m UNITED STATES OF AMERICA ^ . . FOUNDED 1836 WASHINGTON, D. C, Bl9574 V__________3S^ ^^^ Mfc^L' oJAyi^lj A VIEW />\ plication for the Cure of Difeafes of Indired Debiliufx > -""i"\<^ >?V ' , ^i * ) AND /. (.V,, ^- LV ?> I A DISSERTATIO ^\\" \ /qJ, ON THE SOURCE OF [ ^-J \ ^ ^^L> / DISEASES; v^Ji^^ IN WHICH IS ATTEMPTED TO PROVE, BY A NUmVrTTUS INDUCTION OF FACTS, THAT THEY NEVER ARISE FROM CONTAGION, BUT ARE ALWAYS PRODUCED BY CERTAIN STATES, OR CERTAIN VICISSITUDES OF THE ATMOSPHERE* By CHARLES MACLEAN, of Calcutta. WHITEHALL: Printed by WILLIAM YOUNG, Bookseller, No. 52, Second-street, corner of chesnut-street, 1797. A VIEW OF THE SCIENCE-LIFE; ON THE PRINCIPLES ESTABLISHED ELEMENTS °* MEDICINE, OF THE LATE CELEBRATED ^OHN BROWN, M. D. -WITH AN ATTEMPT TO CORRECT SOME IMPORTANT ERRORS OF THAT WORK J AND CASES IN ILLUSTRATION, CHIEFLY SELECTED FROM THE RECORDS 0? THEIR PRACTICE, AT THE GENERAL HOSPITAL, AT CALCUTTA. BY WILLIAM TATES & CHARLES MACLEAN. " "I'here are fome modern Praclioners, who declaim againft: " medical Theory, in general, not confidering, that to think " is to theorife ; and that nO one can diredx a Method of (i Cure to a Perfon labouring under Difeafe, without think- « ing,—that is without theorifing ; and happy, therefore, " is the Patient, whofe Phyfician pofleffes the bed Theory." Darwin's zoonomia.—preface, p. 2. PBilaDeipina: 1797. c~ ADVERTISEMENT. JTlE who abandons Principles in Deference to po- pular clamour, and he who perfeveres in Error in fpight of Convidion, may indeed obtain a momentary Celebrity; but they are equally unqualified for the Promotion of Science. As Truth, not an indifcriminate AJJertion of any Dodrine, is the Objed of this Publication, Mem- bers of the Profejion, and others who may be fo in- clined, are invited to communicate Fads, or Obfer- vations, whether they may tend to confirm, or refute the Principles which it avows. The Communications thus received, will be pub- lifhed, with Comments, with or without the Name of the Author, as may be mofl agreeable to himfelf. Papers on this fubjed, addrejfed to Mr. Mac- lean, to Mejfirs Thomson fcf Ferris, Printers, Calcutta, or the Publifher, Philadelphia, will be at- tended to. -* PREFACE. JTlAVING applied to practice, in the General Hofpital, at Calcutta, thofe medical Principles, vulgarly known by the Name of the Brunonian Doctrine ; and being convinced, from the Refult, of their Conformity to truth ; we think it may be ufeful to attempt to promulgate the Doctrine in India, where it feems to be almoft wholly unknown, and to call forth the Attention of medical Men, to a Subjeft fo worthy of In- veftigation. Some Cafes are annexed, in illuftration of the Mode, in which, according to our Ideas, the Principles of the Doftrine mould be applied to practice. To thofe who cannot be acquainted with the Circumilances, it may be proper to explain, why two Names appear to this Publication. Having carried on our Pradice together, in the General B PREFACE, Hofpital, at Calcutta, and having by Chance difcovered, that each of us entertained a De- fign of Attempting to promulgate the Doarine of Brown, with fome modifications, in India ; we thought it might be more conducive to the End in View, to confider the Subjeft conjointly.—The Refult is now fubmitted to the Public. William Yates. Charles Maclean. I N D E Page. CASE of dyfentery, of high degree, cured by opium, in which falivation was produced by the me- dicine. - 54 >---- Dyfentery cured by mercury and opium, - 60 ■ Dyfentery, terminating fatally, in which fali- vation was not produced, after having ufed an immenfe quantity of mercury, - 64 ----- Incipient confumption, cured by opium, pro- ducing a flight degree of falivation, - 69 .---- Contufion and Concuflion, of uncommon degree, cured, not only without blood-letting, or other evacuations, but by the application of ftimulant powers, yr ■----■ Typhus, cui-ed by calomel, &c. given fo as not to produce evacuations, - - 77 —— Intermittent, cured, by mercury ; fhewing that falivation arifes from indiredi debility, and is to be cured by ftimulant powers, - 82 —— Anomalous, in its fymptoms, occurring in a pa- tient of plethoric habit, with a peculiar flotv- nefs of pulfe, cured by opium and mercury, 87 96 108 li INDEX. Pagf. CASE, Peripneumony, in an advanced ftage, treated unfuccefsfully with mercury ; in which un- common adhefions, &c. of the thoracic yi fcera were found upon diffe£lion, go _________ Hepatitis, treated unfuccefsfully with opium, mercury, and other ftimulant po;ver., with a defcription of the appearances upon diffec tion, - - _____ Dyfentery, treated unfuccefsfully, with a de- fcription of the appeari rices upon differ Jon, IOO _____ Dyfentery of high degree, treated fuccefs fully, ,____ Fever, &c. in which a great quantity of mer- cury was ufed, fhewing that falivation ariles from the fubdu&ion, or irregular application of that medicine. - - "6 ____ Fever cured by mercury, &c. in farther illuf- tration of the mode of applying that medicine, according to principle, - - 121 CONTAGION, not the caufe of peftilential difeafes, 33 DEBILITY, direft,—difeafes of, - - 33 36 ,___________Cure of, - - - 36 „______,----- Indirect,—difeafes of, - 37 42 _______..____-Proportion of, to difeafes of direct dibility, 37 42 ___________. Difeafes of warm climates, without ex- ception, of this ftate - 37 _----------Cure of, - - 37 40 DISEASES, definition of, - - 30 _______---- In what refpecis they differ, - 30 ,_______-----Two cannot poffibly co-exift in the whole or any part of a living body, »\ _____-----Principles of cure, - ' 31 ___________Suppofed to have arifen from exceffive excitement, depend upon a ftate of ex- hauftion, or indirect debility, 42 INDEX. Hi Page. EXCITABILITY, what, .... 2g ------------------Accumulation of, - 30 ------------------Middle or healthy ftate of, 30 ------------------Exhauftion of, - - 30 EXCITEMENT what, - - - 31 ■ -------Exceffive does not exift, - 46 EXHAUSTION, incrcafed by the abftra&ion of ftimuli, 42 INFLAMMATION, always depends on a ftate of de- bility, direct or indirect, - 48 " ------Cure of, depends on the applicati- on of ftimulant powers, - 51 LOCAL DISEASES, - - - 48 -------Depend upon accumulation or exhauftion of the excitability, - - - - 48 MEDICINES, called cathartics are ftimulant, - 46 POISONS, effeds of, .... 32 PURGING, arifes from indired debility, - 46 STIMULI, divifion of into ordinary and extraordinary, 32 STIMULANT, or exciting powers, what, - 29 ——-----------Powers applied to a body in a ftate of accumulation will produce exhauftion, 44 ERRATA. Introduction, page 23d, line 13th, forfenttments read, Ditto 2 2d, ioreffea, road affecl. Page 24th, line 15th, for molis, read moles. INTRODUCTION. i_J PON examining the records of medicine, from the earliefl: periods, it appears that phy- licians have never confidered the living body as fubjeft, like all other parts of the univerfe, to regular and immutable laws; but feem actually to have drawn an oppofite conclufion. It is from this circumftance principally, that the practice of medicine has hitherto acquired fo fmall a portion of certainty, as ftillto merit the appellation bellowed upon it, more than two thoufand years ago, of a " conjectural art." The various doctrines which have been pub- lifhed to the world, regarding the human body, are in general, nothing more than a mere af- femblage of words, without the power of con- veying any diftinct ideas. *Hypothefis has fuc- * As truth is but one, and the hypothefis, which may be formed upon any given fubject, infinite ; fo the chance of any hypothefis being true, is as one is to an infinite number ; or the certainty of its being erroneous> abfolute. Every juft deduction o£ reafoning, is properly called theory. But thefe terms are, to the great detriment of fcience, very generally confounded. € i8 INTRODUCTION. ceeded hypothefis, in the fame regular manner, that phyfician has fucceeded phyfician. Opi- nions have been adopted, according to the chances of education; fupported by the au- thority of great names ; and religioufly adhered to, as fundamental axioms, into the truth of which it would have been herefy to enquire. The mifchiefs arifing from this fource, " greatly extend their influence, and fpread in " every poflible direction, when error acquires " the patronage of authority, and the protection " of dignified names. It then takes its chair " in the fchools, and affumes the pompous " titles of profound, refined, or liberal know- u ledge. Raifed to this eminence, the induf- " try of a fingle teacher, or author, may cor- " rupt thoufands ; that of a few, whole na- " tions; and the addition of a proportional " number, ruin the education of a world. " This univerfal diffufion of error, receives tc fanction and eftablifhment from the progrefs " of time. It becomes venerable : and every " attempt to detect it, is branded with the name " of profanity or madnefs."* Such has, un- happily, been too long the ftate of fcience. * Vide Introduction to the Outlines, &c. by John Brown, p. n. INTRODUCTION. I g But, of late years, every department of human knowledge has undergone a rapid improvement. The dawn of reafon has, in a particular degree, begun to enlighten the medical world ; and the practice to aflume a confiflency, which could only be founded on the difcovery of the laws, by which all living bodies are governed. This difcovery, one of the grandeft efforts of the human mind, that ever dignified the page of fcience, the difcoveries of the immortal Newton himfelf not excepted, is contained in the Elements of Medicine, of the late celebrated John Brown. This difcovery, hitherto neg- lected from ignorance, oppofed from the fhame of recantation, and calumniated from intereft, prejudice, and paffion, contains fo many unde- . niable truths that, to an unbiaffed mind, it only requires to be known, in order to be admired and adopted. The doctrine, although it has not yet been fanctioned by the medical fchools of Britain, has, however, been very generally re- ceived, in the other fchools of Europe, and in America. fl In the Univerflty of Pavia," fays Dr. Rafori, " undoubtedly one of the firft in " Europe, there is hardly a ftudent endowed " with talents, who is not a Brunonian. The " doctrine begins equally to fpread in Ger- " many. Many of the periodical publications u of that country have noticed it, and the Ele- 20 INTRODUCTION. " menta have lately been publifhed there. A " friend at Genoa affures me, that feveral fur- " geons to French men of war have informed <" him, that Brown is known and much admired «' in France. In the Univerfity of Pavia, " Brown is in high efteem, even with fome of " the mod refpeftable profeffors ; and in other " parts of Italy, I can aflert, from my own " knowledge, that old phyficians have not refuf- " ed their fanction to many of the Brunonian •" principles."* One of his Italian critics, fuppofed to be Profe^for Carminati, fays, " Quaerenti mihi " caufas incredibilis propeillius commotionis ani- " morum, atque ingentis fere plaufus, quibus " nuperime fingularis ilia hypothefis, cui novum " Univerfas Medicinas Syftema celebrifmus An- " glice Scriptor et Medicus Bruno fuperftruxit, " ab iis optimae fpei adolefcentibus excepta eflet, " qui inflorentiflimoTicinenfi Archigymnafio fa- u lutaris artis fludiis omnibus mecum incumbunt., " peraduum fane, non fuit eas **** invenire. Many tranflations and editions of this work and various criticifms upon it, have appeared in different parts of Europe, which it is by no means necefiary to enumerate here. That * Vide Beddoes' Life of Brown, SHTRODUCTlotf; IT <£heknowledge of it has alfo made a considerable progrefs, among the medical philofophers of America, is evident, from the frequent allufions made to it, in a late publication, by Dr. Rufh, of Philadelphia. " The principle of the gradu- " al application of ftimuli to the body, in all " the difeafes of indirect debility on the one " hand, and of direct on the other, opens a " wide field for the improvement of medicine. " Perhaps all the difcoveries of future ages, will " confifl more in a new application of eftablifh- " ed principle, and in new modes of exhibiting " old medicine, than in the difcoveries of new " theories, or of new articles of the Materia * Medica."