptoms of typhus gravior or mitior, I gave the medicines ufually exhibited in both the fpecies of that fever. I took notice in the hiftory of this fever, that it was fometimes accompanied by the fymptoms of a dyfentery. Where this diforder appeared, I prefcrib- ed lenient purges and opiates. Where thefe failed of fuccefs, I gave the bark in the intermiffions of the pain in the bowels, and applied blifters to the wrifts. The good effects of thefe remedies led me to conclude, that the dyfentery was the febris introverfa of Doctor Sydenham. I AM BILIOUS REMITTING FEVER. $g I AM happy in having an opportunity, in this place, of bearing a teftimony in favor of theufefulnefs of opi- um in this diforder, after the neceflary evacuations had been made. I yielded, in prefcribing it at firft, to the earneft folicitations of my patients for fomething to give them relief from their infupportable pains, par- ticularly when they were feated in the eyeballs and head. Its falutary effects in procuring fweat, and a remiffion of the fever, led me to prefcribe it afterwards in almoft every cafe, and always with the happieft ef- fects. Thofe phyficians enjoy but little pleafure in practifing phyfic, who know not how much of the pain and anguifli of fevers, of a certain kind, may be leflened, by the judicious ufe of opium. In treating of the remedies ufed in this diforder, I have taken no notice of blood-letting. Out of feve- ral hundred patients whom I vifited in this fever, I did not meet with a fingle cafe, before the 27th of September, in which the ftate of the pulfe indicated this evacuation. It is true, the pulfe was full, but ne- ver hard. I acknowledge that I was called to feveral patients who had been bled without the advice of a phvfician, who recovered afterwards on the ufual days of the folution of the fever. This can only be afcrib- ed to that difpofition which Doftor Cleghorn attributes to fevers, to preferve their types under every variety of treatment, as well as conftitution. But I am bound to declare further, that I heard of feveral cafes, in which bleeding was followed by a fatal termination of the difeafe. In this fever relapfes were very frequent, from ex- pofure to the rain, fun, or night-air, and from an ex- cefs in eating or drinking. The fOO ACCOUNT OF THE BILIOUS, &C. The convalescence from this difeafe was mark- ed with a number of extraordinary fymptoms, which rendered patients the fubjecfs of medical attention for many days after the pulfe became perfectly regular, and after the crifis of the difeafe. A bitter tafte in the mouth, accompanied by a yellow color of the tongue, continued for near a week. MOST of thofe who recovered, complained of nau- fea and a total want of appetite. A faintinefs, efpe- cially upon fitting up in bed, or in a chair, followed this fever. A weaknefs in the knees was univerfal. I met with two patients, who were moft fenfible of this weaknefs in the right knee. An inflammation in one eye, and in fome inftances in both eyes, occurred in feveral patients after their recovery. But the moft remarkable fymptom of the conva- lefcence from this fever, was an uncommon dejection of fpirits. I attended two young ladies who fhed tears while they vented their complaints of their ficknefs and weaknefs. One of them very aptly propofed to me, to change the name of the diforder, and to call it, in its prefent ftage, inftead of the Break-bone, the Break-heart fever. To remove thefe fymptoms, I gave the tincture of bark and elixir of vitriol in frequent dofes. I likewife recommended the plentiful ufe of ripe fruits ; but I faw the beft effecls from temperate meals of oyfters, and a liberal ufe of porter. To thefe were added, gentle ex- ercife in the open air, which gradually completed the cure. AN [ ioi ] A N ACCOUNT Of THE Scarlatina Anginofa, AS IT APPEARED IN PHILADELPHIA, IN THE YEARS 1783 and 1784. THE beginning of the month of July was unufu- ally cool; infomuch that the mercury in Fa- renheit's thermometer flood at 61 ° in the day time, and fires were very comfortable, efpecially in the even- ing. In the laft week but one, of this month, the weather fuddenly became fo warm, that the mercury rofe to 94-j °, at which it remained for three days. As this heat was accompanied by no breeze from any quarter, the fenfe of it was extremely diftrefling to many people. Upwards of twenty perfons died in the courfe of thefe three days, from the excefs of the heat, and from drinking cold water. Three old people died fuddenly within this fpace of time. This extreme heat was fucceeded by cool weather, the mercury hav- ing fallen to 63 °, and the month clofed with produc- ing a few intermitting and remitting fevers, together with feveral cafes of inflammatory angina. The weather in the month of Auguft was extremely variable. The mercury, after Handing for feveral days at 102 account of the at 92 °, fuddenly fell fo low, as not only to render fires neceflary, but in many places, to produce froft. Every genus of fever made its appearance in this month. The fynocha was fo acute, in feveral cafes, as to require from three to four bleedings. The remitting fever was accompanied by an uncommon de- gree of naufea and faintinefs. Several people died, after a few days illnefs, of the typhus gravior, of Doctor Cullen. The intermittents had nothing pecu- liar in them, either as to their fymptoms or method of cure. Towards the clofe of the month, the fcarlatina anginofa made its appearance, chiefly among children. The month of September was cool and dry, and the fcarlatina anginofa became epidemic among adults as well as young people. In moft of the patients who were affected by it, it came on with a chillinefs and a ficknefs at the ftomach, or a vomiting ; which laft was fo invariably prefent, that it was with me a pa- thognomonic fign of the difeafe. The matter difcharged from the ftomach was always bile. The fwelling of the throat was, in fome inftances, fo great, as to pro- duce a difficulty of fpeaking, fwallowing, and breath- ing. In a few inftances, the fpeech was accompanied by a fqueaking voice, refembling that which attends the cynanche trachealis. The ulcers on the tonfils were deep, and covered with white, and in fome inftances, with black floughs. In feveral cafes there was a dif- charge of a thick mucus from the nofe, from the be- ginning, but it oftener occurred in the decline of the difeafe, which moft frequently happened on the fifth day. Sometimes the fubfiding of the fwelling of the throat was followed by a fwelling behind the ears. An SCARLATINA ANGINOSA. IO3 An eruption on the fkin generally attended the fymptoms which have been defcribed. But this fymp- tom appeared with confiderable variety. In fome peo- ple it preceded, and in others followed the ulcers and fwelling of the throat. In fome, it appeared only on the outfide of the throat and on the breaft ; in others, it appeared chiefly on the limbs. In a few, it appear- ed on the fecond or third day of the diforder, and never returned afterwards. I faw two cafes of erup- tion without a fingle fymptom of the fore throat. The face of one of thofe patients was fwelled, as in the eryfipelas. In the other, a young girl of feven years old, there was only a flight rednefs on the fkin. She was feized with a vomiting, and died delirious in fifty, four hours. Soon after her death, a livid color appear,. ed on the outfide of her throat. The bowels, in this degree of the diforder, were in general, regular. I can recollect but few cafes which were attended by a diarrhoea. The fever which accompanied the diforder was generally the typhus mitior of Doctor Cullen. In a few cafes it afllimed the fymptoms of the typhus gravior. The difeafe frequently went off with a fwelling of the hands and feet. I faw one inftance in a gentle- woman, in whom this fwelling was abfent, who com- plained of very acute pains, in her limbs, refembling thofe of the rheumatifm. In two cafes which terminated fatally, there were large abfceffes; the one on the outfide, and the other on the infide of the throat. The firft of thefe cafes was accompanied by troublefome fores on the ends of the 104 ACCOUNT OF THE the fingers. One of thefe patients lived twenty-eight, and the other above thirty days, and both appeared to die from the difcharge which followed the opening of their abfceffes. Between the degrees of the difeafe which I have defcribed, there were many intermediate degrees of indifpofition which belonged to this diforder. I saw in feveral cafes a difcharge from behind the ears, and from the nofe, with a flight eruption, and no fore throat. All thefe patients were able to fit up and walk about. I saw one inftance of a difcharge from the infide of one of the ears in a child, who had ulcers in his throat and the fqueaking voice. In fome, a pain in the jaw, with fwellings behind the ears and a flight fever, conftituted the whole of the difeafe. In one cafe, the difeafe came on with a coma, and in feveral patients it went off with this fymptom. A few inftances occurred of adults, who walked about, and even tranfacted bufinefs until a few hours before they died. The intermitting fever, which made its appearance in Auguft, was not loft during this month. It con- tinued to prevail, but with feveral peculiar fymptoms. In many perfons it was accompanied by an eruption on the fkin, and a fwelling of the hands and feet. In fome, it was attended by a fore throat and pains be- hind scarlatina anginosa. 105 hind the ears. Indeed, fuch was the prevalence of the contagion which produced the fcarlatina anginofa, that many hundred people complained of fore throats without any other fymptom of indifpofition. The flighteft occafional or exciting caufe, and particularly cold, feldom failed of producing the diforder. The month of October was much cooler than Sep- tember, and the difeafe continued, but with lefs alarm- ing fymptoms. In feveral adults, who were feized with it, the hardnefs of the pulfe indicated blood-let- ting. The blood, in one cafe, was covered with a buffy coat, but beneath its furfaee it was diflolved. In the month of November the difeafe affumed feveral inflammatory fymptoms, and was attended with much lefs danger than formerly. I vifited one pati- ent, whofe fymptoms were fo inflammatory as to re- quire two bleedings. During the decline of the dif- eafe, many people complained of troublefome fores on the ends of their fingers. A number of children like-. wife had fore throats and fever, with eruptions on their fkins, which refembled the chicken-pox. I am difpofed to fufpect that this eruption was the effect of the contagion of the fcarlatina anginofa, as feveral in- ftances occurred of patients who had all the fymptoms of this difeafe, in whom an eruption of white blifters fucceeded their recovery. This form of the difeafe has been called by Sauvage, the fcarlatina variolofa. I saw one cafe of fore throat, which was fucceed- ed not only by fwellings in the abdomen and limbs, but by a catarrh, which brought on a fatal confump- tion. O A CON* 106 ACCOUNT OF THE A considerable fhock of an earthquake was felt on the 29th of this month, at ten o'clock at night, in the city of Philadelphia ; but no change was per- ceived in the difeafe, in confequence of it. In December, January, and February, the weather was intenfely cold. There was a thaw for a few days in January, which broke the ice of the Delaware, but it was followed by cold fo exceffive as to clofe the river till the beginning of March. The mercury on the 28th and 29th of February, flood below o in Faren- heit's thermometer. For a few weeks in the beginning of December the difeafe difappeared in the circle of my patients, but it broke out with great violence the latter end of that month, and in the January following. Some of the worft cafes that I met with, (three of which proved fatal) were in thofe two months. The difeafe difappeared in the fpring, but it fpread afterwards through the neighbouring flates of New- Jerfey, Delaware and Maryland. I shall now add an account of the remedies which I adminiftered in this diforder. In every cafe that I was called to, I began the cure by giving a vomit joined with calomel. The vomit was either tartar emetic or ipecacuana, according to the prejudices, habits, or conftitutions of my patients. A quantity of bile was generally difcharged by this medicine. Befides evacuating the contents of the ftomach, it cleanfed the throat in its paffage down- wards. To enfure this effect, from the calomel, I al- ways scarlatina anginosa. 107 ways directed it to be given mixed with fyrup or fugar and water, fo as to diffufe it generally over every part of the throat. The calomel feldom failed to produce two or three ftools. In feveral cafes I was obliged, by the continuance of naufea, to repeat the emetics, and always with immediate and obvious advantage. I gave the calomel in moderate dofes in every ftage of the diforder. To reftrain its purgative effects, I add- ed to it a fmall quantity of opium. During the whole courfe of the diforder, where the calomel failed of opening the bowels, I gave leni- ent purges, when a difpofition to coftivenefs required them. The throat was kept clean by detergent gargles. In feveral inftances I faw evident advantages from add- ing a few grains of calomel to them. In cafes of great difficulty of fwallowing or breathing, the patients found relief from receiving the fleams of warm water mixed with a little vinegar, through a funnel into the throat. A perspiration kept up by gentle dofes of an- timonials, and diluting drinks, impregnated with wine, always gave relief. In every cafe which did not yield to the above re- medies on the third day, I applied a blifter behind each ear, or one to the neck, and I think, always with good effects. I met with no cafes in which the bark appeared to be indicated as an antifeptic, except the three in which the difeafe proved fatal. Where the fore throat was io8 account of the was blended with the intermitting fever, the bark was given with advantage. But in common cafes it was unneceffary. Subfequent obfervations have led me to believe, with Doftor Withering, that it is fometimes hurtful in this diforder. This difeafe proved fatal in many parts of the country, upon its firft appearance ; but wherever the i mode of treatment here delivered, was adopted, its mortality was foon checked. The calomel was ufed very generally in New-Jerfey and New-York. In the Delaware ftate, a phyfician of character made it a prac- tice not only to give calomel, but to anoint the out- fide of the throat with mercurial ointment. ADDITIONAL scarlatina anginosa. 109 Additional Obfervations upon the Scarlatina Anginofa. THIS difeafe has prevailed in Philadelphia, at dif- ferent feafons, ever fince the year 1783. It has blended itfelf'occafionally with all our epidemics. Many cafes have come under my notice fince its firft appearance, in which dropfical fwellings have fucceed- ed the fever. In fome inftances there appeared to be effufions of water not only in the limbs and abdomen, but in the thorax. They yielded, in every cafe that I attended, to purges of calomel and jalap. Where thefe fwellings were neglected, they fometimes proved fatal. In the winter of 1786, 7, the fcarlatina anginofa was blended with the cynanche parotidea, and in one inftance with a typhus mitior. The laft was in a young girl of nine years of age. She was feized with a vomit- ing of bile and an efflorefcence on her breaft, but difco- vered no other fymptoms of the fcarlatina anginofa till the fixteenth day of her fever, when a fwelling appear- ed on the outfide of her throat; and af^er her recovery, a pain and fwelling in one of her knees. In the month of July 1787, a number of people were affected by fudden fwellings of their lips and eyelids. Thefe fwellings generally came on in the night, were attended with little or no pain, and went off in two or additional observations or three days. I met with only one cafe in which there was a different iffue to thefe fymptoms. It was in a patient in the Pennfylvania hofpital, in whom a fwelling in the lips ended in a fuppuration, which, notwithftanding the liberal ufe of bark and wine, proved fatal in the courfe of twelve days. Im the months of June and July 1788, a number of people were affected by fudden fwellings, not only of the upper and lower lips, but of the cheeks and throat. At the fame time many perfons were affected by an inflammation of the eyes. The fwellings were attended with more pain than they were the year be- fore, and fome of them required one or two purges to remove them; but in general they went off without medicine, in two or three days. Is it proper to refer thefe complaints to the fame contagion which produces the fcarlatina anginofa ? The prevalence of the fcarlatina anginofa at the fame time in the city ; its difpofition to produce fwel- lings in different parts of the body ; and the analogy of the intermitting fever, which often conceals itfelf under fymptoms that are foreign to its ufual type; all feem to render this conjecture probable. In one of the cafes of an inflammation of the eye, which came under my notice, the patient was affecfed by a vomiting ua few hors before the inflammation appeared, and com- plained pf a ficknefs at his ftomach for two or three days afterwards. Now a vomiting and naufea appear to be pathognomonic fymptoms of the fcarlatina anginofa. In the autumn of 1788, the fcarlatina anginofa ap- peared with different degrees of violence in many parts of the city. In two inftances it appeared with an ob- ftinate upon the scarlatina ANGINOSA. Ill Jlinate diarrhcea; but it was in young fubjects, and not in adults, as defcribed by Doctor Withering. In both cafes, the difeafe proved fatal; the one on the third, the other on the fifth day. In the month of December of the fame year, I faw one cafe in which a running from one of the ears and a deafnefs came on, on the fifth day, immediately after the difcharge of mucus from the nofe had ceafed. This cafe terminated favourably on the ninth day, but was fucceeded for feveral day* afterwards by a trouble- fome cough. I shall conclude this effay by the following re- marks. i. CamphoR has often been fuipended in a bag from the neck, as a prefervative againft this difeafe. Repeated obfervations have taught me, that it poffeffes little or no efficacy for this purpofe. I have had rea- fon to entertain a more favourable opinion of the be- nefit of wafliing the hands and face with vinegar, and oF rinfing the mouth and throat with vinegar and water every morning, as a means of preventing this diforder; 2. When ever I have been called to apatientwhere the fcarlatina appeared to be in a forming ftate, a vomit of ipecacuana, or tartar emetic, mixed with a few grains of calomel, has never failed of completely checking the diforder, or of fo far mitigating its violence, as to dif- pofe it to a favourable iffue in a few days; and if thef* obfervations fliould ferve no other purpofe, than to a- waken the early attention of patients and phyficians to this fpeedy and effectual remedy, they will not have been recorded in vain. AN [ 1" ] A N INQUIRY INTO THE CAUSE AND CURE OF THE Cholera Infantum. BY this name I mean to defignate a difeafe, called, in Philadelphia, the " vomiting and purging of " children." From the regularity of its appearance in the fummer months, it is likewife known by the name of " the difeafe of the feafon." It prevails in moft of the large towns in the United States. It is diftinguiflied in Charlefton, in South-Carolina, by the name of " the April and May diforder," from making its firft appearance in thofe two months. It feldom appears in Philadelphia till the middle of June, or the beginning of July, and generally continues till near the middle of September. Its frequency and danger are always in proportion to the heat of the weather. It affects children from the firft or fecond week after their birth, till they are two years old. It fometimes begins with a diarrhoea, which continues for feveral days without any other fymptom of indifpofiti- on ; but it more frequently comes on with a violent vomiting and purging and a high fever. The matter difcharged from the ftomach and bowels is generally yellow or greeri, but the ftools are fometimes flimy and bloody, without any tincture of bile. In fome inftances INQUIRY INTO THE CAUSE, &C. 113 inftances they are nearly as limpid as water. Worms are frequently difcharged in each kind of the ftools that has been defcribed. The children in this ftage of the diforder, appear to fuffer a good deal of pain. They draw up their feet, and are never eafy in one pof- ture. The pulfe is quick and weak. The head is un- ufually warm, while the extremities retain their natu- ral heat, or incline to be col i. The fever is of the remitting kind, and difcovers evident exacerbations, efpecially in the evenings. The difeafe affects the head fo much, as in fome inftances to produce fymptoms not only of delirium, but of mania, infomuch that the children throw their heads backwards and for- wards, and fometimes make attempts to fcratch, and to bite, their parents or nurfes. A fwelling frequently occurs in the abdomen^ and in the face and limbs. An intenfe thirft attends every ftage of the diforder. The eyes appear languid and hollow, and the children ge- nerally fleep with them half clofed. Such is the infen- fibility of the fyftem in fome inftances in this diforder, that flies have been feen to alight upon the eyes when opened, without exciting a motion in the eyelids to remove them. Sometimes the vomiting continues without the purging, but more generally, the purging continues without the vomiting, through the whole courfe of the diforder. The ftools are frequently large, and extremely foetid, but in fome inftances, they are without fmell, and refemble the drinks or ali- ment which had been taken into the body. The dif- eafe is fometimes fatal in a few days. 1 once faw it carry off a child in four and twenty hours. Its durati- on is varied by the feafon of the year, and by the changes in the temperature of the weather. A cool day frequently abates its violence, and difpofes it to a favourable termination. It often continues with occa- P fional II4 INQUIRY INTO THE CAUSE AND CUR* fional variations in its appearance, for fix weeks or two months. Where the difeafe has been of long conti- nuance, the approach of death is gradual, and attend- ed by a number of diftreffing fymptoms. An emacia- tion of the body, to fuch a degree as that the bones come through the fkin, livid fpots, a fingultus, con- vulfions, a ftrongly marked hippocratic countenance, and a fore mouth, generally precede the fatal termina- tion of this diforder. Few children ever recover, alter the laft fymptoms which have been mentioned make their appearance. . This difeafe has been afcribed to feveral caufes; of each of which I fhall take notice in order. I. Tr has been attributed to dentition. To refute this opinion, it will be neceflary to obferve, that it ap- pears only in one feafon of the year. Dentition I acknowledge fometimes aggravates the diforder; hence we find it is moft fevere in that period of life, when the greateft number of teeth make their appearance, which is generally about the tenth month. I think I have obferved more children to die of this diforder at that age, than at any other. II. Worms have likewife been fufpected of being the caufe of this difeafe. To this opinion, I object the uncertainty of worms ever producing an idiopathic fever, and the improbability of their combining in fuch a manner as to produce an annual epidemic difeafe of any kind. But further, we often fee the diforder in all its force, before that age, in which worms ufually produce difeafes; we likewife often fee it refill the moft powerful anthelmintic medicines ; and laftly, it appears from diffection, where the difeafe has proved fatal, that not OF THE CHOLERA INFANTUM. 