'*?. ^fev : .<&& m &<■. <$m :$•*. mm !&.--■■ :?i$£. $fe SOfc -■? UNITED STATES OF AMERICA. ^ . . FOUNDED 1836 WASHINGTON, D. C. 8PO 16—67244-1 AN INAUGURAL ESSAY ON THE Effects of Cold upon the Human Body. Submitted to the Examination of the REV. JOHN EWING, S. T. P. PROVOST, THE MEDICAL PROFESSORS AND TRUSTEES, OF THE UNIVERSITY OF PENNSYLVANIA, FOR THE DEGREE OF DOCTOR OF MEDICINE, On the 12th Day of May, 1797. /C\\ C"" ' ^ • •— \* - /• BY . "\ ' JOHN EDMONDS STOCA, Of Gloucejler/kirc, j-/.0-. .- , MEMBER OF 1 HE MEDICAL AND NATURAL H.STORY SOCIBTIBI OF £D1NBURCH. PHILADELPHIA: PRINTED BY JOSEPH GALES, BETWEEN NOS. 126 AND 128, NORTH SECOND STREtt. »797« Wiib crtft of gold, fhould fultry Sirius glare, And with his kindling treffes fcorch the air ;— Nymphs! on light pinion lead your banner'd hods High o'er the cliffs of Orltney't gulphy coafts; To where in azure coif and ftarry ftole, Grey Twihght fits, and rules the (lumbering Pole. There Nymphs! alight, array your dazzling powers, With fudden march alarm the torpid heurs; On ice-built ifles expand a thoufand,fails, Hinge the rtrong helms, and catch the frozen gales ; The winged rocks lo feverifh climates guide, Where fainting zephyrs pant upon the tide: While fwarihy nations crowd the fultry coaft, Drink the frefh breeze, and hail the floating froft, Nymphs I veil'd in mifi the melting tr'afures fteeri And cool with ar&ic fnows the tropic year. Botanic Garden, Canto ift. TO Ben,, nin Rufli, M,D. PROFESSOR OF THE INSTITUTES, AND OF CLINICAL MEDICINE, IN THE UNIVERSITY OF PENNSYLVANIA. SIR, I was too confcious of the numerous defecls of this probationary Effay, to requeft your permiffion to dedicate it to you; yet, at the fame time, was too fenfible of the ad- vantage of placing it under your protection, to forego that diftinftion: hence, without folicitation, I have taken a liberty, which your known benevolence will lead you to excufe, although your judgment mould con- demn the imperfect compofition, for which your patronage is requefted. Another, and a ftill more powerful motive, concurred to influence me in 3M73<1 in taking this ftep. Feeling, as I do, the connection which has exifted between us for fome time paft, both as an honor, and a privilege, I could not forbear making ufe of this public. opportunity, -of expreffing my gra- titude for the benefit which I have derived from your inftruflions, both as your private Pupil, and as an attendant Lipon your public Leftures. With the moft fincere wifhes, that your valuable life may be preferved for the advancement of Medical Science, and that your exertions to alleviate the evils of humanity, may be crowned with continued and encreafmg fuccefs, I remain, Sir, Your grateful and affectionate Pupil, JOHN EDMONDS STOCK. Philadelphia, May 2d, 1797. AN INAUGURAL ESSAY, &c. AN fubmitting the following Eflay, to the in- fpe&ion of the Truftees and Faculty of the Uni- verfity of Pennfylvania, as a neceffary ftep for obtaining a medical degree, I cannot forbear following the example of many of my predeceflbrs, in foliciting indulgence for the imperfecT; per- formance of a talk impofed by neceffity, and un- dertaken with much anxiety and apprehenfion. The variety of purfuits which neceffarily occupies the mind of the Medical Student, muft in general prevent him from paying fuch exclufive attention to any fingle fubjeft, as will enable him to elu- cidate what was before obfcure, or to throw many new lights upon what was already known. In general, therefore, he muft content himfelf with the more humbleomce of arranging theobfervations and experience of others, in fuch a manner, that the praife of induftry may be granted him, although that of invention or originality be denied. Wnilit » fo ( 2 ) fo many fages and philofophers, have confumed a long and laborious life in exploring the receffes of the temple of Medical Science, new difcoveries can fcarcely be expefted from him, who, with trembling and uncertain fteps, is yet lingering on the threfhold. An Inquiry into the Effefts of Cold upon the Human Body, naturally divides itfelf into two parts. The firft, mould comprife the principal fa&s of its operation upon the fyftem in a healthy ftate; the fecond, fhould apply the fafts thus collected, in order to regulate the ufe of it as a remedy in a morbid ftate. Under the firft head it may be neceffary to in- quire, what point in the temperature of the at- mofphere, produces the fenfation of cold, when applied to the human body. The 6oth degree of Fahrenheit may perhaps be aflumed as a ftandard, fince various writers have obferved, that in tem- perate climates, the body conftantly retains its natural heat in a man of middle age, when the thermometer ftands at 62 degrees.* A temperature inferior to this, gradually abftrafts the fenfible heat of the body. Although this definition be general, it is perhaps fufBciently accurate for the prefent purpofe. When the body is expofed for a time to any de- gree of temperature inferior to the point above- mentioned, one of its moft evident effects is a weakened a&ion of the heart and arteries. This is more particularly obvious when the cold ap- plied, be either violent in its degree or long in its duration. Various experiments prove this faft. In cold countries the pulfe is uniformly flow. In Greenland it feldom beats above forty ftrokes in a minute. Of the effects of cold water in weakening the * Cullen's Firft Lines, Se£t. 88, Differtatio Inauguralis &< Frigore, Edinburgi 1780. ( 3 ) the pulfe, a decifive experiment is recorded by Dr. Rufh in his Account of the Yellow Fever of 1793.* " In an experiment," fays he, "which was made at my requeft by one of my pupils, by placing his feet in cold pump-water for a few minutes, the pulfe was reduced 24 ftrokes in a minute, and became fo weak as hardly to be per- ceptible." Experiments upon the effects of cold water upon the pulfe, have been alfo made by Dr. Marcard, firft phyfician to the Duke of Holftein, with re- mits precifely fimilar. After it had been applied for about four minutes, he obferves that the pul- fations were uniformly much diminifhed, both in force and frequency. This gentleman has written a German treatife upon the Medical Effecls of Bathing in general. From this performance, by the kindnefs of a literary friend, I was furnifhed with the above facl:. I lament that my ignorance of the language in which it is written, fhould have precluded me from the perufal of a work which appeared to contain many observations highly va- luable and interefting. Another general effeft of cold, is a palenefs of the fkin, produced by the contraction of the fuperficial veflels, and the fuppreflion of perfpiration. This is called by Dr. Cullen its aftringent quality, t This palenefs is of fhort duration, being foon fucceeded by an encreafed rednefs, the blood having now ruined into the veflels and formed congeftion. From this efFect, cold has been fuppofed to be a ftimulus. But although it may in fome inftances appear to be pofleft of a ftimulating power, I fhall endeavour hereafter to fhew, that this is always of the indirect kind; * Rufti on the Yellow Fever, p. 288, 2d edition. t Firft Lines, Sett. 90. ( 4 ) kind; this inquiry, however, may be properly poft- poned at prefent. After this rednefs has continued for fome time, if cold be ftill applied, the colour changes to a livid hue, and by a ftill longer application of it, gan- grene is at length produced. A third general effeft of cold, is its power of encreafing the appetite for food. The abfence of the invigorating influence of heat, renders the ufe of other ftimuli more neceflary for the prefervation of animal life. Hence we are prompted by na- ture to take in a greater quantity of aliment, in order to fupply the deficiency. The union of cold with its other exciting caufcs feems eflential to the production of Scurvy. That this is the cafe appears evident from the defcrip- tion of the difeafe given by Dr. Cullen in his Nofology. * To the account of its fymptoms he prefixes the words " in regione frigida." It is alio rendered probable by its comparatively rare appear- ance in warm climates and feafons, and from warm clothing having a confiderable effect in preventing its attacks, or in moderating its violence.t It may here be remarked, that various opinions have been formed, with regard to the favorable or unfavorable effects of cold upon the health of man. " It is thought by many," fays the elegant author of the Botanic Garden, J " that frofts are in general " falubrious to mankind. The bills of mortality, " however, in frofty feafons, are an evidence in "** the negative, as in long frofts many weakly and " old people perifh from debility occafioned by the " cold." This idea has led the author in another part of the fame work, to fuggeft a fcheme for preventing * Vide Synopfis, Vol. 2d, p. 291. + Firft Lines, Vol. 4, Se£t. 1797. + Botanic Garden, Vol. ift3 Additional Note 12. ( 5 ) preventing or diminifhing its injurious effects; the benevolence of which is more obvious than its prac- ticability. " If," he obferves, " the