* Another proof of the excellence of the doc- trine, no lefs convincing, is deducible from the frequent plagiarifms of its fundamental princi- ples, by which fome men, defirous of pafling them upon the world as their own difcoveries, have lately endeavoured to eftablifh a reputation for fuperior genius. Any attempt to detect thefe, in their various and moft infinite ramifi- cations, would, as Dr. Beddoes f very juftly re- * Vide " An Account of the bilious remitting yellow Fe- ver,'"—page 284. f It would be injuftice, upon this occafioti, to pafs over without a tribute of applaufe, the laudable exertions of Dr. 22 INTRODUCTION. marks, be now unneceffary. Among the molt confpicuou0, however, in this lift, we may par- ticularife Doctor Gritanner.— There is not a fingle idea in any of the papers, which he has publifhed upon that fubject, that is not borrow- ed from the Doctrine of Brown, or the different modifications of it, difcuffed in the Medical So- ciety of Edinburgh, and recorded upon its books. Thefe he has freely ufed, without the fmalleft acknowledgment. His doctrine, of the principle of irritability, is taken from a paper, written by a refpectable member of that Society. Dr. G. was a ftudent at Edinburgh, long af- ter the publication of the Elementa Medicina ; and at a time, when the principles of the doc- trine, were the fubje£t of investigation, in the literary Societies of that Univerfity. His plagia- rifms mud therefore have been wilful ; and no acknowledgment, fubfequent to detection, can Beddoes, in promulgating the knowledge of Brown 's dodrine, He is perhaps the only author in Britain, who has dared pub- lickly to affert the merits of it. This ingenious conduft, and the liberal manner in which he ftepped forward, to benefit the unfortunate family of our illuftrious philofopher,* equally evince his fuperior mind, and univerfal philanthropy. * Vide a new edition of the Elements of Medicine, of John Brown, M. D. with a biographical Preface by Thomas Bed- docs, M. D. INTRODUCTION. 23 be confidered as an atonement. There is fome- thing fo flagitious in the attempt to rob departed genius of its honours—honours too, in the ac- quifition of which friendfliips, emolument, and eafe, were all facrificed,—that it cannot be too feverely reprobated. It is a common and often a true obfervation, that" no man is a prophet in his own country." Accordingly, it appears, that this doctrine was longer neglected, and is flill more anxioufly op- pofed in Britain, than in other nations. Few men at an advanced period of life, have fufficient courage to relinquifh fentiments to which they have been habituated, from their early years ; fewer ftill have candour enough to acknowledge the truth of what they have ftrenuoufly oppofed ; and young men, although generally open to con- viction, feldom have fufficient confidence in them- felves, to item the torrent of general opinion. The rifing generation, however, in order to adopt the new doctrine, will not have many facrifices to make. It will neither effect their intereft, nor wound their vanity. That the force of truth already begins to fi- lence the unmeaning clamour, which has hither- to been made againfl this doctrine in Baitain, is evinced, by the reception of a late volumi- nous publication, of which the chief merit con- -4'4 INTRODUC'TrONv fifts in, an occafional and imperfect: coincidence- with the principles of Brown. It will readily be perceived, that we allude to the Zoonomia of Dr. Darwin,—a work which, from the excel- lent character and reputed talents of its author, had raifed confiderable expectation in the public mind. But difappointment, on the perufal, was in proportion to the previous expectation. In- flead of important and luminous corrections of the doctrine, which might have been looked for, at this time of day, from a man of abili- ties, purfuing the fame tract of inveftigation, a want of argument and correct reafoning, is found to pervade the whole. It is fuch a rudis indigejia- que molis that, after wading through nearly fix hundred pages,* it feems impoffible to compre- hend the fcientinc principles, upon which the author intended to build his doctrine. From thefe ftrictures, it ought not to be inferred, that we wifli to detract from the merits of the excel- lent poet, who has fo elegantly fung the " Loves of the Plants." But juitice forbids that, out of refpedt to character or reputation, one man fhould be allowed to affume to himfelf, any por- tion of that honour, which exclufively belongs to another. Science knows no perfonal diftinc- * At the time this was written, the firft volume only, of Darwin's Zoonomia, appeared in India. INTRODUCTION. 25 tions. The author of a grand difcovery, is, at Ieaft, entitled to poflhumous fame. The origin of this, like every other difcovery of importance, has been attempted to be traced to hints thrown out by preceding authors. E< ven the vifionary fpeculations of Cullen, havj been mentioned, as the fource, of fome of its fundamental principles .-—with juft as much pro- priety might they he imputed to any ingenious fuggeftion in " The life and Opinions of Trif- tram Shandy." Upon the whole, it may with confidence be afferted, that this doctrine is, in all its parts, original, as it is undoubted true, and important in its application. And thofe, who are difpofed to deny it this merit, fhould, in decency, adduce fomething like argu- ment, inftead of the ebullitions of vanity, de- traction, or jealoufy. After this eulogy, the reader may perhaps expect, that the following pages contain a mere verbal copy of Brown's Elements of Medicine ; but he will foon perceive, that this is not the cafe. For, although its fundamental principles are in- difputably true, there are feveral errors in the detail, and fome of them of very configurable importance. His opponents, however, if truth had been their object, fhouid have endeavoured to perfect the doctrine, by a correction of its errors, inftead of illiberally aiiccting, on ac- 26 introduction. count of partial blemifhes, to reject the whole. To the candid, liberal, and enlightened, it will appear much lefs wonderful, that Brown fhould have fome times erred, than that he fhould have been fo pre-eminently fuccefsful, in firft pointing out, to the world, the right path of medical in- veftigation. The principal deviations, from the original doctrine, to be found in the following " View " of the Science of Life," are thefe : i ft.—It is demonftrated, that difeafes of excef- five excitement cannot exifl; and that all thofe, which have been fo called, are difeafes of in- direct debility. 2dly.—Almost the whole of the difeafes, which were ranked, by Brown, and his follow- ers, among the difeafes of direct debility, are fhewn to be difeafes of indirect debility. 3dly.—In the mode of applying the exciting powers, for the cure of difeafes of indirect debi- debility. From this ftatement, it appears, that the al- terations, here made in the doctrine, as they affect the method of cure, in more than one half of the difeafes, to which living bodies are fubject, are of the firft importance ; and there- fore deferve a candid examination. itroduction. 27 It may be proper to remark, that fome per- fons have affected to reject this doctrine, upon the very grave and folemn ground, of its being favourable to intemperance. To thofe however, who will take the trouble of making themfelves acquainted with its principles, it will only be neceffary to obferve, that fuch perfons do not underffand the fubjedt. In climates and countries where the tranfition, from health to difeafe, and from difeafe to death, is often alarmingly rapid, and health always pre- carious, the knowledge of a doctrine, which re- duces the practice of medicine to a degree of cer- tainty hitherto unknown, cannot but be attend- ed with great and evident advantages. To dif- fufe that knowledge in India, where the doctrine feems to have been but little cultivated, and to have acquired but a fmall degree of reputation fo juftly due to it, is the defign of this undertak- ing. The attempt is made with the greater con- fidence, from having experienced, in the appli- cation of the principles to practice, a degree of fuccefs, far beyond even the moft fanguine expec- tations, that had previoufly been formed in theory. If, however, this confidence fhould not, after a fair inveftigation, be juftified by the experience of others, the fubject remains open for free dif- 2§ INTRODUCTION. cuflion, by which alone the dodrine muft, final- ly, be either confirmed, or refuted. As it is, for obvious reafons, defireable, that a knowledge of medical fcience, fnould not be ex- clufively confined to medical men, we have en- tirely diverted our obfervations of the myfterious garb, in which fuch knowledge is ufually con- veyed to the world. VIEW OF THE SCIENCE o* LIFE. CHAPTER I. FUNDAMENTAL PROPOSITIONS. !• —x~Vll living bodies poffefs a certain proper- ty, capable of being acted upon by external pow- ers, fo as to produce the phcenomena of life. This property is denominated excitability.* II.—The external powers are all fuch objects as, applied to the whole, or a part of any living- body, are capable of acting upon the excitabili- ty- They are denominated stimuli, or exciting powers. HI.—Upon the application of the exciting pow- * Some recent modifiers of this dodtrine, are of opinion, that the exciting powers z£t upon the mufcular fibre only; and therefore ufe the term irritability. But as the powers which produce, as well as thofe which remove difeafe, evident- ly affect the whole body, we think it fafer to retain the more comprchenfive term, adopted by the original author. 30 VIEW OF THE ers in a due, deficient, or exceflive degree, depend the different ftates of the excitability. IV.—Upon the different ftates of the excita- bility depend all the phcenomena of health, and difeafe. , V.—There are three ftates of the excitabi- lity. ift.—The ftate of accumulation.----- When a portion of the ufual ftimuli is withheld, the excitability accumulates ; and the body be- comes fufceptible of impreflion, in the direct ratio of the fubduction. This ftate conftitutes difeafes of accumu- lation, or ©f DIRECT DEBILITY. 2dly.—The middle ftate. When the exci- tability is fuch, that the application of the accuf- tomed degree of exciting powers, produces tone, or health. 3dly.—The ftate of exhaustion. When the application of ftimuli, has been greater than that which produces healthy action, the excita- bility is exhaufted ; and the body becomes lefs fufceptible of impreflion, in the direct ratio of the accefs. This ftate conftitutes difeafes of exhaustion, or of indirect debility. SCIENCE OF LIFE. 3 I VI.—The ftates of accumulation, and exhauf- tion of the excitability, in their different degrees, conftitute all the difeafes, to which living bodies are fubject. VII.—Diseases differ from 'each other, only in the degree of accumulation, or exhauftion of the excitability in the whole, or parts of the body. VIII.—Consequently, as two degrees of the fame ftate, or two different ftates of the excitabi- lity, cannot take place at the fame time, in the whole, or any particular part of the body, two difeafes cannot poflibly co-exift, in the whole, or a particular part. IX.