11^ not a fingle worm has been difcovered in the bowels. It is true worms are in fome inftances difcharged in this diforder, but they are frequently difcharged in greater numbers in the hydrocephalus internus, and in the fmall-pox, and yet who will affert either of thofe difeafes to be produced by worms. III. The fummer fruits have been accufed of pro- ducing this diforder. To this opinion, I object that the difeafe is but little known in country places, where children eat much more fruit than in cities. As far as I have obferved, I am difpofed to believe that the mo- derate ufe of ripe fruits, rather tends to prevent, than to induce the difeafe. From the difcharge of bile which generally intro- duces the difeafe, from the remiflions and exacerbations of the fever which accompanies it, and from its occur- ring nearly in the fame feafon with the cholera and re- mitting fever in adults, I am difpofed to confider it as a modification of the fame difeafes. Its appear- ance earlier in the feafon than the cholera and remit- ting fever in adults, muft be afcribed to the conftitu- tions of children being more predifpofed from weak- nefs to be acted upon, by the remote caufes which pro- duce thofe diforders. I shall now mention the remedies which are pro- per and ufeful in this diforder. I. The firft indication of cure is to evacuate the bile from the ftomach and bowels. This fliould be done by gentle dof«s of ipecacuana, or tartar emetic. The vomits fliould be repeated occanonally, if indi- cated, in every ftage of the diforder. The bowels fhould Il6 INQUIRY INTO THE CAUSE AND CURE fhould be opened by means of manna, caftor oil, or magnefra. I have generally found rhubarb improper for this purpofe, while the ftomach was in a very irritable ftate. In thofe cafes, where there is reafon to believe that the offending contents of the primae viae have been difcharged by nature, (which is often the cafe) the emetics and purges fhould by no means be given ; but, inftead of them, recourfe muft be had to II. Opiates. A few drops of liquid laudanum, combined in a teftaceous julep, with pepper-mint or cinnamon-water, feldom fail of compofing the ftomach and bowels. In fome inftances, this medicine alone fubdues the difeafe in two or three days; but where it does not prove fo fuccefsful, it produces a remiffion of pain, and of other diftrefling fymptoms, in every ftage of the diforder. III. Demulcent and diluting drinks have an agreeable effect in this difeafe. Mint and mallows teas, or a tea made of blackberry roots infufed in cold water, together with a decoftion of the fhavings of hartlhorn and gum arabic with cinnamon, fhould all be given in their turns for this purpofe. IV. Glysters made of flaxfeed tea, or of mut- ton broth, or of ftarch diffolved in water, with a few drops of liquid laudanum in them, give eafe, and pro- duce other ufeful effects. V. Plasters of Venice treacle applied to the re- gion of the ftomach, and flannels dipped in infufions of bitter and aromatic herbs in warm fpirits, or Ma- deira wine, and applied to the region of the abdomen, often afford confiderable relief. VI. As OF THE CHOLERA INFANTUM. MJ VI. As foon as the more violent fymptoms of the difeafe are compofed, tonic and cordial medi- cines fliould be given. The bark in decoction, or in fubftance, (where it can be retained in that form) mixed with a little nutmeg, often produce the moft falutary effecfs*. Port wine or claret mixed with water, are likewife proper in this ftage of the diforder. After the difeafe has continued for fome time, we often fee an appetite fuddenly awakened for articles of diet of a ftimulating nature. I have feen many children recover from being gratified in an inclination to eat falted fifti, or the different kinds of falted meat. In fome inftances they difcover an appetite for butter, and the richeft gravies of roafted meats, and eat them with obvious relief to all their fymptoms. I once faw a child of fixteen months old, perfectly reftored, from the loweft ftage of this diforder, by eating large quan- tities of rancid Englifli cheefe, and drinking two or three glaffes of port wine every day. She would in no inftance eat bread with the cheefe, nor tafte the wine, if it was mixed with water. We fometimes fee relief given by the ufe of the warm bath, in cafes of obftinate pain. The bath is more effectual, if warm wine is ufed, inftead of water. I have had but few opportunities of trying the effects of cold water applied to the body in this dif- order ; but from the benefit which attended its ufe in the cafes in which it was prefcribed, I am difpofed to believe that it would do great fervice, could we over- come the prejudices which fubfift in the minds of pa- rents againft it. After * Several of the phyficians of the Philadelphia Difpenfary have allured me, that they have lately given in this diforder, (after the ufual evacuations) from one grain to two grains of allum every two or three hours, as 9 tonic and tx aftringent, with gre.it fuccefs. • Il8 INQUIRY INTO THE CAUSE AND CURE After all that has been faid in favor of the re- medies that have been mentioned, I am forry to add, that I have very often feen them all adminiftered with- out effect. My principal dependance, therefore, for many years, has been placed upon VII. Country air. Out of many hundred children whom I have lent into the country in every ftage of this diforder, I have loft only three, two of whom were fent, contrary to my advice, into that un- healthy part of the neighbourhood of Philadelphia call- ed the Neck, which lies between the city and the con- flux of the rivers Delaware and Schuylkill. I have feen one cure performed by this remedy, after convul- fions had taken place. To derive the utmoft benefit from the country air, children fhould be carried out on horfeback, or in a carriage, every day ; and they fhould be expofed to the open air as much as poflible in fair weather in the day time. Where the convenience of the conftant benefit of country air cannot be obtained, I have feen evident advantages from taking children out of the city once or twice a day. It is extremely agreeable to fee the little fufferers revive, as foon as they efcape from the city air, and infpire the pure air of the country. I shall conclude this inquiry, by recommending the following methods of preventing this diforder, all of which have been found by experience to be ufeful. l. The daily ufe of the cold bath. 2. A faithful and attentive accommodation of the dreffes of children, to the ftate and changes of the air. 3. A MO- OF THE CHOLERA INFANTUM. 119 3. A moderate quantity of falted meat taken oc- cafionally in thofe months in which this difeafe ufually prevails. It is perhaps in part from the daily yfe of falted meat in diet that the children of country people efcape this diforder. 4. The ufe of found old wine in the fummer months. From a tea-fpoonful, to half a wine glafs full, accord- ing to die age of the child may be given every day. It is remarkable, that the children of perfons in eafy circumftances, who fip occafionaliy with their parents, the remains of a glafs of wine after dinner, are much lefs fubject to this diforder, than the children of poor people who are without the benefit of that article of diet. 5. Cleanliness both with refpect to the fkin and cloathing of children. Perhaps the neglect: of this di- rection may be another reafon why the children of the poor are moft fubject to this diforder. 6. The removal of children into the country before the approach of warm weather. This advice is pecu- liarly neceflary during the whole period of dentition. I have never known but one inftance of a child being affected by this diforder, who had been carried into the country in order to avoid it. OBSERVA- [ 12° ] OBSERVATIONS ON THE Cynanche 'Trachealis. I TAKE great pleafure in thus publicly acknow- ledging a miftake, which I committed in my letter to Do£tor Millar, publifhed by him in London in the year 1770, in fuppofing that there was but one fpecies of this diforder, and that that was fpafmodic. I am now fatisfied, from repeated obfervations, that there is another fpecies, which I fhall take the liberty of calling the cynanche trachealis humida. I exclude, as a fpecies of this diforder, the cy- nanche trachealis maligna. Many of the fymptoms of the cynanche trachealis occur in the malignant fore throat, but they fhould by no means conftitute the name, or a fpecies of that difeafe. I have feen the fame fymptoms in the fcarlatina anginofa, and yet I never thought of ranking a cynanche trachealis fcarla- tina among the fpecies of that diforder. I have like- wife feen the cynanche trachealis in the laft ftage of the fecondary fever of the fmall-pox, without fuppofing that it ought to derive a fpecific name from that difeafe. The fpecies of diarrhoea would be innumerable, if, every time it occurred as a fymptom of other difor- ders, it was to receive a fpecific name, and to be con- fiderel as an idiopathic diforder. The OBSERVATIONS, &C. 121 The reafons which I offered in my letter to Doc- tor Millar, for believing that the cynanche trachealis is frequently a fpafmodic diforder, continue to operate upon me with as much force as ever. But a number of diflections, related by different authors, fatisfy me, that the cynanche trachealis humida is a diftinct: fpecies from the fpafmodic, and requires a different method of cure. The cynanche trachealis fpafmodica is known, 1. By coming on fuddenly, and that generally in the n ight. 2. By frequent and perfect intermiffions of the fymp- toms for hours, and in fome inftances for days, with- out the leaft fenfible difcharge from the trachea. And, 3. By yielding to antifpafmodic remedies, particu- larly to the warm bath. If thefe facts had left any reafon to doubt of a fpaf- modic fpecies of this diforder, I fhould have been con- firmed in the opinion, by the diffection of a child in the year 1770, who died by it, in whom no marks were to be found of a membrane, or even of mucus in the trachea. The lungs and trachea appeared to be in a found ftate. The cynanche trachealis humida is known, 1. Br coming on-gradually, and that moft com- monly in the day time. 2. By its continuing or increafing for feveral days without any remarkable remiffion, or even abatement uf the fymptoms, Q 3-B* 1(32 OBSERVATIONS ON THE 3. By the difcharge of phlegm or mucus from the trachea, and the occafional appearance of it in the ftools. And, 4. By not yielding to antifpafmodic medicines. My opinion of the caufe of the membrane which is formed in the trachea, continues to be the fame as expreffed in my former publication*, with this dif- ference, that I believe the membrane to be the effeft of the humid fpecies only, and that it is not an acciden- tal confequence of the fpafmodic, as I once fuppofed. During the paroxyfms of the diforder, the fymptoms are nearly the fame in both fpecies. They are defcribed by Doctor Miliar, in his obfervations on the afthma and .hooping, cough, in the following words : " Children " (fays he) at play were fometimes feized with it, but " it generally came on at night. A child who went " to bed in perfect: health, waked an hour or two af- " terwards in a fright, with his face much flufhed, or " fometimes of a livid color ; incapable of defcribing " what he felt; breathing with much labor, and with ." a convulfive motion in the belly ; the returns of " infpiratiou and expiration quickly fucceeding each " other * "The veffcls of the trachea and bronchise always abound with a thin " mucus, which is poured into them in proportion as they are irritated by in- " flammation, or the action of the external air. Children abound with a " greater quantity of mucus in thefe parts than adults ; and when it is accu- " mulated in the trachea or bronchia: in a greater quantity than ordinary, " they are unable, upon the accountof their weaknefs, to bring it up. It is " eafy to conceive in what manner it is converted into a thin membrane, after " its more fluid parts are diffipated. We have an analogy of this in the nofe. " Were the paffages of this organ lefs in our reach, it is probable a membraae " refembling that found in the trachea would be found in it every four ani " twenty hours, efpecially when it was affected by a cold. We always find " the phlegm accumulated in proportion to the time the diforder has continu- " ed. In all the cafes of membrane mentioned by Doctor Home, the pati- " ents never died before the third day, and in many cafes, not before the »4 fourth and fifth days.." Letter to Doctor Millar. CYNANCHE TRACHEALIS. »83 ** other in that particular fonorous manner, which is " often obferved in hyfteric paroxyfms. The child's " terror fometimes augmented the diforder. He " clung to the nurfe,- and if he was not fpeedily re- " lieved by coughing, belching, fneezing, vomiting or " purging, the fuffocation increafed, and he died in " the paroxyfm." To this defcription of the cynanche trachealis, I beg leave to add the three following obfervations. 1. The noife which patients make in coughing in this diforder, refembles the barking of a young dog. This fymptom is fo univerfally prefent, that I always rely upon it as a pathognomonic fign of the difeafe. before it is completely formed. I have obferved this barking cough, in one inftance of cynanche trachealis humida, to continue for feveral days after the patient was out of danger. 2. During the continuance of the difeafe there is frequently an eruption of little red blotches on the fkin, which is accompanied by fenfible relief to the patient. This eruption fometimes appears and difappears two. or three times in the courfe of the difeafe. 3. The difeafe is not confined wholly to children. 1 have feen two cafes of the fpafmodic fpecies in adults. Doctor Cullen has given birth to a controverfy refpecting the inflammatory nature of the cynanche trachealis. He has included it in the order of phleg- mafiae in his clafs of pyrexia. I acknowledge that I have generally feen both the fpecies that have been mentioned, without inflammatory fymptoms, and fome- times 3=4 OBSERVATIONS on the times without fever, efpecially in the firft ftage of the diforder. When either fpecies has been attended by a hard pulfe, it has been only in plethoric habits, or when it has been complicated with fymptoms of catarrh or peripneumony. Perhaps it may appear improper, after fuch a declaration, to have adopted the name given to this diforder by Doctor Cullen. I fhould have had no objection to Doctor Michaelis's name of " angina po- lypofa," did it not exclude the fpafmodic fpecies of this difeafe ; nor fhould I hefitate in adopting the more generic term of " fuffocatio ftridula" of Doctor Home, if the difeafe were not now fo generally known by the name given it by Doctor Cullen*. The remedies to be ufed in cynanche trachealis fpafmodica, are, 1. Bleeding, when it is connected with pneumonic fymptoms; 2. Vomits; 3. Purges; and, 4. Antifpafmodic medicines, more efpecially the warm bath, opium, affafcetida and blifters. The remedies which are proper in the cynanche trachealis humida, are the three firft which are men- tioned for the cure of the fpafmodic fpecies, and calo- mel. Our principal dependence muft be placed upon this laft medicine. A large dofe of it fhould be given as foon as the difeafe difcovers itfelf, and fmaller dofes fhould be given every day, while any of its fymptoms continue. The bark is fcarcely a more certain remedy for * The vulgar name of this difeafe in Pennfylvania is the Hives. It ap- pears to be a corruption of the word " heaves," which took its rife from the manner in which the lungs heave in refpiration. The worft degrees of the diforder are called the " bowel-hives," from thegreat motion of the abdomi- nal mufcles in refpiration. cynanche trachealis. 125 for intermittents, than calomel, when thus adminifter- ed, is in this fpecies of cynanche. In what manner does the calomel aft in this difor- der ? Is it by increafing the fecretion of mucus in the numerous glands of the fauces, cefophagus, ftomach and bowels, and thereby leffening the excretion of it in the trachea ? The analogy of the fecretions and excre- tions, in other parts of the body, whether promoted by nature or art, feems \o favour this conjecture. I shall only add upon the fubject of this diforder, that inftances of its mortality have been very rare in Philadelphia, fince the general ufe of the remedies which have been mentioned. AN [ »*6 1 A N ACCOUNT or the EFFECTS of BLISTERS AND BLEEDING, IN THE CURE OF OBSTINATE Intermitting Fevers. THE efficacy of thefe remedies will probably be difputed by every regular-bred phyfician, who has not been a witnefs of their utility in the above diforder; but it becomes fuch phyficians, before they decide upon this fubject, to remember, that many things are true in medicine, as well as in other branches of philofophy, which are very improbable. In all thofe cafes of autumnal intermittents, whe- ther quotidian, tertian, or quartan, in which the bark did not fucceed after three or four days trial, I have feldom found it fail after the application of blifters to the wrifts. But in thofe cafes where blifters had been neglect- ed, or applied without effect, and where the difeafe had been protracted into the winter months, I have generally cured it by means of one or two moderate bleedings. The EFFECTS OF BLISTERS AND BLEEDING,&C I27 The pulfe in thofe cafes, is% generally full, and fometimes a little hard, and the blood when drawn, for the moft part appears fizy. The bark is feldom neceflary to prevent the return of the diforder. It is always ineffectual, where blood- letting is indicated. I have known feveral inftances where pounds of this medicine have been taken with- out effe£t, in which the lofs of ten or twelve ounces of blood has immediately cured the diforder. How fhall we reconcile the practice of bleeding in intermittents, with our modern theories of fever ? May not the long continuance of an intermittent, by debilitating the fyftem, produce fuch an irritability in the arteries, as to difpofe them to that fpecies of inflammatory diathefis which is founded on indirect: debility ? Or, May not fuch congeftions be formed in the vifcera, as to produce the fame fpecies of inflammatory diathefis that occurs in feveral other inflammatory difeafes ? Doctor Cullen has taught us, in his account of the chronic hepatatis, that there may be topical affection and inflammatory diathefis, without much pain or fever; and had I not wuneffed feveral cafes of this kind, I fliould have been forced to have believed it poflible, not only in this diforder, but in many others, from the facts which were communicated to me by Doctor Michaelis in his vifit to Philadelphia in the year 1783. I ONCE 128 EFFFCTS OF BLISTERS AND BLEEDING, &C I ONCE intended to have added to this account of the efficacy of blifters and bleeding in curing obftinate intermittents, teftimonies from a number of medical gentlemen, of the fuccefs with which they have ufed therft; but thefe vouchers have become fo numerous, that they would fwell this eflay far beyond the limits I with to prefcribe to it. AN [ *29 ] A N ACCOUNT or THE DISORDER OCCASIONED BY DRINKING COLD WATER IN WARM WEATHER, AND THE METHOD OF CURING IT. FEW fummers elapfe in Philadelphia, in which there are not inftances of many perfons being affe&ed by drinking cold water. In fome feafons four or five perfons have died fuddenly from this caufe, in one day. This mortality falls chiefly upon theJ la- bouring part of the community, who feek to allay their thirft by drinking the water from the pumps in the ftreets, and who are too impatient, or too ignorant, to ufe the neceflary precautions for preventing its mor- bid or deadly effects upon them. Thefe accidents fel- dom happen, except when the mercury rifes above 850 in Farenheit's thermometer. Three circumftances generally concur to produce difeafe or death from drinking cold water. 1. The patient is extremely warm. 2. The water is extreme- ly cold. And, 3. A large quantity of it is taken in- to the body. The danger from drinking the cold wa- ter is always in proportion to the degrees of combi- nation which occur in the three circumftances that have been mentioned.. ' The I30 OF THE DISORDER OCCASIONED BY The following'fymptoms generally follow, where cold water has been taken, under the above circum- ftances, into the body. In a few minutes after the patient has fwallowed the water, he is affefted by. a dimnefs of fight, he ftaggers in attempting to walk, and unlefs fupportcd, falls to the ground ; he breathes with difficulty ; a rat- tling is heard, in his. throat; his noftrils and cheeks expand and contract in every act of refpiration ; his face appear* fuffufed with blood, and of, a livid color; his extremities become cold, and his pulfe impercept- ible ; and unlefs relief is fpeedily obtained, the dif, order terminates in death, in four or five minutes. Tins defcription includes only the lefs common cafes of the effects of drinking a large quantity of cold water, when the body is.preternaturalty heated. More frequently, patients are feized with acute fpafms in the breaft and ftomach. Thefe fpafms are fo painful as to produce fyncope, and even afphyxf. They are fome- times of. the tonic, but more frequently of the clonic kind. In the intervals of the fpafms the patient ap- pears to be perfectly well. The intervals between each fpafm become longer or fhorter, according as the dif- eafe tends to life or death. It may not be improper to take notice, that punch, beer, and even toddy, when drank under the fame circumftances as cold water, have all been known to produce the fame morbid and fatal effects. I KNOW of but one certain remedy for this difeafe, and that is liquid laudanum. The dofes of it, as DRINKING COLD WATER. 13* as in other cafes, ctf fpafm, fhould be proportioned \o the violence of the difeafe. From a tea-fpoonful to near a table-fpoonful have been given in fome inftances, -before relief has been obtained. Where the powers of life appear, to be fuddenly fufpended, the fame re- medies fhould be ufed, which have been fo fuccefsfully employed i,n recovering perfons fuppofed to be dead from drowning. Care, fhould be taken in every cafe of difeafe, or apparent death, from drinking cold water, to pre- vent the patient's fuffering from being furrpunded, or even attended by too many people. Persons who have been recovered from the im- mediate danger which attends this difeafe, are fome- times affected after it, by inflammations and obftruc- tions in the breaft or liver. They generally yield to the ufual remedies which are adminiftered in thofe complaints, when they arife from other caufes. If neither the voice of reafon, nor the fatal ex- amples of thofe who have periflied from this caufe, are fufficient to produce reftraint in drinking a large quantity of cold liquors, when the body is preternatu- rally heated, then let me advife to 1. Grasp the veffel, out of which you are about to drink, for a minute or longer with both your hands. This will abftract a portion of heat from the body, and impart it at the fame time to the cold liquor, provided the veffel is made of metal, glafs, or earth ; for heat follows the fame laws, in many inftances, in pafling through I32 OF THE DISORDER OCCASIONED, &C. through bodies, with regard to its relative velocity, which we obferve to take place in elecfricity. 2. If you are not furnifhed with a cup, and are obliged to drink by bringing your mouth in contact with the ftream which iffues from a pump, or a fpring, always wafli your hands and face previoufly to your drinking, with a little of the cold water. By re- ceiving the {hock of the water firft upon thofe parts of the body, a portion of its heat is conveyed away, and the vital parts are thereby defended from the acr tion of the cold. AN [ >33 1 A N ACCOUNT OF THE EFFICACY of COMMON SALT, IN THE CURE OF Hemoptyfis. FROM the prefent eftablifhed opinions and prac- tice refpecting the caufe and cure of haemoptyfis, the laft medicine that would occur to a regular-bred phyfician for the cure of it, is common salt ; and yet I have feen and heard of a great number of cafes, in which it has been adminiftered with fuccefs. The mode of giving it, is to pour down from a tea, to a table-fpoohful of clean fine fait, as foon as poffible after the haemorrhage begins from the lungs. This quantity generally ftops it; but the dofe muft be repeated daily for three or four days, to prevent a re- turn of the diforder. If the bleeding continues, the fait muft be continued till it is checked, but in larger dofes. I have heard of feveral inftances in which two table-fpoonfuls were taken at one time for feveral days. It fometimes excites a ficknefs at the ftomach, and never fails to produce a burning fenfation in the throat in its paffage into the ftomach, and confiderable thirft afterwards. I HAVE THE EFFICACY OF COMMON SALT I have found this remedy to fucceed equally well in haemorrhages, whether they were active or paflive, or whether they occurred in young or in old people. I had prefcribed it for feveral years before I could fatisfy myfelf with a theory, to account for its extra- ordinary action upon the human body. My inquiries led me to attend more particularly to the following fa6b. t j. Those perfons who have been early inftructed in vocal mufic, and who ufe their vocal organs mo- derately through life, are feldom affected by an ha^ morrhage from the lungs. 2. Lawyers, players, public cryers, and city watchmen, all of whom exercife their lungs either by long or loud fpeak ing, are hfs affected by this difcur- 6er, than perfons. of other occupations. I acknowledge I cannot extend this obfervati- on to the public teachers of religion. 1 have known feveral inftances of their being affected by baemoptyfis; but never but one in which the diforder came on in the pulpit, and that was in a perfon who had been recently cured of it. The cafes which I have feen, have generally been brought on by catarrhs. To this diforder, the practice of fome of our Ame- rican preachers difpofes them in a peculiar manner; for it is very common with this clafs of them, to ex- pofe themfelves to the cold or evening air immediate- ly after taking, what a celebrated and eloquent preach- er ufed to call a pulpit faeat. 3. This IN THE CURE OF HEMOPTYSIS, 135 3. Tins haemorrhage chiefly occurs in debilitated habits, or in perfons afflicted by fuch a difpofition to confumption, as indicates a weak arid relaxed ftate of the lungs. 4. It generally occurs when the lungs are in a paflrve ftate; as in fitting, walking, and more fre- quently in lying. Many of the cafes that I have known, have occurred during fleep, in the middle of the night. From thefe facts, is it not probable that the com- mon fait, by acting primarily and with great force upon the throat, extends its ftimulus to the bleeding veffel, and by giving it a tone, checks the further effufion of blood ? I shall only add to this conjecture the following ©bfervations. 1. I have never known the common fait perform a cure, where the haemorrhage from the lungs has been a fymptom of a confumption. But even in this cafe, it gives a certain temporary relief. 2. The exhibition of common fait in the haemop- tyfis, fhould by no means fupercede the ufe of occa- fional bleeding when indicated by plethora, nor of that diet which the ftate of the pulfe, or of the ftomach, may require. 3. I HAVE given the common fait in one cafe with fuccefs, in an haemorrhage from the ftomach, accom- panied by a vomiting ; and have heard of feveral cafes in which it has been fuppofed to have checked a difcharge 136 THE EFFICACY OF COMMON SALT, &C. difcharge of blood from the nofe and uterus, but I can fay nothing further in its favor in thefe laft hae- morrhages, from my own experience. It may perhaps ferve to leffen the prejudices of phyficians againft adopting improvements in medicine, that are not recommended by the authority of colleges or univerfities, to add, that we are indebted to an old woman, for the difcovery of the efficacy of common fait in the cure of basmopryfis. FREE [ >37 ] FREE THOUGHTS UPON THE CAUSE AND CURE OF THE Pulmonary Confumption. THE ancient Jews ufed to fay that a man does not fulfil his duties in life, who paffes through it, without building a houfe, planting a tree, and leav- ing a child behind him. A phyfician, in like manner, fliould confider his obligations to his profeffion and fociety as undifcharged, who has not attempted to lef- fen the number of incurable difeafes. This is my apo- logy for prefuming to make the confumption the fub- ject of a medical inquiry. Perhaps I may fuggeft an idea, or fact, that may awaken the ideas and facts which now lie ufelefs in the memories or common-place books of other phyficians; or I may direct their attention to fome ufeful experi- ments upon this fubject. I shall begin my obfervations upon the confump- tion, by remarking, i. That it is unknown among the Indians in North-America. S &. It 138 THOUGHTS on the consumption. 2. It is fcarcely known by thofe citizens of th.-r United States, who live in the firfl ftage of civilized life, and who have lately obtained the title of the firfl fdtlers. The principal occupations of the Indian confift in war, fifhing, and hunting. Thofe of the firft fet- tler, are fifhing, hunting, and the laborious employ- ments of fuhduing the earth, cutting down forefts, building a houfe and barn, and by diftant excurfions in all kinds of weather, to mills and courts. All of which tend to excite and preferve in the fyftemv fome- thing like the Indian vigor of conftitution. 