nations who inhabit this hemifphere of the globe, inftead of deftroying their feamen or exhaufting their wealth in unneceffary wars, could be induced to unite their labours to navigate thofe immenfe maffes ol ice which encircle the North Pole, into the more fouthern oceans, two great advantages would refulfc to mankind, the tropic countries would be much cooled by their folution, and our winters in this latitude would be rendered much milder, for per- haps a century or two, till the maffes of ice became again enormous." * Here however we fhould call to mind the fcene in which thefe obfervations were made, fmce per- haps, many of the fuppofed infalubrious effects of cold, may rather be attributed to its frequent al- ternations with heat, in the variable climate of England. That this alternation is favorable to the production of difeafes of the inflammatory kind, has been frequently obferved. The venerable Sydenham long fince remarked it, and his forcible expreflions upon the fubject, manifeft the deep conviction which he entertained of its injurious power. He reprefents its deftructive operation as fuperior to the combined effects of plague, famine, and the fword.t Whether cold, unlefs violent in its degree, produce confequences equally injurious in a fteady and fettled climate, appears rather doubt- ful. Dr. Rufh informs us, in his lectures, that during the intenfe and regular cold of winter in Ruflia, inflammatory difeafes are fcarcely known. As the inhabitants of that country, expect no change of temperature during that feafon, their clothing * Botanic Garden, Vol. ift, Canto ift, Note on line 529. + Wallis's Sydenham, Vol. ift, p. 357. ( 6 ) clothing and habitations are carefully adapted to the rigour of the climate. But upon the arrival of Spring, they are expofed to fevers of a high degree of malignity. Having been thus led infenfibly to the confide- ration of fome of the morbid effects of cold, it may here be remarked, that the beft fecurity againft them, confifts in the ufe of nourifhing aliment and the application of warm clothing, particularly to the lower extremities. Attention to this laft cir- cumftance is particularly neceffary in variable cli- mates. A pernicious fubftitute for the article above-mentioned, in order to defend the body from injury from cold, has been fought for in the ufe of fpirituous liquors. This delufive idea has been ably and fuccefsfully combated by Dr. Rufh. He has fhewn that the ftimulus which they afford is xtranfitory, that the temporary warmth which they produce is always fucceeded by chillinefs, and that they leave the fyftem in a ftate more fenfible to the impreflion of cold than before. * Cold acts upon the body more powerfully in the fleeping than in the waking ftate. Hence a cold night iucceeding a warm day in the month of Auguft frequently produces ficknefs. The debi- lity of cold is here aided by the inaction of fleep fuddenly induced upon the fyftem. t The application of cold to the furface of the body caufes, in a given time, an encreafed flow of urine. The fact will admit of important ap- plication under the fecond head of this Effay. Cold, when combined with moifture, produces fenfations much more diftreffing, and chills the body much fafter, than dry cold, of a much lower temperature. This fact is thus accounted for by Dr. * Rufh's Inquiries, Vol. 2, page 67. + Rufli's Inquiries, Vol. 4, page 128. ( 7 ) Dr. Darwin. " In cold, moift days," he obferves, " as we pafs along, or the wind blows upon us, a new iheet of cold water is as it were perpetually applied to us and hangs upon our bodies; now as water is 800 times denfer than air, and is a much better conductor of heat, we are ftarved with cold like thofe who go into a cold bath, both by the great number of particles in contact with the fkin, and their greater facility of receiving our heat."* A Angular effect of cold is related by Bruce in his travels to difcover the fource of the Nile. Whilft he was failing up that river, he obferved that the chilling air of the night, conftantly depreft the fpi- rits and excited the terrors of the failors who na- vigated the boat. If we admit the beautiful and elegant explanation of the phenomena of fear, given in the firft volume of Zoonomia, this effect may be referred to the Laws of Affociation. The firft application of cold at the moment of birth to the ' tender fkin of the infant, produces thofe fenfations which are ever afterwards connected with the ap- prehenfion of danger, and conftitute its natural exprefhon. t Hitherto I have only attempted the hiftory of the effects of moderate cold, but if our inquiries be extended to the confideration of greater degrees of it, we fhall find them to be much more powerful and extenfive. Of the mode by which a degree of heat capableof refilling thefe effects isgenerated inthe human body, various theories have been propofed. A late writer J remarks that "an habitual putrefcent ftate of the human body, feems neceffary in very cold climates, as it affords the natural and moft effectual means of corre&ing their influence, and fupporting the proper degree of heat neceffary to life." To prove * Botanic Garden, Part ift, Additional Note 12. + Darwin's Zoonomia, Vol. ift, Seft.xvi. 8. Sea.xxix.4. + Wilfon on Climates, p. 186. C « ) prove that this theory is vifionary, we have .only to confult the ingenious inaugural differtation of Dr. Seybert, in which he has demonftrated the fallacy of the opinion, that the putrefactive procefs takes place in the living body. The explanation of this fact muft be attempted therefore, in another way. That the oxygene received into the lungs in refpiration, is the great fupport of animal heat, is now generally admitted. The air in thefe cold countries is highly condenfed, and muft confe- quently contain in a given quantity, a larger pro- portion of oxygene, and hence at each act of ref- piration, a proportionably greater quantity of ca- loric is difengaged. In tracing the effects of great degrees of cold, their analogy to thofe produced by great degrees of heat muft naturally excite our attention. Both produce relaxation of the veflels, gangrene, and other fimilar effects.* In Siberia the refemblance of the phenomena produced by caufes fo totally oppofite is particularly obfervable, and in Nova Zembla cold produces blifters on the face and ears.t In the other regions of eternal froft, which lie under the fame latitudes, metallic fubftances blifter the fkin, like red-hot iron. This analogy might be purfued further. It might comprehend the debility produced bv the exceflive operation of either of thefe caufes, which though different in its kind, produces effects very fimilar. It has even been extended by fome writers to the faculties and operations of the mind. Dr. Fergufon, in his Effay on the Hif- tory of Civil Society, obferves, that, " Under the extremes of heat and cold, the active rage of the human foul appears to be limitted, and men are of inferior importance either as friends or as ene- mies. * Browne's Elements, Vol. ift, p. 97. + Boyle's Treatife cm Cold. ( 9 ) mies. In the one extreme, they are dull and flow, moderate in their defires, regular and pacific in their manner of life; in the other, they arefeverifh in their paflions, weak in their judgments, and ad- dicted by temperament to animal pleafures; in both the fpirit is prepared for fervitude; in the one it is fubdued by the fear of the future; in the other it is not roufed, even by its fenfe of the prefent." A fimilar remark is made by Dr. Wilfon, in his obfervations upon the Effects of Climate, from which I have already inferted an extract. In fpeaking of the inhabitants of the Frigid Zone, after fhewing their refemblance in form, colour, and various other particulars, to the natives of the Tropical countries, he concludes with obferving, that they refemble them in indolence, ftupidity and cowardice.