—The cure of all difeafes depend upon an application of ftimuli, in a degree proportionate to the accumulation, or exhauftion of the exci- tability. X.—The degree of power, with which the fun£tions of life are performed, is expreffed by the term excitement. Thus, there is a heal- thy excitement, when the functions of life are juftly performed. But in proportion as a deviati- on from health takes place either in direct or indirect debility, fo the functions of life are per- formed with lefs power, or the excitement is di- minifhed. 32 VIEW of the CHAPTER II. OF STIMULI, OR THE EXCITING POWERS. XI.—All objects in nature, capable of pro- ducing an effect upon living bodies, are ftimu- lant, (n.) XII.—Stimuli, may be divided into ordinary, and extraordinary. ift.—Ordinary ftimuli, are all fuch powers as are ufually applied to living bodies, in a ftate of health. 2dly.—Extraordinary ftimuli, are fuch as are occafionally applied to living bodies', as noxi- ous, or may be ufed, as curative powers. Of this defcription are all the active fubftances that are or may be employed as medicines, whether animal, vegetable, or mineral. Substances ufually called poisons, as their deleterious operation depends wholly upon their fuperior degree of ftimulant power, ought not to be diftinctly confidered. Any ftimulant, when ex- hibited in fufficient quantity to exhauft the exci- tability, acts as a poifon. SCIENCE OF LIFE. 3 Contagion has been enumerated as a caufe of peftilential difeafes. But as the exiftence of fuch a power is by no means proved, it ought not to be admitted in philofophieal difquifitions. 1 The grounds of diffent, from an opinion fo uni- verfally received, will be fully explained in ano- ther place. CHAPTER III. APPLICATION OF STIMULI, OPv THE EXCITING POWERS, FOR THE CURE OF DISEASES. 1. Difeafes of dire d Debility, or of Accumulation. XIII. As the body becomes fufceptible of im- preflion, in the direct ratio of fubduction of fti- muli (v. 1.), it follows that the force of ftimu- lus to be applied, in the cure of difeafes, of this ftate, fhould be inverfely as the accumulation of the excitability. Thus in the cafe of perfons who have been expofed to great degrees of cold, heat fhould be applied, firft in a degree not much greater than the lowefl temperature, to which the perfon has been expofed, and gradually increafed to the ufual ftandard. To frozen limbs, the E 34 VIEW OF THE firft application fhould be fnow, then cold wa- ter, afterwards water lefs cold, and fo on, through the various degrees, until motion and fenfation are fully reftored. Whereas, by the immediate application of the accuftomed degree of heat, death would be produced in the whole, or thofe parts of the body, which had been expofed.—■ To perfons who may have remained long without food, nourifhment fhould be exhibited in the fame gradual manner. The quantity ufually ta- ken at a meal would, in fuch a cafe, inftantly extinguifh life,—a fact of which there are many inftances upon record. The eyes of perfons, who have been long* kept in darknefs, become exceedingly fenfible to the fmalleft degree of light. Thofe unfortunate beings, whom the mif- taken and perverfe policy of man has doomed to long confinement in dungeons, become, in the courfe of time, capable of diftinguifhing all the corners of their gloomy abode ; where, upon their firft entrance, they could diftinguifh nothing. The impreflion of the full glare of a meridian light, upon organs in fuch a ftate of fufceptibility, would occafion inftant and irreco- verable blindnefs. A perfon, fuddenly awoke in the night, can fcarcely bear even the fmall de. gree of light, emitted from a common candle. It is only by the gradual approach of day, that the eye is enabled to bear the full force of the mid-day fun. science of Life. 35 Scurvy feems to be a difeafe of direct debili- ty, occafioned by the abfence of fome of the ufual exciting powers, particularly nutritive food, heat, and the mental ftimuli. Thefe powers muff begradually applied, inorder to re-produce health. Upon this principle it is, that vegitables andvegi- table acids, as being lefs ftimulant than frefh ani- malfood, are found fo ufeful in the cure of fcurvy. An immediate indulgence inthelatter, after a long abftinence, would produce dangerous confequen- ces. In advanced ftages of this difeafe, a very finall quantity of ftimulus, fuch as aglafs of ardent fpi- rits, oraftrong mental impulfe, hasbeenfrequent- ly known to extinguifli life. That diminution of heat has a fhare inthe produ&ionof fcurvy, is evi- dent from its more frequent occurrence in cold, than in hot climates. And that the abfence of the mental ftimuli, is often a fource of this difeafe, is obvious from this,—that every circumftance that can occur, during a long voyage, calculated to roufe the mind to moderate exertion, will pro- ducean alleviation of the fymptoms;—the fight of an enemy—the fight of land—approach to the de- ftined port—the anticipation of the pleafures of the fhore, &c. This is farther corroborated by the frequency of fcurvy among the enflaved Afri- cans, in their paffage to the Weft Indies, where all the mental ftimuli are as completely abflract- ed, as can be fuppofed to happen in almoft any _\6 VIEW OF the poffible fituation. . The difeafe in this cafe affects the men, more than the women and children. The reafon is evident. With men, the tranfiti- on from liberty to flavery, is greater than with women and children, accuftomed, in their mofl free ftate, to look up to them as their fuperiors. The minds of the latter too, from being lefs ex- ercifed, are the lefs capable of reflection, and become more eafily reconciled to their new fitua- tion ; which is alfo rendered lefs irkfome, by the indulgence ufually granted to them, even on board of fliips, employed in the vile traffic of flaves. The abfence of thofe objects, which were wont to excite pleafurable fenfation in the mind, pro- duce difeafes of this ftate.—Such is the defpond- ence of a lover, in the abfence of the object be- loved : and that melancholy, with which fome perfons are affected, when abfent from their na- tive country. XIV.-—As the fituations, in which the ordi- nary ftimuli can be with-held, in any confidera- ble degree, are rare, the difeafes of this ftate are consequently few in number ; and feldom be- come objects of medical treatment. XV.—In all of them, the cure confifts in a gradual re-application of thofe exciting powers, SCIENCE OF LIFE. 37 the abstraction of which occafioned the difeafe ; or, in fituations where that is impracticable, by a fimilar application of other powers equivalent in force. i.-Difeafes ofindired Debility, or of Exhauftion. XVI.—As the body becomes lefs fufceptible of impreflion, in the direct ratio of the exceffive application of ftimuli (v. iiij, it follows that the force of ftimulus to be applied, in the cure of difeafes of this ftate, fhould be directly as the exhauftion of the excitability. XVII.—As all difeafes arife, either from accu- mulation or exhauftion of the excitability, (vi.) and as the difeafes of accumulation have been fhewn to be extremely few (xiv), difeafes of in- direct will probably be to thofe of direct debility, in fome fuch proportion, as nine hundred and ninety nine to one. The difeafes of warm cli- mates may be confidered, without exception, as difeafes of exhauftion, or of indirect debility. XVIII.—As the higheft excitement is the greateft degree of health, it is evident that, in difeafe, health is to be reproduced, by the ap- plication of fuch a degree of ftimulant power, as is calculated to fupport the higheft ftate of ex- citement, of which the body, at the time, is 38 VIEW OF THE capable. Let the middle ftate of the excitability for inftance, be reprefented by 20, and the appro- priate degree of ftimulus, producing healthy ex- citement, by 20 alfo (vide Table) ; let the dimi- nifhing orincreafingfum of ftimulus, in propor- tion to the accumulation or exhauftion of the ex- citability, be reprefented by numbers, as in the annexed table. If the excitability is exhaufted to 10, thefumof ftimulus to be applied, in or- der to produce the greateft excitement, which the ftate of the body will allow, will be as 30. Every degree of ftimulus, beyond that, will exhauft the body ftill farther, and every degree, below if, will retard the cure. Thus 35 degrees of ftimu- lus will be too much, 25 too little. XIX.—As the production of the healthy ftate is always gradual and progreffive, and is effected by the powers of life ; it follows that, in proportion to the degree, in which thefe powers can be maintained, the cure will be accelerated. There is no other mode of fupporting them, but by an application of ftimuli, proportionate to the fufceptibility of impreflion. XX.—As the fum of the powers, producing; difeafe, cannot poffibly be afcertained, the degree of ftimulus to be applied, for the reproduction of health, muft be entirely regulated by obfervation SCIENCE OF LIFE. 39 of the effects, arifing from the application of me- dicines. XXI.—As the varieties of difeafes that occur, from the higheft degree of accumulation, to the loweft degree of exhauftion, of excitability ; fo is the variety, in the degree of ftimulus, neceffary to be applied, for the cure. XXII.—This variety is of very great extent. The ufual mode, therefore, of prefcribing certain fixed dofes of medicines, in every difeafe, what- ever may be the degree of it, is and muft be nugatory and inefficacious ; excepting when thefe dofes happen, by mere chance, to correfpond with the ftate of excitability.—In afcertaining thefe degrees, and proportioning the ftimuli, confift the judgment of the phyfician. XXIII.—If, for example, opium, sether, vo- latile alkali, the preparations of mercury, wine, bark, &c. exhibited in the ufual dofes, do not produce effects, which indicate an approximation to health,—fuch as a diminution of frequency,* and an increafe of ftrength, in the pulfe, a cool- nefs of the fkin, moifture of the tongue, refrefh- ing fleep, and the other familiar figns of increaf- * There is fometimes a peculiar flownefs, which is equal- ly a fign of debility, with a quicknefs of pulfe. Vide Cafe feth. 40 VIEW OF THE ing excitement,—it is evident that the dofes are infufficient, and fhould be increafed, until thefe effects are produced. XXIV.—The dofes fhould be repeated in fuch a manner, as to maintain the higheft degree of excitement, of which the body, at the time is capable. But in proportion as the excitability accumulates, or the body approaches to the ftate of health, the dofes fhould be gradually and pro- portionally diminifhed, until at length, health being eftablifhed, nothing more than the action of the ordinary exciting powers is required. XXV.