I' *■§■■ 1-JH I NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service A CONCISE ECONOMICAL PLAN or THE FAMILY Medical Inftitution !& FOR ADMINISTRING ADVICE AND MEDICINES; * TO FAMILIES AND INDIVIDUALS, POSSESSING SMALL FORTUNES ANI> MODERATE INCOMES: Upon Liberal, Safe, H$norabh and Eafy Terms, At their own Habitations and refpe&ive abodes intended to operate as a fecurky from dangerous delays, unfcientitic bewiJdercd pra^ice, and injudicious prefcription. __!*_-____ iJ:. By JAMES SMITH, M. D. " VU Unita Forftor. " New-York, Printed by T. Kirk. ECONOMICAL PLAN, &c. XJlS Health is one of the greatefl bleffing3 we can enjoy, every method whereby it can be pre- ferved when prefent and reftored when loft, in all wife and well regulated States has been confidered one of the firft objects of the focial art. Fame, Wealth or Honor, without the poffeffion of it, will be render- ed to the poffeflbrs of them almoft nugatory bleffings. As it gives a relifh to all our other enjoyments it rauft be a matter of the firft importance, when mankind are mifled in things refpecting its prefervation. To remove the veil from the eyes of the deluded and devife the means which connects the prefervation of an obfcure individual, with the general prefervation, by bringing fo great a blefling equally to the cottages of the poor as to the palaces of the rich, will merit the applaufe and gratitude of all who are interefted in the common feli- city. An active compaffion^ which interefts itfelf in all the afflictions of the human race, has induced the author to fubmit a new mode to public infpection ; whereby we mean to exercife the duties of our pro- feflion as nearly conformable to the ancient ufcges and prevailing exiftent circumftances, confidant with the dignity of a liberal profeliion and the general intereft ♦f the public will admit. It is prefumed the utility ( 4 ) and integrity of the intention will obviate every ©bjec- tion to the novelty of the defign, and defend the authors from the odium of popular prejudices, and fhield them from the fiiafts of detra&ion ; as it is meant without intending to injure other practitioners of refpec- tability : to correct the errors of a compound fyftem, which, the practice and experience of civilized nations have found to be fubverfive of all order, decency and public fafety. As the w'.fdom of our legiflature has de- vifed for the fecurity of property, the belt means for re- gulation of the practice of the law by the exercife of dif- tinct functions, we were encouraged to hope from the calamities which we have lately experienced, and the prefident's fpeeeh ; a profeffion equally honorable and nfeful would not have elcaped their mod: tender regards, and that the neceffity of our fcheme would have come recommended and enforced by the wholefome provi- lions of guardian laws, as one of the moll effectual means of avoiding the objections made to a non-com- pliance with ancient ufage and preventing in future the mortality we deplore. We refer our readers to the arguments in favor of the utility of this inftitution which have ahead y ap- peared through the medium of the public prints, and will be (till further illuftrated by a folemn addrefs, which, will fhortly meet the eye of a candid public, as foon as the object in view becomes matter of general contemplation. The ill grace with which the author has incurred the cenfure of a divine principle, by in- dulging a fpirit of egotifm, it is confidently hoped eperating on candor, will be considered ia the light of ( 5 ) a natural defence againft malignant afperfions propagat- ed with all the rage of the raoft vindictive malice during the reign of the hue Epidemic, and as naturally re- fulting from the nature of a fcheme of diffufive utility, principally intended for the relief and inftruction of that middle clafs of fociety, who, from a want of com- petent aids during illnefs, are moil expofed to the mif- chievous confequences of empeiical practice and the delufive arts of ignorant prefumptious ambition. Whatever (hate of public confidence other prac- titioners have a right to affume, or are entitled to expect from exercifing their talents after the old mode, we do not conceive ourfelves equal to the talk of perform- ing the functions of Phyfician, Surgeon, Man-mid- wife, and Apothecary, in one perfon, and as incom- patible with that duty we owe to the great public to which we belong, whofe interefts are blended with our own. We prefume not to profcribe rules for others, nor wilh to depreciate their refpective merits in the public eye, being content with being permitted to prefcribe lules for ourfelves. Characters may ex.