* This train of reafoning, our author purfues to a confiderable extent in another part of the fame work. He again introduces his theory of putref- cency, and endeavours to prove, that the floth and inactivity, which are equally characteriftics of the inhabitants of the Tropical and Polar regions, proceed from a fimilar putrefcent tendency in their bodies. Had he ftopped here, the delufions of theory would not merit reprehenfion. But his errors cannot be contemplated with equal indul- gence, when he declares that the extremes of cold and heat render a climate alike unfavorable to the growth or maintenance of public liberty; for hu- manity calls on us to condemn the opinion, that there exifts either in the frozen regions of the Pole, or the burning fands of the Tropics, a phyfical neceffity for the horrors of flavery. Many of the effeas of exceflive degrees of cold, remain yet to be pointed out. When the c French * Wilfon on Climate, p. 254. C *o ) French Academicians wintered at Tornea in Lap- land, the external air, when fuddenly admitted into their rooms, converted the moifture of the air into whirls of fnow; their breafts feemed to be rent when they breathed it, and the contact of it was intolerable to their bodies. * A fimilar inftance of the effects produced by the reception of air fo intenfely cold into the lungs, is recorded by Boyle in his philofophical Treatife upon Cold. He gives it upon the authority of Dr. Fletcher, who, about the time of his publi- cation, was ambaffador from England to Ruflia. " I found," fays the latter gentleman, " that when I came out of a warm room into the cold, I fenfibly drew my breath ftiff and even ftifling with cold; fo powerfully and fuddenly does the intenfely re- frigerated air, work upon the organs of refpiration. "f How far may the diftreffing fenfations expe- rienced upon the admiflion of this intenfely cold air into the lungs, be referred to the large quantity of oxygen gas, which muft neceffarily be prefented in a volume of air fo much condenfed ? This opinion is I think rendered probable by the phenomena of Pulmonary confumption. In its firft ftage it partakes ftrongly of the inflammatory diathefis. Hence Dr. Beddoes attributes the origin of this difeafe to the prefence of too much oxygene in the fyftem.J We find it occurringmoft frequent- ly in cold climates, and in the winter feafon. May it not therefore be caufed by the encreafed quantity of oxygene taken in at each refpiration in cold weather, operating upon predifpofing debility in the lungs ? May not a ftill greater degree ot oxygene contained in each volume of air, produce at each refpiration fenfations ftill more acute and diftreffing * Encyclopaedia Britannica, Vol. 5. + Boyle's Works abridged, Vol. 1, p. 655. J Beddoes on Confumption. ( " ) diftreffmg, till they at length arrive to the point above-mentioned ? But to return to our fubject. Cold thus violent, when long applied, termi- nates fatally. Seven thoufand Swedes are laid to have perifhed at once, in attempting to pafs the frozen mountains, which form the weftern barrier between that country and Norway.* Cold, how- ever, much lefs intenfe in its degree, even though it be but a few degrees lower than the freezing point of Fahrenheit, if combined with the moifture pro- duced by the folution of fnow and hail, may prove equally fatal. The reafon of this has already been1 explained. The evaporation which takes place, gradually carries off all the heat of the body, till there no longer remains a fufficient degree of it, for the fupport of animal life. In fuch cafes, the perfon firft feels himfelf exceedingly chill and un- eafy, he gradually becomes unwilling to walk or ufe exercife to keep himfelf warm; and at lait turns drowfy, fits down to refrefh himfelf with fleep, and awakes no more. The drowfinefs produced by exceflive cold, feems an univerfal effect, and was long ago remarked by Boyle, in that Treatife which I have already had occafion to quote. Under this head he inferts fome extracts of a letter in which we find the following paffage. "As to thofe who are killed with cold, they perifh diffe- rently. For fome not being fufhcienlly fortified againft the cold by their own internal heat, nor competently armed againft it by furs, inunctions, and other external means; after having their hands and feet firft feized, till they grow paft feeling it, the reft of their bodies is fo invaded, that they are taken with a drowfinefs that gives them an extreme propenfity * Encyclopaedia Britannica, Vol. 5. + Boyle on Cold. ( » ) propenfity to fleep, which, if indulged, they awake no more, but die infenfibly." But a more recent inftance of this effect of cold, is detailed in a manner peculiarly interring, in Captain Cook's firft Voyage. Whilft that intrepid navigator lay at anchor in the bay of Good Succefs in the Terra del Fuego, the exceflive cold and mu- tability of weather, in thofe fouthern regions, had nearly proved fatal, to fome of the companions of his expedition. Dr. Solander, Mr. Banks, and fome other gentlemen, with their attendants, let out on a fummer's morning, in order to botanize. They afcended a mountain for this purpofe, but were fuddenly furprized by fuch ftorms of fnow and haif, as rendered their return to the fhip for that night, utterly impracticable. Dr. Solander had warned his companions of the drowfinefs with which perfons about to perifh with cold were al- ways affected, and had earneftly conjured them, upon no account to give way to it. It is remark- able, that notwithftanding this caution, he was himfelf the firft who feemed likely to fall a victim. He was feized with a violent inclination to fleep, nor was it in the power of his companions to prevent him from fitting down for that purpofe. He was however foon roufed by their united exertions; but during the fhort fpace of a few minutes, his feet were fo much diminifhed by the contraction of the mufcles, that his fhoes fell off, when he was compelled to rife, and it was not without difficulty that he was recovered. The morning proving fa- vorable, they accomplifhed their return to the fhip, but with the lofs of two of their companions, who had perifhed from the feverity of the cold.* It is worthy of remark, that infants feem pofleft of a greater power of refining the effects of thefe exceflive * Cook's firft Voyage. ( 13 ; exceflive degrees of cold, than adults. Of this fact an inftance is related by Dr. Rufh in his Lees tures. He gives us the hiftory of an Indian woman, who having been accidentally expofed without fhelter to the inclemency of a wintry night, was found in the morning frozen to death, with an infant ftill alive at her fide. In many inftances of this kind, however, life, though apparently fufpended, may, if proper means be ufed, be reftored. Although excite- ment be abftracted, excitability for fome time re- mains, and till this alfo be extinguifhed, hopes of recovery may be entertained. But fo much is the excitability with regard to the ftimulus of heat accumulated, that it is neceffary to apply it with great caution, and very gradually. The hidden application of it, has frequently proved fatal. Tiflbt obferves, that " If heat be applied to a frozen part, the cafe proves irrecoverable. Intolerable pains are the confequence, which pains are fpeedily attended with an incurable gangrene, and there is no means left to fave the patient's life, but by cutting off the gangrened limbs."* Of this he gives us a melancholy inftance, in the cafe of an inhabitant of Coffonay, who had both his hands frozen. Some warm liniments were applied to them, the confequence of which was the neceffity of cutting off fix of his fingers. To avoid thefe fatal confequences, the body fhould be immerfed in cold fpring-water, it may even be neceffary to render it colder, by putting in a little fnow or ice. This addition is recom- mended by the author juft quoted; of its propriety I confefs myfelf rather dubious. This moderate encreafe of temperature will be fufficiently ftimu- lating to a body which has been long expofed to an * Advice to the People, p. 458. •4 J an intenie degree of cold, and as life and motion gradually return, greater degrees of comparative heat may be applied, till the body return to its former temperature. The fame plan of treatment has been purfued with fuccefs, even after many fymptoms of gan- grene had appeared, in confequence of the impru- dent application of heat. It fhould therefore by no means be neglected, where it can be made ufe of fufficiently early, to give any profpect of a for- tunate event. The diftreffing fenfations which are experienced when we fuddenly expole the hands or feet to the fire, after being much chilled by cold, ftrongly indicate the neceffity of the cautious application of ftimuli. The encreafed fenfibility to heat which is acquired by expofure to cold, did not efcape the notice of the great Father of Medicine. " Thofe," fays he, " who after journeying through fnow, or any other great cold, are very much chilled either in their feet, or their hands, or their head, fuffer greatly at night, when they are covered up warm, from a burning and tingling; and fome are even affected with blifters, as if they were burnt by fire."