—All the difeafes enumerated by Brown, as difeafes of accumulation or direct debi- lity, with perhaps the fingle exception of fcur- vy, are difeafes of exhauftion. Typhus, Inter- mittents, Dyfentery, and fome other difeafes, as they appear to be occafioned by expofure to cold, and moifture, a deficiency of nutriment and of other ftimuli, have been ranked, by him, in the clafs of difeafes of accumulation. But as the fum of the powers, which are concerned in the pro- duftion of any particular difeafe, cannot be afcer- tained, the nature of it can only be determined by the effects of the ftimulant powers, applied for the cure. And, as the cure of thefe difeafes de- pends upon the application of the molt powerful ftimuli, it neceffarily follows that, they are difeaf- es of indirect debility. SCIENCE OF LlfE. 41 This error feems to have arifen from an opi- nion, that upon the abftraction of ftimuli from (or in the the words of Brown, the application of directly debilitating powers to) a body in a ftate of exhauftion, the irritability would accu- mulate ; or that direct would be fuperinduced on ^direct debility. But this opinion is evidently erroneous. If from a perfon labouring under plague, malagnant fever, or gangrenous fore throat, all the ufual remedies are with-held, and only cold water given, no accumulation of the excitability will take place ; but on the contrary, the exhauftion will rapidly proceed, to the ex- tinction of life. If a perfon, previoufly exhauf- ted by expofure to exceflive heat, drinks large- ly of, or plunges himfelf into cold water, the exhauftion will not be removed ; but on the contrary, thofe greater degrees of it produced, conftituting Tetanus, Spafmsof theftomach, &c. And that thefe are all difeafes of indirect debility, the mode of cure, which confifts intheapplication of a very high degree of ftimulant power, is a fuf- ficient proof. Gout is a familiar instance in point. The ftate of body liable to this difeafe, is produc- ed by a long continued application of food and (drink, ftimulant in too high a degree. Let a gouty perfon be expofed to cold and moifture, and a paroxyfm will readily be produced. Let him fuddenly refrain from his ufual oauntity of F 42 VIEW OF THE food and drink, his ftomach or head will be af- fected ; and the moft powerful ftimuli, as iEther, Brandy, &c. will be requifite to re- lieve him. XXVI.—Hence it follows that, in difeafes of exhauftion, the irritability does not accumulate upon the abftraction of ftimuli ; but on the contrary, the ftate of exhauftion is, thereby, in- creafed. XXVII.—It follows alfo that, in the production of Typhus, Intermittents, Dyfentery, and fuch other difeafes as have appeared to arife from ex- pofure to cold, moifture, &c. and have therefore been ranked by Brown, among the difeafes of direct debility, the body muft have previoufly been in a ftate exhauftion. By a fubduction of exciting powers, from a body in fuch a ftate, the previous degree of exhauftion muft be in- creafed, and the difeafes of that ftate confequent- ly induced. XXVIII.—Most of the difeafes of exhauftion appear to be produced in this manner. CHAPTER IV. OF diseases denominated by brown, diseas- es OF excessive excitement.* XXIX.—Asthere are three ftates of the excita- bility, (v. i, 2, 3 ) fo there are three correfpond- ing ftates of excitement. * Vide Lynch's Table, prefixed to Beddoes's edition of Brown's Elements of Medicine. SCIENCE OF LIFE. 43 lit.—The ftate of diminifhed excitement, from a deficient application of ftimuli, corref- ponding with the ftate of accumulation, or di- rect debility. «. ■ 2dly.—The ftate of high excitement, from a due application of ftimuli, correfponding with the middle ftate of the excitability or health. 3 of ftimulus,producing J healthy excitement. Difeafes on, in degrees. of exhaufti their various < l9 r8 17 16 *S H l3 12 11 10 9 8 7 6 5 4 3 2 1 21 22 23 24 25 26 27 28 29 3° 3* 3* r 33 34 35 36 37 38 39 Appropriate of ftimulus. degrees o or Death.. Degrees of ftimulus to be applied, to pro- duce the greateft pof- fible excitement. C5* EXPLANATION of the TABLE. This Table is meant merely to convey a general idea of the manner, in which ftimuli fhould be increafed, or diminifh- fd, in proportion to the exhauftion, or accumulation of the excitability. It is not fuppofed, that the degree of the excitability, or the proportion of ftimulus reprefented by the figures in the table, can be afcertained in any other man- ner, than by obfervation of the effects produced by their ap- plication. The range of figures, is by no means fufficient to exprefs the various degrees of accumulation and exhaufti- on of the excitability, that can take place, between the middle ftate and death. It will however, be fufficient to give a general idea of the mode of cure, deducible from the principles laid down in the preceding pages. CASES, By Dr. TATE S. CASE I. X? rancis Lote, aged 35, was admitted into the General Hofpital, at Calcutta, on the ift of May, 1796.—At that time, he complained of general pains over his body, with all thofe fymptoms which indicate an exhaufted conftitu- tion. On the 15th of May, he came under my care. At that time I found his mouth fore, from the ufe of Mercury ; and he was much purged and griped. On the 3d of June, when I difcontinued attending him, his complaints were confiderably relieved, by the ufe of Opium. On the 21 ft of Auguft, he again came under my care, in a ftate of extreme debility, with ex- ceffive purging, and bloody ftools. During the whole of this time, he had remained in the Hof- pital ; but, from neceffary arrangements, had fallen, during intervals, under the care of other CASES, &c. 55 gentlemen. During the laft of thefe intervals, he was fo extremely weak that, in the act of vo- miting, the right clavicle was fractured, which occafioned much pain. On that and the two f ucceffive days, I gave him eighty drops of Tinc- ture of Opium, morning, and evening. On the 24th, in the morning, as no effect feemed to be produced by the medicine, it was ordered to be given three times a day. At one o'clock P. M. the fame day, I was called to him ; and found him complaining of violent pain in the bowels, with inceffant purging. He had taken the 2d draught about an hour before. The draught was ordered to be immediately repeated. At 9 P. M. he was not relieved ; upon which 150 drops of Tincture of Opium was prefcribed immediately and ordered to be repeated at 12 o'clock. A glyfter, with 200 drops of Tincture of Opium was alfo given. On the 25th he was eafier. The glyfters, with 200 drops of Tincture of Opium, were continued every three hours, and the draught, with 150 drops, was repeated in the evening. On the 26th, in the morning, he was nearly in the fame ftate ; the glyfters were continued, and the draughts ordered 3 times in the day. At 9 P. M. I found that the relief from the glyfters, was merely temporary, that he had ftools every hour, and no inclination to fleep. Four hundred drops of Tincture of Opium were 5^ CASES, &C. ordered in glyfter, every two hours, and a fourth draught of 200 drops to be taken at 12 o'clock. On the 26th he was eafier ; he had fix or feven ftools in the night, with lefs griping. Slept better than he had done, fince he came to the Hof- pital. His pulfe beat about 90 ftrokes in the minute ; previous to this his pulfe had been very quick and fmall, but the ftate of it was not particularly noted ; he had 150 drops of Tinc- ture of Opium in the morning, and 200 at 12 o'clock. Four hundred drops were ordered in glyfter, every three hours. One P. M. He had 5 ftools fince morning ; the glyfters were continued ; and a draught of 200 drops or- dered to be taken at 4 o'clock. At 8 P. M. he had 13 ftools fince the laft vifit, with a good deal of pain in his bowels. He had not flept ; was ordered a draught of four hundred drops of Tincture of Opium at ten o'clock. Auguft the 28th, he had flept a little the preceding night ; bowels were eafier ; pulfe 80 ; had draughts of 200 drops every two hours, with the glyfters occafionally. At 2 P. M. his pulfe was 90 ; he was in other refpects as before: had ta- ken three draughts. The draughts of 200 drops were repeated every hour. At 9 P. M. his pulfe was ftill 90 ; he had dofed much, but had no found fleep; he had taken 4 draughts. A draught of 400 drops was ordered to be given CASES, &C. *m at 12 o'clock. On the 29th, his pulfe was 80, and ftrong ; he had 3 ftools, with lefs pain ; but flept little ; the draughts of 200 drops were continued every hour.—2 P. M. had inceffant ftools fince morning, with violent pain of the bowels ; glyfters of 400 drops were ordered eve- ry hour. 8 P. M. had four ftools fince 2 o'clock ; had taken only one draught; his bowels were eafy after the glyfters; pulfe 112.—Eight draughts, with 200 drops each, were ordered to be placed at his bed-fide, of which he was direct- ed to take one every hour, during the night, with glyfters of 500 drops every hour, in the intervals between the draughts.—30th,had fix ftools during the night. He was free from pain, and his pulfe 80 and full ; the draughts were continued every two hours, and the glyfters occafionally. 9 o'clock P. M. he had eight or ten ftools fince morning, with fome griping ; pulfe 90. The draughts were increafed to 300 drops every two hours ; and the glyfters continued.—31ft, had paffed a good night ; his pulfe was 90 ; he had five ftools ; his medicines were continued as the day before. In the evening, he was nearly the fame ; no alteration was made in his medi- cines—September the ift, he had fix ftools during the night, with griping : did not fleep ; had no blood in his ftools ; for two days ; the draughts of three hundred drops were given every hour, and the glyfters of five hundred drops were conti- H rg CASES, &C. nued as before, and repeated according tohis own difcretion, as the tenefmus and griping might in- dicate.—8 P. M. he was much worfe ; had eight ftools during the day, and no fleep ; his pulfe was 120, and he was fo extremely weak, that I con- fidered him as approaching to diffolution. Draughts of 500 drops each, were ordered to be given every hour, and the glyfters of 500 drops, to be continued as before.—2d, he had not flept, but felt himfelf better; pulfe 104; his medicines were continued, in the fame manner during the whole of that day. On the 3d, his pulfe was 100 ; he had flept well the preceding night; his medicines were continued. On the 4th, he was much better, had dofed much, and had only two ftools ; the draughts were directed to betaken occafionally, as circumftances might indicate—This plan was continued until the 14th, at which time his mouth became fore, and the flow of faliva was increafed, as if he had been ufing mercury. The draughts and glyfters were, from that period, ordered to be repeated occafi- onally, according to his own difcretion. On the 22d, the difcharge of faliva continued in the fame ftate.—On the 26th, he was better ; and his bow- els eafy.— 29th, he continued without pain, with two or three ftools in the day, and his ftrength increafing. On the 30th, when 1 difcontinued attending him, he had only two ftools in the CASES, &c. 59 day, without pain ; and felt a returning appetite. Being a fenfible and fteady man, he was, at that time, allowed to proportion the ftrength and frequency of the draughts and glyfters according to his own judgment.—During the whole of the time that he was under my care, he had an al- lowance of wine from one to two or three bot- tles in the 24 hours, according to exigency.— From his good fenfe and punctuality, I have a perfect reliance upon his having conformed to my orders, in every particular, as far as it is poflible for patients, in an hofpital, to do. The treatment of this cafe may give fome idea of the manner in which ftimuli fhould be increafed, in difeafes of great exhauftion, until the quantity is afcertained, which is capable of producing the higheft degree of excitement. It will fhew the very great quantity of the moft powerful ftimuli that may be neceffary, in fome difeafes of that ftate, in order to effect a cure ; and is alfo an example of the mode in which the dofes ought to be repeated. The forenefs of the mouth, and the increafed flow of faliva, evince that there is a greater fimilitude between the action of opium and mercury, than has yet been acknowledged. The forenefs of the mouth and fpitting commenced, after the quan- tity of opium was diminifhed. Upon renam- ing the draughts, the mouth became lefs fore, do CASES, &C. and the flow of falava decreafed ; and upon leaving them off, the forenefs and fpitting in- creafed. This was repeatedly remarked by the patient himfelf. It fhould be obferved, in or- der to prevent a rafh imitation, where the cir- cumftances are not alike, that the tincture of opium employed; upon this occafion, was much weaker than what is ufually made in Europe ; that a very great degree of exhauftion had taken place ; and that the dofes were gradually increafed, from eight drops to five hundred. CASE II. .