- i(t the omnipotency of whofe genius in this progref- five age of mental illumination, who, may be able fully to embrace the whole talents neceffary for a compound practice, but we have our doubts if fuch do really exilr, as neither our experience or the hiftory of medicine have yet informed us what age or conntry has claimed the honor of giving birth to fuch prodi- gies of human intellect or univerfality of medical ta- lents. Non omnia prfjtmvs omnes : with different ta.- lents formed we varioufly excel. When too many ( <5 ) objects engrofs our attention, all will be neglected, I and we can be perfect in none. Dazzled by the blaze of fuch curiofities which form an epoch in the natural h iftory of man, we (hall bow wich fubmiflive refpect and veneration when we find irunificent nature fhall pro- i duce a phenomenon without an example in the old world, and profiting by the wifdom of ancient ex- perience, endeavour to walk in the beaten track which i wifer men have trod with th^ mod beneficial effects to themfelves and the fociety to which they belong. This inftitution will be under the direction of Doctor James Smith whofe claims to public attention muft principally reft upon the merits of thirty-four years practice, joined to the education he received under the patronage and direction of the celebrated ' Doctor Fothergill which was the mod extenfive and liberal, and not confined to any fingle unirerfity. A previous univerfity education laid the foundation of his Medical refearches. By the advice of one of the firfr. phyfiologifts of the age, the practice of Pharmacutical Chemiftry too often neglected in the education of a Phyfician pre- ceded the ftudy of the fcience. In the year 1759, he left America, and immediately upon his arrival in London by the advice of his patron became private differing pupil, and refident in the houfe of Doctor William and Mr. John Hunter, univerfally acknow- ledged, as a Surgeon and Anatomifts, to hold the rank of unrivalled eminence in all Europe. He at the fame time entered perpetual Pliyficians pupil at St. Thomas and Guys hofpitals, tfhich at that pet iod ( 7 ) were pre-eminently difUnguifhed, and received addi- tional luftre andTame from the genius cf an Akenfide, nrd the ingenuity of a Ruffel. The Lectures of M'Lauren and Fordice in Chemiftry and Midwifery, were not neglected. That bo means of medical in- ftruction might be omitted, he afteiwards purfued his fiudies regularly for many years in the univerfmes of Edinburgh, Leyder. and Paris. The names of Munro, Cullen, Whytt, Rutherford, Hope, Young, of Edinburgh, Albinus, Gaubius, Van Royan and Albinus the younger of Leyder., Aftruck, Roel, Pe- tit and Farraing, of Paris, who, in the different branches of medical fcience, were defervedly efteem- ed the mod eminent profeffors in Europe, fwell the lift of his preceptors ; mod of whom had received their education under the tuition of that great lumi- nary of medical fcience, the illuftrious Boeihaave, before whofe time this fcience for two thoufand years, was what the poet fays of Chaos : Rudes indigejlaqut woks, a rude and undigefted mafs wrapt up in cabilifti- cal myfteries, and enigmatical obfcurities from whence no fure or certain light co«ld be drawn to found a ra- tional practice upon : and who, by the uncommon vi- gour of his penetrating genius, laid the beft foundation for the curitive indications. Having compleated his education in Europe he returned to America, and in the year 1767 began to give in Kings College, Lectures on Chemiftry, with a view to the introduction of a Medical School in this city upon the beft plans eftablifhed in Europe, which laid the firft foundation of that inftitution from which ( 8 ) fource fo many beneficial advantages have been derived ( to the public. He was appointed in the origin of that cftablifhment the firft profefTor in Chemiftry and Materia Medica, and had given his introductory lec- tures in Chemiftry when Sir Henry More, whofe affluence and virtues had formerly