* Thofe difagreeable affections of the extremities, which are called chilblains, are univerfally owing to this caufe, and are cured with equal readinefs by the judicious application of cold water. The fymptoms attending the extinction of life from cold, feem in many cafes to refemble Apo- plexy. The drowfinefs which comes on, is pro- bably the effect of a turgefccnce of the head; the blood being accumulated there, by the contraction of the extreme veflels, and probably in fome in- flances extravafated. This is rendered probable, by * Hippocrates de vctcri Medieina, Seft. 29. ( is ) by attending to the effects produced upon thofe who neglect the immerfion of the head when in a cold bath: this neglect often produces acute head- achs, and bleeding at the nofe. In this imperfect fketch of the phenomena of cold, the following curious fact, related by Dr. Whytt, in his Treatife on Nervous Difeafes, has certainly a claim for infertion. The fubject of it was a girl of eight years of age, whofe fyftem had become irritable to an extraordinary degree. " It was remarkable in this patient, that the application of cold to any part of the body, immediately brought on a fit of coughing, whether in a hori- zontal pofition in bed, or in a Handing, or fitting pofture. Nay, when the the cough was ftopped by the anodyne powers of the pediluvium, and whilft her legs continued to be immerfed in it, if a bottle of cold water was applied to any part of her body, or her hands immerfed in cold water, the cough was renewed, but ceafed in a fhort time, after removing the bottle or cold water from her hands, if her feet remained covered with the warm water." Not having Dr. Whytt's ingenious Treatife at hand, I have made the above quota- tion from the account of the cafe given in Dr. Gardiner's Obfervations on the Animal GEco- nomy. Two other circumftances appear neceffary to be noticed in the firft part of this Effay, in order to render this little hiftory of the Effe&s of Cold, lefs incomplete. Thefe are the effects of taking cold liquors when the body is heated, and the effects of thofe luxuries which grace our tables under the name of ices. That the ufe of cold liquors when the body is warm, is attended with morbid, and fometimes mortal effe&s, is unhappily a fact of too frequent experience. ( >6 ) experience. Accidents from this caufe often oc- cur in the ftreets of Philadelphia, during the burning heats of fummer. Dr. Rufh has men- tioned three circumftances as generally concurring, in his Effay upon this fubject.* 1. That the patient is extremely warm. 2. That the water is extremely cold. And 3. A large quantity of it is fuddenly taken into the body. " The danger," he obferves, " is always in proportion to the de- grees of combination which occur in thefe three circumftances." For the hiftory of the fymptoms, which follow the ufe of cold water, under the circumftances already mentioned, I fhall again quote the above treatife, as the defcription is equally accurate and comprehenfive. " In a few minutes," fays our author, " after the patient has fwallowed the wa- ter, he is affected by a dimnefs of fight, he ftag- gers in attempting to walk, and unlefs fupported falls to the ground; he breathes with difficulty; a rattling is heard in his throat; his noftrils and cheeks contract and expand with every act of refpiration; his face appears fuffufed with blood, and of a livid colour; his extremities become cold, and his pulfe imperceptible; and unlefs relief is fpeedily obtained, the diforder terminates in death, in four or five minutes." " This defcription includes only the lefs com- mon cafes, of the effects of drinking a large quantity of cold water, when the body is preter- naiurally 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 afphyxia." The cure of this difeafe confifts in giving lau- danum, in dofes proportioned to its violence. And * Inquiries, Vol. ift, p. 181. ( *7 ) And in cafes where the vital funaions appear to be fufpended, the remedies ufed to recover per- fons apparently drowned, may be employed with advantage. Tiffot obferves, that a pleurify, fo violent as to deftroy life in a few hours, is fometimes produced by drinking cold water when the body is much heated. The external application of cold water to the body in thefe circumftances, is alfo attended with considerable danger. Dr. Michael Rofa, an Ita- lian Phyfician of much celebrity,* has recorded a very interefting cafe of a young lady, who, in the evening of the firft of May, which had proved un- ufually warm, bathed almoft the whole of her body, with fome water which had been expofed in a bowl for fome time to the rays of the fun. The particulars of the cafe are too lono-to be men- tioned here, but the following are the principal faas. Notwithftanding the coldnefs of the water was much diminifhed by the precaution above related, the ufe of it, was followed in about fix days by an acute pain of the head, fucceeded by a fore-throat and high fever; which, though it fometimes apparently left her, returned at inter- vals for many months. Nor was fhe entirely freed from the confequences of her imprudence, till the following fummer. All the injurious effeas which have been enu- merated as attending the ufe of cold liquors, when the body is heated, may naturally be fuppofed to follow the ufe of ices. Every caution, therefore, which the contemplation of thefe effeas may ren- der neceffary with regard to the former, muft apply with peculiar force to the latter. They are moft gratifying, when the body has been d expofed * Offervazioni fopra alcune Malattie particolari, p. 102, ( i8 ) expofed to the heat of a crowded room, and are often moft injudicioufly introduced as a refrefh- ment, after the heat and fatigue occafioned by dancing. That under thefe circumftances they fhould prove detrimental to the fyftem, might naturally be expeaed. But even when the body is perfeaiy cool, the effeas of the introduaion of aliment fo much below the temperature of the bo- dy, may be highly noxious. Dr. Haller informs us, that the cold water which he drank whilft croffing the Alps, which is entirely furnifhed by the folution of thofe immenfe maffes of ice which cover their fummits, produced a pain in his breaft refembling pleurify. Dr. Rufh relates in his Leaures, the cafe of a Major in the American army, who, from impru- dently eating a quantity of ice-cream, was affliaed with a fcirrhus in the ftomach, which terminated fatally, at the diftance of twelve months. The late General Wayne was attacked by a difeafe fo acute as to threaten his life, in the year 1792, from imprudently taking a large, draught of iced punch. The fuppreffion of the menftrual difcharge has alfo been enumerated amongft the effeas pro- duced by the ufe of ices.* With thefe faas, I conclude this imperfea hiftory of the general Effeas of Cold upon the Syftem in Health, and fhall now proceed to in- quire into the faas of its Operation in a Morbid State, the confideration of which was allotted for the fecond part of this Effay. * Tjffot, p. 357. SECOND ( *9 ) SECOND PART. IT will be neceffary before we can lay down any rules for the ufe of cold as a remedy in certain difeafes, to inquire to what clafs it belongs, as our praaice will otherwife be uncertain and ineffi- cacious. Much contradiaion has arifen from the various and contradiaory effeas which have been afcribed to cold. By fome praaical writers it has been claffed amongft Sedative, by others amongft Tonic remedies, and as fuch recommended in cafes of debility. The illuftrious Cullen, to whofe acute and penetrating genius, the medical world is under fo many and fuch great obligations, in his general view of the Cure of Fever, has affigned a place to cold as a remedy, under two claffes of fo different a nature, that were its effeas fo oppofite, great uncertainty muft neceffarily arife in its ufe. Under the head of thofe remedies which moderate the violence of reaaion, he places cold as a fedative. Amongft thofe which remove the caufes, or obviate the effeas of debility, by fupporting and encreafing the aaion of the heart and arteries, he claffes it as a tonic. From the faas above quoted, we may, however, (I think) conclude, that the operation of cold upon the arterial fyftem is direaiy the reverie, unlefs in cafes of great indirea debility. And even in fuch cafes it may perhaps be queftioned, whether, when difeafe has been fo violent as to proftrate the ftrength of the arterial fyftem from exceflive aaion, the ufe of cold, unlefs combined with other remedies more ( *0 ) more powerfully debilitating, would be found fufficient to remove that oppreffion, and thus ex- cite the veffels into freer and more powerful aaion. It may be afked, whence is it that when the body is debilitated by the heat of fummer, cold- bathing fo fpeedily reftores ftrength. This muft be explained in the fame way. The various pow- ers affigned to cold, arife from a proper diftinaion not having been made, between direa and in- direa debility. In cafes of the former kind, the application of cold muft almoft uniformly be in- jurious, whereas the ufe of it in the latter, by lowering the excefs of aaion, which is its caufe, may reitore the fyftem to its regular and healthy ftate. The effeas of cold in the latter ftate of debility, are happily illuftrated by Dr. Browne in his Ele- ments of Medicine.