3. It is lefs common in country places than in ci- ties, and increafes in both, with intemperance and fedentary modes of lite. 4. Ship and houfe carpenters, fmiths, and all thofe artificers, whofe bufinefs requires great exertions of ftrength, in the open air in all feafons of the year, are lefs fubject to this diforder, than men who.work un- der cover, and at occupations which do not require the conftant action of their limbs. 5. Women who fit more than men, and whofe work is connected with lefs exertion, are moft fubv ject to the confumption. From thefe'facts it would feem, that the moft pro- bable method of curing the confumption, is to revive- in the conftitution, by means of exercife or labor, that vigor which belongs to the Indians, or to mankind in their firft ftage of civilization. The THOUGHTS ON THE CONSUMPTION. 139 The efficacy of thefe means of curing confumpti- on will appear, when we inquire into the relative merit of the feveral remedies which have been ufed by phyficians in this diforder. I shall not produce among thefe remedies the nu- merous receipts for fyrups, boluffes, electuaries, de- coaions, infufions, pills, medicated waters, powders, draughts, mixtures, and diet-drinks, which have fo long and fo fteadily been ufed in this difeafe; nor (hall I mention as a remedy, the beft accomodated diet, fubmitted to with the moft patient feli-denial; for not one of them all without the aid of exercife has ever, I believe, cured a fingle confumption. 1. Sea-voyages have cured confutations; but it has been only when they have been fo long, or fo fre- quent, as to fubftitute the long continuance of gentle, to violent degrees of exercife of a fhorter duration. 2. A change of CLIMATE has often been pre- fcribed for the cure of confumptions, but I do not re- collect; an inftance of its having fucceeded, except when it has been accompanied by exercife, as in tra- velling, or by fome active laborious purfuit. Doctor Gordon of Madeira, afcribes the inefficacy of the air of Madeira in the confumption, in part to the difficulty patients find of ufing exercife in carria- ges, or even on horfeback, from the badnefs of the roads in that ifland. 3. Journies have often performed cures in the confumption, but it has been chiefly when they have been long, and accompanied by difficulties which have roufed 140 THOUGHTS ON THE CONSUMPTION. roufed and invigorated the powers of the mind and body. 4. Vomits and nauseating medicines have been much celebrated for the cure of confumptions. Thefe, bv procuring a temporary determination to the furfaee of the body, fo far leffen the pain and cough as to enable patients to ufe profitable exercife. Where this has not accompanied or fucceeded the exhibition of vomits, I believe they have feldom afforded any permanent relief. 5. Blood-letting has often relieved confumpr tions; but it has been only by removing the trouble- fome fymptoms of inflammatory diathefis, and there- by enabling the patients to ufe exercife, or labor, with advantage. 6. Vegetable bitters and fome of the sti- mulating gums have in fome inftances afforded relief in confumptions; but they have done fo only in thofe cafes where there was great debility, accompani- ed by a total abfence of inflammatory diathefis. They have moft probably acted by their tonic qualities as fubftitutes for labor and exercife. 7. A PLENTIFUL and REGULAR PERSPIRATION excited by means of a flannel fhirt worn next to the fkin, or by means of a ftove-room, or by a warm cli- mate, has in many inftances prolonged life in confump- tive habits; but all thefe remedies have acted as palli- atives only, and thereby have enabled the confump- tive patients to enjoy the more beneficial effects of exercife. 8. Blisters, THOUGHTS ON THE CONSUMPTION. 14! 8. Blister!;, setons, and issues, by determin- ing the perfpirable matter from the lungs to the fur- face of the body, leffen pain and cough, and thereby prepare the fyftem for the more falutary effects of exercife. 9. The effects of swinging upon the pulfe and refpiration, leave us no room to doubt of its being a tonic remedy, and therefore a fafe and agreeable fub- ftitute for exercife. Form all thefe facts it is evident that the remedies for confumptions muft be fought for in thofe exercifes and employments which give the greateft vigor to the conftitution. And here I am happy in being able to produce feveral facts which demonftrate the fafety and certainty of this method of cure. During the late war, I faw three inftances of perfons in confirmed confumptions who were perfectly cured by the hardfhips of a military life. They had been my patients previoufly to their entering into the army. Befides thefe, I have heard of four well atteft- ed cafes of fimilar recoveries from nearly the fame re- medies. One of thefe was the fon of a farmer in New-Jerfev, who was fent to fea as the laft refource for a confumption. Soon after he left the American fliore, he was taken by a Britifh cruifer, and compel- led to fhare in all the duties and hardlhips of a common failor. After ferving in this capacity for twenty two months, he made his efcape, and landed at Bofton, from whence he travelled on foot to his father's houfe, (nearly four hundred miles) where he arrived in perfect health. Doctor 142 thoughts on the consumption. Doctor Way of Wilmington informed me, that a certain Abner Cloud, who was reduced fo low by a pulmonary confumption as to be beyond all relief from medicine, was fo much relieved by flceping in the open air, and by the ufual toils ot building a hut and improving a farm in the unfettled parts of a new coun- ty in Pennfylvania, that he thought him in a fair way pf a perfect recovery. Doctor Latimer of Wilmington, had been long afflicted with a cough and an occafional hamoptyfis. He entered into the American army as a furgeon, and ferved in that capacity till near the end of the war; during which time he was perfectly free from all pul- monic complaints. The fpitting of blood returned foon after he fettled in private practice. To remedy this complaint, he had recourfe to a low diet, but finding it ineffectual, he partook liberally of the ufual diet of healthy men, and lie now (as he lately inform- ed me) enjoys a good fliare of health. It would be very eafy to add many other cafes, in which labor, the employments of agriculture, and a life of hardfhip by fea and land, have prevented, re- lieved, or cured not only the confumption, but pul- monary difeafes of all kinds. To the cafes that have been mentioned, I fhall add only one more, which was lately communicated to me by the venerable Doctor Franklin, whofe converfation at all times conveys inflruction, and not lefs in medi- cine than upon other fubjects. In travelling, many years ago, through New-England, the doctor overtook the poft-rider ; and after fome inquiries into the hif- tory of his life, he informed him that he was bred a fhoemaker; THOUGHTS ON THE CONSUMPTION. 143 Ihoemaker ; that his confinement, and other circum- stances, had brought on a confumption, for which he was ordered by a phyfician to ride on horfeback. Finding this mode of exercife too expenfive, he made intereft, upon the death of an old poft-rider, to fucceed to his appointment, in which he perfectly recovered his health in two years. After this he returned to his old trade, upon which his confumption returned. He again mounted his horfe, and rode poft in all feafons and weathers, between New-York and Connecticut river, (about 140 miles); in which employment he continued upward of thirty years, in perfect health. These facts, I hope, are fufficient to eftablifh the advantages of reftoring the original vigor of the con- ftitution, in every attempt to effect a radical cure of confumption. But how fhall thefe remedies be applied in the time of peace, or in a country where the want of woods, and brooks without bridges, forbid the attainment of the laborious pleafurcs of the Indian mode of hunt- ing ; or where the univerfal extent of civilization does not admit of oar advifing the toils of a new fettlement, and improvements upon bare creation ? Under thefe circumftances, I conceive fubftitutes may be obtained for each of them, nearly of equal efficacy, and attain- able with much lefs trouble. 1. Doctor Sydenham pronounced riding on horfi- back, to be as certain a cure for confumptions as bark is for an intermitting fever. I have no more doubt of the truth ot this affertion, than I have that inflamma- tory fevers are now lefs frequent iu London, than they were in the time of Doctor Sydenham. If riding on Viorfebacl; I44 THOUGHTS ON THE E CONSUMPTION. horfeback in confumptions has ceafed to be a remedy in Britain, the fault is in the patient, and not in the remedy. " It is a fign that the ftomach requires milk, " (fays Doctor Cadogan) when it cannot bear it." In like manner, the inability of the patient to bear this manly and wholefome exercife, fervcs only to demon- ftrate the neceffity and advantages of it. I fufpect the fame objections to this exercife which have been made in Britain, will not occur in the United States of America; for the Americans, with refpect to the fymp- toms and degrees of epidemic and chronic difeafes, appear to be nearly in the fame ftate that the inhabi- tants of England were in the feventeenth century. I can eafily conceive the vigor of the human conftitu- tion to have been fuch in Doctor Sydenham's time, as that a defluxion or ulcer in the lungs fhould have had no more effect in increafing the action of the arterial fyftem, than a moderate inflammation of the eyes has at prefent in exciting an inflammatory fever in a good conftitution : hence the fafety and advantage formerly of riding on horfeback in pulmonic complaints. We find, in proportion to the decline of the vigor of the body, that many occafional caufes produce fever and inflammation, which would not have done it an hun« dred years ago. 2. The laborious employments of agriculture, if fteadily purfued, and accompanied at the fame time by the fimple, but wholefome diet of a farm-houfe, and a hard bed, would probably afford a good fubftitute for the toils of a favage or military life. 3. Such occupations or profeflions as require con- ftant labor or exercife in the open air, in all kinds of weather, may eafily be chofen for a young man who, either THOUGHTS ON THE CONSUMPTION. H5 cither from hereditary predifpofition, or an accidental affection of the lungs, is in danger of falling into a confumption. In this we fliould imitate the advice given by fome wife men, always to prefer thofe pro- feflions for our fons which are the leaft favourable to the corrupt inclinations of their hearts. For example, where an undue paflion for money, or a crafty difpofi- tion difcover themfelves in early life, we are directed to oppofe them by the lefs profitable and more difinte- refted profeflions of divinity, or phyfic, rather than cherifh them by trade, or the practice of the law*. 4. There is a cafe recorded by Doctor Smollet, of the efficacy of the cold bath in a confumption; and I have heard of its having been ufed with fuccefs in a negro man in one of the Weft-India iflands. To ren- der this remedy ufeful, or even fafe, it will be necef- fary to join it with labor, or to ufe it in degrees that fhall prevent the alternation of the fyftem with vigorand debility: for I take the cure of confumption to depend upon the fimple action of tonic, without the leaft mix- ture of debilitating powers. Indeed, I conceive it to be eafier to palliate the fymptoms, and prolong life, by the ufe of the powers which are Jimply debilitating, than by a mixture of both of them. This is not a folitary fact in the human body. We often fee a ftiff neck and fpafms, brought on by a perfon's being expo- fed, at the fame time, to a ftream of air from a door or T window, * It is very common for parents to prefer fedentary occupations for fuch of their children' who are of delicate constitutions, and the mora adtive occupa- t.ons for thole of them who are robuft. The reverfe of this pradYice fhould be followed. The weakly children thould be trained to the laborious, and the robuft to the 1'eJcotary occupalio.is. From a negledi of this pi-adicr, nuny hundred apprentices to taylors, fhoenwkers, conveyancers, wakh- m.«k'r<, rtlverfmithj, mantuamaker?, *:. &c. perifh every year by «m- fumption*. tjfi THOUGHTS ON THE CONSUMPTION. window, and to the heat of a warm room, where neither would have been injurious, if it had acted fingly upon the fyftem. There are many extremes in phyfic, as in other things, which meet in a point. There is an inflammatory diathefis connected with debility, as cer- tainly as with an excefs of tone in the arterial fyftem. And I think I have feen greater degrees of this inflam- matory diathefis in the male inhabitants of cities, than r>f the country, and more in women, than in men. I have moreover feen the moft acute inflammatory difea- fes where the fyftem had been previoufly debilitated by a long continuance of warm weather, or of an obftinate intermitting fever, and in too many inftances by the ufe of fpirituous liquors. This fpecies of inflammato- ry diathefis appears to arife, therefore, from what has been called, and perhaps not improperly, indiretl de- bility. Is it the prefence of this fpecies of inflammato- ry diathefis which renders confumptions fo much more difficult to cure than formerly ? Is it this which often ren- ders riding on horfeback fo ineffectual, or fo injurious in this diforder ? I fufpect it is; and it is to be lamen- ted that it often requires fo much time, or fuch reme- dies to remove this fpecies of inflammatory diathefis, as to reduce the patient too low to make ufe of thofe re- medies afterwards which would effect a radical cure. If it were poflible to graduate the tone of the fyf- tem by means of a fcale, I would add, that to cure confumptions, the fyftem fhould be raifed to the high- eft degree of this fcale. Nothing fhort of an equili- brium of tone, or a free and vigorous action of everv mufcle and vifcus in the body, will fully come up to a radical cure for confumptions. In THOUGHTS ON THE CONSUMPTION. I47 In regulating the diet of confumptive patients, I conceive it to be as neceflary to feel the pulfe, as it is in determining when and in what quantity to draw blood. Where indirect inflammatory diathefis pre- vails, a vegetable diet is certainly proper; but where the patient has efcaped, or paffed this ftage of the dif- order, I believe a vegetable diet alone to be injurious; and am fure a moderate quantity of animal food may be taken with advantage. In both cafes, the diet fhould confift, as much as poifible, of one kind of ali- ment. The prefence or abfence of this inflammatory dia- thefis, furnifhes the indications for adminiftering or re- fraining from the ufe of the bark and balfamic medi- cines. With all the teftimonies of their having done mifchief, many of which I could produce, I have known feveral cafes in which they have been given with obvious advantage; but it was only when there was a total abfence of inflammatory diathefis. Perhaps the remedies I have recommended, and the opinions I have delivered, may derive fome fup- port from attending to the analogy of ulcers on the legs, and in other parts of the body. The firft of thefe occur chiefly in habits debilitated by fpirituous liquors, and the. laft frequently in habits debilitated by the fcrophula. In curing thefe diforders, it is in vain to depend upon internal or external medicines. The whole fyftem muft be ftrengthened, or we do nothing; and this is to be effected Only by exercife and a gene- rous diet. u 148 THOUGHTS ON THE CONSUMPTION. In relating the facts that are contained in this effay, I wifh I could have avoided reafoning upon them; efpecially as I am confident of the certainty *of the facts, and fomewhat doubtful of the truth of my rea- fonings. I shall only add, that if the cure of confumpti- ons fhould at laft be effected by remedies in every re. fpect the oppofites of thofe palliatives which are now fafhionable and univerfal, no more will happen than what we have already feen in the tetanus, the fmall- pox, and in the management of fractured limbs. Should this be the cafe, we fhall not be furprifed to hear of phyficians, inftead of prefcribing any one, or all of the medicines formerly enumerated for con- fumptions, ordering their patients to exchange the amufements or indolence of a city, for the toils of a country life; of their advifing farmers to exchange their plentiful tables, and comfortable fire-fides, for the fcanty but folid fubfiftence, and midnight expo- fure of the herdfman ; or oif their recommending, not fo much the exercife of a paffive fea-voyage, as the atlive labors and dangers of a common failor. Nor fhould it furprife us, after what we have feen, to hear patients relate the pleafant adventures of their ex- curfioris, or labors, in queft of their recovery from this diforder, any more than it does now to fee a ftrong or well fhaped limb that has been broken ; or to hear a man talk of his ftudies, or pleafures, during the time of his being inoculated and attended for the fmalU pox. From THOUGHTS ON THE CONSUMPTION. 149 From a review of the facts and obfervations which have been mentioned, I cannot help thinking that the words of the philofopher, " Quod petis in te eft," ap- ply not more to the means of obtaining happinefs, than they do to the means of obtaining a radical cure for the confumption. I will not venture to affert, that there does not exift a medicine, which fhall fupply, at leaft in fome degree, the place of the labor or exercifes, whofe ufe- fulnefs in confumptions has been eftablifhed by the facts that have been mentioned. Many inftances of the analogous effects of medicines, and of exercife up- on the human body, forbid the fuppofition. I fhall only add, that if there does exift in nature fuch a me- dicine, I am difpofed to believe it will be found in the clafs of tonics. If this fhould be the cafe, I con- ceive its ftrength, or its dofe, muft far exceed the pre- fent ftate of our knowledge or practice, with refpect to the efficacy or dofe of tonic medicines. I except the diforder, which arifes from recent abfceffes in the lungs, from the general obfervation which has been made, refpecting the inefficacy of the remedies that were formerly enumerated for the cure of confumptions without labor or exercife. Thefe abfceffes often occur without being accompanied by a confumptive diathefis, and are frequently cured by nature, or by very fimple medicines. OBSERVA- [ »5° ] OBSERVATIONS Ul'ON WORMS IN THE ALIMENTARY CANAL, AND UPON ANTHELMINTIC MEDICINES. - - . ■ ■ ■ i , ... - .. ■- WITH great diffidence I venture to lay before the public my opinions upon worms: nor fhould I have prefumed to do it, had I not enter- tained a hope of thereby exciting further inquiries upon this fubject. When we confider how univerfally worms ate found in all young animals, and how frequently they exift in the human body, without producing difeafe of any kind, it is natural to conclude, that they ferve fome ufeful and neceflary purpofes in the animal ceco- nomy. Do they confume the fuperfluous aliment which all young animals are difpofed to take before they have been taught, by experience or reafon, the bad confequences which arife from it? It is no ob- jection to this opinion, that worms are unknown in the human body in fome countries. The laws of na- ture are diverfified, and often fufpended under pecu- liar circumftances in many cafes, where the departure from uniformity is ftill more unaccountable, than in the prefent inftance. Do worms produce difeafes from an excefs in their number, and an error in their place, observations upon worms, &c. 151 place, in the fame manner that blood, bile and air pro* duce difeafes from an error in their place, or fromve obfervations upon worms were committed to paper, I have met with the following fads, in a letter from Doftor Capellc of Wil- mington, which has been read .in the College of Phyficians of Philadelphia^ In the livers of fixteen, out of eighteen rats which he diflefted, he informed me that he found a number of the taenia worms. The rats were fat, and ap- peared in other refpscls to have been in perfert health. The two rats m which he found no worms, he fays, « were very lean, and their LverstmaU. " er in proportion than the others." 1$3 observations upon worms which have been mentioned, render the bowels a more quiet and comfortable afylum for them, and thereby provide the fyftem with the means of obviating the* effects of crapulas, to which all children are difpofed. It is in this way that nature, in many inftances, cures evil by evil. I confine, the falutary office of worms only to that fpecies of them which is known by the name of the round worm, and which occurs moft frequently in children. Is there any fuch difeafe as an idiopathic worm- fever? The Indians in this country fay there is not, and afcribe the difcharge of worms to a fever, and not a fever to the worms*. By adopting this opinion, I am aware that I contra- dict the obfervations of many eminent and refpectablc phyficians. Doctor Huxham defcribes an epidemic pleurify, in the month of March in the year 1740,. which he fuppofes was produced by his patients feeding upon fome corn that had been injured by the rain the Au- guft beforef. He likewife mentions that a number of people, and thefe too of the elderly fort^, were afflicted at one time with worms in the month of April in the year 1743. L1 e u t a u D gives an account of an epidemic worm- fever from Velfchius, an Italian phyfician || ; and Sau- vages defcribes, from Vandermonde, an epidemic dyfen- tery from worms, which yielded finally only to worm medicines^. Sir John Pringle, and Doctor Monro, likewife * Seethe inquiry into the difeafes of the Indians, pag. 22. + Vol. II. of his Epidemics, p. 56. J p. 136. || Vol. I. p. 76. ') Vol. II. p. 329. AND ANTHELMINTIC MEDICINES. *53 likewife frequently mention worms as accompanying the dyfentery and remitting fever, and recommend the ufe of calomel as art antidote to them. I grant that Worms appear more frequently in fome epidemic difeafes than in others, and oftener in fome years than in others. But may not the fame heat, moifture and diet, which produced the difeafes, have produced the worms? And may not their dif- charge front the bowels have been occafioned in thofe epidemics, as in the fmall-pox and meafles, by the increafed heat of the body j by the want of nou- rifhment; or by an anthelmintic quality being acci- dentally combined with fome of the medicines that are ufually given in fevers ? In anfwer to this, we are told that we often fee the crifis of a fever brought on by the difcharge of Worms from the bowels by means of a purge, or by an anthelmintic medicine. Whenever this is the cafe, I believe it is occafioned by offending bile being dif- lodged by means of the purge at the fame time with the worms, or by the anthelmintic medicine (if not a purge) having been given on, or near one of the ufual critical days of the fever. What makes the lat- ter fuppofition probable is, that worms are feldom fu- fpected in the beginning of fevers, and anthelmintic medicines feldom given, till every other remedy has failed of fuccefs ; and this generally happens about the ufual time in which fevers terminate in life or death. IT is very remarkable, jhat fince the difcovery and defcription of the* hydrocephalus internus, we hear and read much lefs than formerly, of worm-fevers. I fufpect that diforder of the brain has laid the founda- tion for the principal part of the cafes of worm-fevers U which '54 OBSERVATIONS UPON WORM3 which are upon record in books of medicine. I gran! that worms fometimes increafe the danger from fevers, and often confound the diagnofis and prognofis of them, by a number of new and analogous fymptoms. But here we fee nothing more than that complication of fymptoms which often occurs in difeafes of a very different and dppofite nature. How often are we puzzled by hyfteric and hypochondriac fymptoms in a fever ; and yet what phyfician ever thought of an hy- fteric or an hypochondriac fever ? Having rejected worms as the caufe of fevers, I proceed to remark, that the difeafes moft commonly produced by them, belong to the clafs of neuroses. And here I might add, that there is fcarcely a difeafe, or a fymptom of a difeafe, belonging to this clafs, which is not produced by worms. It would be only publifhing extracts from* books, to defcribe them. The chronic and nervous difeafes of children, which are fo numerous, and frequently fatal, are, I believe, moft commonly occafioned by worms. There is no great danger, therefore, of doing mifchief by preferr- ing anthelmintic medicines in all our firft attempts to cure their chronic and nervous difeafes. I have taken great pains to find out, whether the prefence of the different fpecies of worms might not be difcovered by certain peculiar fymptoms; but all to no purpofe. I once attended a girl of twelve years of age, in a fever, who difcharged four yards of a taenia, and who was fo far from having difeqyered anv peculiar fymptom of this fpecies of worms, that fhe had never complained of any other indifpofition, than now and then a flight pain in the ftomach, which often occurs in young girls from a fedentary life, or from errors in their AND ANTHELMINTIC MEDICINES. 155 their diet. I beg leave to add further, that there is not a fymptom which has been faid to indicate the pre- fence of worms of any kind, as the caufe of a difeafe, that has not deceived me; and none oftener than the one that has been fo much depended upon, viz. the picking of the nofe. A difcharge of worms from the bowels, is, perhaps, the only fymptom that is pathog- nomonic of their prefence in the inteftines. I shall now make a few remarks upon anthel- mintic remedies. But I ftiall firft give an account of fome experi- ments which I made in the year 1771, upon the com- mon earth-worm, in order to afcertain the anthelmin- tic virtues of a variety of fubftances. I made choice of the earth-worm for this purpofe, as it is, according to naturahfts, exactly the fame in its ftructure, man- ner of fubfiftence, and mode of propagating its fpecies, with the round worm of the human body. In the firft column I fhall fet down, under dif- tinft heads, the fubftances in which worms were placed; and in the fecond and third columns the time of their death, from the action of thefe fubftances upon them. I. Bitter and Astringent SUBSTANCES. Watery Infufion of Aloes, ---------■ of Rhubarb, ———— of Peruvian bark, II. Purges. Watery Infufion of Jalap, --------- of Bears-foot, • of Gamboge, HI. Salts. 1. Acids. Vinegar, - ' - Lime Juice, - - - Diluted nitrous Acid, Hours. Minutes. 4« 3° 17 \\ convulfcd. 