----De Haes, aged 40, was admitted into the General Hofpital, at Calcutta, on the evening of the 26th of Auguit, 1796, with dyfentery of eight days Handing. He had about 30 ftools in the day, containing flime, mixed with blood ; and complained of much pain in his bowels. His pulfe was 90 in the minute. At 9 o'clock P. M. he was ordered to rub in, half an ounce of Mercurial Ointment, with half a drachm of Calomel, and to take a hundred drops of Tinc- ture of Opium, to be repeated at 12 o'clock— 27th, the Ointment was omitted by neglect. He continued in the fame ftate. Half an ounce CASES, &e. 61 of Mercurial Ointment, with a drachm of Ca- lomel, was ordered to be rubbed in immediately, and repeated at 12 o'clock. A hundred drops of Tincture of Opium was defired to be given every two hours.— 1 o'clock P. M. he had ten ftools fince morning, with blood and flime. Had taken only two draughts. The Ointment was ordered to be repeated at 4 o'clock, a glyf- ter with two hundred drops of tincture of opi- um to be given every two hours, and one bot- tle of wine to be taken in the courfe of the evening—8 P. M. pulfe 100. He had fix ftools with lefs pain. The ointment was rubbed in, and glyfters were regularly adminiftered. The ointment was ordered to be again repeated at 9 o'clock, the glyfters to be continued, a draught of a hundred and fifty drops of tincture of opium to be given immediately, and to be re- peated at 12 o'clock ; and a bottle of Madeira to be given during the night.—28th, he had vo- mited feveral times during the night, but had only one ftool ; pulfe 75. The ointment was ordered to be repeated, the glyfters to be omit- ted, a draught with one hundred drops of tinc- ture of opium to be given, and the wine to be continued.—2 P. M. pulfe 72; vomited twice fince morning ; he had only two ftools, and the pain was lefs ; he flept a little. The ointment, draught, and wine were repeated.—9 P. M. pulfe 62 CASES, &C. 84, had vomited twice, and had fix ftools. He complained of virtigo; the ointment was repeated, a draught of two hundred drops of tincture of opium was ordered to be given at 1 2 o'clock, and the wine to be continued.—29th, his pulfe was 80 and full. He had ten ftools, confifting of flime and blood. The ointment and wine, were continued, and a draught, with one hun- dred drops of tincture of opium, ordered every two hours—9 P. M. his pulfe was 80, he had fix ftools, and frequent vomitting, particularly after taking the Maderia wine. The ointment was repeated, two hundred drops of tincture of ♦ opium ordered every two hours, and port wine to be given in lieu of the Madeira.—30th, pulfe 74. He had two ftools, vomited only once, and flept a little. The ointment and wine were repeated, and the draughts with two hundred drops, continued every third hour.—9 P. M. he had feveral ftools in the courfe of the day, with much pain. No return of vomiting ; pulfe 100. The ointment was repeated with two drachms of calomel. Draughts of two hundred drops each, were ordered to be continued every two hours. The port wine became difagreeabie to him, and Medeira was again given—31ft, pulfe 84 ; had only two ftools, and flept well. His mouth was a little fore. The ointment was repeated with one drachm of calomel, and the draughts CASES, &C. 61 Were continued every third hour.—9 P. M. pulfe 80, he had eight ftools. His fkin and tongue were moift, and he began to fpit a little. He had flept fome during the day. The oint- ment, draughts, and wine were continued. September the ift, pulfe j6, he had only one itool, flept well, and was better in every refpedt. The ointment was repeated, with half a drachm of calomel ; and the draughts and wine were continued.—8 P. M. continued better. He had no pains, excepting in going to ftool. The dif- charge of falava was confiderable. He had flept during the day. The ointment was omitted. A draught of two hundred drops of tincture of opium was ordered at 12 o'clock; and the wine was continued.—2d, he had only one ftool during the night ; pulfe 68 ; the ointment was repeated without the calomel; and the wine continued—8 P. M. he had flept during the day, and fpit confiderably ; the draught of two hun- dred drops was repeated at 12 o'clock, and the wine continued.—3d, he had flept well, and had no ftool ; the ointment was entirely omitted ; and the evening draught and wine were conti- nued.—From that period the wine, and draughts occafionally, were continued until the 30th of September, at which time I left him in an ad- vanced ftate of convalefcence. 64 CASES, &c. The great quantity of mercury that was ufed, in this cafe, in conjunction with opium and wine, fhew what a high degree of ftimulant power may fometimes be required to effect a cure, in the ftate of exhauftion, which confti- tutes dyfentery. CASE III. Jacob Meyer, aged 3$, was admitted into the General Hofpital, at Calcutta, on the 23d of Auguft, 1796, with pain of bowels and frequent ftools. Thefe complaints appeared at firft to be flight ; and feemed for fometime, to give way to ordinary dofes of calomel and opi- um. On the 29th he became worfe ; and the fame treatment was perfevered in, but without effect. On the ift of September, calomel and opium, of each two grains, every fecond hour, and a draught of eighty drops of tincture of opium, twice a day, were prefcribed. The fymptoms ftill increafed in force. On the 3d, he had very frequent ftools with violent pain in the bowels ; and could not bear the leaft pref- fure on the caput coli. His pulfe was 132, thirft extreme, tongue furred ; and he had no fleep. Half an ounce of mercurial ointment, Cases, &c. 65 and one drachm of calomel were rubbed in. The calomel and opium were given every hour. On the 4th his pulfe was 120, he had vomited through the night, tongue brown and furred. The ointment was rubbed in, and to be repeat- ed at 12 o'clock ; the pills of calomel and opium were continued.—9 P. M. pulfe 130 ; he had feveral ftools during the day ; tongue dry ; he thought that he fpit more than ufual, but his mouth did not feem affected ; one ounce of ointment and two drachms of calomel were rubbed in, and the pills were continued.—On the 5th his pulfe was 120, he complained of violent pain in his bowels ; the medicines were continued as the day before.—6th, his pulfe was 100 ; he complained of violent pain on preffing the arch of the colon, had frequent ftools with profufe perfpiration, and appeared to be much alarmed and dejected ; no increafe of the quan- tity of faliva; the ointment and pills were con- tinued in the fame manner.—7 P. M. his pulfe was 124 ; in other refpects as before ; he was immerfed in the warm bath, and afterwards had one ounce of ointment, with half an ounce of calomel rubbed in ; the pills were continued. —7th, pulfe 112; complaints were nearly as the day bfore. He had an eruption upon the fkin, fuch as ufually appears, when falivation cannot be produced, after having ufed a large quantity i 66 cases, Sec. of mercury. The warm bath, with the oint- ment and calomel, were repeated ; and the ca- lomel in the pills was increafed to four grains.— 8 P. M. pulfe 128, he had inceffant ftools, accompanied by violent pains of the abdomen; his tongue was brow* and furred, and fkin co- vered with profufe moifture. The bath was ordered to be repeated, and an ounce of oint- ment, with two ounces of calomel, to be rubbed in, immediately after the bath. A fcruple of colomel and fix grains of opium were ordered to be given every fecond hour—8th, pulfe 112; he had inceffant ftools, with violent pain. He felt eafe from the warm bath ; had taken five dofes of the calomel and opium. The warm bath was ordered to be repeated three times in the day, the ointment and calomel to be again rub- bed in, and the pilb to be continued.—8 P. M. pulfe 120, there was no increafe in the quantity of faliva from the mercury, he had inceffant ftools with blood, and was extremely debilitated. Had taken fix dofes of the calomel and opium in the courfe of the day. Could not bear the leaft preffure upon the colon. The warm bath was ordered to be repeated, and afterwards two ounces of ointment, with four ounces of calomel, to be rubbed in. The calomel and opium to be given every hour—9th, pulfe 112 and fmall. He had Rools innumerable. The medicines were CASE.1:, Sec. 67 continued. 9 P. M. his pulfe was almoft im- perceptible, and extremities cold. The medi- cines were continued as far as circumftances would admit. 10th at 1 o'clock, A. M. he ex- pired. The body of this patient was either not open- ed, or the appearances upon diffection were neglected to be noted down, at the time ; and were confequently forgotten. But from the analogy between this cafe and all the others, in which the mouth could not be affected, in the ufual manner, by mercury, there can fcarcely be a doubt that the colon and rectum, if not the whole of the abdominal vifcera were in a ftate of local difeafe. The cafes of diffection, def- cribed by Mr. Maclean, will explain this point more fully. Of many cafes of dyfentery, and other difeafes, that were opened by us, in which falivation could not be produced by mercury, there was not one without confirmed local difeafe of the vifcera, either of the thorax or abdomen, or both. Those, who may look upon the quantity of medicine here prefcribed as extraordinary, fhould confider, that when a patient is evidently in- curable, by the common practice, it becomes the duty of the practitioner to depart from it. 63 CASES, &c. An oppofite conduct is dictated, much more by a fly regard to reputation, than an earneft and confcientious defire of faving the lives of patients. Nothing can be more eafy than to take fhelter under cuftomary forms. CASES, By Mr. MACLEAN. CASE IV. EXTRACTED FROM THE JOURNAL OF THE ENGLISH EAST INDIA COMPANY'S SHIP NORTHUMBERLAND. Mr. ------, Cadet, aged 17,—tall, of a flender make, and confumptive habit ; June 13th, 1791, he had, fince the commencement of the voyage, in April 1791, been much indif- pofed with fea-ficknefs; for the laft ten days, had feverifh fymptoms, and for two days a diar- rhoea ; his fkin was hot and dry, tongue foul and parched, pulfe quick and fmall.—He was order- ed to take two table fpoonsful every hour of a mixture, confifting of a hundred drops of tinc- ture of opium, andTne pint of water, with an ounce of cinnamon water.—In the evening, there was a remiffion of the diarrhoea ; but it re- turned on the 14th, the mixture having been dif- 7° CASES, ScC continued in the night.* One grain of opium was ordered to betaken every hour.— 15th, after hav- ing taken five pills, his fkin became moift, his pulfe full, he fell afleep (about 8 o'clock P. M.), and continued free from diarrhoea all night. He had perfpired profufely, and his tongue and lips were lefs parched ;—having complained of thirft, he was ordered wine and water for drink.—16th, the opium having been injudicioufly difcontinu- ed on the 15th, all his fymptoms returned; his tongue was foul and parched, his pulfe quick and fmall, his fkin hot and dry ; he was confiderably purged, and had much thirft ; one grain of opi- um was ordered to be taken every hour.