* " If," fays he, " cold fome- times feems to ftunulate, it produces that effea, not as aaual cold, but either by diminifhing ex- ceflive heat, and reducing it to its proper ftimulant temperature, or by accumulating the excitability diminifhed by exceflive flimulus, and communi- cating energy to the ftimulus of the exciting powers, now aaing too languidly. An inftance of this operation of cold occurs in the Torrid Zone, where actual cold is fcarcely to be procured, and in the ufe of refrigerants, as they are called, in fevers." To the authority of Dr. Browne, that of Dr. Rufh may here be added. He has claffed cold amongft thofe remedies, " which leffen, by the abftraction of ftimulus, the morbid and exceflive aaion of the blood-veffels."t From * Vol. ift, Sea. 37. + Inquiries, Vol. 4th, p. 183. ( 21 ) From thefe obfervations therefore, and from the faas mentioned in the former part of this Effay, I am led to believe that cold is ftriaiy a fedative remedy, and that all its apparent tonic effeas are produced indireaiy. Its fedative effeas appjar from its diminifhing the aaion of the heart and arteries, from the palenefs of the fkin which fol- lows its firft application, from the debility and inaaivity obferved in the inhabitants of cold countries, and from the long application of it gra- dully diminifhing the vital powers, till it extin- guifhes them entirely, either in particular parts or in the whole body. When we contemplate the nature of the difeafes in which it has been ufed, and the effeas which it has produced, this opinion will perhaps receive additional confirmation. Cold may be applied as a remedy, under three forms, air, water, and ice or fnow. There may exift degrees of morbid aaion fo violent as to re- quire the combined operation of all thefe forms, as there may exift others fo moderate, as to render the ufe of one only neceffary. The ufe of cold as a remedy in certain difeafes, has had to ftruggle with much oppofition. The admiffion of atmofpheric air, even in warm wea- ther, was at one period cruelly denied in fevers, but a more rational mode of praaice obtains now, almoft univerfally. Dr. Cullen himfelf, appears to have been at times under confiderable doubts with regard to the beneficial effeas of cold. After mentioning fome cafes, in which much advantage has been faid to follow its ufe, he thus expreffes himfelf: " What is the mode of its operation, to what circumftances of fever it is particularly adapted, or what limi- tations it requires, I (hall not venture to deter- mine, ( « ) mine, till more particularly inftruaed by further experience." * In another part of the fame work, however, he expreffes himfelf with more confidence, and de- clares, that cold water taken into the ftomach, may prove an ufeful tonic in fevers.t The expla- nation of the mode in which cold is in thefe cafes erroneoufly imagined to exert a tonic power, has already been attempted. Mr. Aitken, of Edinburgh, in his Elementary Treatife upon Medicine, propofes fome very ra- tional ideas upon this fubjea. " The application of water of low temperature," he obferves, " to the cutaneous furface of the body, or the ufe of the cold bath, as a refrigerant remedy during fever, might be juftified upon the fame principle as that of other cold applications with a view to produce the like effea." J Modern practitioners have carried the ufe of cold as a remedy, to an extent fcarcely contem- plated in idea by their predeceffors, and with the happieft effeas. The hiftory of thefe will con- ftitute the remaining part of this Effay. If what has been already obferved of the ope- ration of Cold, be admitted as juft, we fhould naturally be led to infer, that its beneficial effeas muft be confined to difeafes of great morbid aaion. Agreeably to this opinion, we fliall find that the ufe of it may be proportioned in its extent to the degree of morbid aaion prefent in the fyftem, and that it is injurious in thofe difeafes where this is feeble, as in the typhus ftate of fever. In * Firft Lines, Seft. 133. + Firft Lines, Se£t. 206. t Aitken's Elements, Vol. ift, p. 394. ( 23 ) In order to give a methodical difplay of the difeafes in which cold has been applied, I fhall adopt, in part, the arrangement laid down by Dr. Rufh, in the fourth volume of his Inquiries, and fhall therefore begin with the ufe of it in the various difeafes claffed by him under the head of the Malignant State of Fever. This ftate of fever the Doaor fuppofes to con- ftitute the higheft grade of inflammatory diathefis. He includes under it, the Plague, the Yellow- Fever, the Gout, and the Small-Pox. To thefe he has lately added the Hydrophobia, which he has proved from its caufe, fymptoms and mode of cure, to be fimply a malignant ftate of fever.* As, however, the gout and fmall-pox will occur here- after under another head, I fhall for the prefent confine my attention to the jairn firft mid lllL kft of this ftate of fever, and fhall therefore give a brief fketch of the ufe of cold in the cure of the plague. This difeafe is happily but little known in the more enlightened parts of Europe. Its hiftory is therefore in fome degree imperfea; but it appears to be a difeafe of a highly inflammatory nature. Of the propriety of the free admiffion of cool air moft writers upon the fubjea appear to be con- vinced. ' There are fome faas upon record of its intentional, and others of its accidental cure by cold water. Bruce informs us in his Travels, that the inhabitants of the ifland of Maffuah cure the malignant fevers to which they are fubjea, by keeping the patient as it were in a perpetual bath of cold water. Dr. Rufh relates in his Leaurds, the cafe of a man ill of the plague, who was travelling to Aleppo. The inhabitants denied him lodging for fear of infeaion; he was therefore obliged to pafs * Le&ures in 1797. ( 24 ) pafs the night in the open air. In this fituation the falling of a violent fhower of rain completely wetted him, and in the morning he was perfeaiy cured. Dr. Henderfon, in his obfervations on the plague, obferves, that " the ufe of cold water, or even water in which ice has been diffolved, will probably be of advantage in warm feafons, or when there is a tendency to an encreafed fecretion of bile." In another part of his work, he informs us that " the plague is faid to have been cured, by ex- pofing the patient to the dew and rain, and by throwing fait water over the body." The wealthy inhabitants of Smyrna preferve themfelves in health by wetting their houfes, whilft the plague ii deftfQying thoufands of their lefs opulent or provident neighbours.* The water- carriers in Aleppo, who are in a conftant ftate of humidity, efcape the plague. Even the dews which fall in Egypt about mid- fummer, are fometimes fo plentiful, as to deftroy this diftemper entirely, t From thefe faas, and from the analogy which appears to exift between this difeafe and the yellow- fever, which is fo ably traced by Dr. Rufh;^ it is probable that ice might be ufed here with ad- vantages equal to thofe which have been derived from it in the yellow-fever, the next fubjea of our inquiry. Amidft the various and contradiaory opinions entertained by different praaitioners with regard to the origin and treatment of the yellow-fever, which * Rufh's Inquiries, Vol. 4, p. 61. + Memoirs of Baron de Tott, Part 4, p. 69. X Rufh on the Yellow-Fever, ad edit. p. 169. ( 25 ) which affliaed the city of Philadelphia in the year 1793, it may be obferved, that all agreed in re- commending the ufe of cold water and cool air. Their efficacy was proved in a remarkable manner, by the fudden check given to the ravages of the difeafe by cold weather and heavy rains. The author of a letter publifhed by Dr. Rufh in his account of this fever,* obferves, that " he places the greateft dependance, for the cure of the difeafe, on throwing cold water twice a day over the naked body. The patient is to be placed in a large empty tub, and two buckets full of water, of the temperature of about 75 or 80 degrees of Fah- renheit's thermometer, according to the ftate of the atmofphere, are to be thrown over him. He is then to be wiped dry and put to bed. It is com- monly followed by an eafy perfpiration, and is always attended with great refrefhment to the patient. This remedy, however, muft be applied from the earlieft attack of the difeafe, and continued regularly through the whole courfe of it." In the poftfcript to this letter the author remarks, that " the praaice of applying the cold bath in fevers is not new. In a malignant fever which prevailed at Breflaw in Silefia, and proved ex- tremely fatal, yielding to none of the ufual re- medies, Dr. De Haehn, a phyfician of the place, had recourfe to this remedy, and found it effeau.d. It has alfo been ufed with advantage in England in putrid fevers. In many of the Weft-India iflands it is generally ufed in their malignant fevers. Dr. Stevens, a gentleman of high charaaer in his profeffion, who is now in this city, allures me that in the ifland of St. Croix, where he has praaifed medicine for many years, it has been found more effeaual than any method heretofore praaifed." E Whatever * Rufli on the Yellow Fever, ad edit. p. 209. ( ^ ) Whatever benefits, however, may have been derived from the temporaiy application of cold water, much greater and more permanent advan- tages have followed the long continued ufe of it. Indeed an application fo fudden as that above defcribed, appears rather an .ambiguous remedy, as it muft accumulate the excitability of the fyftem, with regard to the ftimulus of heat. For this opinion, I have the authority of Dr. Browne, who remarks, that " heat is always hurtful in fthenic difeafes, but ftill more fo after a previous application of cold."