1 1$ z. A1MI. *56 OBSERVATIONS UPON WORMS 2. Alkali. A watery Solution of Salt of Tartar, - 3. Neutral Salts. In a watery Solution of com- mon Salt, - ■----ot Nitre, —— of Sal Diuretic, - - ■----of Sdl Ammoniac, - ----of common Salt& Sugar, 4.. J^arthv and Metallic Salts. In a watery Solution of Epfom Salt, - ■----of Rock Alum, ----■ of Corrofive Sublimate, —— of Calomel, ----of Turpefh Mineral, —— of Sugar of Lead, ----of green Vitriol, - - ----of blue Vitriol, - - ——of white Vitriol, - IV. Metals. Filings qf Steel, Filings of Tin, - - - V. Calcareous Earth. Chalk, VI. Sedative Substances. Watery Infufion of Opium, ----of Carolina Pink-root, ----of Tobacco, VII. Essential Oils. Oil of Wormwood, - + —— of Mint, ---of Caraway Seed, ---of Amber, ——ofAnifeed, ——of Turpentine, VIII. Arsenic. A watery Solution of white Arfenic, IX. Fermented Liquors. In Madeira Wine, — Claret, - X. Distilled Spirit. Common Rum, Hours. Minutes. convulfed, throwing up a mucus on the furfaee of the water. 1 convulfed. ditto. ditto. 4 0 OBSERVATIONS UPON WORMS fmuate themfelves, efpecially in the morning. When we with to chflodge worms from the bowels by fugar or melaffes, we muft give thefe fubftances in large quantities, fo that they may efcape in part the action of the ftomach upon them. I can fay nothing from my own experience of the efficacy of the mineral falts, compofed ot copper, iron and zinc, combined with vitriolic acid, in deftroying worms in the bpwels. Nor have I ever ufed the corrofive fublimate in fmall dofes as an anthelmintic. I have heard well-attefted cafes of the efficacy of the oil of turpentine in deftroying worms. The expreffed juices of onions and of garlic are very common remedies for worms. From one of the experiments it appears that the onion juice pofleffes Itrong anthelmintic virtues. I have often prefcribed a tea fpoonful of gunpow- der in the morning upon an empty ftomach, with ob- vious advantage. The active medicine here is proba- bly the nitre. I have found a fyrup made of the bark of the Ja- maica cabbage tree*, to be a powerful as well as a moft agreeable anthelmintic medicine. It fometimes purges and vomits, but its good effects may be obtain- ed without giving it in fuch dofes as to produce thefe evacuations. There is not a more certain anthelmintic than Ca- rolina pink-rootf. But as there have been inftances of * Geoffrea, of Linnaeus. + Spigelia Marylandica, of Linnaeus. AND ANTHELMINTIC MEDICINES. l6l of death having followed exceffive dofes of it, impru- dently adminiftered ; and as children are often affected by giddinefs, ftupor, and a rednefs and pain in»the eyes, after taking it, I acknowledge that I have ge- nerally preferred to it, lefs certain, but more fafe me- dicines for deftroying worms. 3. Of the medicines whofe action is compounded of mechanical and chemical qualities, calomel, jalap, and the powder of fteel, are the principal. Calomel, in order to be effectual, muft be given in large dofes. It is a fafe and powerful anthelmin- tic. Combined with jalap, it often brings away worms when given for other purpofes. Of all the medicines that I have adminiftered, I know of none more fafe and certain than the fimple preparations of iron, whether they be given in the form of fteel-filings or of the ruft of iron. If ever they fail of fuccefs, it is becaufe they are given in too fmall dofes. I generally prefcribe from five, to thirty grains every morning, to children between one year, and ten years old; and I have been taught by an old fea-captain, who was cured of a taenia by this medicine, to give from two drachms to half an ounce of it, every morning, for three or four days, not only with fafety, but with fuccefs. I shall conclude this effay with the following remarks. i. Where the action of medicines upon worms in the bowels, does not agree exaftly with their aftion up- on the e^rth-worms in the experiments that have been X related, %$2 OBSERVATIONS UPON WORMS, &C. related, it muft be afcribed to the medicines being more or lefs altered by the action of the ftomach upon them. I conceive that the fuperior anthelmintic qua- lities of pink-root, fteel-filings, and calomel (all of whichacted but flowly upon the earth-worms compa- red with many other fubftances) are wholly occafioned by their efcaping the digeftive powers unchanged, and acting in a cdncentrated ftate upon the worms. 2. In fevers attended with anomalous fymptoms, which are fuppofed to arife from worms,' I have con- ftantly refufed to yield to the felicitations of my pa- tients, to abandon the indications of cure in the fe- ver, and to purfue worms-as the principal caufe of the difeafe. While I have adhered fteadily to the ufual remedies for the different genera and fpecies of fever, in all their ftages, I have at the fame time blended thofe remedies occafionally with anthelmentic medicines. In this I have imitated the practice of phyficians in many other difeafes ; in which troublefome and dan- gerous fymptoms are purfued, without feducing the attention from the original diforder. AN [ 163 ] A N ACCOUNT OF THE EXTERNAL USE OF ARSENIC IN THE CURE OF CANCERS. Read before the American Philofophical Society; February 3, 1786. A FEW years ago a certain Doctor Hugh Mar- tin, a furgeon of one of the Pennfylvania regi- ments ftationed at Pittflburg, during the latter part of the late war, came to this city, and advertifed to cure cancers with a medicine which he faid he had difcover- ed in the woods, in the neighbourhood of the garri- fpn. As Doctor Martin had once been my pupil, I took the liberty of waiting upon him, and afked him fome queftions refpefting his difcovery. His anfwers were calculated to make me believe, that his medicine was pt a vegetable nature, and that it was originally an Indian remedy. He fhewed me fome of the me- dicine, which appeared to be the powder of a well-dried root of fome kind. Anxious to fee the fuccefs of this medicine in cancerous fores, I prevailed upon the doc- tor to admit me to fee him apply it in two or three cafes. I obferved in fome inftances, he applied a powder to the parts affefted, and in others only touch- ed them with a feather dipped in a liquid which had a white fediment,. and which he made me believe was 4* 164 ACCOUNT OF THE USE OF ARSENIC the vegetable root diffufed in water. It gave me great; pleafure to witnefs the efficacy of the doctor's appli- cations. In feveral cancerous ulcers, the cures he performed were complete. Where the cancers were much connected with the lymphatic fyftem, or accom- panied with a fcrophulous habit of body, his medicine always failed, and, in fome inftances, did evident mif- chief. Anxious to difcover a medicine that promifed re- lief in even a few cafes of cancers, and fuppofing that all the cauftic vegetables were nearly alike, I applied the phytolacca or poke-root, the ftramonium, the arum, and one or two others, to foul ulcers, in hopes of fee- ing the fame effects from them which I had feen from Doftor Martin's powder; but in thefe I was difap- pointed. They gave fome pain, but performed no cures. At length I was furnifhed by a gentleman from Pittfburg with a powder which I had no doubt, from a variety of circumftances, was of the fame kind as that ufed by Doftor Martin. I applied it to a fungous ulcer, but without producing the degrees of pain, in- flammation, or difcharge, which I had been accuftom- ed to fee from the application of Doftor Martin's powder. After this, I fliould have fufpefted that the powder was not z fimple root, had net the doftor con- tinued upon all occafions to affure me, that it was wholly a vegetable preparation. In the beginning of the year 1784 the doftor died, and it was generally believed that his medicine had died with him. A few weeks after his death I procured, from one of his adminiftrators, a few ounces of the doctor's powder, partly with a view of applying it to a cancerous fore which then offered, and partly with a view IN THE CURE OF CANCERS. 165 a view of examining it more minutely than I had been able to do during the doctor's life. Upon throwing the powder, which was of a brown color, upon a piece of white paper, I perceived diftinftly a number of white particles fcattered through it. I fufpefted at firft that they were corrofive fublimate, but the ufual tefts of that metallic fait foon convinced me that I was mif- taken. Recollecting that arfenic was the bafis of moft: of the celebrated cancer powders that have been ufed in the world, I had recourfe to the tefts for detecting it. Upon fprinkling a fmall quantity of the powder upon fome coals of fire, *it emitted the garlic fmell fo perceptibly as to be known by feveral perfons whom I called into the room where I made the experiment, and who knew nothing of the object of my inquiries. After this, with fome difficulty I picked out about three or four grains of the white powder, and bound them between two pieces of copper, which I threw into the fire. After the copper pieces became red hot, I took them out of the fire, and when they had cooled, dif- covered an evident whitenefs imparted to both of them. One of the pieces afterwards looked like dull filver. Thefe two tefts have generally been thought fufficient to diftinguifh the prefence of arfenic in any bodies; but I made ufe of a third, which has lately been com- municated to the world by Mr. Bergman, and which is fuppofed to be in all cafes infallible. I infused a fmall quantity of the powder in a fo- lution of a vegetable alkali in water for a few hours, and then poured it upon a folution of blue vitriol in water. The color of the vitriol was immediately changed to a beautiful green, and afterwards precipi- tated. I SHALL l66 ACCOUNT OF THE USE OF ARSENIC I shall clofe this paper with a few remarks upon this powder, and upon the cure of cancers and foul ulcers- of all kinds. 1. The ufe of cauftics in cancers and foul ulcers is very ancient, and univerfal. But I believe arfenic to be the moft efficacious of any that has ever been ufed. It is the bafis of Plunket's and probably of Guy's well known cancer powders. The great art of applying it fuccefsfully, is to dilute and mix it in fuch a manner as to mitigate the violence of its action. Doftor Mar- tin's compofition was happily calculated for this pur- pofe. It gave lpfs pain than the common or lunar cauftic. It excited a moderate inflammation, which feparated the morbid from the found parts, and pro- moted a plentiful afflux of humors to the fore during its application. It feldom produced an efcar ; hence it infinuated itfelf into the deepeft recefles of the can. cers, and frequently feparated thefe fibres in an un- broken ftate which are generally called the roots of the cancer. Upon this account, I think, in an ulce- rated cancer it is to be preferred to the knife. It has no action upon the found fkin. This Doftor Hall proved by confining a fmall quantity of it upon his arm for many hours. In thofe cafes where Doftor Martin ufed it to extract cancerous or fchirrous tumors that were not ulcerated, I have reafon to believe that he always broke the fkin with Spanifh flies. 2. The arfenic ufed by the doftor was the pure white arfenic. I fhould fuppofe from the examinati- on I made of the powder with the eye, that the pro- portion of arfenic to the vegetable powder, .could not be more than ^ part of the whole compound. I have reafon to think that the doftor employed differ- ent IN THE CURE OF CANCERS. 167 cnt vegetable fubftances at different times. The vege- table matter with which the arfenic was combined in the powder which I ufed in my experiments, was pro- bably nothing more than the powder of the root and berries of the folanum lethale, or deadly nightfliade. As the principal, and perhaps the only defign of the vegetable addition was to blunt the activity of the arfe- nic, I fhould fuppofe that the fame proportion of com- mon wheat flour as the doftor ufed of his cauftic vege- tables, would anfwer nearly the fame purpofe. In thofe cafes where the doftor applied a feather dipped in a liquid to the fore of his patient, I have no doubt but his phial contained nothing but a weak folution of arfenic in water. This is no new method of applying arfenic to foul ulcers. Doftor Way of Wilmington, has fpoken in the higheft terms to me of a walh for foulneffes on the fkin, as well as old ulcers, prepared by boiling an ounce of white arfenic in two quarts o£ water to three pints, and applying it once or twice a day. 3. I mentioned formerly that Doftor Martin was often unfuccefsful in the application of his powder. This was occafioned by his ufing it indifcriminately in all cafes. In fchirrous and cancerous tumors, the >knife fliould always be preferred to the cauftic. In cancerous ulcers attended with a fcrophulous or a bad habit of body, fuch particularly as have their feat in the neck, in the breafts of females, and in the axillary glands, it can only protract the patient's mifery. Moft of the cancerous fores cured by Doftor Martin were feated on the nofe, or cheeks, or upon the fur- face or extremities of the body. It remains yet to difcover a cure for cancers that taint the fluids, or in- fect the whole lymphatic fyftem. This cure I appre- hend i68 ACCOUNT OF THE USE OF ARSENIC, &.C. hend muft be fought for in diet, or in the long ufe of fome internal medicine. To pronounce a difeafe incurable, is often to ren- der it fo. The intermitting fever, if left to itfelf, would probably prove frequently, and perhaps more fpeedily fatal than cancers. And as cancerous tumors and fores are often neglefted, or treated improperly by injudicious people, from an apprehenfion that they are incurable, (to which the frequent advice of phyfi- cians " to let them alone," has no doubt contributed) perhaps the introduftion of arfenic into regular practice as a remedy for cancers, may invite to a more early application to phyficians, and thereby prevent the de- plorable cafes that have been mentioned, which are often rendered fo by delay or unfkilful management. 4. It is not in cancerous fores only that Doftor Martin's powder has been found to do fervice. In fores of all kinds, and from a variety of caufes, where they have been attended with fungous flefh or callous edges, I have ufed the doctor's powder with advantage. I flatter myfelf that I fhall be excufed in giving this detail of a quack medicine, when the fociety reflect that it was from the inventions and temerity of quacks, that phyficians have derived fome of their moft active and ufeful medicines. OBSERVA- t «% ] OBSERVATIONS' ON THE CAUSE AND CURE OF THE TETANUS. Read before the American Philofophical Society, March 17, 1786. DURING my attendance, as phyfician-general, upon the military hofpitals of the United States, in the courfe of the late war, I met with feveral cafes of the tetanus. I had frequently met with this disorder in private practice, and am forry to fay, that I never fucceeded with the ordinary remedy of opium in any one cafe that came under my care. I found it equally ineffeftual in the army. Baffled in my expeftations from a remedy that had been fo much celebrated, I be- gan to inveftigate more particularly the nature of the diforder. I found it to be a diforder of warm climates, and warm feafons. This led me to afcribe it to relax- ation. I refolved to attempt the cure of it by a fet of medicines in fome meafure the oppofites of moft of the medicines that have been employed in that diforder. Soon after I adopted this refolution, I was called to vifit Col. John Stone, who was wounded through the foot at the battle of Germantown, on the 4th of Octo- ber 1777. He was in the third day of a tetanus. His fpafms were violent, and his pains fo exquifite that his cries were heard near a hundred yards from his quar- ters. His head was thrown a little backwards, and Y his OBSERVATIONS ON THE CAUSE his jaw had become ftiff and contracted. He was un- der the care of a fkilful regimental furgeon, who was pouring down opium in large quantities without effeft. Duty and friendfhip both led me to do my utmoft to fave the life of this valuable officer. I immediately difmiffed the opium, and gave him large quantities of wine and Dark, to the amount of two or three ounces of the latter, and from a bottle to three pints of the former in the day. In a few hours I was delighted with their effects. His fpafms and pains were lefs fre- quent and violent, and he flept for feveral hours, which he had not done for feveral days and nights before. With the fame indication in view, I applied a blifter between his flioulders, and rubbed in two or three ounces of mercurial ointment upon the outfide of his throat. He continued to mend gradually under the operation of thefe medicines, fo that in ten days he was out of danger, although the fpafm continued in his wounded foot for feveral weeks afterwards. In the fummer of the year 1782, I was called to vifit a fervant girl of Mr. Alexander Todd, merchant of this city, who had brought on a tetanus by fleeping in the evening on a damp brick pavement, after a day in which the mercury in Farenheit's thermometer had flood at near 90 °. The cafe was nearly as violent and alarming as the one I have defcribed. I treated her in the fame manner, and with the fame fuccefs. To the above named medicines, I added only the oil of amber, which fhe took in large dofes, after I fuf- pefted the tonic and ftimulating powers of the bark and wine began to lofe their effects. The good effects of AND CURE OF THE TETANUS. l?l of the oil were very obvious. She recovered gradu- ally, and has continued ever fince in good health. In the fummer of the fame year, I was called t» Alexander Leflie, a joiner, who had run a nail in his foot. I found him the day afterwards in extreme pain, with fmall convulfions, and now and then a twinge in his jaw. The wound in his foot was without fwell- ing or inflammation. I dilated the wound and filled it with lint moiftened with fpirit of turpentine. This in a little while produced a gopd deal of pain and a great inflammation in his foot, While I was prepa- ring to treat him in the manner I had treated the two former cafes, the pains and fpafms in his body fud- denly left him, and in twenty-four hours after I faw him, he complained of nothing but of the pain and fwelling in his foot, which continued for feveral weeks, and did not leave him till it ended in a fuppuration. From the hiftory of thefe three cafes, 1 beg leave to make the following remarks, l. That the predifppfition to the tetanus depends upon relaxation. This relaxation is generally produ- ced by heat; but exceffive labor, watchings, marches, or fatigue from any caufe, all produce it likewife; and hence we find it more frequent from wounds received in battles, than from fimilar wounds received in any other way. Thefe wounds more certainly produce the tetanus, if they have been preceded for fome time with warm weather. Doftor Shoepft, the phy- fician-general of the Anfpach troops who ferved at the fiege of York in the year 1781, informed me of a fingular fact upon this fubject. Upon converting with the French furgeons after the capitulation, he was informed by them that the troops whp arrived juft before 172 OBSERVATIONS ON THE CAUSE before the fiege from the Weft-Indies with Count de Grafle, were the only troops belonging to their nation who fuffered from the tetanus. There was not a fin- gle inftance of that diforder among the French troops who had fpent a winter in Rhode-Ifland. 2. As the tetanus feems to be occafioned by relaxa- tion, the medicines indicated to cure it are fuch only as are calculated to remove this relaxation, and to re- ftore a tone to the fyftem. The bark and wine ap- pear to aft in this way. The operation of the blifters is of a more complicated nature. That they are fe- dative and antifpafmodic in fevers is univerfally ac- knowledged, but in the peculiar ftate of irritability which occurs in the tetanus, perhaps their effects are more fimply ftimulating. But I will go one ftep fur- ther. In order to cure this diforder, it is neceflary not only to produce an ordinary tone in the fyftem, but fomething like the inflammatory diathefis. The abfence of this diathefis is taken notice of by all authors, par- ticularly by Doftor Cullen*. Mercury appears to aft only by promoting this diathefis. Hence it never does any fervice unlefs it be given time enough to produce a falivation. The irri- tation and inflammation produced in the mouth and throat, feldom fail to produce the inflammatory dia- thefis, as blood drawn in a falivation has repeatedly fhewn. I apprehend that the oil of amber afts as a fti- mulant chiefly in this diforder. I have heard of a te- tanus being cured in the ifland of Grenada by large dofes of muftard. Doftor Wright, lately of the ifland * Firft Lines, Vol. III. AND CURE OF THE TETANUS, 173 ifland of Jamaica, relates in the fixth volume of the London medical effays, feveral remarkable cafes of the tetanus being cured by the cold bath. Both thefe remedies certainly aft as ftimulants and tonics. By reafoning a priori, I conceive that electricity would be found to be an equally powerful remedy in this diforder. As a general inflammatory diathefis difpofes to to- pical inflammation, fo topical inflammation difpofes to general inflammatory diathefis. Wounds upon this account are lefs apt to inflame in fummer than in win- ter. In the tetanus, I have uniformly obferved an ab- fence of all inflammation in the wounds or injuries that produced it. Doftor Stoll of Vienna has made the fame obfervation*. A fplinter under the nail produces no convulfions, if pain, inflammation or fuppuration follow the accident. It is by exciting pain and inflammation, I apprehend, that the fpirit of turpentine afts in all wounds and punctures of nervous and tendinous parts. I have never known a fingle inftance of a tetanus from a wound, where this remedy had been applied in time. It was to excite an inflammation in the foot of Mr. Leflie, that I dilated the wound and filled it with the fpirit of turpentine. I was not furprifed at its good effefts in this cafe, for I was prepared to expeft them. I find a remarkable cafe related in Doftor W. Monro's Thefis, publifhed in Edinburgh in the year 1783, of a black girl who had a tetanus from running a nail in her foot, being perfectly cured by deep and ex- tenfive incifions being made in the wounded part by Doftor John Bell, of the ifland of Grenada. It • Pars tenia, rationis medendi, p. 423. 174 observations, on the cause It is by producing inflammation in a particular part, and tone in the whole fyftem, I appicfiend, that the amputation of a wounded limb fometimes cures a. tetanus; and it is becaufe the degrees of both are too inconfiderable to oppofe the violence of the fpafms in the advanced ftages pf the tetanus, that amputation often fails of fuccefs. I have been informed by a phyfician who refided fome time at St. Croix, that the negroes on that ifland always apply a plafter made of equal parts of fait and tallow to their frefh wounds, in order to prevent a locked jaw. The fait always produces fome degree of inflammation. If the fafts that have been ftated are true, and the inferences that have heen drawn from them are juft, how fhall we account for the action of the opium in curing this diforder ? I do not deny its good effects in many cafes, but I believe it has failed in four cafes out of five in the hands of moft practitioners. It is remarkable that it fucceeds only where it is given in very large dofes. In thefe cafes I would fuppofe that its fedative powers are loft in its ftimulating. It is ' upon a footing, therefore, in one refpeft, with the ftimulating medicines that have been mentioned; but from its being combined with a fedative quality, it is probably inferior to moft of them. I am the more inclined to adopt this opinion, from an account I once received from Doftor Robert, of the ifland of Domi- nique, who informed me, that after having cured a negro man of a tetanus with large dofes of opium, he was afterwards feized with a diforder in his ftomach, of which he died in a few days. Upon opening him, he found his ftomach inflamed and mortified. I do not forbid AND CURE OF THE TETANUS. lf$ forbid the ufe of opium altogether in this diforder. I think fmall dofes of it may be given to eafe pain, as in other fpafmodic diforders; but as its qualities are complicated, and its efficacy doubtful, I think it ought to yield to more fimple and more powerful remedies. To the cafes that have been mentioned, I could add many others, in which I have reafon to believe that the excitement of a topical inflammation by artifi- cial means, has effectually prevented a tetanus. To this account of the tetanus, I beg leave to fub- join a few words upon a diforder commonly called the jaw-fall in infants, or the trifmus nafcentium of Doc- tor Cullen, which is nothing but a fpecies of tetanus. I HAVE met with three cafes of it in this city, all of which proved fatal. The ftage of the diforder in which I was confulted, and the age and weaknefs of the infants, forbad me to attempt any thing for their relief. I have introduced the fubject of this diforder in children, only for the fake of mentioning a faft com- municated to me by the late Doftor Cadwalader Evans of this city. This gentleman praftifed phyfic for fe- veral years in Jamaica, where he had frequent oppor- tunities of feeing the tetanus in the black children. He found it in every cafe to be incurable. He fuppofed it to be connected with the retention of the meconium in the bowels. This led him invariably to purge every child that was born upon the eftates committed to his care. After he adopted this practice, he ne- ver met with a fingle inftance of the tetanus among children. Perhaps \y6 observations on the cause, &.C. Perhaps it may tend to enlarge our ideas of the te- tanus, and to promote a fpirit of inquiry and experi- ment, to add, that this diforder is not confined to the human fpecies. I have known feveral inftances of it in horfes, from nails running in their feet, and other accidents. It is attended with a rigidity of the muf- cles of the neck, a ftiffnefs in the limbs, and fuch a contraction of the jaw as to prevent their eating. It is generally fatal. In two cafes I had the pleafure of feeing the difeafe perfectly cured by applying a poten- tial cauftic to the neck under the mane, by large dofes of oil of amber, and by plunging one of them into the river, and throwing buckets of cold water upon the other. How far the reafonings contained in this paper may apply to the hydrophobia, I cannot determine, having had no opportunity of feeing the difeafe fince I adopted thefe principles ; but from the fpafmodic nature of the diforder, from the feafon of the year in which it generally occurs, and above all, from the cafe related by Doftor Fothergill, of a young woman having efcaped the effefts of the bite of a mad cat by means of the wound being kept open, (which from its feverity was probably connected with fome degrees of inflammation) is it not probable that the fame reme- dies, which have been ufed with fuccefs in the tetanus, may be ufed with advantage in the hydrophobia ? In a difeafe fo deplorable, and hitherto fo unfuccefsfully treated, even a conjecture may lead to ufeful experi- ments and inquiries. ADDITI. [ >77 ] Additional Obfervations UPON THE Tetanus and Hydrophobia. SINCE the publication of the foregoing obferva- tions, in the fecond volume of the American Philofophical tranfaftions, I have received letters from feveral phyficians in America, and one from Doftor James Currie of Liverpool, in Great-Britain; in each of which are contained cafes that confirm the efficacy of toniG remedies, more efpecially of wine and the cold bath, in the cure of tetanus. My own experience has furnifhed two new cafes, in addition to thofe which are publifhed, in favor of the firft of thofe remedies, joined with mercury. I am, notwith- ftanding, obliged to own, that the method of cure above mentioned has failed, in fome inftances, in the hands of feveral refpeftable practitioners in Philadel- phia ; but I have reafon to believe it was only where it was not ufed in the firft ftage of the diforder, or where every poflible advantage has not been taken of the combined powers of all of the tonic remedies that have been mentioned^ Th e Rev. Dr. Henry Muhlenberg, principal of the German college in Lancafter, informed me in the month of June 1787, that he had often met with the trifmus iiafcentium among the children of poor peo- Z I78 ADDITIONAL OBSERVATIONS UPON THE pie belonging to his congregation. After reading the account of Doftor Evans's fuccefsful method of pre- venting that diforder in Jamaica, by mean's of gentle purges, he recommended that practice to the parents of children where he fufpefted the difeafe might take place, and always with fuccefs. The more I have confidered the caufes and fymp- toms of hydrophobia, the more I am difpofed to afcribe it to the fame proximate caufe as the tetanus. 