ra^Gd him to the fupieme magistracy of the Iftand of Jamaica, prefent- ed a more lucrative and ample field for regular prac- tice and exertion of his utility. After four years re- fidence in a climate where the late Epidemic is ende- mial a temperament bending under the pteffuie of too I much nervous fenfibility, compelled him after having experienced three different attacks of the Nervous Cholic and Yellow Fever, to quit that ftation and return to England, and feek an eftablifhment in the County of Surry. Frequent confutations refulting from an extenfive practice, and a blended union of the ] talents, genius, learning and experience of the mofl eminent of the London Phyficians in that vicinage, afforded during the fpace of twenty-eight years many diftinguifhijrg peculiarities favorable to the advance- ment of medical knowledge, beyond the reach of the ordinary means of a collegiate education, or mere li- mited experience. In the year 1785 he was appointedphyfician under the authority of an act of parliament, to prevent a- bufes in the hofpitals for the leception of lunatics. When a lucrative and honorable poft was to be filled by the death of Dr. Spence, his open difavowal of the Principles of the court fyftem, which gained him the friendlhip of a Chatham, Lanfdown, and Camden, ( 9 ) the friends of America, did not preclude, him from the patronage of an Honflow, Amhurft, King, Gran- ley, LiveipooJ, or Pit; who, under their own in- fpection had witneffed the recovery of the under Se- cretaiy of State, and the firft fervant of a royal Dutchefs, whofe maladies had baffled the flcill of the firft in the lift of medical fame among the king's phy- ficians. It was a matter of no importance to them. whether the phyfician to be elected had advocated or oppofed their ruinous and deftructive policy during the ftorms of oui revolution, was rocked in his cra- dle in Pearl Street, or St. James's. The fplendor of high rank was loft in the character of gentleman and eclipfed by a liberality doubly refined from the populer lees of party animofity- The indefinite ge- nius of map, they well knew was not to be confined within the narrow limits of piofeffional ability or pri- vate intereft. Or that, it could reft with torpid apa- thy an inactive fpectator, when the mod portentious events had fhook potentates from their thrones and decided the fate of empires. The experience of Fo- thergill the friend of American Rights, andiimilar inftances innumerable in Britain had taught them what fome have yet to learn, that the character of poli- tician and phyfician were not incompatible with each other, and that it was natural to fuppofe when our liberties were violated the latter would be fafpended until they were recovered by the fortitude of a Wafh- ington, and the bravery of America. Such baneful follies fway only the tools of party, who laugh at the dupes of 'heir ambition. Of what import is it to the B p.uient whether he is raifed from the bed of languifli- ment by the advocate of peace or war. Whether he conceives the grand inteiefts of his country will be bsft promoted by the olive branch or the fword. Whether the decrees of unerring wifJom are to be accomplifhed by the agency of an infidel nation or the worfhippers of the fage of Nazireth, who, in the courfe of myfterious providence, frequently employs diffeient inftruments to execute his defigns. Whe- ther when funk under the preffure of a malignant dif- eafe he is relieved by an active poifon judicioufly dofr ed, or lime water and milk, mercury or antimony, bark, 'opium, or fteel. In an art of rational conjec- ture, who are to be the judges of the propriety of thefe means but phyficians themfelves. Miferable is the condition of that people wheie men who are not bred to the prefeffion piefume to decide upon the me- rits of thofe whofe whole lives have been employed in flrenuous efforts to obtain fliill upon the broad bails of the raoft libeial education. Are fuch prefumptuous blockheads to be informed, the weakeft ftomachs will digeft iron, which will elude the powers of a ftrong one : that the mod invaluable remedies do principally, conlift in the fortunate combinations of the mod ac« tive poifons which taken into the ftomach are changed by a chymicul procefs, earned on within the fyftem into the mildeft remedies. Contraria