* In another part of his work he thus expreffes himfelf. " In a particular manner, atfer the ap- plication of cold in an intenfe degree, muft the application of heat be avoided, becaufe its ope- ration, from the increafe of the excitability by cold, becomes more effeaive." " Cold is the beneficial degree of temperature in the cure of this diathefis, but it muft be cold not followed by any confiderable degree of heat. That miftake, therefore, in medical praaice, of thinking cold hurtful in fthenic diathefis by a fti- mulant operation, fhould be correaed; and its benefit in the fmall-pox is not to be underflood to arrive fo much from its mere debilitating decree, as from avoiding the ftimulus of heat alter its ope- ration, "f Dr. Wiftar, in a letter giving the hiftory of an attack of the difeafe which he had himfelf en- countered, gives a ftrong teftimony from his own experience, of the efficacy of cool air, in abating the exceflive aaion of the arterial fyftem. J Dr. * Elements of Medicine, Vol. 2d, p. 2. + Elements of Medicine, Vol. ift, p. 289. £ Rufh on the Yellow Fever, 2d edit. p. 235. ( 27 ) Dr. Rufh purfued the ufe of thefe remedies to a much greater extent. " Cold water," fays he, £ was a raoft agreeable and powerful remedy in this diforder. I direaed it to be applied by means of napkins to the head, and to be injeaed into the bowels by way of glyfter. It gave the fame eafe to both, when in pain, that opium gives in pain from other caufes. I likewife advifed the wafhinp- of the face and hands, and fometimes the feet, with cold water, and always with advantage."* The ufe of cold water applied by means of napkins to the head, is not unknown to thofe who indulge in an intemperate ufe of wine, as after an evening of excefs it is frequently made ufe of bv them, in order to prevent the fever which would otherwife be the confequence of the debauch the next morning. In the yellow-fever of 1794, Dr. Rufh ufed the fame remedies, with effeas equally happy, and purfued them to equal if not greater extent. To relieve violent pain in the bowels, he applied cloths dipt in cold water to the lower part of the belly. He applied them alfo for three fucceffive days and nights, to the head of one of his female patients, during an inflammation of her brain, which fuc* ceeded her fever. During this period, they were changed for the greater part of the time every ten or fifteen minutes. In 1795, he encreafed the coldnefs of pump-water by diffolving ice in it, and in fome cafes applied powdered ice in a blad- der to the head, with great advantage.f It may not here be improper to add fome fafts of the modes in which he has ufed cold, in this ftate of fever, as detailed in his Leauivs. He * Rufh on the Yellow Fever, ode-lit. p. r.8-. ■7 Inquiries, Vol. 4th, p. c;. ( *8 ) He does not conceive it neceffary to wafli the whole of the body with cold water: local appli- cation to the parts particularly affeaed with pain, or to the head when the difeafe has a determination thither, will in general be fufficient. Ice, he obferves, was ufed many years ago in the cure of Influenza. There are various modes of ufing it; the moft convenient appears to be that already mentioned, as when included in a bladder it may be put into bed with the patient, and ap- plied to any part where it is neceffary. On the internal ufe of cold liquors in this difeafe, Dr. Mofeley obferves,* that Galen cured all his pa- tients, after the firft ftage of it, with cold water; and goes fo far as to fay, he never loft one, where cold water was given in a proper manner." He appears, however, to be dubious himfelf, with regard to adminiftering cold water internally. He afferts that " cold water is improper in the be- ginning of the difeafe, and it is too rapid in its termination, to admit of any delay, or interval, that is not filled up with medicine. Nor can it be given at the fame time that the patient is under the operation of cathartics."t The experiments of Dr. Rufh feem to lead to a contrary opinion. In hydrophobia, which conftitutes one of the higheft grades of thisjy»d-of fever, Dr. Rufh re- commends that the various debilitating remedies fhould be ufed with equal freedom as in the yellow- fever. The free admiffion of cold applications, is confequently included. The ufe of cold water in this difeafe has the fan£tion of high antiquity. Celfus recommends that the patient fhould be fuddenly thrown into a pond, and if he cannot fwim, that he be left there * Mofeley on Tropical Difeafes, 5dedit. p. 440. + Mofeley, p. 441. ( ^9 ) there till be almoft drowned. Sometimes raifing him to the furface, at others keeping him under, and thus compelling him to fwallow a quantity of cold water.* Some faas of the operation of cold water in this difeafe, may be feen in Southwell's Medical Ef- fays.t Amongft others, he gives us the hiftory of a cafe, which was delivered to the Academy of Sciences. The patient was tied to a tree, and while in this fituation had two hundred buckets of water poured upon him: he recovered without any other affiftance. In Italy large quantities of cold water are ftill given in fevers, after the manner of the ancients, with a view to procure vomiting and fweating. J This is alfo laid to be a part of the praaice of the Spanifh phyficians, and is called the Diaeta Aquca.§ " I am perfuaded," fays Brydone, " that in fkilful hands, few remedies would be more effec- tual in many of our ftomach and inflammatory complaints, than a free ufe of iced liquors; as hardly any thing has a ftronger or more immediate effea upon the frame; and furely our admi- niftering of warm drinks and potions in thefe com- plaints, tends often to nourifh the difeafe. It is the common praaice in Sicily, to give quantities of ice-water to drink in inflammatory fevers; nay, fo far have they carried it, that Dr. Sanghes, a ce- lebrated Sicilian phyfician, covered the breaft and belly of his patients with fnow or ice; and they aflure us, in many cafes with great fuccefs."|| Among * Cellus, Lib. 5, Cap. 27, § 2. + Vol. 2, p. 94. + Mofeley, p. 441. § Cullen's Firft Lines, Seft. 1.57. || Tour through Sicily, &c. Amer. cd.t. p. 3CJ. ( 3° ) Among the objeaions which have been made to the external application of cold water and ice, that which forbids their ufe whilft the fyftem is under the aaion 'of mercury, appears to have had fome influence upon many. The effea laid to be produced by cold under thefe circumftances, is that it caufes the mercury to fall upon the mouth. This however is very beneficial in this ftate of fever. That this effea is produced by cold, * is denied by John Hunter, nor indeed does he fup- pofe that any injurious confequences follow expo- pofure to cold, whilft a patient is taking mercury in any form. Dr. Rufh ufes cold applications of all kinds, with the greateft freedom, whilft he is adminiftering large dofes of calomel, nor has this praaice been attended with any unfavorable effeas. f Having fpoken thus largely of the application of cold in this ftate of fever, it will not be neceffary to be equally minute in thofe ftates which remain to be confidered. On thefe, therefore, I fhall fay as little as poffible, premifing only, that the ufe of this remedy, like every other, muft be regu- lated by the violence of the inflammatory fymp- toms, for the removal of which it is applied. Of the gangrenous ftate of fever, much need not be faid. This epithet is adopted by Dr. Rufh in the room of putrid, which he rejects entirely. He fuppofes that this ftate of fever, is nothing more * Hunter on the Lues, London edit. p. 339—349. + As an additional proof that cold applications are not forbidden by the ufe of mercury, I will here obferve, that a fellow-ftudent in this Univerfity, informs me, that he has often applied pounded ice to venereal buboes, in order to prevent fuppuration, with the happieft effecls ; although the patient was at the fame time ufing mercui \ both internally and externally. ( 3i ) more than the iffue of a violent inflammation left in the hands of nature, or accelerated by ftimu- lating medicines. Here therefore the ufe of cold is ftrongly indicated. Some confufion appears to have arifen in me- dical writings, from giving to this ftate of fever, the name of Typhus. When we read of the be- neficial effeas, derived from wafhing the body in cold water and vinegar in Typhus fever, we can fcarccly fuppofe that this appellation refers to that ilate, in which the arterial fyftem labours under dircEl debility; but muft rather refer to that in which the debility is of the indireEl kind. Omitting feveral intermediate ftates of fever, defcribed by Dr. Rufh, which, as, with the ex- ception of the Typhus, they all partake more or lefs oi the inflammatory diathefis, require the ap- plication of cold in a degree proportioned to their refpeaive violence, I proceed next to the Inteftinal State of Fever, or Febris Introverfa of Dr. Sy- denham, under which clafs are comprehended Cholera Mobus, Diarrhcea, Dyfentery, and Colic. In this clafs of difeafes the cutaneous furface of the body feems to be peculiarly affeaed. Hence blifters are fo univerfally recommended bypraaical writers. The external application of cold there- fore may be prefumed to be beneficial, if it have been proved to be ufeful in what may be called the primary ftates of fevers of this clafs. Cholera morbus being the fever of the higheft grade, would, it fhould feem, require the freeft ufe of cold, but I have not yet met with any faas of its operation. In the Cholera Infantum, Dr. Rufh obferves, that " he has had but few opportunities of trying the effeas of cold water applied to the body; but from ( 3* ) from the benefit which attended its ufe in the cafes m which it was prefcribcd, he is difpofed to be- lieve that it would do great fervice, if the pre- judices which fubfift in the minds of parents againft it, could be overcome.