1. They both affect the mufcles of deglutition. I have lately feen a tetanus brought on by a fractured leg, in which an attempt to fwallow the fmalleft quantity of any li- quid, produced the fame fudden and general convul- fions which occur in the hydrophobia. 2. They both proceed from caufes which appear to be related to each other, viz. from wounds, and from the action of cold after the body has been previoufly weakened by heat and exercife. Of the laft, we have a remarkable proof in an account of a fpontaneous hydrophobia, publifh- ed by Mr. Arthaud, prefident of the circle of Phila- delphians at Cape Francois, in the firft volume of the tranfaftions* of that new and enterprizing fociety. 3. They both fometimes appear as fymptoms of the fame idiopathic diforder, viz. the hyfieria. 4. They both yield to the fame remedies, viz. to the excite- ment of an inflammation in the wounded part of the body, or to a long continued difcharge of matter from it, and to mercury. Of the efficacy of each of thefe remedies, there are proofs, not only in Mr. Arthaud's obfervations upon the hydrophobia, before mentioned, but in Vanfwieten's commentaries upon Boerhaave's aphorifms t. T ♦Recherche?, memoires, -et obfervations fur lcs maladies epirooti^ues^ de Saint Domingue, p. 220. t Aphorifm 1143, N° 1. TETANUS AND HYDROPHOBIA. 179 To thefe facts I fhall add one more, which may ferve ftill further to eftablifh the famenefs of the indi- cations of cure in the tetanus and hydrophobia. In the London medical journal for the months of April, May, and June, 1784, I find the following account publifhed by Doftor De Mathiis, phyfician to the king of Naples' army. " During his refidence in Calabria, " (the doftor tells us) that having one day caught a " viper in the fields, he had occafion in his way home " to pafs by a farm-yard, where he faw a dog chain- " ed that was faid to be mad, He offered water to " this dog, upon which he immediately fell into con- " vulfions. Recollecting his viper, he was tempted « to try its effects by applying it to the dog's throat. " This was accordingly done, and the confequences » were, the head of the dog fwelled, the fymptoms of " the hydrophobia eeafed, and thp animal recovered." If more fafts fhould occur, which fhall fhew the relation that the tetanus and hydrophobia have to each, other, perhaps we may be led to conclude, that the wound inflifted by the teeth of a dog fometimes acts in the fame manner in producing hydrophobia, that wounds made by a nail, or any obtufe lacerating in- strument aft, in producing tetanus ; and that both dif- eafes may be prevented, or cured, with equal certain- ty by the fame tonic remedies. THE [ i8o ] THE RESULT o i OBSERVATIONS MADE UPON THE DISEASES WHICH OCCURRED IN THE Military Hofpitals of the United States, DURING THE LATE WAR. l. ^ I ^ H E army when it lay in tents was always more JL fickly, than when it lay in the open air. It was likewife more healthy when it was kept in motion, than when it lay in an encampment. 2. Young men under twenty years of age were fubjeft to the greateft number of camp difeafes. 3. The fouthern troops were more fickly than the northern or eaftern troops. 4. The native Americans were more fickly than the natives of Europe who ferved in the American army. 5. Men above thirty, and five and thirty years of age, were the hardieft foldiers in the army. Perhaps the reafon why the natives of Europe were more healthy than the native Americans, was, they were more advanced in life. 6. The RESULT OF OBSERVATIONS, &C. l8l 6. The fouthern troops fickened from the want of fait provifions. Their ftrength and fpirits were re- ftored only by means of falted meat. 1 once faw a private, in a Virginia regiment, throw away his ration of choice frefh beef, and give a dollar for a pound of falted bacon. 7. Those officers who wore flannel fhirts or waifl- Coats next to their fkins, in genera} efcaped fevers and difeafes of all kinds, 8. The principal difeafes in the hofpitals were the ty- phus gravior and mitior of Doctor Cullen. Men who came into the hofpitals with pleurifies or rheumatifms, foon loft the types of their original difeafes, and fuf- fered, or died, by the above mentioned fever. 9. This fever always prevailed moft, and with the worft fymptoms in winter. A free air, which could only be obtained in fummer, always prevented, or mi- tigated it, xo. In all thofe cafes, where the contagion was re- ceived, cold feldom failed to render it active. When- ever an hofpital was removed in winter, one half of the patients generally fickened on the way, or foon after their arrival at the place to which thev were fent. 11. Drunken foldiers and convalescents were moft fubjeft to this fever. 12. Those patients in this fever who had large ulcers on their backs or limbs, generally recoveied. 13. I met j82 RESULT OF OBSERVATIONS UPON THE 13. I met with feveral inftances of buboes, alfo of ulcers in the throat, as-defcribed by Doctor Donald Monro. They were miftaken by fome of the junior furgeons for venereal fores, but they yielded to the common remedies of the hofpital fever. 14. There were many inftances of patients in this fever, who fuddenly fell down dead, upon being mo- ved, without any previous fymptoms of approaching diffolution. This was more efpecially the cafe, when they arofe to go to ftool, 15. The contagion of this fever was frequently conveyed from the hofpital to the camp, by means of blankets and clothes. 16. Those black foldiers who had been previoufly flaves, died in a greater proportion by this fever, or had a much flower reco/ery from it, than the fame number of white foldiers. 17. The remedies which appeared to do moft fer- vice in this diforder were vomits of tartar emetic, gen- tle dofes of laxative falts, bark, wine, and volatile fait in large dofes, and in fome cafes, blifters. 18. An emetic feldom failed of checking this fever if exhibited while it was in a forming ftate, and before the patient was confined to his bed. 19. Many caufes concurred to produce, and in- creafe this fever; fuch as the want of cleanlinefs, ex- ceffive fatigue, the ignorance or negligence of officers in providing fuitable diet and accommodations for their men, the general ufe of linen inftead of woollen clothes in DISEASES OF MILITARY HOSPITALS. I&3 in the fummer months, and the crouding too many patients together in one hofpital, with fuch other in- conveniencies and abufes, as ufually follow the union of the purveying and diretting departments of hofpitals in the fame perfons. But there is one more caufe of this fever which remains to be mentioned, and that is, the fudden affemblingof a great number of perfons together of different habits and manners, fuch as the foldiers of the American army were in the years 1776 and 1777. Doctor Blane informs us in his obfervations upon the difeafes of feamen, "that it fometimes happens " that a fhip with a long eftablifhed crew fhall be very " healthy, yet if ftrangers are introduced among them, "" who are alfo healthy, ficknefs will be mutually pro- " duced." The hiftory of difeafes furnifhes many proofs of the truth of this affertion*. It was very remarkable, that while the American army at Cam- bridge in the year 1775, confifted only of New-Eng- land men (whofe habits and manners were the fame) there was fcarcely any ficknefs among them. It was not till the troops of the eaftern, middle and fouthern ftates met at New-York and Ticonderoga in the year 1776, that the typhus became univerfal, and fpread with fuch peculiar mortality in the armies of the Uni- ted States. 20. The dyfentery prevailed in the fummef of 1777 in the military hofpitals. in New-Jerfey, but with very few inftances of mortality. This dyfentery was frequently followed by an obftinate diarrhoea, in which the warm bath was found in many cafes to be an ef- fectual remedy. r n a 7 21. I SAW » " Cleanlinefs is founded on a natural averfion fo what is unfeemly and offenfive in the perfons of others; and there feems alfo to be an inftinclive horror at ftrangers implanted in human nature for the fame purpofe, as is vi- fible in young children, and uncultivated people. In the early ages of Rome, the fame word fignified both a ftranger and aa enemy." Dr. Blane,p. 235. 184 RESULT OF OBSERVATIONS UPON THE 21. I saw feveral inftances of fevers occafioned by the ufe of the common ointment made of the flour of fulphur and hogs lard, for the cure of the itch. The fevers were probably brought on by the expofure of the body to the cold air, in the ufual method in which that ointment is applied. I have fince learned, that the itch may be cured as fpeedily by rubbing the parts affected, two or three times with the dry flour of ful- phur, and that no inconvenience and fcarcely any fmell, follow this mode of ufing it. 22. In gunfhot wounds of the joints, Mr. Ranby's advice of amputating the limb was followed by fuccefs. I faw two cafes of death where this advice was ne- glefted. 23. There was one inftance of a foldier who loft his hearing, and another of a foldier who had been deaf, who recovered his hearing by the noife of ar* tillery in a battle. 24. Those foldiers who were billetted in private houfes, generally efcaped the contagion of the hofpi- tal fever, and recovered fooneft from all their difeafes. 25. Soldiers are but little more than adult chil- dren. That officer, therefore, will beft perform his duty to his men, who obliges them to take the moft care of their health. 26. Hospitals are the finks of human life in an army. They robbed the United States of more citi- zens than the fword. Humanity, ceconomy, and philofophy, all concur in giving a preference to the conveniencies and wholefome air of private houfes; and diseases of military hospitals. i8j and fhould war continue to be the abfurd and unchrif- tian mode of deciding national difputes, it is to be hoped that the progrefs of fcience will fo far mitigate one of its greateft calamities, as to produce an aboli- tion of hofpitals for acute difeafes* Perhaps there are no cafes of ficknefs in which reafon and religion do not forbid the feclufion of our fellow-creatures from the offices of humanity in private families, except where they labour under the calamities of madnefs and the venereal difeafe, or where they are the fubjefts o£ fome of the operations of furgery. A a AN C *86 J ■"■r:::'Ti •- ■• ■ AN AC CO U NT OF TH* . .. ... ."..HV ' :.. Influence of the military amd political events of the american revolution -'» 5 :. upon Tut H U MA N BODY. THERE were feveral circumftances peculiar to the American revolution, which fhould be men- tioned previoufly to an account of the influence of the events which accompanied it, upon the human body. i. The revolution interefted every inhabitant of the country of both fexes, and of every rank and age that was capable of reflection. An indifferent, or neutral fpeftator of the controverfy, was fcarcely to be found in any of the ftates. 2. The fcenes of war and government which it introduced, were new to the greateft part of the inha- bitants of the United States, and operated with all the force of novelty upon the human mind. 3. The controverfy was conceived to be the moft important of any that had ever engaged the attention of mankind. It was generally believed by the friends of. the revolution, that the very exiftence of freedom upon our globe, was involved in the iffue of the con- teft in favor of the United States. 4. Tiif, influence of the revolution, &c 187: 4. The American revolution included, in il the cares of government, as well as the toils and dangers of war. The American mind was, therefore, frequent- ly occupied at the fame time, by the difficult and com*. plicated duties of political and military life. 5. The revolution was conducted by men who had been pornyir«, and whofe fenfe of the bleflings of liberty was of courfe more exq.uifite than if they had juft emerged from a ftate of flavery. 6. The greateft part of the foldiers in the armies of the United States had family connections and pro- perty in the country, 7. The war was carried!on by the Americans againft a nation, to whom they had long been tied by the nu- merous obligations of confanguinity, laws, religion, commerce, language, intereft, and a mutual fenfe of national glory. The refentments of the Americans of courfe rofe, as is ufual in all difputes, in proportion to the number, and force of thefe ancient bonds of affection and union. 8. A predilection to a limited monarchy, as an effential part of a free and fafe government, and an attachment to the reigning king of Great-Britain, (with a very few exceptions) were univeffel in every part pi the United States. 9. There was at one time a fudden ^Ablution of civil government in all, and of eecjg&aftieal eftabUlh- ments in feveral of the ftates. 10. The expences of the war were fupported by means of a paper currency, which was continually de- preciating. From 188 INFLUENCE of the revolution From the aftion of each of thefe caufes, and fre- quently from their combination in the fame perfons, effefts might reafonably be expected, both upon the mind and body, which have feldom occurred ; or if they have, I believe were never fully recorded in any age or country. It might afford fome ufeful inftruftion, to point out the influence of the military and political events of the revolution upon the underftandings, paffions, and mo- rals of the citizens of the United States; but my bufi- nefs in the prefent inquiry, is only to take notice of the influence of thefe events upon the human body, through the medium of the mind. I shall firft mention the effefts of the military, and fecondly, of the political events of the revolution. The laft muft be confidered in a two-fold view, ac- cordingly as they affefted the friends or the enemies of the revolution. I. In treating of the effefts of the military events, I fhall take notice, firft, of the influence of aBual war, and, fecondly, of the influence of the military life. In the beginning of a battle, I have obferved thirft to be a very common fenfation among both officers and foldiers. It occurred where no exercife or aftion of the body could have excited it. Many officers have informed me, that after the firft onfet in a battle, they felt a glow of heat, fo uni- verfal as to be perceptible in both their ears. This was the cafe in a particular manner, in the battle of Princeton, on the third of January in the year 1777, on which day the weather was remarkably cold. A VETE-. upon the human body. 189 A veteran colonel of a New-England regiment, whom I vifited at Princeton, and who was wounded in the hand at the battle of Monmouth on the 28th of June, 1778, (a day in which the mercury flood at 90 ° of Farenheit's thermometer), after defcribing his fituati- on at the time he received his wound, concluded his ftory by remarking, that " fighting was hot work on a M cold day, but much more fo on a warm day." The many inftances which appeared after that memorable battle, of foldiers who were found among the flain without any marks of wounds or violence upon their bodies, were probably occafioncd by the heat excited in the body by the emotions of the mind, being added to that of the atmofphere. Soldiers bore operations of every kind immedi- ately after a battle, with much more fortitude than they did at any time afterwards. The effefts of the military life upon the human body come next to be confidered under this head. In another place* I have mentioned three cafes of pulmonary confumption being perfectly cured by the diet and hardfliips of a camp lite. Doctor Blane, in his valuable obfervations on the difeafes incident to feamen, afcribes the extraordinary healthinefs of the Britifh fleet in the month of April 1782, to the effefts produced on the fpirits of the foldiers and feamen, by the victory obtained over the French fleet on the 12th of that month; and relates, upon the authority of Mr. Ives, an inftance in the war between Great Britain and the combined powers of France and Spain in 1744, in which the fcurvy, as well as other difeafes, were checked by the profpeft of a navaj engagement. The * Page 141, 190 INFLUENCE OF THE REVOLUTION The American army furnifhed an inftance of the effefts of viftory upon the human mind, which may ferve to eftablifh the inferences from the fafts related by Doftor Blane. The Philadelphia militia who join- ed the remains of General Wafhington's army in De- cember 1776, and fhared with them a few days after-< wards in the capture of a large body of Heffians at Trenton, confifted of 1500 men, moft of whom had been accuftomed to the habits of a city life. Thefe men flept in tents and barns, and fometimes in the open air during the ufual colds of December and Ja- nuary ; and yet there were only two inftances of fick- nefs, and only one of death, in that body of men in the courfe of near fix weeks, in thofe winter months. This extraordinary healthinefs of fo great a number of men under fuch trying circumftances, can only be afcribed to the vigor infufed into the human body by the viftory of Trenton having produced infenfibility to all the ufual remote caufes of difeafes. Militia officers and foldiers, who enjoyed good health during a campaign, were often affected by fevers and other diforders, as foon as they returned to their refpeftive homes. I knew one inftance of a militia captain, who was feized with convulfions the firft night he lay on a feather bed, "after fleeping feveral months on a matrafs, or upon the ground, Thefe affections of the body appeared to be produced only by the fud- den abftraftion of that tone in the fyftem which was ex- cited by a fenfe of danger, and the other invigorating objects of a military life. The nostalgia of Doftor Cullen, or the home- ficknefs, was a frequent difeafe in the American army, more efpecially among the foldiers of the New-England ftates. upon the human body. *9» ftates. But this difeafe was fufpended by the fuperior aftion of the mind under the influence of the princi- ples which governed common foldiers in the American army. Of this General Gates furnifhed me with a re- markable inftance in 1776, foon after his return from the command of a large body of regular troops and militia at Ticonderoga. From the effects of the nof- talgia, and the feeblenefs of the difcipline, which was exercifed over the militia, defertions were very fre- quent and numerous in his army, in the latter part of the campaign; and yet during the three weeks in which the general expected every hour an attack to be made upon him by General Burgoyne, there was not a fingle defertion from his army, which confifted at that time of 10,000 men. The patience, firmnefs, aftd magnanimity with which the officers and foldiers of the American^my endured the complicated evils of hunger, cold, and na- kednefs, can only be afcribed to an infenfibility of body, produced by an uncommon tone of mind excited by the love of liberty and their country. Before I proceed to the fecond general divifion of this fubjeft, I fhall take notice, that more inftances of apoplexies occurred in the city of Philadelphia, in the winter of 17/4, $, than had been known in for- mer years. I fhould have hefitated in recording this faft, had I not found the obfervation fupported by a faft of the fame kind, and produced by a nearly fimi- lar caufe, in the appendix to the praftical works of Doftor Baglivi, profeffor of phyfic and anatomy at Rome. After a very wet feafon in the winter of 1694, 5, he informs us, that "apoplexies difplayed their rage; " and perhaps (adds our author) that fome part of this " epidemic \$t influence of the revolution " epidemic illnefs was owing to the univerfal grief arid " domeftic care, occafioned by all Europe being en- " gaged in a war. All commerce was difturbed, and " all the avenues of peace blocked up, fo that the " ftrongeft heart could fcarcely bear the thoughts of " it." The winter of 1774, 5, was a period of un- common anxiety among the citizens of America. Every countenance wore the marks of painful folici- tude, for the event of a petition to the throrie of Bri- tain, which was to determine whether reconciliation, or a civil war, with all its terrible and deftroying con- sequences, were to take place* The apoplectic fit, which deprived the world of the talents and virtues of the Honorable Peyton Randolph, Efq. while he filled the chair of congrefs in 1775, appeared to be occafi- oned by the preffure of the uncertainty of thofe great events upon his mind. To the name of this illuftrious payfct, feveral others might be added, who were af- fected by the apoplexy.in the fame memorable year. At this time, a difference of opinion upon the fubjeft of the conteft with Great-Britain, had fcarcely taken place among the citizens of America. II. The political events of the revolution produ- ced different effefts upon the human body, through the medium of the mind, accordingly as they acted up- on the friends or enemies of the revolution. ' I shall firft defcribe its effefts upon the former clafs of citizens of the United States. Many perfons of infirm and delicate habits, were reftored to perfect health, by the change of place, or occupation, to which the war expofed them. This was the cafe in a more efpecial manner with hyfterica! women, UPON THE HUMAN BODY. I93 women, who were much interefted in the fuccefsful iffue of the conteft. The fame effefts of a civil war upon the hyfteria, were obferved by Do6tor Cullen in Scotland, in the years 1745 and 1746. It may per- haps help to extend our ideas of the influence of the paflions upon difeafes, to add, that when either love, jealoufy, grief, or even devotion, wholly engrofs the female mind, they feldom fail, in like manner, to cure, or to fufpend hyfterical complaints. The population in the United States was more ra- pid from births during the war, than it had ever been In the fame number of years fince the fettlement of the country. I am difpofed to afcribe this increafe of births chief- ly to the quantity and extenfive circulation of money, and to the facility of procuring the means of fubfift- ence during the war, which favoured marriages among the labouring part of the people*. But I have fuffi- cient documents to prove, that marriages were more fruitful than in former years, and that a confiderable number of unfruitful marriages became fruitful during the war. In 1783, the year of the peace, there were feveral children born of parents who had lived many years together without iffue. Mr. Hume informs us, in his hiftory of England, that fome old people, upon hearing the news of the re- storation of Charles the lid, died fuddenly of joy. There was a time when I doubted the truth of this af- B b fertion ; * Wheat, which was f .U Sefore the war for feven (hillings and fixpence, was fold for feveral years during the war for four, and in fome places tor two and fixpence, Pennfylvania currency per Vjlhel. Eeggars of every defcripti- on difappeared in the year 1776, and were feldom feen till near the clofe of the war. INFLUENCE of the REVOLUTION fertion; but I am now difpofed to believe it, from hav- ing heard of a fimilar effect from an agreeable poli- tical event, in the courfe of the American revolution. The door-keeper of congrefs, an aged man, died fud- denly, immediately after hearing of the capture of Lord Cornwallis's army. . His death was univerfally afcribed to a violent emotion of political joy. This fpecies of joy appears to be one of the ftrongeft emo- tions that can agitate the human mind. Perhaps the influence of that ardor in trade and fpeculation, which feized many of the friends of the revolution, and which was excited by the fallacious nominal amount of the paper money, fhould rather be confidered as a difeafe than as a paflion. It unhinged the judgement, depofed the moral faculty, and filled the imagination, in many people, with airy and imprac- ticable fchemes of wealth and grandeur. Defultory manners, and a peculiar fpecies of extempore conduct, were among its charafteriftic fymptoms. It produced infenfibility to cold, hunger, and danger. The trading towns, and in fome inftances the extremities of the Unit- ed States, were frequently vifited in a few hours or days by perfons affected by this difeafe; and hence " to tra- vel with the fpeed of a fpeculator" became a common faying in many parts of the country. This fpecies of infanity (if I may be allowed to call it by that name) did not require the confinement of a bedlam to cure it, like the fouth-fea madnefs defcribed by Doftor Mead. Its remedies were the depreciation of the papef money, and the events of the peace. The political events of the revolution produced up- on its enemies very different effects from thofe which have been mentioned. Th£ UPON THE HUMAN BODY. *95 The hypochondriasis of Doftor Cullen, occurred in many inftances in perfons of this defcription. In fome of them, the terror and diftrefs of the revolution, brought on a true melancholia*. The caufes which produced thefe difeafes, may be reduced to four heads. 