—On the 17th, the pills having been again imprudent- ly difcontinued in the night, he appeared rather confufed, his ftrength was much exhaufted, and his complaints remained the fame. The pills were ordered to be repeated, and continued through the night.f He was allowed mutton or * This fubdudtion was improper. In every cafe, as well as in this, it will be found detrimental. f The cofufion of head, and other bad fymptoms, which frequently follow the exhibition of opium, are, as I have uni- formly obferved, owing to the medicine not being repeated at proper intervals. la every cafe, which requires fo high a ftimu- lant power as that of opium, the exhibition of the dofes fhould be regulated by principle.—They ought to be repeated in the night as well as in the day.—3 ut the difficulty of doing this, CASES, &C. *ji chicken broth, and fago alternately, as his fan- cy directed ; and wine and water for drink.— 18th, the pills were regularly taken, day and night, excepting in the intervals of fleep ; his pulfe was flower and more full : and he was in other refpects better, but weak, his fkin was covered with a healthy moifture; he com- plained of fome forenefs of his mouth and throat; he had eat fome bifcuit, foaked in tea, for break- fait, and was ordered fago for dinner and fup- per, the pills were continued.—19th, his pulfe was ftronger, an eruption appeared on his face, fuch as often happens after taking opium or mer- cury.—He complained that his mouth was very fore, and was ordered to have a gargle ; the pills, &c. were continued as before.—20th, he was better, the pills, fago, &c. were regularly faken, and he drank plentifully of wine and wa- ter ; his thirft was diminifhed ; the pills and re- gimen were ordered to be continued as before.— 21 ft, he was ftronger, and declared himfelf in eve- ry refpect better ; the only complaints that re- mained were a forenefs of the mouth and fauces, which may arife from the ignorance or careleffnefs of practi- tioners, the prejudices or obftinacy of patients, or the negli- gence of attendants, has often occafioned bad confequences, which have been erronconfly imputed to the opium. 72 CASES, ScC. and fome fwelling of the face; the pills, &c. were continued.—22d, forenefs of the mouth and throat were troublefome ; he fpit more freely than ufual, the increafed flow of faliva fomewhat refembling that which takes place after the ufe of mercury.* He appeared in other refpects fo much better, that the pills were difcontinued.f —23d, he had flept tolerably ; but his fkin was hot, and he complained of debility. No medi- cines were prefcribed.—24th, flept ill, and was much haraffed with a cough and fpitting ; his pulfe was quick and irregular, and he was op- preffed with clammy fweats,—half a grain of opium was prefcribed every half hour, and bark in wine was given in the intervals. Regimen as before. From that period to the 27th, his me- dicines were punctually adminiftered ; his cough, fpitting, and clammy fweats were diminifhed ; his pulfe, fkin, and tongue were nearly in a heal- thy ftate ; and the diarrhoea entirely flopped.— 28th, he was ftronger, had a good appetite, and * I cannot fay, at this diftance of time, whether there was any ulceration of the gums, having omitted to notice it in the Journal. f This is the third error that was committed in the treat- ment of this cafe, in fuddenly withdrawing a ftimulus, to which the patient had been for fome time accuftomed, and before health was completely re-eftablifhed. CASES, SiC. m~ could fit up ; his medicines, kc. were continued. After this, it was thought unneceffary to make daily reports in the Journal. His medicines were continued for fome days, and gradually left off as he approached the healthy ftate. In the above cafe, the medicines were regu- larly given, either by a friend of the patient's, who took a particular intereft in his welfare, by Mr. Ridges, then furgeon's mate of the Nor- thumberland, or by myfelf.—The relapfes which always took place, upon fuddenly laying the me- dicines afide, or with-holding them even for a night, fliew the neceffity of repeating the dofes, with the utmoft regularity and care. The fore- nefs of the mouth, together with the increafed flow of faliva, after the ufe of opium, was not a peculiar circumftance. Upon that fubject, the following remark appears in my Journal :— "• In many cafes, in which opium was freely giv- <*£ en, for a length of time, a confiderable in- " creafe in the flow of faliva, was obferved to " take place, and to continue long after the me- " dicine was laid afide. But in cafes, where a " confiderable fpitting had before exifted, opium " as well as mercury had the effect of leffening " it." Thefe facts, with the explanation of them, will be confidered in another place. K CASE V. EXTRACTED FROM THE JOURNAL OF THE ENGLISH EAST INDIA COMPANY'S SHIP NORTHUMBERLAND. Ensign G—, 36th regiment, a flout healthy man, about 25 years of age, went up, in a fit of playfulnefs, to the main-top-maft-head, on the evening of the 1 oth of June, 1791. Af- ter having remained there a fhort time, he fell afleep upon the crofs-trees, and about mid-night fell down upon the quarter-deck. In the fall, he firft ftruck with his hip, as was fuppofed, againft an iron ftauncheon in the main-top, which bent; he then came upon the mizzen-ftay, which took him, as far as could be collected from the confuf- ed intelligence of fome people upon deck, about the middle of the abdomen ; and from the ftay he fell upon the quarter-deck. He was, as may well be fuppofed, entirely infenfible; much blood was difcharged from his mouth, nofe, ears, and even from his eyes ; in this ftate he was carried down to his cabbin ; upon examina- tion, no fracture was found ; the whole confe- quences of the fall feemed to confift of contufi- ons or concuffion, the marks of which were very CASES, Sec. -P general over his body. His pulfe was fmall, but regular. There happened to be in the fhip four profeffional gentlemen, befides myfelf. They all feemed of opinion, that Mr. G. fhould imme- diately lofe blood. Some of them infilled upon it, with much earneftnefs; and the by-ftanders, knowing that to be the common practice, joined in urging a compliance. I replied, that, how- ever common the practice might be, I was con- vinced of its being entirely wrong; and that I would not, even with the fanction of a majority, do what I was certain muft endanger the life of my patient. But that if any of the gentlemen prefent, chofe to take charge of Mr.—G, they might have an opportunity of bleeding him, with propriety, if convinced in their confeience that it was right; and I would give them my opinion when afked. This offer was not accepted. Mr. G. was not bled. In the courfe of two hours from the accident, he became fenfible ; was fick at flomach, and vomited. This, as a fymptom of concuffion ufually enumerated, would far- ther indicate, according to the hypothefes of the fchools, and the practice of hofpitals, copious blood-letting. That, however, did not alter my plan. I was aware indeed that, if the pati- ent died, his death would be attributed to the non-obfervance of cuftomary forms. But I was 76 casts, Sec. alfo perfuaded that, if he lived, after having been copioufly bled, it would be infpite of the blood-letting. He was my friend, as well as my patient ; and in defiance of obloquy, I deter- mined to do what appeared to me beft, in order to fave his life. Externally the moft powerful ftimulating fubftances were applied, inconcourfe or fuGceflion. For four days he could not move in bed, without excruciating pain. He had fmall opiates occafionally, wine, and nourifhing food ; and once half an ounce of fal catharticus amarus, fo as to produce one ftool. Nothing more was done. He had not an unfavourable fymptom. The pains gradually abated ; and on the eighth day, from the fall, he was carried upon deck in a chair. That there was abfolutely a confiderable de- gree of concuffion in this cafe appears, from his having wholly loft the fight of one eye, although, when the marks of contufion had difappeared from that fide of his face, the eye looked almoft as well as the other. He complained at times of headach, which was always relieved by wrapping up his head in warm cloths. The iffue of this, as well as of every other cafe of contufion or concuflion, which I have feen treated, either in or out of hofpitals, convinced CASES, &C. nj me, that blood-letting is not only unneceffary but pernicious. In private practice, 1 fear, a mean and criminal compliance with vulgar prejudice, in order to conciliate vulgar favour, too often influences practitioners, whofe better judgments would lead them to reject intirely fo deplorable a remedy :—a remedy of which the ufe is not only contrary to all principle ; but which, fo far as I know, cannot adduce a fingle uncontrovert- ible fact, in proof of its utility. CASE VI. William Holloway, aged 22, was admitted into the General Hofpital, at Calcutta, on the 3d of September, 1796, with fymptoms of typhus fever, of feveral days flanding. At bed time, he took two grains of opium, and fix grains of calomel.—4th, he had flept a little ; his tongue was parched and black ; pulfe 96 , he had two ftools on the 3d. Six grains of calomel, and fix grains of powder of jallap, were ordered to be given every four hours.—5th, in addition to his former fymptoms, he complained of cough and pain of bread. He had only one ftool, fince he began to take the powders. The powders. 78 cases, Sec. were ordered to be repeated, and a draught, with fixty drops of tincture of opium to be given at bed time.—9 o'clock, P. M. he had not yet taken the draught prefcribed for him in the morning ; the pain of his breaft was more fevere ; he had no ftool for twenty-four hours ; was ordered a glyfter with one ounce of caftor oil, and one ounce of Glauber's falts ; and afterwards to take the draught.—6th, he had no ftool from the glyft- er. His pulfe was 116 ; his tongue furred and black, and his mouth exceedingly parched ; he was a little confufed, and had a flight degree of fubfultus tendinum. Two ounces of the common infufion of fenna was ordered every hour, and a glyfter, double the ftrength of the former, every fecond hour until he fhould have a ftool or two.— 7 o'clock P. M. he had one copious ftool, after having taken feveral dofes of the infufion, and two or three glyfters. Four grains of opium and four grains of calomel were ordered to be taken at 8 o'clock, and to be repeated at 12— On the 7th, he conceived himfelf better ; pulfe 108 ; his tongue was ftill furred and fkin hot. He was allowed twelve glafles of wine in the day. Ten grains of calomel, and fifteen grains of powder of jallap, were prefcribed every four hours.—9 o'clock, P. M. his fkin was very hot, pulfe only 100 ; he had taken three of the pow- CASES, &C ~g ders, and had 3 ftools ; he complained that his tongue was fore. It was ftill furred and black in the middle. He was ordered a draught, with a hundred drops of tincture of opium, at 8 o'clock, and again at twelve.—8th, his pulfe was 100, and heat of fkin more moderate ; but his tongue remained foul ; he expreffed a wifh for porter.* A bottle of porter was allowed him ; —and the wine was continued. The powders and draughts were repeated.—9th, he remained nearly in the fame ftate ; but complained of a fevere cough. He had two ftools. All his me- dicines were continued as the day before.— 10th, he had no cough, and refted well ; his pulfe was 112; he had no ftool; two ounces of infufion of fenna were ordered to be taken every hour through the day, and the draughts to be repeated at night.—1 ith, his pulfe was 116, tongue very foul, and mouth parched ; he had flept but lit- tle ; and had no ftool fince the 9th.—A glyfter, with two ounces of caftor oil, and two ounces of Glauber's falts, was ordered to be given imme- diately, and to be repeated according to circum- ftances. The powders were given as before.