* Diarrhoea, as a milder grade, would require remedies proportioned. In the diarrhoea of in- fants, Dr. Darwin recommends expofure of the body to the cold air. In dyfentery, glyfters of cold water, and even of water in which ice has been diffolved, have been adminiftered with the happieft effeas. Dr. Rofa, whom I have already quoted, exhibited glyfters of cold fpring-water, to an Italian gentle- man who laboured under a moft violent dyfentery, attended with the moft excruciating pain. An immediate relief was obtained, but fuch a chill was given to the body of the patient, that his teeth chattered with the cold. After enduring this ap- plication for a little time, he became impatient, and refufed to have it adminiftered for two days, in confequence of which his complaint returned with redoubled violence, but again left him upon the renewal of the cold glyfters, and upon per- illing in their ufe, a fpeedy cure was obtained.t In colic, Dr. Rufh informs me, that he has given glyfters of cold-water, with immediate re- lief. One of his patients in particular, who is often affliacd with it, has derived fuch benefit from their ufe, that fhe ufes an injeaion of this kind, whenever fhe has an attack of the difeafe. Dr. Cullen obferves, that when every purgative has failed in this difeafe, the aaion of the in- terlines * Inquiries, Vol. ift, p. 166. + Oflervazioni, &c. p. 133. ( 33 ) teftines has been effeaually excited by throwing cold water on the lower extremities.* The Pulmonary State of Fever is next to be confidered; under which are included True and Baftard Pneumony in their acute forms, Catarrh from Cold or Contagion, and Chronic Pneumony or Pulmonary Confumption. In the true pneumony, all writers agree upon the propriety of a cool regimen. Upon this point, Sydenham, Cullen and Browne, however oppofed in general, unite their fuffrages. The latter par- ticularly inculcates its importance, and extends its ufe to the falfe pneumony alfo. Dr. Cullen, how- ever, recommends cold to be guarded againft in the treatment of this laft difeafe. For the cure of catarrh, Dr. Browne repeatedly afferts in various parts of his work, that the fimple application of cold is infufficient. The ufe of ice in the influenza, or that fpecies of catarrh which proceeds from contagion, has been already hinted at. In pulmonary confumption, Dr. Rufh informs us in his Leaures. that he has ufed the cold bath with great fuccefs. In his treatife upon this fub- jea, he obferves that " he has repeatedly pre- scribed walking in a cold air, in the inflammatory flage of confumption, with advantage, and has often had the pleafure of finding a fingle walk of two or three miles, in a clear cold day, produce nearly the fame dimunition of the force and fre- quency of the pulfe, as the lofs of fix or eight ounces of blood."t Brydone affures us, that " he knew an Englifh lady at Nice, who was cured in f a * Firft Lines, Sett. 1448. ■f- Inquiries, Vol. 2d, p. 125. ( 34 ) a fhort time of a very threatening confumption, only by a free indulgence in the ufe of ices."* We now come to the Anginofe State of Fever, which includes all thofe morbid affeaions claffed by Dr. Cullen under the head of Cynanche. If this ftate of fever be ftriaiy inflammatory, if the cynanche maligna be only the confequence of a high degree of cynanche inflammatoria, analogous to the produaion of the gangrenous ftate of fever from violent inflammation, is there not an error in the prefent mode of treating this clafs of difeafes ? Should not the throat rather be expofed to the cold air than proteaed from it, or might not even cold water be applied with advantage ? In the tonic fpecies of the rheumatic and ar- thritic ftates of fever, cold air, and in fome in- ftances cold water, has been applied with the hap- pieft effeas to the inflamed limb. The ufe of flannel and warm applications, has been gene- rally recommended in cafes of this kind. If the relief experienced from the contrary plan of treat- ment, fhould prove that they have been recom- mended without fufficient reafon, may not the warm regimen adopted in the treatment of cy- nanche, perhaps be difcovered to be equally erroneous ? In the Maniacal State of Fever, the free appli- cation of cold, is pretty generally admitted. Dr. Cullen obferves that " maniacs have often been relieved, and fometimes entirely cured, by the ufe of cold-bathing, efpecially when adminiftered in a certain manner. This feems to confift in throw- ing the madman into cold water by furprize; by detaining him in it for fome length of time; and pouring water frequently upon the head, while the whole of the body except the head is immerfed in * Tour through Sicily, &c. p. 323. ( 35 ) in the water; and thus managing the whole pro- cefs, fo as that with the affiftance of fome fear, a refrigerant effea may be produced. This I can affirm, has been often ufeful; and that the external application of cold may be of fervice, we know further from the benefit which has been received, in fome maniacal cafes, from the application of ice and fnow to the bare head, and from the appli- cation of the clay-cap."* Dr. Browne maintains the fame opinion, and advifes that the patient fhould be immerfed in water as cold as pofiible, and kept under it, covered all over for a long time, till he is almoft killed. Perhaps however every effea defired, might be produced without keeping the head of the patient under water, and thus endangering fuffocation, by conftant applications of pounded ice or fnow to the head, as this will be fufficient to prevent the determination of the blood thither, which might otherwife be the refult of a partial immerfion. Dr. Rufh relates in his Leaures, the cafe of a maniac who made his efcape from his friends, and flept all night in the open air. The fudden chill fo much reduced the morbid excitement, that in a few days his reafon was reftored. In the Apopleaic State of Fever, cold air and cold applications to the head, have been much re- commended. " One of the moft effeaual methods of roufing apopleaics," fays Dr. Cullen, " feems to be throwing cold water on feveral parts of the body, or wafhing the body all over with it."t In the Hydrocephalic State of Fever, Dr. Rufh applied vinegar, in which ice had been diffolved, to the head, with evident advantage. He found that * Firft Lines, Sect. 1570. f Firft Lines, Seel. 1131—1139* ( 36 ) mat linen cloths, wetted with cold vinegar or wa- ter, and applied to the forehead, contributed veiy much to relieve the acute pain in the head which generally accompanies this difeafe.* If the Hydropical State of Fever, be an inflam- matory difeafe accompanied with watery effufion, it might be expeaed that cold would produce be- neficial effeas in it. Dr. Monroe notices the effi- cacy of travelling in cold weather in this diforder. It fhould feem that the cold here operates as a fedative, and co-operates with the fatigue produced by labour or exercife, in reducing the tone of the arterial fyftem.t Since an encreafed fecretion of urine is the con- fequence of the application of cold to the cutaneous furfaceofthebody, might it hot be advantageoufly ufed with that indication in this difeafe ? It is not uncommon to take children affected with a temporary ifchuria, out of bed, and place them upon a cold flone or marble hearth, which gene- rally at once removes the obftruaion. Dr. Sydenham was accuftomed to make his pa- tients in the fmall-pox, rife from their beds and remain for fome time in the cool air, when they were labouring under a fymptomatic ifchuria. After a fhort time the urine flowed freely. J An obfervation of Dr. Darwin, in his chapter upon the retrograde abforbents, may afford addi- tional ground for this pra6lice. When the body is fuddenly expofed to cold air, or fprinkled with cold water, he fuppofes that the lymphatics of the bladder and inteftines, invert their motions, and return * Inquiries, Vol. 2d, p. 219—227, + Inquiries, Vol. 2d, p. 177. J Wallis's Sydenham, Vol. ift, p. 197. ( 37 ) return the fluids which were previoufly abforbed, into the inteftines and bladder. * The Eruptive State of Fever, comprehends the Small-Pox, Meafles, and the other Exanthemata of Dr. Cullen. The ufe of cold, in the firft clafs of difeafes, is now well eftablifhed; perhaps how- ever, the cold regimen might be purfued with ad- vantage to a greater extent than it has hitherto been. The following faa gives countenance to this opinion. Twelve or fourteen children, belonging to fome foldiers, in a regiment which was march- ing from Glafgow to the Highlands, were feized on the road with the fmall-pox. The weather turned out remarkably cold, with a conftant rain during the march, and the children being carried on horfeback in open panniers, with little more than a fingle blanket to defend them from the cold and rain; the furgeon of the regiment was under fome apprehenfion of bad confequences from a fituation fo much expofed. His fears, however, were ill-founded, for all the children had a mild and diftina fort, more like the inoculated than the natural fmall-pox, and they foon recovered.t It does not appear fufficiently obvious, why the meafles fhould not be treated in the fame manner as the fmall-pox. Fears have been en- tertained that the application of cold, to ufe the common phrafe, caufes the meafles to ftrike in; but Dr. Browne ftrenuoufly denies that fuch an effea is ever produced, and enters fully into a vindication of a cold regimen in this difeafe. J Dr. Cullen has an obfervation which feems to confirm this idea. "It has been an unhappy opinion," * Zoonomia, Vol. ift, Seft. 29. 