1. The lofs of former power or influence in government. 2. The deftruftion of the hierarchy of the Englifh church in America. 3. The change in the habits of diet, company and manners, produced by the annihilation of juft debts by means of depreciated pa- per money. And, 4. The negleft, infults, and op- preffion, to which the loyalifts were expofed, from individuals, and in feveral inftances, from the laws of fome of the ftates, It was obferved in South-Carolina, that feveral gentlemen who had protected their eftates by fwearing allegiance to the Britifh government, died foon after the evacuation of Charlefton by the Britifh army. Their deaths were afcribed to the neglect with which they were treated by their ancient friends, who had adhered to the government of the United States. The difeafe was called, by the common people, the Protec- tion Fever. From the caufes which produced this hypochon- driafis, I have taken the liberty of diftinguifhing it by the fpecific name of Revolutiana. In fome cafes, this difeafe was rendered fatal by exile and confinemenc; and, in others, by thofe per- fons who were afflicted with it, feeking relief from fpirituous liquors. The * Infania partialis fipe dyfpepfia, of Do£to,r Cullen. 196 influence of the revolution, &c. The termination of the war by the peace in 1783, did not terminate the American revolution. The minds of the citizens of the United States were wholly unprepared for their new fituation. The excefs ot the paffion for liberty, inflamed by the fuccefsful iffue of the war, produced, in many people, opinions and conduct which could not be removed by reafon, nor reftrained by government. For a while, they threat- ened to render abortive the goodnefs of heaven to the United States, in delivering them from the evils of flavery and war. The extenfive influence which thefe opinions had upon the understandings, passions, and morals of many of the citizens of the United States, conftituted a fpecies of infanity, which I fhall take the liberty of diftinguifhing by the name of Anarchia. I hope no offence will be given by Hie freedom of any of thefe remarks. An inquirer after philofophical truth, fhould confider the paffions of men in the fame light that he does the laws of matter or motion. The, friends and enemies of the American revolution muft have been more or lefs than men, if they could have fuftained the magnitude and rapidity of the events that charafterifed it, without discovering fome marks of human weaknefs, both in body and mind. Perhaps thefe weakneffes were permitted, that human nature might receive frefh honors in America, by the con- tending parties (whether produced by the controver- sies about independence or the national government) mutually forgiving each other, and uniting in plans of general order and happinefs. AN [ *97 ] A N INQUIRY I NTO THt Relation of Tafiles and Aliments TO EACH OTHER; a:.'d into the INFLUENCE OF THIS RELATION UPON Health and Pleafure. IN entering upon this'fubjeft, I feel like the clown, who, after feveral unsuccessful attempts to play upon a violin, threw it haftily from him, exclaiming "at the fame time, that " there was mufic in it," but that he cotiH not bring'it out. I shall endeavour, by a few brief remarks, to lay a foundation for more fuccefsful inquiries upon this difficult fubjeft. Attraction and repulfion feem to be the active principles of the univerfe. They pervade not only the greateft but the minutest works of nature. Salts, earths, inflammable bodies, metals, and vegetables, have all their refpeftive relations to each other. The order of thefe relations is fo uniform, that it has been afcribed by fome philofophers to a latent principle of intelligence pervading each of them. Colors, 198 INQUIRY INTO THE RELATION OF Colors, odors, and founds, have likewife their refpeftive relations to each other. They become agree- able and difagreeable, only in proportion to the na- tural or unnatural combination which takes place be- tween each of their different fpecies. Jt is remarkable, that the number of original colors and notes in mufic is exactly the fame. All the va- riety in both proceeds from the difference of combi- nation. An arbitrary combination of them is by no means productive of pleafure. The relation which every color and found bear to each other, was as im- mutably eftablifhed at the creation, as the order of the heavenly bodies, or as the relation of the objefts of chemiftry to each other. But this relation is not confined to colors and founds alone. It probably extends to the objefts of human aliment. For example; bread and meat, meat and fait, the alkalefcent meats and acefcent vegetables, all harmonize with each other upon the tongue ; while fifh and flefh, butter and raw onions, fifh and milk, when combined, are all offenfive to a pure and healthy tafte. It would be agreeable to trace the analog}' of founds and taftes. They have both their flats and their fharps. They are both improved by the contrast of difcord?. Thus pepper, and other condiments, (which are dif- agreeable when taken by themfelves) enhance the re- lifh ot many of our aliments, and thev are both de- lightful in proportion as they are fimple in their com- pofition. To illuftrate this analogy by more exam- ples from mufic, would lead us from the fubjeft of the prefent inquiry. It tastes and aliments to each other. 199 It is obfervable that the tongue and the ftomach, like inftinft and reafon, are, by nature, in unifon with each other. One of thefe organs muft always be dif- ordered, when they difagree in a fingle article of ali- ment. When they both unite in articles of diet that were originally difagreeable, it is Owing to a perverfi- on in each of them, similar to that which takes place in the human mind, when both the moral faculty and the confcience lofe their naturat fenfibility to virtue and vice. Unfortunately for this part of fcience, the tafte and the ftomach are fo much perverted in infancy and childhood by heterogeneous aliment, that it is dif- ficult to tell what kinds and mixtures of food are na- tural, and what are artificial. It is true, the fyftem poffeffes a power of accommodating itfelf both to ar- tificial food, and to the moft difcordant mixtures of that which is natural; but may we not reafonably fuppofe, that the fyftem would preferve its natural ftrength and order much longer, if no fuch violence had been offered to it ? If the relation of aliments to each other follows the analogy of the objefts of chemistry, then their union will be influenced by many external circumftances, fuch as heat and cold, dilution, concentration, reft, motion, and tbe addition of fubftances which promote unnatural, or deftroy natural mixtures. This idea en- larges the field of inquiry before us, and leads us ftill further from fafts and certainty upon this fubjeft, but at the fame time it does not preclude us from the hope of obtaining both ; for every difficulty that arifes out of this view of the fubject, may be removed by ob- fervation and experiment. I come 20O INQUIRY INTO the relation of I come now to apply thefe remarks to health and pleafure. I fhall Select only a few cafes for this pur- pofe; for if my principles are true, my readers can- not avoid discovering many other illustrations of them. l. When an article of diet is grateful to the tafte, and afterwards difagrees with the ftomach, may it not be occafioned by fome other kind of food, or by Some drink being taken into the ftomach, which refufes to unite with the offending article of diet ? 2. May not the uneafinefs which many perfons feel after a moderate meal, arife from its having con- fifjted of articles of aliment which were not related to each other ? g. May not the delicacy of ftomach which fome- times occurs after the fortieth or forty-fifth year of human life, be occafioned by nature recovering her empire in the ftomach, fo as to require fimplicity in diet, or fuch articles only of aliment, as are related ? May not this be the reafon why moft people, who have paffed thofe periods of life, are unable to retain or to digeft fifh and flefh at the fame time, and why they ge- nerally dine only upon one kind of food ? 4. Is not the language of nature in favor of fim- plicity in diet, difcovered by the avidity with which the luxurious and intemperate often Seek relief from variety and fatiety, by retreating to fpring water for drink,* and to bread and milk, for aliment ? 5. May not the reafon why plentiful meals of fifh, venifon, oyfters, beef or mutton, when mtd alone, lie ■V TASTES AND ALIMENTS TO EACH OTHER. ZOl ie fo eafily in the ftomach, and digeft fo fpeedily, be occafioned by no other food being taken with them ? A pound, and even more, of the above articles, fre- quently opprefs the fyftem much lefs than half the quantity of heterogeneous aliments-. 6. Does not the facility with which a due mixture of vegetable and animal food digefts in the ftomach, in- dicate the certainty of their relation to each other ? 7. May not the peculiar good effefts of a diet whol- ly vegetable, or animal, be occafioned by the more frequent and intimate relation of the articles of the fame kingdoms to each other ? And may not this be the reafon why fo few inconveniencies are felt from the mixture of a variety of vegetables in the ftomach? 8. May not the numerous acute and chronic dif- eafes of the rich and luxurious, arife from heteroge- neous aliments being diftributed in a diffuftd, inftead of a mixed ftate, through every part of the body ? 9. May not the many cures which are afcribed to certain articles of diet, be occafioned more by their being taken alone, than to any medicinal quality inhe- rent in them? A diet of oyfters in one inftance, of ftrawberries in another, and of fugar of rofes in many inftances, has cured violent and dangerous diforders of the breaft*. Grapes, according to Doftor Moore, when eaten in large quantities, have produced the fameJalu- tary effeft. A milk diet, perfifted in for feveral years, has cured the gout. I have feen many cafes of dyf- pepfia cured by a fimple diet of beef or mutton, and C c have * \r3r.fwieten, jaoo. 3. 202 INQUIRY INTO THE RELATION OF have heard of a well attefted cafe of a diet of veal alone having removed the fame diforder. Squalhes, and turnips likewife, when taken by themfelves, have cured that diftreffing complaint in the ftomach. It has been removed even by milk, when taken by itfelf in a mode- rate quantity*. The further the body, and more efpe- cially the ftomach, recede from health, the more this fimplicity of diet becomes neceflary. The appetite in thefe cafes does not fpeak the language of uncorrupt- ed nature. It frequently calls for various and impro- per aliment -f but this is the effect of intemperance hav- ing produced an early breach between the tafte and the ftomach. Perhaps the extraordinary cures of obftinate dif- eafes which are fometimes performed by perfons not regularly educated in phyfic, may be occafioned by a long and fteady perfeverance in the ufe of a fingle arti- cle of the materia medica. Thofe chemical medicines which decompofe each other, are not the only fubftan- ces which defeat the intention of the prefcriber. Ga- lenical medicines, by combination, I believe, frequent- ly produce effefts that are of a compound and contra- ry nature to their original and fimple qualities. This remark is capable of extenfive application, but I quit it as a digression from the fubjeft of this inquiry. 10. I wish it to be obferved, that I have condemn- ed the mixture of different aliments in the ftomach only in a few cafes, and under certain circumftances. It remainsyet to determine by experiments, what chan- ges are produced upon aliments by heat, dilution, ad- dition, concentration, motion, reft, and the addition of * Medical obfervations aiid inquiries; Vol. 6. p. 310. 31 TASTES AND ALIMENTS TO EACH OTHER. 203 of uniting fubftances, before we can decide upon the relation of aliments to each other, and the influence of that relation upon health. The olla podrida of Spain, is faid to be a pleafant and wholefome difti. It is probably rendered fo, by a previous tendency of all its ingredients to putrefaction, or by means of heat producing a new arrangement, or addition new rela- tions of all its parts. I fufpeft heat to be a powerful agent in difpofing heterogeneous aliments to unite with each other; and hence a mixture of aliments is probably lefs unhealthy in France and Spain, than in England, where fo much lefs fire is ufed in preparing them than in the former countries. As too great a mixture of glaring colors, which are related to each other, becomes painful to the eye, fo too great a mixture of related aliments oppreffes the.fto- mach, and debilitates the powers of the fyftem. The original colors of the flcy, and of the furfaee of the globe, have ever been found the moft permanently agreeable to the eye. In like manner, I am difpofed to believe that there are certain fimple aliments which correfpond, in their fenfible qualities, with the intermediate colors of blue and green, that are moft permanently agreeable to the tongue and ftomach, and that every deviation from them is a departure from the fimplicity of health and nature. 11. While nature feems to have limited us to fimplicity in aliment, is not this reftriftion abundant- ly compenfated by the variety of taftes which fhe al- lows us to impart to it in order tod'iverfify and increafe the pleafure of eating? It is remarkable that fait, fugar, muftard, horfe-radilh, capers, and fpiees of all kinds, according to Mr. Goffe's experiments, related by Ab- be 204 IN'QUIRY INTO THE RELATION Or be Spallanzani*, all contribute not only to render ali- ments Savoury, but to promote their digeftion. 12. When we confider, that part of the art of cookerv confifts in rendering the tafte of aliments a- greeab'e, is it not probable that the pleafure of eating might be increafed beyond our prefent knowledge upon that fubjeft, by certain new arrangements or mixtures of the fubftances which are ufed to impart a pleafant tafte to our aliment ? 13. Should philofophers ever ftoop to this Sub- ject, may they not difcover and afcertain a table of the relations of Sapid bodies to each other, with the fame accuracy that they have afcertained the relation of the numerous objefts of chemiftry to each other ? 14. When the tongue and ftomach agree in the fame kinds of aliment, may not the increafe of the pleafure of eating be accompanied with an increafe of health and a prolongation of life ? 15. Upon the pleafure of eating, I fhall add the following remarks. In order to render it truly ex- quifite, it is neceffary that all the SenSes, except that of tafte, fhould be as quiefcent as possible. Thofe per- fons mistake the nature of the appetite for food, who attempt to whet it by accompanying a dinner by a band of mufic, or by connecting the dining table with an extenfive and delightful profpeft. The excitement of one fenfe, always produces cojlapfe in another. Even conversation Sometimes detracts from the pleafure of eating; hence great feeders love to eat in filence, or alone; and hence the fpcech of a paifionate Frenchman, while * Difiertations, Vol. 1. Fage 346. .TASTES AND ALIMENTS TO EACH OTHER. 20$ while dining in a talkative company, was not fo im- proper as might at firft be imagined. " Hold your tongues, (faid he) I cannot tafte my dinner." I know a phyfician who, upon the fame principle, always (huts his eyes, and requefts filence in a fick chamber, when he wifhes to determine by the pulfe the propriety of blood-letting, in cafes where its indication is doubtful. His perceptions become more diftinft, by confining his whole attention to the SenSe of feeling. It is impossible to mention the circumftance of the fenfes acting only in fucceflion to each other in the enjoyment of pleafure, without being Struck by the im- partial goodnefs of Heaven, in placing the rich and the poor fo much upon a level in the pleafures of the table. Could the numerous objefts of pleafure, which are ad- dreffed to the ears and the eyes, have been poffeffed at the fame time, with the pleaSure of eating, the rich would have commanded three times as much pleafure in that enjoyment as the poor ; but this is fo far from being the cafe, that a king has no advantage over a beggar, in eating the fame kind of aliment. WITH this remark, I Shall clofe this collec- tion of Inquiries and Obfervations. To the interefts of fcience and humanity, I thus publicly devote them. If the hiftories of epidemics, which I have given, con- tain no difcoveries, they may perhaps prove uSeful, by fhewing the degrees of affinity between Similar diSeaSes in the Same latitudes, and in the Same ftate of Society in different countries, and thereby contribute to form a complete fyftem of the hiftory of epidemics. I SHALL 806 INQUIRY INTO THE RELATION OF t shall make no apology for having fuggefted feveral new remedies Sor common diSeaSes. Each of thofe remedies has been fo often, and fo fucceSsfully, adminiftered in Philadelphia, and in the neighbouring ftates, that I fhall leave them to plead their own caufe before the bar of the public. An apology will be more neceflary for thofe opi- nions in which I have taken the liberty of differing from fome of the prefent eftablifhed Systems of medi- cine- My motives for publifhing thefe opinions were, that if true, they might be placed in a Situation to re- ceive fupport from the inquiries and obfervations of other phyficians ; and if they are erroneous, that they might, as fpeedily as possible, be examined and re- futed. Nor will my errors be without benefit to me- dicine. " Men (fays M. de Fontenelle) cannot, upon •c any fubject, arrive at what is rational, till they have " firft, on that very fubjeft, exhaufted all imaginable- " folly. How many abfurdities (adds the fame en- •* lightened author) Should we not now utter, if the *' ancients had not faid them before us, and thus de- *' livcred us from the trouble of repeating them."— The uniformity of nature in this inftance, with her conduct in the production of moral happinefs, deferves our particular attention. As good can be known by mortals, only by the means of evil; fo truth, perhaps, can be difcovered by them, only through the means of error. THE END. * APPENDIX: CONTAINING, THE NEW METHOD or Inoculating for the Small-Pox. DELIVERED IN A LECTURE IN THE UNIVERSITY OF PENNr SYLVANIA, ON TUX 20th OF FEBRUARY) Ijil. ALSO, OBSERVATIONS ON TUX Duties of a Phyfician, AND THE METHODS OF IMPROVING MEDICINE, ACCOMMODATE!* TO THE PRESENT STATE OF SOCIETTT AND MANNERS IN THE UNITED STATES. DELIVERED IN THE UNIVERSITY OF PEN NSY L V AN! A» ON THf 7th Or FEBRUARY I789, AT THE CONCLUSION Or A COURSE OF LECTURES UPON CHEMISTRY AND THX PRACTICE, OF PHYSIC. PUBLISHED AT THE REQUESTOFTHE CLASS. B Y BENJAMIN RUSH, M. D. rROFESSOR OF CHEMISTRY IN THE UNIVERSITY OP PENNSYLVANIA. THE SECOND EDITION WITH ADDITIONS. ---------'-----~-—~S PHILADELPHIA: frxnted an© sold by PRICHARD 6? HALLt in MAftKfK STREET NEAR FRONT STRXIT, M.BBC.LXXXIX, 13?, hi i w=ssssssss= szzssssammamsssi GENTLEMEN, IT muft afford no fmall pleafure to a benevolent mind in the midft of a war, which daily makes fo much havoc with the human fpecies, to reflect, that the fmall-pox which once proved equally fatal to thou- fands, has been checked in its career, and in a great degree fubdued by the practice of Inoculation. It is foreign to my purpofe to deliver to you the hiftory of this art, and to mark the various Heps that have attended its progrefs to its prefent ftate of im- provement. We have yet to lament the want of uni- formity and of equal fuccefs in the practice of it a- mong phyficians, A great number of pamphlets have been written upon the fubjeft without exhaufting it. There is ftill ample room left for the man of genius to exercife his talents for obfervation and reafoning upon it. The facts I mean to lay before you are fo incon- siderable, compared with what ftill remain to be known upon this fubjeft, that I have to requeft, when your knowledge in it is compleated, that you would bury my name in filence; and forget that ever I ventured to lay a fingle ftone in this part of the fabric of fcience* In treating upon this fubjeft, I fliajl I. Consider the proper fubjefts and feafons fo* inoculation. II. I shall defcribe the method of communis eating the diforder. (II. I shall A THE NSW METHOD OF ■ III. I shall confider the method of preparing the body for the fmall-pox. IV. I shall mention the treatment proper during the eruptive fever ; and, V. Point out a few cautions that are neceflary after the difeafe is over. I. Formerly there were great difficulties in the choice of the fubjefts for Inoculation. But experience teaches us that it may be praftifed in every ftage of life, and in almoft every condition of the human body. In infancy the periods before and after dentition are to be preferred. But we feldom fee any great inconve- niencies from fubmiting to the general neceflity of ino- culating children between the ages of three months and two years!, Indeed we often fee children cut three or four teeth during the preparation and eruptive fever without the leaft addition being made to any of the troublefome fymptoms which accompany the fmall-pox. There is one inconvenience attending the choice of the firft months of infancy for inoculating, and that is, the matter Often fails of producing the diforder in fuch young fubjefts. I have frequently failed in two or three attempts to communicate the diforder to children tinder four months old with the fame matter that has fucceeded in a dozen other patients inoculated at the fame time. When the inoculation fucceeds in fuch ten- der fubjefts, they generally have lefs fever, and fewer puftules, than are common in any future period of life. Although a phyfician would prefer a patient in good health to any other as a fubject for inoculation, yet cafes often occur in which it is neceflary to communi- cate INOCULATING FOR THE SMALL-POX. 5 cate the fmall-pox while the body is affefted with fome other diforder. I can with pleafure inform you, that the fmall-pox is rendered fo perfectly fafe by ino- culation, that there are few chronic difeafes which fliould be confidered as obftacles in the way of it. I have inoculated patients labouring under a tertian fe- ver, obftrufted vifcera, the hooping cough, the hypo- chondriafis, the afthma, the itch, and other cutaneous diforders, and even pregnant women, with the fame, and in fome inftances, with greater fuccefs than per- fons in perfeft health. Deft. Cullen informs us that he has feen inoculation fucceed in fcrophulous patients. A phyfician in Jamaica informed me that he had ino- culated Negroes with fuccefs in the worft ftage of the yaws. To thefe fafts I muft add one more extraor- dinary than any that has been yet mentioned ; Doft. Brown, my late colleague in the care of the military hofpitals, informed me, that he had feen inoculation fucceed in patients who were feized, after the infefti- on was communicated, with the hofpital fever. The preparation of the body mould be accommodated to the difeafe which affefts it. Some phyficians have thought the fmall-pox received in this way, was a re. medy for other difeafes, but my experience has not confirmed this opinion. On the contrary, I am dif, pofed to think that no other change is produced by inoculation than by the regimen and medicines that are ufed to prepare the body for the fmall-pox. Nor does the fmall-pox, during its continuance, afford any fecurity againft the attacks of other difeafes. I have feen the moft alarming complication of the fmall-pox and meafles in the fame perfon. The feafons commonly preferred for inoculation in this country are, the fpring and fall. It may be. prac- tifed B THE NEW METHOD OF tifed with equal fafety in the winter, a due regard be- ing had to the temperature of the air in the preparati- on of the body. The principal objection to inoculating in the fum- mer months in this climate, arifes from the frequency of bilious diforders at that feafon, to which the prepa- ration neceflary for the fmall-pox probably difpofes the body. This caution applies more directly to children who at a certain age are more fubjeft than grown peo- ple to a diforder in their bowels in warm weather. II, The methods of communicating the fmall-pox by inoculation, have been different in different coun- tries, and in the different aeras of its progrefs towards its prefent ftage of improvement. The fcab, doffel of lint, and the thread impregnated with variolous matter and bound up in a gafti in the arm, have been laid afide. We are indebted to Mr. Sutton for the mode of communicating it by a.flight puncture with the point of a lancet, or needle, dipt in frefli matter. As it is dif- ficult fometimes to procure matter in a frefh ftate, I have been led to ufe it with equal fuccefs by preferr- ing it on lint in a bpx, and moiftening it with cold water juft before I ufed it. Matter may be kept in this way for a month without lofing its infectious quality, provided it be not expofed to heat or moifture. The former deftroys its power of infecting as certain- ly as the fait of taitar deftroys the acidity of vinegar. Moifture by remaining long upon the matter, proba- bly deftroys its virulence by fubjefting it to fermenta- tion. The longer matter has been kept in a general way, the longer the diftance will be between the time of INOCULATING FOR THE SMALL-POX. 7 of communicating the diforder and the eruptive fever. It will be proper always to yield to the prejudices o£ our patients in favour of matter taken from perfons who have but few puftules. But lam perfuaded from re- peated obfervations, that the difeafe is no ways influen- ced by this circumftance. I am fatisfied likewife that there is no difference between the effefts of the matter, whether it be taken in its watery or purulent ftate. The puncture fliould not be larger than is fufficient to draw one drop of blood, but it fliould always be made by a fharp lancet, for the fudden inflammation and fuppu- ration, excited by a dull lancet, fometimes throw off the matter fo as to prevent its infecting the body*. No plafter or bandage fliould be applied over the punfture. It fliould be made in the left arm of all fubjefts. The objections to inoculating in the leg are too obvious to be mentioned. I have heard of the difeafe being communicated by rubbing the dry fkin with the matter. My own obfervations upon this fub- jeft give me reafon to fufpeft the facts that are con- tained in books relative to this mode of infecting the body. I have bound large pieces of lint dipt in frefli matter for 24 hours upon the arm, without producing the diforder. A practitioner of phyfic in New-Jer- fey informed me that he once gave a confiderable quan- tity of frefli variolous matter in a dofe of phyfic with- out infecting his patient. I fufpeft the matter that produces the difeafe is of the fame nature with certain poifons, which require to be brought in contact with a wound or fore in the body before they produce their effefts. I deliver this opinion with diffidence. The fubjeft • I am difpofed to believe that the external applications which are ufed by the Indians foYthe cure of the bite of poifonous fnakes, act only by exciting inflammation and fuppuration, which difcharge the poifon from the wounJ before it is abferbed. All their external remedies are of tJlmuLnng na? hue. 8 the new method op fubjeft ftands in need of more experiments and inveft!