— 7 o'clock, P. M. his pulfe was only 100 ; tongue * The defire for beer or porter, is a fymptom that frequently occurs, when the mouth begins to be affedled, after having ufed mercury. 80 cases, Sec. cleaner, and moift.—He had one ftool after hav- ing taken two glyfters. He remarked that he had, for the firft time, a diftinct paroxyfm of fever in the afternoon. The draughts were given as ufual.—12th, his pulfe was 92, and his fkin nearly of a healthy temperature ; his tongue remained a little furred ; he had no ftool. The glyfters, powders, and draughts, were directed to be given in the fame manner as the day before.— 13th, when I vifited him, he was found afleep, feemed eafy, and his fkin cool. The medicines were ordered to be continued.—7 o'clock P. M. his pulfe was 76 ; fkin moift and cool; he had two ftools, and was inclined to fleep. The draughts were continued.—14th, he was not (o well as the day before ; his pulfe was 96 in the morning, and 92 in the evening, and his tongue rather foul. The medicines were continued. On the 15th, his fkin, tongue, and pulfe, ap- proached nearly to the healthy ftandard. He expreffed a defire to eat, and was ordered to have chicken broth. The powders and draughts were continued. On the 16th, he had no fe- verifh fymptom, his tongue was fore at the edges, and there was an increafed flow of faliva. The powders were omitted, and the draughts conti- ed. From that period, he was convalefcent, and only took one draught occafionally at night. On CASES, &C g I the 23d, he was free from complaint, and dis- charged fro m the Hofpital.—During the whole of the time, he was allowed wine and porter, as at firft prefcribed. \This cafe is not given as an uncommon one, ither in refpect to the violence of the difeafe, or the quantity of medicines that were prescrib- ed. The hiftory of it fhews, that the fum of fti- mulant power firft applied, was inadequate to effect a cure, even in a cafe of flight difeafe ; for the fymptoms by no means approached to the feverity of typhus gravior. In every fever, what- ever be its nofological defcription, the fame plan would have been purfued, increafing or dimi- nifiling the force of the exciting powers, in pro- portion to the degree of indirect debility. If fuch a quantity, as was ufed here, be neceffary for the cure of mild typhus, what powerful fti- muli muft often be required in typhus gravior, dy- fentery, or plague ? The intervals, I think, at which the medicines were repeated, are too long. The duration of the action of each dofe of mercury or jallap is not, perhaps near fo much as four hours—pro- bably not more than one. But whatever it be, fuch is the period exactly, at which dofes ought to be repeated. 8* > cases, &c. In this, as well as in many cafes, both of dy- fentery and fever, I have given caftor oil, jallap, and other cathartics, with a view fimply to in- creafe the excitement. In fo far as they effect that, and thereby invigorate the functions of life, they are proportionally as ufeful as opium, xther, mercury, brandy, wine, or bark. But the purging I conceive to be proportionally as in- jurious a confequence, and as much a mark of in- direct debility, as the headach, ficknefs, and vom- iting, which follow an exceffive or irregular ufe of thefe fubftances. This fubject is confidered at greater length elfewhere. CASE VII. John Brown, aged 28, was admitted in- to the General Hofpital, at Calcutta, on the 10th of July, 1796, with typhus fever—He had befides a fore leg, and chancres. His fever, although apparently flight, was very obflinate. In the courfe of two months, he was feveral times almoft cured, by fmall and frequently repeated quantities of opium, mercury, wine, and bark, varied accor- ding to circumftances. But, feemingly in confe- quence of internal local affection, he as often r?- lapfed, without any apparent caufe. His fever, cases, 5cc. 83 from continued became remittent, and from re- mittent intermittent. Qn the 24th of September, fufpecling the exiftence of local difeafe, I repre- fented to him the neceffity of undergoing fuch a courfe of mercury as to affect his mouth, to which he had hitherto expreffed an infuperable averfion. He had, for fome days previoufly, taken calomel in fmall dofes; and had latterly two emetic?, at his own requeft.* On that day, he was ordered to take ten grains of calomel, and fifteen grains of jaliap every four hours.—25th, he had taken three powders in the courfe of the day, and was excef- * That tartar emetic is a ftimulant of very high power is Evident, from the fmall quantity of it, which produces the ftate of indirect debility, that occafions vomiting. It fhould be given in fuch a manner, as to increafe and to fupport the excitement. But this will be found difficult, as the duration of its a£lion feems to be even fhorter than that of opium. If its a&iori does not continue more than a quarter of an hour, might it not be repeated at fuch fhort intervals, and the dofes fo gradually reduced, as not to allow the eftablifhment of in- direct debility ? If, when given at fuch a random rate, as to produce vomiting, and the moft difagreeable fenfations that can be imagined, medicines fometimes produce good effects, how much more ufeful muft they b-V'when given according to :uft principles? 1 he prejudices of patiernts may fometimes be turned to their advantage, by judicioufly alternating ftimuli, fo as to humour their whims. The medical prejudices of the vulgar, are generally dictated by thofe of phyfscians. At pre- fent they are as unreafonably in favour of tartar emetic, as they are againlt opium. 54 cases, Sec. fively purged and griped through the nightf. He had no fever. Two grains of opium, and four grains of calomel were directed to be taken every three hours, through the day, and four grains of each at bed time.—26th, the fame plan was con- tinued ; and he had no return of fever.—27th, he had no fever, and his mouth was very fore. The pills were ordered to be given every fix hours.— 28th, his head, face, tongue and throat, were much fwelled ; he had a confiderable difcharge of blood from the mouth and fauces, and fome purging. In this cafe, the medicines were by no means cor- rectly exhibited. But it is probable alfo, that they were not regularly taken. Salivation, or, in cafes of local difeafe, where falivation cannot be produced, a difcharge of blood frbm the mouth and fauces, does not take place, while the mercu- ry is regularly taken, but when it is either fudden- ly laid afide, or given at improper intervals.* The f This is one of many fad\s that prove purging to be the effect of a ftate of indirect debility, occafioned by the impro- per fubdudion of ftimulant powers. Had the powders been regularly repeated in the night, the purging and griping would not have taken place. This I have obferved fo repeatedly with refpect to calomel, that I have no hefitation in afferting it to be an undoubted fact. * Vide the fubfequent cafes, and the " Treatife on Mercu- ry." cases, Sec. 85 following mixture was prefcribed—tincture of o- pium three hundred drops—water one pint—pep- permint-water and fugar, as much as will make the mixture agreeable—an ounce of it to be taken every hour. The pills were omitted. On the 29th and 30th, he continued the mixture ; his mouth was better ; he had no fever, and but little purging ; and his pulfe was 86.—Oftober the ift, his pulfe was j6, and of good ftrength ; his mouth was much better ; and he had no return of fever. The tincture of opium was diminifhed to two hun- dred drops.—From that period, he recovered ftrength, and had no return of fever. The mix- ture was gradually decreafed in ftrength and dif- continued. On the 16th of October, he was dif- charged, apparently well. There are feveral inferences to be drawn from this cafe. The obftinacy of the fever convinced me, that it depended upon local difeafe, and de- termined me to give mercury in large dofes. The difcharge of blood from the mouth and fauces, without a previous increafed flow of faliva, was an additional proof of the exiftence of internal local affection. And, altho' this patient left the Hof- pital apparently well, I am convinced, from the circumftances mentioned, as well as from an ir- regularity of his bowels, that his abdominal vif- cera were in a difeafed ftate, and that his exemp- \ *6 CASES, Sec tion from general difeafe was merely temporary. From thefe obfervations, I would not be under- ftood to infer, thar. mercury acts as a fpecific in re- moving local difeafe ; but that, by fupporting the exeitement of the whole body, it invigorates each particular part, and thus occafions, to a certain extent, the regeneration of thofe organs, which may have been injured by difeafe. This is not the only inftance, in which the good effects of opium have been experienced, where an exceffive falivation, or a difcharge of blood from the fauces, after the ufe of mercury, had taken place. As thefe fymptoms happen from too fudden a fubduction, or an irregular re- petition of the mercury ; fo they may be either obviated or removed, by a proper application of the fame power.' But as the prejudices of pa- tients will feldom admit of a continuance of the medicine, in thefe cafes, it is abfolutely necef- fary to fubftitute fome other ftimulantpower, equiv- alent in force. Thofe which I have found to an- fwer belt, are opium blifters, and the warm bath. Other ftimuli, juftly proportioned, might no doubt anfwer equally well. But from the end- lefs hypothefes of the art, no fuccefsful attempts have yet been made to afcertain their relative powers. This is a difcovery, which, however diftant, I am yet fanguine enough to expect. CASES, &C. 87 For, in the medical as in the moral world, at- tachment to principles inftead of perfons, may be expected to increafe, with the progrefs of knowledge. CASE. VIII, Henry Dollawal, aged 26, was admitted into the General Hofpital, on the even- ing of the 22d of October, 1796. He had, for a fortnight before, complained of headach, pain of loins, hoarfenefs, and cough, &c. pulfe 58. He was ordered to take two grains of opium and four grains of calomel, at 9 o'clock, P. M. and again at twelve.—on the 23d, he was fomewhat eafier. Pulfe as before. He had no ftool. One grain of opium and three grains of calomel, were given every three hours ; and feveral glyfters of caftor oil.—9 o'clock P. M. he had one flooL The opium and calomel were defired to be re- peated as the night before. Pulfe 64.—24th, he thought himfelf better ; but his cough continued fevere. Pulfe 56. He was defired to take four grains of colomel every three hours.—9 o'clock P. M. he was not fenfible that the pills produced any effect. Four grains of opium and ten grains of calomel were ordered to be taken immediate- 88 cases, Sec. ly, and repeated at 12 o'clock.—25th, he was feized in the morning with violent fpafms. Pulfe 64. He was put into the warm bath, which was ordered to be repeated according to circumftan- ces. Afterwards, two grains of opium and four grains of calomel were directed to be taken eve- ry two hours, day and night.—26th, he was much better, and had no cough. The pills were continued.—27th, he thought himfelf better. His pulfe beat only 44 ftrokes in the minute. The pills were repeated every three hours.— 28th, his mouth was gently affected. Two grains of opium and two grains of calomel were given every three hours.—29th, he was in every refpect better, had fome flight fpitting, and felt a returning appetite. Pulfe 68.—One grain of opium and one grain of calomel were given eve- ry four hours.