4. t Gardiner on the Animal (Economy, p. rc5. + Elements of Medicine, Vol. 2d, Sett. 446. ( 38 ) opinion," fays he, "with moft phyficians, that eruptive difeafes were ready to be hurt by cold; and that it was therefore neceffary to cover up the body very clofely, fo as thereby to encreafe the external heat. We now know that this is a mif- taken opinion; that encreafing the external heat of the body is very generally mifchievous; and that feveral eruptions not only admit, but require the application of cold air."* In the Haemorrhagic State of Fever, daily ex- perience eftablifhes the utility of cold applications. Cold liquors and cold air have produced the moft beneficial effeas in Haemoptyfis, and cold water applied to the fcrotum, has checked the moft violent and diftreffing cafes of it. In Epiftaxis the fame remedies have been ap- plied with equal advantage. Cold applications to the neck have been particularly ferviceable. In Haemorrhagia Uterina, whether occurring in a ftate of pregnancy or otherwife, as alfo in cafes of it fucceeding parturition, cold has been fuccefs- fully applied in a great variety of forms. Cold water has been fuccefsfully injeaed into the uterus by Dr. Gordon of Copenhagen, in fe- veral cafes of profufe flooding. Levret introduced a bit of ice into the uterus with the fame indication, and with equal fuccefs.t In the Hemorrhoidal State of Fever, great relief has been obtained from repeated applications of cold water to the part affiled. The Spafmodic State of fever is the next in or- der, including Hooping-Cough and Tetanus. Much advantage has been derived from expofing children, labouring. under the convulfions which fometimes * Firft Lines, Sett. 728. + Vide Aitken's Elements, Vol. ift, p. 259, 263. ( 39 ) fometimes accompany the fmall-pox and hoop- ing-cough, to a flream of cold air. For tetanus, the affufion of cold water is ef- teemed by Dr. Mofeley by far the moft efficacious remedy: he recommends that the patient fhould either be immerfed for fome minutes in a tub of cold water every two hours ; or that he fhould be placed upon the floor, and from two to eight or ten pails-full of the coldeft water be fuddenly poured upon him. In the Weft-Indies, where this is unhappily a difeafe of frequent occurrence, this remedy obtains almoft univerfally. A Dutch praaitioner in the ifland of Nevis, cured one pa- tient by laying him in wet fheets; but was obliged, for fear of the ill confequences attending a deviation from eftablifhed cuftoms, to relinquifh this mode of treating the difeafe. * I do not however imagine that cold water exerts any fpecific influence in the cure of this difeafe; but that all the good effeas refulting from its ufe, may be attributed to its debilitating powers, by which it takes down morbid excitement. The wrapping the patient in fheets kept conftantly wet, would appear, therefore, to be the moft eligible and the moft effeaual mode of the application of cold. The laft ftate of fever which I fhall here notice, is the Cutaneous, or Mifplaced Fever. Under this head, Dr. Rufh includes Leprofy, the Nettle- Rafh, and the Prickly Heat. Thefe mifplaced ftates of fever require the remedies adapted to the primary difeafe. In the prickly heat, Dr. Mofe- ley * Medical Commentaries, Vol. 2, p. 112, Amer. edit. Mofeley on Tropical Difeafes, p. 493 and feq. Cullen's Firft Lines, Sect. 1280. ( 40 ) ley recommends that cold-bathing or cold appli- cation fhould be cantioufly avoided, for fear of repelling it.* This fear is perhaps equally ground- lefs with that which was long entertained of re- pelling the fmall-pox. Dr. Wade on the con- trary affures us, that the cold-bath may be ufed with the greateft fafety, in the prickly heat, and other cutaneous eruptions, t Some faas of the operation of cold, which could not conveniently be claffed under any of the foregoing heads, remain yet to be treat- ed of. Tiffot relates two remarkable inftanceS of the good effeas of the cold bath, in cafes of Infolation, or as it is commonly termed, a Stroke of the Sun. The firft is, of a man, who, having been for a long time expofed to the fcorching rays of the fun, became highly delirious, though without fever, and proved really mad. After repealed bleeding, he was thrown into a cold- bath. This was frequently repeated, and cold water at the fame time poured upon his head. By this mode of treatment, he recovered, though very gradually. The fecond is the cafe of an officer, who having rode poll for feveral days fucceffively, in very hot weather, fwooned away immedi- ately upon difmounting at the end of his journey; nor, could he be recovered by the ufual applications in fuch cafes. He was cured however at laft, in confequence of being plunged into a bath of freezing water. It fhould, * Tropical Difeafes, p. 20. t Medical Commentaries for 1793 p. 2P3. '( 4t ) fhould, however, be obferved, fays our au- thor, that the cold-bath fhould never be ad- miniftered in thefe cafes, without previous bleeding. * In Tympanites, a difeafe, the cure of which has been reckoned among the defiderata of the healing art, Dr. Cullen obferves, that " cold drink has been conftantly prefcribed, and cold-bathing has been employed with ad- Vantage; and there have been feveral inftances of the difeafe being fuddenly and entirely cured, by the repeated application of fnow to the lower belly."t A curious and anomalous cafe of violent and diftreffing head-ach, which was cured by drink- ing cold water, may perhaps be properly men- tioned in this place. An officer in the fervice of the Duke of Wirtemberg, had been for fome time affliaed with fo fevere a head-ach, that he had even fubmitted to the operation of the trepan in hopes of relief, though with- out effea. In this ftate he was advifed to make ufe of a remedy very lirnple in its na- ture, but which was afferted to be infallible, provided the patient perfevered in its daily ufe. It con filled in drinking fix quarts of fpring-water daily for three months. Although he had little faith in the remedy, he fo foon perceived a mitigation of his complaint, that he perfifted in the ufe of it, and within the time prefcribed, was relieved from a dif- order, which for eighteen months had baffled g every * Advice to the People, p. 257. + Firft Lines, Seft. 1642. ( 4* ) every medicine, and deprived him of every enjoyment. No particular regimen was en- joined, except that excefs in eating or drink- ing fhould be cautioufly avoided. At the period when the hiftory of this cafe was related, the patient had been free from eve- Ty fymptom of the difeafe for nearly three years.* All the beneficial effeas of cold enumerated in the preceding pages, depend upon its judi- cious application. I have attempted to fhew that fudden applications of it may prove highly injurious, if the patient be afterwards expofed to heat. Moderate degrees of it, long and conftantly applied, with a cautious avoiding of heat, are the moft likely to prove efficacious. The utility of cold applications in partial inflammation from mechanical violence, burns, &c. need not be infilled upon here. From what has been already obferved of the gene- ral effeas of cold in inflammatory action, their propriety will be fufficiently apparent. A more minute confideration of thefe effeas would lead me to the hiftory of the extenfive ufe of cold in fome furgical cafes, which, if purfued, would extend this Effay to too great a length. Here, therefore, I fhall conclude this very imperfea fketch of the Effeas of Cold upon the Human Body. Of its defeas I am fully confcious; but from the anxiety which I fhould otherwife * Medical Commentaries, Amer. edit. Vol. 8, pag« 499- C 43 ) otherwife feel upon this account, I am much relieved by the recolleaion of the candour of that body, to whofe infpeaion it is to be fubmitted. FINIS. MedL.Hiit. WZ nil c-i uW