conlrariis meden- tur. That medicines which will eat the proud flefli of an ulcer ordiffolve a metal are by a known Jaw of the animal economy, inoxious when taken into the fto- mach, and that to deftroy the confidence of a def- ( II ) ponding patient, in the opinion of his Phyfician, is a direct violation of an evangelical precept. In vain may univerfities inftiuct :—In vain may the legiflature interpofe its authority, if fuch practices are fuffered to continue with impunity ; efpecially at a time when a defolating peftilence was depopulating the land with unexampled rapidity. part, will be under the inflection andfuperintendency of Doctor James Clarke, with proper affiftants who will conftantly attend at his difpenfary oppofite St. Paul's Church, compound and difpenfe the medicines pre. fcribed, receive letters of recommendation, keep a regifter of the patrons of this inftitution and fub- fcribing Families, and give early notice when and '< where their attendance will be required, which will be fpeedily attended to. Thofe who wifh to be more particularly informed of its objects, will receive every information by fignifying their defire of a pcrfonal interview. CONDITIONS. EveTy perfon who vvou'd wifh to take the bene- fit cf this inftitution, will be attended at the mo- derate price of Twenty Shillings a head per annum. Medicines will be charged at half price, agreeable to the medical rates eftablifhed by general curtom. As different perfons in the fame family may ( I» ) be divided in their choice of medical affidance, any number belonging to the fame family will be admitted io tne full benefits of this inftitution, or be permit- ted to withdraw their fubfcription when it fhall no longer fuit the conveniency to continue the fame, by paying in their quarterly fubfcriptions. Non fub- fcribers will be charged in proportion to the ufages e- ftablifhed by other practitioners of credit and reputa- tion, which will^C^KWfiftitution .upon the-fame footing with ancient ufage, and anfwer all the objecti- ons, which, have been hitherto made to the phyfician from a fpirit of innovation or unwillingnefs to yield to fafhions of ancient prejudice. A s the benefits to the practioners mud be fuppo- fed to arife from conftant employ, and the number of the fane in proportion to the fick rules for pre- ferving health, preventative remedies againft the yel- low fever, and other difeafes incident to the feafon and climate fuitable to the different temperaments, age, fex,and conditutions of the fubferibers, will be admi- nistered and inculcated, and occafional domiciliary vifits made condufive to that end, which will obviate the neceffity of a removal into the country during the reign of the epidemic, or at lead mitigate the violence and mortality of the difeafe from want of timely aid and jildicious piefcription- Tnhproflactic or preventative cure, is the fir fb duty of the phyfician. Every feafon of the year from the vicicitudes of the atmofphere produce their corref- pondente ffects. Local and univerfal, fexual and infan- tile difeafes require different means of p reverition, ven- ( 13 ) unit, occur its mtrbo is the primary object of our plan,. which nothing but a midaken ceconomy will de- feat. The human frame like every mechanic ma- chine is condructed by the Supreme Architect, to lad for a certain period of time, and like it liable to have its actions or functions impeded from pre-difpo- lingor oecafional caufes, and difeafe produced. The whole man from his birth is a difeafe. Wholefome rules when obferved will obviate the effects of thofe noxious caufes and health be preferved till the lamp of life is exhaufted by age, and the wheels of nature worn out. The facility of the cure will modly de- pend upon timely aid and rational practice founded upon fcientifie principles ripened by long experience, and a regular inftrudtion in the knowledge of difeafes, equally beneficial to the patient and phyfician. As the medicines will be furnifhed at half price agreeable to the medical rates eftablifhed by general cudom at the expenfe of the inditution, no profits can be derived from that fource, therefore none will confequently be prefcribed but of the bed kind to fe- cure the reputation of the Phyfician, procure fpeedy relief to the patent, diminifhthe fatigue of protra&ed cure, and taking