* gation. III. I come now to confider the beft method of preparing the body for the fmall-pox. This muft be done, ill by diet, and 2dly by medicine. The diet fliould confift chiefly of vegetables. I have ne- ver feen any inconvenience from the free ufe of milk as a part of the preparative diet. In fome habits, where a morbid acid prevails in the ftomach, we may indulge our patients in a little weak flefh broth two or three times a week with fafety. Tea, coffee, and even tfCak chocolate, with bifcuit or dry toaft, may be ufed as ufual, by perfons accuftomed to that kind of aliment. Wine and fpirits of all kinds fhould be withheld from our patients during the preparation. The more acef- cent their drinks are, the better. It is unneceffary that this change in the diet fliould take place till a day or two before the time of communicating the diforder. The fyftem accommodates to a vegetable and low diet in the courfe of three weeks or a month, fo as to de- feat in fome meafure the advantages we expected from it. The good effefts of it appear to depend in a great degree upon the fuddennefis with which we oblige our patients to conform to it. For this reafon, when we are called upon to inoculate perfons who have lived more than three or four weeks upon a low diet, we fliould always direct them to live a few da)ls upon a- nimal food before we communicate the diforder to them. By thefe means we may produce all the good effefts of the fudden change in the diet I have already mentioned. 2. The medicines moft commonly ufed to prepare the body for the fmall-pox are antimo- ny and mercury. The latter has had the preference, and has been given in large quantities under a notion Of INOCULATING FOR THE SMALL-POJC. 9 of its being a fpecific antidote to the variolous matter. Many objections might be made to this opinion; I fhall mention only three. 1. We often fee the diforder in a high degree af- ter the fyftem is fully impregnated with mercury. 2. We often fee the fame falutary effefts of mer* cury when given before the diforder is communicated to the body, that we perceive when it is given after inoculation ; in which cafe we are fure the mercury cannot enter into mixture with the variolous matter fo as to deftroy it. 3. If mercury acted frjecifically in cteftroying the Variolous matter, it would render every other part of the preparation unneceffary, but this we know is not the Cafe, for the negleft or improper ufe of the vege- table diet or cool regimen is often attended with an extraordinary number, or virulence of the fmall-pox, even in thofe cafes where mercury is given in the largest quantity. The way in which mercury prepares the body for the fmall-pox, feems to be by promoting the feveral excretions, particularly that by perfpiration, which by diminifhing the quantity of the fluids and weakening the tone of the folids, renders the fyftem lefs liable to a plentiful eruption of the fmall-poX; But I object to the ufe of this medicine for the following reafons. 1. It effectually deprives us of all the benefits of the cool regimen; for mercury, we know, always difpofes the fyftem to take cold. %. ?. All *0 THE NEW METHOD OF 2. All the good effefts of mercury may be procu- red by purges which do not fubjeft the body to the above mentioned inconvenience. The purges may be suited to the conftitutlons, and in fome cafes, even to the inclinations of our pati. ents. I have feen jalap, rhubarb, fenna, manna, a- loes, foluble tartar, Glauber and Epfom falts, and the butternut pill, all given with equal fuccefs. The quan- tity fhould be fufficient to procure three or four ftools every day. A little magnesia fhould always be mix- ed with rhubarb and jalap in preparing children. It will be fufficint for the mothers and nurfes of infants to conform ftriftly to the vegetable diet. I have ne- ver feen any advantages from giving them even a fingle dofe of phyfic. It is hardly neceffary to obferve, that the quality, dofe, and number of purges are to be determined by the age, fex, and habits of our patients. A confti- tution enfeebled with a previous difeafe forbids the ufe of purges, and requires medicines of a reftorative kind. Patients afflicted with cutaneous diforders bear larger and more frequent dofes of phyfic than are in- dicated in more healthy fubjefts. In adult fubjefts of a plethoric habit, blood- letting is very ufeful on the third or fourth day after inoculation. We are not to fuppofe, that every fat perfon labours under a plethora. A moderate de- gree of fat is fo far from rendering the difeafe more violent, efpecially in children, that I think I have generally found fuch fubjefts have the fmall-pox more favourably than others. Moderate INOCULATION FOR THE SMALL-POX. 11 Moderate exercife in the oped air fhould be ufed during the preparation. But hard labour and every thing that promotes fweat or fatigue, as alfo the extremes of heat and cold, fliould be avoided. IV. We come now to confider the treatment of the body during the eruptive fever. On the eighth day after inoculation our patients are generally feized with the common fymptoms of fever. Some- times this fever appears on the sixth and feventh day after inoculation. But when it is irregular it is often delayed till the ninth and tenth days. I have feen many inftances of it on the fourteenth, a few on the fifteenth and fixteenth, and one cafe in which it did not come on till the eighteenth day after the infection was communicated to the body*. The place where the punfture was made with the lancet or needle generally ferves as an harbinger of the ap- proaching fever. A flight inflammation appears about it and a *pock rifes up in the center. But this remark is liable to fome objections. I have feen four inftances in which the fever came on at the ex- pected time, and the diforder went thro' all its ftages with the greateft regularity, and yet there was no fign of an inflammation or pock near the fpot where the punfture was made : even the punfture itfelf became invifible. On the other hand we fometimes fee an inflammation and pock on the arm appear on the eighth and ninth days without any fever accom- panying * Since the publication of *he firft edition of this leflure, I have heard of two cafes, in one of which the fever did not come on till the 20th, and in the other till the 21ft day after the infection was communicated to the body. In fome of thefe tedious cafes, I have feen an inflamma- tion and fuppuration on the punctured part of the arm on the 8th day without any fever. Perhaps in thefe cafes the inflammation and fuppuration are- only cuticular, and that the fmall-pox is taken fronj the matter which is formed by them. 19 THE NEW METHOD OF panying them. Some phyficians pretend that this inflammation and folitary pock are fufficient to con- ftitute the difeafe, but repeated experience has taught me to be very cautious in relying upon thefe equi- vocal marks. It is true, I have fometimes feen pa- tients fecured againft the fmall-pox both in the na- tural way and by inoculation where thefe marks have appeared ; but I have as often feen fuch patients feized afterwards with the fmall-pox in the natural way to the great diftrefs of families and mortifi- cation of phyficians. Upon this account I make it a conftant practice to advife a fecond or third ino- culation where a fever and eruption have been want- ing. As the abfence of thefe fymptoms is probably occafioned by the weaknefs or age of the variolous matter, or the too high ftate of preparation of the body, we fhould always guard againft both, by making the punfture the fecond time with frefh matter, by fubjefting our patients to a lefs abftemious diet, and by giving fewer dofes of phyfic. I have heard it remarked, that if a flight rednefs and a fmall pimple appeared on the arm on the third day after inocula- tion, it was a fign the matter had infected the whole conftitution. I acknowledge I have often feen a greater degree of rednefs on the third than on the fecond day after inoculation, but I have not been able to eftablilh a diagnostic mark from it; for I have feen the difeafe produced on the ufual days where the rednefs has appeared on the fecond day, and in fome cafes where it has not appeared until the eruptive fever. I am led here unwillingly to difcufs the old quef- tion, Is it poflible to have the fmall-pox in the natural way after inoculation ?—In many of the cafes inoculating for the small-pox. 13 cafes fuppofed to be the fmall-pox from inoculation, it is probable the matter has been taken from the chicken-pox, which refembles the fmall-pox in many of its peculiarities, but in none more than that of leaving pits or marks on the fkin. But there are certainly cafes where there are the moft irrefragible proofs of the infection implanted by inoculation being of a variolous nature, where the diforder has been afterwards taken in the natural way. In thefe cafes I would fuppofe the variolous matter produced only a topical or cuticular diforder. We fee fome- thing analogous to this in nurfes who attend pati- ents in the fmall-pox. But further, this topical or cuticular infection may be produced by art in per- fons who have had the fmall-pox in the natural way. Some years ago I made a punfture on my left hand with a lancet moiftened with variolous matter. On the eighth day an inflammation appeared on the place accompanied with an efflorefcence in the neighbour- hood of it, which extended about two inches in every direction from the fpot where the punfture was made. On the eleventh day I was furprifed to find two pocks (if I may venture to call them fuch) the one on the outfide of the fourth finger of my left hand, and the other on my forehead. They re- mained there for feveral days but without filling with matter, and then dropped off rather in the form of a foft wart than of a common fcab. Doft. Way of Wilmington repeated the fame experiment upon himfelf, but with an iffue to his curiofity more ex- traordinary than that I have juft now related. On the eighth day after he had made a punfture on his hand, a pock appeared on the fpot, which in the ufual time filled with matter, from which he inocu- lated feveral children, who fickened at the ufual time, and t,| the new method of and went thro' all the common ftages and fymptoms of the fmall-pox. It would feem from thefe fafts, that it is neceffary the fmall-pox fhould produce fome impreflion upon the zuhole fyftem, in order to ren- der it ever afterwards incapable of receiving an im- preflion of a similar nature. A fever and an erup- tion therefore feem neceffary for this purpofe. As the inflammation of the arm on the eighth day is a fign of the topical and cuticular infection, fo an eruption (tho' ever fo fmall) feems to be the only cer- tain fign of the infection of the whole fyftem. The eruption is the more decifive in its report in propor- tion as it comes out and goes off in the ufual man- ner of the fmall-pox in the natural way. In thofe cafes where patients have been fecured againft a fe- cond attack of the diforder, where there have been no obvious fever or vtfible eruption, I think I have obferved an unufual inflammation, and a copious and long continued difcharge of matter from the arm. Perhaps this may ferve as an outlet of the matter, which in other cafes produces the fever and eruption. I am the more difpofed to embrace this opinion from the teftimony which feveral authors have left us of the effefts of ulcers in fecuring the body from the infecti- on of the plague. The effefts of iffues are ftill more to our purpofe. We obferve a plentiful difcharge of matter from them every time the body is expofed to cold, and the febrile effefts of it upon the fyftem are thereby frequently obviated. How far a ratio exifts between the degrees of inflammation and the difcharge of matter from the arm, and the degrees of fever and eruption, muff be determined by future and very accurate obfervations. If it fliould appear that there are the leaft inflammation and fmalleft difcharge where there have been the higheft. fever and moft copious eruption, INOCULATING FOR THE SMALL-POX. 15 eruption, and on the contrary, if it fhould appear that there are the greateft inflammation and difcharge where there have been the leaft fever and fmalleft erup- tion, I muft beg leave to add, without attempting in this place to explain the reafons of it, that the re- mark, if generally true, is liable to fome exceptions. But the fubject is involved in darknefs ; I fhall be fatisfied if I have brought you within fight of the promifed land. Your own ingenuity, like another Jewifli leader, muft conduct you thither. The indications in the treatment of the body during the eruptive fever are, ill. To regulate the degree of fever. 2d. To mitigate troublefome and alarming fymptoms-. The fever which produces the eruption is general- ly of the inflammatory kind. It fometimes therefore comes on with the fymptoms of great heat, preceded with chillinefs, and determination to the head and breaft, and a full hard pulfe. The remedies pro- per in this cafe are, a. Bloodletting. The quantity to be drawn muft be regulated by the violence of the fymptoms, the conftitution, habits, and even country of the patient, and by the feafon of the year. I have never found more than one bleeding, to the quantity of twelve or fourteen ounces, neceffary in any ftage or degree of the eruptive fever of the fmall-pox by inoculation. B. Cool air is of the utmoft confequence in the1 eruptive fever. The ufe of this remedy in fevers marks" i6 the new method of marks an aera, not only in the management of the1 fmall-pox, but in medicine. The degrees of cold fliould always be increafed in proportion to the vio- lence of the fever. Stove-rooms, fo common in this country, fhould be carefully avoided. The more we oblige our patients to fet up and walk in the open air, the better. Even in thofe cafes where they Ian* guifh moft for the bed, they fhould be encouraged rather to lie upon, than under the bed cloaths. Children fhould be ftript of flannel petticoats that come in contact with their fkins, and even clouts fliould be laid afide if poflible, without great inconve- nience, and at any rate they fhould be often removed- Great and obvious as the advantages of cold air appear to be in the eruptive fever, it has fometimes been ufed to an excefs that has done mifchief. There are few cafes where a degree of cold below forty of Farenheit'3 thermometer is neceffary in this ftage of the fmall- pox. When it has been ufed below this, or where patients have been expofed to a damp atmofphere" fome degrees above it, I have heard of inflammations of an alarming nature being produced in the throat and breaft. c. The bowels, more efpecially of children, fhould be kept open with gentle laxatives. And d. Cool fubacid drinks fhould be ufed plentifully until the eruption is completed. Sometimes the fmall-pox comes on with a fever the reverfe of that which we have defcribed. The heat is inconsiderable, the pulfe is weak, and fcarcely quicker than ordinary, and the patient complains of but (light pains in the back and head. Here the treat- ment INOCULATING FOR THE SMALL-POX. i} ment fliould be widely different from that which has been mentioned when the fever is of the inflammato- ry kind. Bleeding in this cafe is hurtful, and even cool air muft be admitted with caution. The bufinefs of the phyfician in this cafe is to excite a gentle aftion in the fanguiferous fyftem, in order to produce the degree of fever which is neceflary to the eruption of the pock. For this purpofe he may recommend the ufe of warm drinks, and even of a warm bed, with ad- vantage. If the eruption delays beyond the third day, with all the circumftances of debility that have been mentioned, I have frequently ordered my patients to eat a few ounces of animal food, and to drink a glafs or two of wine, with the moft defifable fuccefs. The effefts of this indulgence are moft obvious where the weaknefs of the fever and the delay of the erup- tion in children, have made it neceffary to allow it to mothers and nurfes. The fmall-pox by inoculation fo feldom comes on with the fymptoms of a putrid fever, that little need be faid of the treatment proper in fuch cafes. I (hall only obferve, that the cold regimen in the highest degree, prorhifes more fuccefs in thefe cafes than in any others. I have repeatedly been told, that when the fmall-pox appears confluent among the Africans, it is a common practice for mothers to rub their children all over with pepper, and plunge them im- mediately afterwards into a fpring of cold water. This, they fay, deftroys a great part of the pock, and difpo- fes the remainder to a kindly fuppuration. From the fuccefs that has attended the ufe of the cold bath in putrid fevers in fome parts * of Europe mentioned C in * In a diffcmtion entitled " Epidemia "Oerna qua Wratijlaviant, ■in 1737 ajfiixit," publiftied in the appendix te the A&a Nat. Curios. Vol. i8 THE NEW METHOD OF in a former lecture, I am difpofed to believe in the efficacy of the African remedy. The fever generally lafts three days, and the erup- tion continues for a similar length of time, counting the laft day of the fever as the firft day of the erup- tion. But this remark is liable to many exceptions. We fometimes obferve the eruption to begin on the firft, and often On the fecond day of the fever, and we fometimes meet with cafes in which a fecond erup- tion comes on after the fever has abated for feveral days, and the firft eruption considerably advanced in its progrefs towards a complete fuppuration. This is often occafioned by the application of exceffive cold or heat to the body, or by a fudden and premature ufe of ftimulating drinks or animal food. I come now to treat of the beft method of miti- gating troublefome and alarming fymptoms. The only alarming fymptom is convulfions, to which children are fubjeft during the time of dentition. Thefe have been lefs frequent, fince the liberal and judici- ous ufe of cool air in the eruptive fever than former- ly. They are often relieved by putting the^ feet in warm water. But a more effeftual and fpeedy me- thod of curing them is to expofe our patients fuddenly to the open air. The colder the air the quicker re- lief it affords in thefe cafes. To prevent the return of the fits, as well as to allay any difagreeable and troublefome ftartings, a few drops of laudanum fhould be Vol. X. it appears, that warning the body all over with cold water in putrid fevers, attended with great debility, was attended with fuccefs at Breflaiv in Slefia. The practice has fince been adopted we are told by feveral of the neighbouring countries. Cullsn's first lines 0* THE P&ACYICS Or PHYSIC. INOCULATION FOR THF SMALL-POX 10 be given. They generally yield in a little while to this excellent remedy. The next fymptom which demands the aid of our art, is the inflammation and fore on the arm. Poultices of all kinds fhould be laid afide, as tending to increafe the inflammation and fore. Inftead of thefe, the part affected fliould be waflied three or four times a day with cold water*. This application is not only agree- able to our patients, but foon, checks the progrefs of the inflammation, arid difpofes the fore to heal about the time the eruption is completed. The eyes fliould likewife be wafhed frequently with, cold water, to fecure them from puftules and inflammation. With refpeft to thofe alarming or troublefome fymptoms which oc- cur in thofe cafes where the pocks are numerous, or confluent, they happen fo feldom in inoculation that they do not come properly under our notice in this place. They are moreover fully difcuffed by Dofts. Boerhaave, Huxham, Hillary and other praftical writers. V. I come now, in the laft place, to deliver a few direftions that are neceffary after the eruption an4 fuppuration are over. It is well known that eruptions of an obftinate na- ture fometimes follow the fmall-pox. Thefe I believe are often occafioned by a too fudden and fpeedy ufe ot animal food. To guard againft thefe difagreeable co n- fequences of inoculation, it is of the utmoft importance to enjoin a cautious and gradual return to the tree uie ol an animal diet, and at the fame time it will be ne- cellary * Where the inflammation on the arm has been fo confiderable as not to yield immediately to the application of cold water, 1 have ufed the yegeto. mineral water with advantage. 20 TH% NEW METHOD, &C, ceffary to give our patients a dofe or two of purging phyfic. Thus, gentlemen, have I delivered to you a fhort hiftory of the new method of inoculating for the fmall- pox. I am aware that prejudices are entertained a- gainft fome parts of it by phyficians of the moft anci- ent name and charafter among us. I have witneffed the effefts of the old and new methods of preparing the. body upon many thoufand patients, and I am fatisfied not onlv from my own obfervations, but from the ex- perience of gentlemen upon whofe judgments I rejy more than upon my own, that the new method is by far the fafeft and moft fuccefsful. Added to this, I can affure my pupils, that I have never known a fingle in- stance of a patient prepared and treated in the manner I have defcribed, that ever had an abfcefs after the fmall-pox, or even fuch an inflammation or fore upon the arra as required the application of a poultice. OBSERVATIONS [ « ] OBSERVATIONS ON THE Duties of a Phyfician, A.m> THE METHODS OF IMPROVING MEDICINE, ACCOMMODATED. TO THE PRESENT STATE OF SOCIETY AND MANNERS IK THE UNITED STATES. DEJ.IV.ER.EJ) IN THE UNIVERSITY OF P.E.N NS Y L V A N I A, O.N,T H E. ' 7tfl OF FEBRUARY 1789, AT THE CONCLUSION OF A COURSE OF LfcCTURjES UF.ON CHE.MISTRY AND THt PRACTICE OF PHYSIC. ''"'I1,1',1 y'l ^iJ-.'.l'.l ' .'■'-^'■- - ■'.*-'.\ ".'.-■..... -..".■? GENTLEMEN, J SHALL conclude our courfe of leftures, by de- livering to you a few directions for the regulation of your future conduft and ftudies, in the line of your, profeffion. I siixll, firft, fuggeft the moft probable means of eftablifliing yourfelves in bufinefs, and of becoming acceptable to your patients, and refpeftable in life. Secondly. I shall mention a few thoughts which have occurred to me on the mode to be purfued, in the further profecution of your ftudies, and for thf improvement of medicine. I. Permit me, in the firft place, to recommend to fuch of you as intend to fettle in the country, to eftablifh yourfelves as early as poflible upon, far,ms. My reafpns for this advice are a$ follow. t X. It OBSERVATIONS ON THE I. It will reconcile the country people to the li- berality and dignity of your profession, by fhewing them that you affume no fuperiority over diem from your education, and that you intend to fliare with them in thofe toils, which were impofed upon man in con- fequence of the lofs of his innocence. This will pre- vent envy, and render you acceptable to your patients as men, as well as phyficians. 2. By living on a farm you may ferve your coun- try by promoting improvements in agriculture. Che- miftry (which is now an important branch of a medi- cal education) and agriculture are clofely allied to each other. Hence fome of the moft ufeful books upon agriculture have been written by phyficians. Witnefs the effays of Dr. Home of Edinburgh, and of Dr. Hunter of Yorkfliire in England, 3. The bufinefs of a farm will furniffi yott with employment in the healthy feafons of the year, and thereby deliver you from the taedium vita?, or what is worfe, from retreating to low or improper company. Perhaps one caufe of the prevalence of dram or grog drinking, with which country practitioners are fome- times charged, is owing to their having no regular or profitable bufinefs to employ them in the intervals of their attendance upon their patients. 4. Tke refources of a farm will create fuch an in- dependence as will enable you to practice with more dignity, and at the fame time fcreen you from the trouble of performing unneceffary fervices to your pa- tients. It will change the nature of the obligation between you and them. While money is the only means c: your fubfiftence, your patients will feel that they are DUTIES OF A PHYSICIAN. S3 are the channels of your daily bread ; but while your farm furnifhes you with the neceffaries of life, your patients will feel more fenfibly that the obligation is on their fide, for health and life. 5. The exigencies and wants of a farm, in flock and labor of all kinds, will enable you to obtain from your patients a compenfation for your fervices in thofe articles. They all poffefs them; and men part with that of which money is only the fign, much more rea- dily than they do with money itfelf. 