more medicine than is- neceffary to prevent a relapfe. The expence of the Phyfician, be- ing limited to a certain fum, mud obvioufly operate as an effectual remedy to thefe evils, and increafe the confidence of the patient in the integrity of the Phy- fician. As dangerous relapfes mud difcredit the infti- tution, the patient will not be neglected in dangerous and acute cafes* or prematurely forfaken until he'is ( 14 ) effectually fccured by a radical cure ; and to convince the employers of the pre-eminent utility of the fchcne. If any doubt fhould arife in the mind of the patient of the neceflity of a union of councils in cafes of emergency, confultations with regular bred phyficians will at any peiiod of the difeafe be approved of, di- verted of indecent pride, pertinacious obftinacy or arrogant felf-fufficiency the invariable concomitants of ignorance untamed by experience. The Phyfician holds it as an opinion that confulta- tions under the influence of malignant animofities will render very little benefit to the patient when to the dif- grace of the art, the laws of decency, morality, and humanity are not preferv:J. Those who are bleft with opulence, who may r.ot chufe to take the benefit of this inftitution them- felves by reafon of previous engagements, may fub- ftribe for the indigent to whom they are charitably difpofed. Country patients inclofing the accuftomary fee, eftablifhed by general confent, may fend a ftate of their cafe drawn up with accuracy and precilion, poft paid, and will have their medicines at half price, or prescrip- tions fent them by the firft conveyance. One fourth of the annual fubfeription to be payed, if requefted, every quarter. Let it be in general ob- ferved that the above fcheme is placing phyfic upon the fame footing with the Clergy. If the means of mo- ral inftruction which teach us fupreme love to the Deity and univerfal benevolence to man, like the blef- fings of light and air, are equally difpenfed by the ( i5 ) Clergy to the opulent and beggar, why fhould not the beft means of reftroring or preferving health be equally within the reach of every rank of citizens, without any regard to the accidental circumftances of poverty or opulence. To bring back the practice of Phyfic to its primi- tive purity—To fhorten the duration and diminish the expence of difeafes—To obviate the danger of inef- fective efforts, to relieve from incompetent aids and neglect of fleeting opportunities, once loft never to be regained—To wreft from the hands of the illitir rate the edged tools of phyfic, rendered ftill more neceffary by the late introduction into the practice of phyfic of the more active poifons of the Galenic and Chymica! temedies, drawn from the vegetable and fof- file kinodoms—To remove the fatal effects of rivalfhip in fliill, and contradictory practice, from avarice, jea- loufy, or oppofite interefts between the Apothecary and Phyfician.—To break down the dangerous afcen- dancy of felf-confident Quacks and undiftinguifhing noftrum-mongers—To reflore the dignity of a liberal profeflion and moft ufeful of all arts from the thraldom and infolent ufurpation of confederated impoftors, to the extinction of medical fcience and injury of ta- leDts—To introduce a harmonious uniformity of de- fign which fhall vibrate like, cords in unifon between all the branches of the medical art.—To combine fci- ence with art, ripened by experience, uniting the ge- nius, learning and fagacity of the phyfician to the activity, fidelity, and induftry of the apothecary.—■ To confine their varied talents to one object, whereby ,( each will become more perfect in the execution of their refpedtive parts.—To bring the benefits of all corjoin. ed down to the ftraiteoed circumf\ances of thpfe who under thepreffuve of large families, c*j»enGve neceffary eftabli.limenis, increafed and increafing tax.as, and other infurmountable difficulties>rfti iltabfcj^ call ip the timely aid of the able.experienced pjtyfifCian.—-To ret cue from diftrefs tjp^ worthy ^tad-, indigent individua.1 and reftorcthe dwopin^ddtirn'qf flph^d/jd^malady. >—To point oatfthe neceffary rqfliuL^es to tye fpccef£ ful practice of the art, of diftinguifliing, preferying and healing difeafes, ace the principal objects of this inftitution* ! 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