6. The refources of a farm will prevent your che- rifhing, for a moment, an impious wifh for the pre- valence of ficknefs in your neighbourhood. A heal- thy feafon will enable you to add to the produce of your farm, while the rewards of an unhealthy feaforl will enable you to repair the inconvenience of your neceffary abfence from it. By thefe means your pur- fuits will be marked by that variety and integrity, in which true happinefs is faid to confift, 7. Let your farms be fmall, and let your principal attention be directed to grafs and horticulture. Thefe afford moft amufement, require only moderate labor, and will interfere leaft with your duties to jour pro- feffion. II. Avoid Angularities of every kind in your man- ners, drefs, and general conduft. Sir Ifaac Newton, it is faid, could not be diftinguiflied in company, by any peculiarity, from a common well-bred gentleman. Singularity in any thing, is a fubftitute for fuch great or ufeful qualities as command refpeft ; and hence we find it chiefly in little minds. The profane and in- delicate i$ OBSERVATIONS ON THE delicate combination of extravagant idea's, improperly called wit, and a formal arid pompous manner, whether accompanied by a wig, a cane, or a ring, fhould all be avoided, as incompatible with the fim- plicity of fcience and the real dignity of phyfic. There is more than one way 6f playing the quack. It is not neceffary, for this pUrpofe, that a man ftiduld adver- tife his fkil'l, or his cures, or that he fhould mount a phaeton and difplay his dexterity in operating to an ignorant and gaping multitude. A phyfician afts the fame part in a different way, who affumes the charac- ter of a madman or a brute in his manners, or who Cdhceals his fallibility by an affected gravity and taci- fuYhity in his intercourfe with his patients. Both characters, like the quack, impofe upon the public. It is true, they deceive different ranks of people ; but we rhuft remember that there are two kinds of vulgar, viz. the rich and the poor ; and that the rich vulgar are often below the poor, in ignorance and credulity. III. It has been objected to our profession, that many eminent physicians have been unfriendly to chri'ftianity. If this be true, I cannot help afcribing it in part to that neglect of public worfliip with which the duties of our profeffion are often incompatible ;- for it has been juffly obferved, that the neglect of this religious and fecial duty generally produces a relaxa- tion either in principles or morals. Let this faft lead you, in felting out in btiflnefe, to acquire fuch habits of punctuality in vifiling your patients, as fhall not in- terfere with afts of public htmiage to the Supreme Being. Dr. Gregory has obferved, that a cold heart is the moft frequent caufe of deiftri. Where this occurs in a phyfician, it affords a frjeeffimption that he is deficient in humanity. But I cannot admit that in- fidelity DUTIES OF A PHYSICIAN. 2£ fidelity is peculiar to our profeffion. On the con- trary, I believe chriftianity places among its friends more men of extenfive abilities and learning, in medi- cine, than in any other fecular employment. Stahl, Hoffman, Boerkaave, Sydenham, Haller and Fothergill, were all chriftians. Thefe enlightened phyficians were considered as the ornaments of the ages in which they lived, and pofterity has juftly ranked them among the greateft benefactors of mankind. IV. Permit me to recommend to you a regard to all the interefts of your country. The education of a phyfician gives him a peculiar insight into the principles of many ufeful arts, and the praftice of phyfic favours his opportunities of doing good, by dif- fusing knowledge of all kinds. It was in Rome, when medicine was praftifed only by flaves, that phyficians were condemned by their profeffion " mutam exercere " artem.-" But in modern times, and in free govern- ments, they fhould difdain an ignoble filence upon public fubjefts. The hiftory of the American revo- lution has refcued phyfic from its former flavifh rank in fociety. For the honor of our profeffion it fhould be recorded, that fome of the moft intelligent and ufeful characters, both in the cabinet and the field, during the late war, have been phyficians. The il- luftrious Dr. Fothergill oppofed faction and tyranny, and took the lead in all public improvements in his native country, without fuffering thereby the leaft di- minution of that reputation,, or bufinefs, in which, for forty years, he flourifhed almoft without a rival in the city of London. V. Study fimplicity in the preparation of your medicines. My reafons for this advice are as follow. D j. Active 26 OBSERVATIONS ON the i. Active medicines produce the moft certain effefts in a fimple ftate. 2. Medicines when mixed frequently deftroy the efficacy of each other. I do not include chemical medicines alone in this remark. It applies likewife to galenical medicines. Nor do I affert that the vir- tues of all thefe medicines are impaired by mixture; but we can only determine when they are not, by aftual experiments and obfervation. jj. When medicines of the fame clafs, or even of different claffes, are given together, the flrongefl only produces an effeft. But what are we to fay to a com- pound of two medicines which gives exactly the fame degrees of impreflion to the fyftem ? The effeft oi them will probably be fuch, if we may judge from analogy, as would have been produced by neither in a fimple ftate. 4. By obferving fimplicity in your prefcriptipns, you will always have the command of a greater num- ber of medicines of the fame clafs, which may be ufed in succession to each other, in proportion as habit renders the fyftem infenfible of their action. 5. By ufing medicines in a fimple ftate, you will arrive at an exact knowledge of their virtues and dofes, and thereby be able to decide upon the numerous and contradiftory accounts, which exift in our books of the charafters of the fame medicines. Under this head I cannot help adding two more directions. i. Avoid DUTIES OF A PHYSICIAN. &J I. Avoid facrifiang too much to the tafte of your patients, in the composition of your medicines. The nature of a medicine may, in fome inftances, be wholly changed, by being mixed with fweet fubftances. The Author of nature feems to have had a design in making medicines unpalatable. Had they been more agree- able to the tafte, they would long ago have yielded to the unbounded appetites of man, and by becoming ar- ticles of diet or condiments, have loft their efficacy in difeafes. 2. Give as few medicines as possible in tinctures made with diftilled fpirits. Perhaps there are but few cafes in which it is fafe to exhibit medicines prepared in fpirits, in any other form than in drops. Many people have been innocently feduced into a love of filrong drink, from taking large or frequent dofes of bitters infufed in fpirits. Let not our profeffion in a fingle inftance be charged with adding to the cala- mities which have been entailed upon mankind by this dreadful fpecies of intemperance. VI. Let me advife you, in your vifits to the fick, never to appear in a hurry, nor to talk of indifferent matters before you have made the neceffary inquiries into the fymptoms of your patient's difeafe. VII, Avoid making light of any cafe; " refpice " finem" fhould be the motto of every indifpofition. There is fcarcely a diforder fo trifling, that has not, directly or indireftly, proved an outiet to human life. This consideration fliould make you anxious and punc- tual in your attendance upon every acute difeafe, and keep you from rifking your reputation by an improper or hafty prognosis. VIII. Do 2? OBSERVATIONS ON THE VIII. Do not condemn, or oppofe, unneceffarily, the fimple prefcriptions of your patients. Yield to them in matters of little confequence, but maintain an inflexible authority over them in matters that are effen- tial to life, IX. Preserve, upon all occasions, a compofed or cheerful countenance in the room of your patients, and infpire as much hope of a recovery as you can, consistent with truth, efpecially in acute difeafes. The extent of the influence of the will over the human body, has not yet been fully afcertained. I reject the futile pretenfions of Mr. Mefmer to the cure of dif- eafes, by what he lias abfurdly called animal magne- tism ; but I am willing to derive the fame advan- tages from his deceptions, which the chemifts have derived from the delufions of the alcfiettiifts. The fafts which he has eftabliflied, clearly prove the influence of the imagination and will upon difeafes. Let us avail ourfelves of the aid which thefe powers of the mind prefent to us, in the ftrife between life and death. I have frequently prefcribed remedies of doubtful ef- ficacy in the critical ftage of acute difeafes, but never till I had worked up my patients into a confidence, bordering upon certainty, of their probable good ef- fefts. The fuccefs of this meafure has much oftener anfwered, than difappointed my expeftations ; and while my patients have commended the vomit, the purge, or the blifter which was prefcribed, I have been difpofed to attribute their recovery to the vigorous concurrence of the will in the action of the medicine. Does the will beget infenfibility to cold, heat, hunger, and danger? Does it fufpend pain, and raife the body above feeling the pangs of Indian tortures ? Let us not then be furprifed that it fliould enable the fyftem <9 DUTIES OF A PHYSICIAN, 2$ to refolve a fpafm, to open an obstruction, or to dif- charge an offending humor. I have only time to hint at this fubject. Perhaps it would lead us, if we could trace it fully, to fome very important difcoveries in the cure of difeafes. X. Permit me to advife you to attend to that pj^rr'-de in the human mind, wlu<*|j constitutes the ^ffoor>**ori of ideas, in your intercourfe with your pa- tients, /fthamber, a chair, a curtain, or even a cup, all belong to the r§eans of life or deatfi^accordingly as .. tVey are affociated wjth cheerful or diftreJSwg ideas, 11 thejtnind of a patientrJ" But this principle is of more- immediate application in thofe chronic difeafes which affect -the^'mind. Nothing can be accomplifhed here, till we produce a m\. dffociation of ideas. For this purpofe, a change of place and company are absolute- ly neceffary. But we muft fometimes proceed much further. I have heard of a gentleman in South-Ca- rolina, who cured his fits of low fpirits by changing his clothes. The remedy was a rational one. It pro- duced at once a new train of ideas, and thus removed the paroxyfin of his difeafe. XI. A physician in ficknefs is always a wel- come vifitor in a family : hence he is folicited to par- take of the ufual fign of hofpitality in this country, by taking a draught of fome ftrong drink every rime he enters into the houfe of a patient. Let me charge you to lay an early restraint upon yourfelves, by refuting to yield to this practice, efpecially in the forenoon. Many phyficians have been led by it into habits of drunkennefs. You will be in the more danger of fall- ing into this vice, from the fatigue and inclemency of weather to which you will be expofed in country prac- tice, 3° OBSERVATIONS ON THE tice. But you have been taught that ftrong drink affords only a temporary relief from thofe evils, and that it tends afterwards to render the body more fen- fible of them. XII. Make it a rule never to be angry at any thing a fick man fays or does to you. Sicknefs often adds to the natural impatience and irritability of the temper. We are, therefore, to fubmit to the fevere and unneceffary toils that are fometimes exacted from us, and to bear even the reproaches of our patients with meeknefs and filence. It is folly to refent in- juries at any time, but it is cowardice to refent an in- jury from a fick man ; fince, from his weaknefs and dependence upon us, he is unable to contend with us upon equal terms. You will find it difficult to attach your patients to you by the obligation of friendfhip or gratitude. You will fometimes have the mortificati- on of being deferted by thofe patients who owe moft to your fkill and humanity. This led Dr, Turner to advife phyficians never to chufe their friends from among their patients. But this advice can never be followed by a heart that has been taught to love true excellency, wherever it finds it. I would rather ad- vife you to give the benevolent feelings of your hearts full fcope, and to forget the unkind returns they will often meet with, by giving to human nature—a tear. Let us not defpair. From the increafing influence of reafon and religion in our world, the time muft foon come, when even phyficians, and the brute cre- ation, fhall become the objefts of the juftice and hu- manity of mankind. XIII. Avoid giving a patient over in an acute difeafe. It is impossible to tell, in fuch cafes, where life DUTIES OF A PHYSICIAN. 3t life ends and where death begins. Hundreds of pa- tients have recovered who have been pronounced in- curable, to the great difgrace of our profeffion. I know that the practice of predicting danger and death upon every occasion, is fometimes made ufe of by phyficians, in order to enhance the credit of their pre- fcriptions, if their patients recover, and to fecure a retreat from blame, if they fliould die. But this mode of acting is mean and illiberal. It is not neceffary that we fhould decide with confidence at any time, upon the iffue of a difeafe. XIV. Cases will frequently occur in which you will be expofed to a ftruggle between a regard for your own reputation, and for the life of a patient. In fuch cafes, let chriftianity determine what is to be done. That new commandment which directs us to make the meafure of our love to our fellow-creatures, the fame as the love of the Author of our religion was to the human race, certainly requires that we fhould at all times rifk, and even facrifice reputation, to preferve the life of a fellow-creature. The pufillanimous, or, as he is commonly called, the fafe phyfician, who, abforbed wholly in the care of his own reputation, views without exertion the laft conflict between life and death in a patient, in my opinion will be found hereafter to have been guilty of a breach of the fixth commandment; while the confcientious, or, as he is commonly called, the bold phyfician, who lofes fight of his character, and even of the means of his fubfiftence, and by the ufe of a remedy of doubtful efficacy turns the fcale in favour of life, performs an aft that bor* bers upon divine benevolence. A phyfician who has only once in his life enjoyed the godlike pleafure that is connected with fuch an aft of philanthropy, will never g3 OBSERVATIONS ON THE never require any other consideration to reconcile hrrn to the toils and duties of his profeffion. XV. I shall now give fome direftions with rc- fpeft to the method of charging for your fervices to your patients. When we confider the expeitce of a medical edu- cation, and the Sacrifices a phyfician is obliged to make of eafe, fociety, and even health, to his profeffion ; and when we add to thefe, the conftant and painful anxiety which is connefted with the important charge of the lives of our fellow-creatures, and above all, the ineftimable value of that bleffing which is the object of his fervices, I hardly know how it is possible for a patient fufficiently and juftly to reward his phyfician. But when we confider, on the other hand, that fick- nefs deprives men of the means of acquiring money; that it increafes all the expences of living ; and that high charges, often drive patients from regular-bred phyficians to quacks ; I fay, when we attend to thefe considerations, we fhould make our charges as mode- rate as possible, and conform them to the following ftate of things. Avoid meafuring your fervices to your patients by fcruples, drachms, and ounces. It is an illiberal mode of charging. On the contrary, let the number and the time of your visits, the nature of your patient's difeafe, and his rank in his family or fociety, deter- mine the figures in your accounts. It is certainly juft to charge more for curing an apoplexy, than an in- termitting fever. It is equally juft to demand more for rifking your life by vifiting a patient in a contagi- ous fever, than for curing a pleurify. You have a right DUTIES OF A PHYSICIAN. 33 right likewife to be paid for your anxiety. Charge the fame fervices, therefore, higher to the mafter or miftrefs of a family, or to an only fon or daughter, who call forth all your feelings and industry, than to lefs important members of a family and of fociety. If a rich man demands more frequent visits than are neceffary, and if he impofes the reftraints of keeping to hours by calling in other phyficians to confult with you upon every trifling occasion, it will be juft to make him pay accordingly for it. As this mode of charging is ftriftly agreeable to reafon and equity, it feldom fails of according with the reafon and fenfe of equity of our patients. Accounts made out upon thefe principles, are feldom complained of by them. I fhall only remark further upon this fubjeft, that the fooner you fend in your accounts after your patients recover, the better. It is the duty of a phyfician to inform his patient of the amount of his obligation to him at leafl: once a year. But there are times when a departure from this rule may be neceffary. An unexjefted mis- fortune in bufinefs, and a variety of other accidents, may deprive a patient of the money he had allotted to pay his phyfician. In this cafe, delicacy and hu- manity require, that he fliould not know the amount of his debt to his phyfician, till time has bettered his cir- cumftances. I shall only add, under this head, that the poor of every defcription fhould be the objefts of your pe- culiar care. Dr. Boerhaave ufed to fay, " they were " his beft patients, becaufe God was their pay mafter." The firft phyficians that I have known, have found the poor the fteps by which they afeended to bufinefs and reputation. Difeafes among the lower clafs of people are generally fimple, and exhibit to a phyfician E the 34 OBSERVATIONS ON THE the beft cafes of all epidemics, which cannot fail of ad- ding to his ability of curing the complicated difeafes of the rich and intemperate. There is an infeparable connection between a man's duty and his interest. Whenever you are called, therefore, to vifiY a poor patient, imagine you hear the voice of the good Sa- maritan founding in your ears, " Take care ef him, " and I will repay thee." I come now to the fecond part of this addrefs, which was to point out the beft mode to be purfued, in the further profecution of your ftudies, and the im- provement of medicine. I. Give me leave to recommend to you, to open all the dead bodies you can, without doing violence to the feelings of your patients, or the prejudices of the common people. Preferve a regifter of the weather, and of its influence upon the vegetable produftions of the year.^ »Above all, record the epidemics of every feafon ; their times of appearing, and difappearing, and the connection of the weather with each of them. Such records, if publifhed, will be ufeful to foreigners, and a treafure to posterity. Preferve, likewife, art account of chronic cafes. Record the name, age and occupation of your patient; defcribe his difeafe accu- rately, and the changes produced in it by your reme- dies ; mention the dofes of every medicine you admi- nifter to him. It is impossible to tell how much im- provement and facility in practice you will derive from following thefe direftions. It has been remarked, that phyficians feldom remember more than the two or three laft years of their practice. The records which have been mentioned, will fupply this deficiency of memory, efpecially in that advanced ftage of life when the ad- vice of phyficians is fuppofed to be most valuable. II. Permit DUTIES OF A PHYSICIAN. 35 II. Permit me to recommend to you further, the ftudy of the anatomy (if I may be allowed the expref- fion) of the human mind, commonly called metaphy- fics. The reciprocal influence of the body and mind upon each other, can only be afcertained by an accu- rate knowledge of the faculties of the mind, and of their various modes of combination and aftion. It is the duty of phyficians to affert their prerogative, and to refcue the mental fcience from the ufurpations of fchoolmen and divines. It can only be perfected by the aid and difcoveries of medicine. The authors I would recommend tt> you upon metaphyfics, are, But- ler, Locke, Hardy Reid, and Beattie. Thefe ingenious writers have cleared this fublime fcience of its technical rubbifh, and rendered it both intelligible and ufeful. III. Do not confine your ftudies and attention only to extraordinary cafes. The moft frequent outlets of human life are through the channels of common difeafes. A late profeffor in the college of Glafgow, when a ftudent in one of the London hofpitals, was obferved to be bufy in examining the pulfe of a patient in a fever, while all his fellow ftudents were employed in examining with uncommon attention the cafe of a child with two heads that had juft been brought into the hofpital. Upon being condemned by his compani- ons for neglecting to profit by the examination of fo new a cafe, he anfwered, " I never expeft in the whole courfe of my life to fee, or hear, of another child with two heads ; but I expect to meet with fevers in my practice, every day of my life." This fenfible anfwer admits of extenfive application to the advancement of medicine. Could we eradicate fevers only from our hills of mortality, how much more fliould we add to the population and happinefs of our country, than by difcovering remedies for polypi and aneurifms ? 36 observations on the IV. Let me remind you, that improvement in medicine is not to be derived, only from colleges and univerfities. Syftems of phyfic are the produftions of men of genius and learning ; but thofe fafts which conftitute real knowledge, are to be met with in every walk of life. Remember how many of our moft ufe- ful remedies have been difcovered by quacks. Do not be afraid, therefore, of converfing with them, and of profiting by their ignorance and temerity in the prac- tice of phyfic. Medicine has its Pharifees, as well as religion. But the fpirit of this feet is as unfriendly to the advancement of medicine, as it is to chri*. ftian charity. By converfing with quacks, we may convey inftruftion to them, and thereby leffen the mif- chief they might otherwife do to fociety. But further. In the purfuit of medical knowledge, let me advife you to converfe with nurfes and old women. They will often fuggeft fafts in the hiftory and cure of difea- fes which have efcaped the moil fagacious obfervers of nature. Even negroes and Indians have fometimes ftumbled upon difcoveries in medicine. Be not a- fliamed to inquire into them. There is yet one more means of information in medicine which fhould not be neglefted, and that is, to converfe with perfons who have recovered from indifpofitions without the aid of phyficians. Examine the ftrength and exertions of nature in thefe cafes, and mark the plain and home- made remedy to which they afcribe their recovery. I have found this t© be a fruitful fource of inftruftion, and have been led to conclude, that if every man in a city, or a diftrift, could be called upon to relate to perfons appointed to receive and publifti his narrative, an exact account of the effefts of thofe remedies which accident or whim has fuggefted to him, it would fur- nifli a very ufeful book in medicine. To preferve the fafts DUTIES OF A PHYSICIAN. 37 fafts thus obtained, let me advife you to record them . in a book to be kept for that purpofe. There is one more advantage that will probably attend the inquiries that have been mentioned ; you may difcover difeafes, or fymptoms of difeafes, or even laws of the animal ceconomy, which have no place in our fyftems of no- fology, or in our theories of phyfic, V. In dangerous cafes that are plain and common, let me caution you againft having recourfe to confulta- tions. They relax exertion, fufpend enterprife,. and leffen refponfibility in a phyfician. They moreover add, unneceffarily, to the expences of a patient. But in difficult and obfcure cafes let me advife you to an- ticipate the fears of your patients, by requejing af- fiftance. Such candor begets fubfequent confidence and bufinefs, for truth is the univerfal interest of man- kind. There are few inftances in which any foHd ad- vantages have been derived from more than two phy- ficians confulting together. Where a greater number are employed, the prefcriptions are generally the re- fult of neutralized opinions, and are of courfe often unfuccefsful. The epitaph of Pliny, viz. " Se turba " medicorum peruiffe," might be infcribed upon the tombstones of many perfons, whofe fick beds had been furrounded by a croud of phyficians. VI. Let me recommend to your particular attenti- on, the indigenous medicines of our country. Cul- tivate or prepare as many of them as poflible, and en- deavour to enlarge the materia medica, by exploring the untrodden fields and forefts of the United States. The ipecacuana, the Seneka and Virginia fnake roots, the Carolina pink-root, the fpice-wood, the faffafras, the butter-nut, the thoroughwort, the poke, and the ftrammonium, 38 OBSERVATIONS ON THE ftrammonium, are but a fmall part of the medicinal produftions of America. I have no doubt but there are many hundred other plants which now exhale in- valuable medicinal virtues in the defart air. Examine, likewife, the mineral waters, which are fo various in their impregnation, and fo common in all parts of our country. Let not the properties of the infefts of Ame- rica efcape your inveftigation. We have already dif- covered among fome of them, a fly equal in its blifter- ing qualities to the famous fly of Spain. Who knows but it may bo referved for America to furnifh the world, from her produftions, with cures for fome of thofe difeafes which now elude the power of medicine? Who knows but what, at the foot of the Allegany mountain there blooms a flower that is an infallible cure for the epilepfy ? Perhaps on the Monongahela, or the Potowmac, there may grow a root that fhall fupply, by its tonic powers, the invigorating effefts of the favage or military life in the cure of confumptions, Human mifery of every kind is evidently on the de- cline. Happinefs, like truth, is an unit. While the world, from the progrefs of intelleftual, moral and political truth, is becoming a more fafe and agreeable abode for man, the votaries of medicine fhould not be idle. All the doors and windows of the temple of na- ture have been thrown open by the convulfions of the late American revolution. This is the time, therefore, to prefs upon her altars. We have already drawn from them difcoveries in morals, philofophy, and govern- ment, all of which have human happinefs for their object. Let us preferve the unity of truth and hap- pinefs, by drawing from the fame fource, in the prefent critical moment, a knowledge of antidotes to thofe difeafes which are fuppofed to be incurable. I HAVE ^DUTIES OF A PHYSICIAN. 39 I H av E now, gentlemen, only to thank you for the attention with which you have honored the courfe of lectures which has been delivered to you, and to affure you, that I (hall be happy in rendering you all the fervices that lie in my power, in any way you are pleafed to command me. Accept of my beft wifties for your happinefs, and may the bleflings of hundreds and thoufands who were ready to perifti, be your por- tion in life, your comfort in death, and your reward in the world to come. THE END. Med. Hist. WZ 270 ★ ★ ARMY * * MEDICAL LIBRARY Cleoclcind Branch y ^ - ^__ , !■,,.. xU.'^IS7TW ' ^{r-^,,, wi- pi i mi i,i i <■'. &*r;-r ""■',!>. *tt ''£\ s>"** ■•'■:■.. .J.',-,'IK*->ii '■\i.i,'i,'i'\"'' ■'■;','•■• :>**•■'■•• '*'VA.-. 'V,!-1! ''' '" '',*i''' • ^ "^IM 1 'J.UnV.' - '