—On the 30th, he was difcharged well. An uncommonly flufhed countenance, and what is called a plethoric habit, together with an unufual flownefs of pulfe, hoarfenefs, cough, and pains, would' have indicated, according to the common practice, blood-letting and other evacu- ations, in this cafe. The powers, however, by which acure was effected, proved,that thefe fymp- toms depended upon a ftate of indirect debili- ty ; and that the ufe of debilitating powers, would have been improper. For the fame rea- cases, &c. 89 fort, it may be inferred, that a peculiar flownefs, as well as a quicknefs of the pulfe, fometimes takes place in a ftate of indirect debility. Every departure of the pulfe from the healthy ftandard, whether in quicknefs or flownefs, depends upon debility ; as well as every deviation from health, in any of the other functions. Coflivenefs, as well as purging, depends upon debility of the in- teftinal canal. This is fhewn from patients affect- ed with the fame difeafe having, in fome cafes a quicknefs, in others, a flownefs of pulfe ; in fome cafes purging, in others coftivenefs ; and all of them being cured by the fame mean:.. It is farther corroborated by the proof, that fuch a ftate as that of exceffive excitement, cannot rake place. As blood-letting is the abftraction of a high ftimulant power, it muft be fhewn that difeafes of evceffive excrement exift, before it can be admitted as a remedy. Or if it be con- tended that blood-letting is ufeful in difeafes of debility, it muit be fhewn that it a£ts as a ftimu- lant power. Mere affertions that it has been found ufeful, do not amount to a fufficient refuta- tion of this reafoning. There was an error of fome importance in the treatment of this cafe, which affords the moft convincing proof of the neceflity of repeating the dofes of medicines, at certain regular inter- vals, and by a certain rule.—On the morning of the 25th,—after having taken four grains of M $0 cases, Sec opium and ten grains of calomel, at nine and at twelve o'clock, the preceding night, the pati- ent was feized with violent griping and fpafms. This fymptom, as I have had frequent opportu- nities of obferving, was undoubtedly owing to the dofes not having been repeated at proper inter- vals. If a dofe of equal ftrength, or one fomewhat fmaller, had been given at three, and another flill fmaller, at fix o'clock in the morn- ing, the ftate of indirect debility, conftituting fpafm, would not have taken place. As thefe fymptoms may be occafioned, or prevented, at pleafure, the fact is incontrovertible. In this cafe, they immediately yielded to the ftimulant power of the warm bath,—another proof that they arofe from a ftate of indirect debility, oc- cafioned bv a deficient frequency or force, in the application of ftimulant powers. Opium, calo- mel, camphor, aether, or caftor oil, given in juft proportions, would have produced the fame effect with the warm bath. But external appli- cations may often, with great advantage and con- venience/, be alternated, or conjoined, with in- ternal remedies. CASE IX. Robert Williamson, aged 25, was admitted into the General Hofpital, at Calcutta, cases, Sec. pi, 't on the 28th of October, with a quick and fmall,/ pulfe, laborious breathing, pain of back, loins, &c. His face was turgid ; and his eyes red and flarting. His tongue was foul and furred. He reported that he was attacked with fever, feven or eight days before, which had become more fevere and continued for the laft two days. Some medicines had been taken before he came into the Hofpital.—At 3 o'clock P. M. when I firft faw him, ten grains of calomel were order- ed to be taken every three hours. At 10 P. M. his pulfe was 112, and his breathing exceeding- ly laborious. A fcruple of calomel was ordered to be given immediately, and to be repeated at one o'clock, A. M. A blifter was applied to his fternum. On the 29th of October, his pulfe was 120, with burning heat of fkin. His tongue felt like a rough board. He had one fmall ftool in the morning. Ten grains of calomel were or- dered to be repeated every three hours.—At 9 o'clock P. M. his pulfe was 124. He had one ftool* ; his breathing was laborious, his eyes * In this cafe the medicine feemed to produce but a very fma'.l effect. If to fupply the wafte of the excitability be the proper function of the lungs, it is evident that, after a cer- tain degree of organic lefion has taken place, it cannot be re- cruited. But ftimuli are not therefore to be withheld. For, by fuch a treatment, the excitability muft be ftill farther exhaust- ed. 9- CA6ES, &C. ftarting, and he feemed in all other refpects worfe. Three grains of opium and twelve grains of calomel were defired to be given immediately, and repeated at twelve o'clock. October the 30th, he died at 4 o'clock, A. M. Upon diffection, the thoracic vifcera were found adhering to each other, in fuch a manner as to form but one mafs. The lungs adhered to the pleuras, mediaftinum, and diaphragm ; the heart to the pericardium ; and the pericardium to all the furrounding parts. The adhefions were remarkably ftrong as well as general. The lungs were of a darker blue than ufual. Upon a gene- ral view of the abdominial vifcera, they appear- ed to be found. The fcrotum was gangrenous. In one of the arms, there was the mark of a re- cent incifion, made by a lancet, This was undoubtedly a cafe of the moft vio- lent peripneumony. According to the common practice, the patient would have been repeatedly bled. Would the abftraction of blood have pro- duced a refolution of the adhefions, which were found in the thorax ? The greateft partizan of the practice, I think, would fcarcely affirm it. According to the confufed notions entertained of peripneumony being a difeafe of exceffive ex- citement, it becomes neceffary, in order to pre- ferve fome appearance of confiftency, to divide cases, &c. 93 the difeafe into different ftages ; and to ufe a different or even an oppofite plan of treatment, in each. Is it poffible that any difeafe can vary in its progrefs, excepting in degree ? And if not, ought the powers applied for the cure to be varied, in the progrefs of any difeafe, except- ing in their degree of force ? Thefe would ap- pear to be the conclufions of reafon and com- mon fenfe. But to overturn fuch flimfy ar- guments, come in medical hypothefes and fay " inflammation wefuppofe arifes from an increaf- " ed impetus of the blood in the part affected, " and is therefore to be cured by diminishing " the quantity of that blood. In peripneumo- «' ny, there is an inflammation of the lungs ; and *' in order to cure the difeafe, the impetus of " the blood in the lungs muft be leffened by " blood-letting." To this curious fabric of " reafoning, I will juft oppofe a fingie fact.— There is not an inflammation, with which we are acquainted, that is not to be cured (as far as it is curable) by the application of ftimulant pow- ers,—as warm fomentations, tincture of opium, tincture of cantharides, camphorated fpirits, aether, volatile alkali, and mercury. If any per- fon ferioufly doubts the fact, it will be an eafy matter ro fubmit it to the teft of experiment;— And if there be any other reafon, for perfever- ing in the practice of blood-letting, than be- caafe it is derived from the hypothefes of the 94 cases, Sec. fchools, and is conformable to cuftom, let it be produced. That blood-letting had been ufed, in this cafe, previous to the patient's having been fent into the hofpital, appears probable from the jncifion in the arm :—-that he was purged is known. As catharticks, however, produce an increafed degree of excitement, before the debili- tating operation of purging fucceeds, their ftimu- lant effects will often more than counterbalance the indirectly debilitating effects, which after- wards arife. But as blood-letting is a directly debilitating operation,— the abftraction of an or- dinary and powerful ftimulus,—it muft always be highly injurious. In difeafes of direct debility, as far as they can become fubjects of medical treat- ment, it muft add to the accumulation ; in thofe tf indirect deb ility, it muft increafe the exhaufti- on (*). It is upon the fuppofition alone that fome difeafes depend upon a ftate of exceffive excite- ment, that blood-letting can ever be thought admillible. And that fuch a ftate does not exift has, in my opinion been fully proved. I know it will be urged, by individuals, that they have found blood-letting ufeful. But this, like many other medical facts, is mere affertion, not proof. Whatever has been ufeful in one cafe, muft be ufeful in every fimilar cafe of dif- eafe. But it is not fo with blood-letting.—It * Vide, « View of the Science of Life," Prop. XXVI. cases, &c. p- has not invariably been found ufeful in any one difeafe. We may therefore, I think, fairly con- clude, that it has never been ufeful in any one cafe of difeafe. If it be laid that this is reafon- ing, and that experience ; let me be permit- ted to afk whether juft reafoning and real experi- ence can ever differ ? It is impoffible.—Whate- ver is true in theory, muft be right in practice. To inculcate a contrary opinion is the grand fhield of empiricifm. Circumftances delivered as facts, from theprefumed experience of indivi- duals, ought never to weigh againft principles, which are deduced from numerous and undoubt- ed facts, and which can be put to the teft of ex- periment by all mankind. The quantity of calomel given here was large. But after taking two fcruples at two dofes, and allowing time for the operation of purging from indirect debility to take place, only one fcanty ftool was produced. This fhews clearly, thai., although the quantity was large, in proportion to what is ufually given, it was by no means fufficiently large in proportion to the exhauftion of excitability that had taken place ; or, in other words, to the violence^of the difeafe. Altho' k be extremely doubtful whether the excitability can ever be accumulated to the healthy ftar.darJ, by any decree of ftimulant power, when fo many t)6 cases, &c. principal organs have become unable to perform their functions ; yet it is certain that, in order to give a patient, in fuch cirumftances, the only chance of cure, the ftimuli fhould be increafed in power, until they produce fome effect. In this cafe, therefore, the medicines fhould have been both increafed in quantity, and more frequently repeated. But as, in every kind of practice, the prejudices of patients, or carelefsnefs of attend- ants, will frequently render it impoffible ftrictly to adhere to the application of principles, we can only make fuch an approach to them, as thefe, and other circumftances, will permit. Had it not been my wifh to bring the theory and practice of this doctrine to the fulleft and fair- eft proof of difcuffion and experiment, this is one of thofe cafes which I would have fuppreff- ed. It is to be regretted that writers do not oft- ener think it neceffary to publifh their unfuccefs- ful, as well as their fuccefsful cafes. CASE X. Robert Woodside, aged 25, was admit- ted into the General Hofpital, at Calcutta, on the 24th of October, with a dyfentery of a fortnights '■T. Cases, Sec. 97 Handing. He had 10 or 12 ftools in the day, with blood; and complained much of headach, pain of loins, griping, and tenefmus. He lay ea- fieft on his right fide. His pulfe was 108 : and he had frequently a flufh in both cheeks. I be- gan by giving him fmall dofes of calomel, fre- quently repeated; frictions of mercurial oint- ment; and draughts of 70 or 80 drops of tinc- ture of opium, repeated according to circumftan- ces, through the night. In the courfe of a few days, the calomel was increafed to fix grains, with two grains of opium, every two hours ; an ounce and a half of ointment was rubbed in at four times, in the courfe of the day ; and draughts, with two hundred drops of tincture of opium * in each, were given, every fecond hour, during the night. The calomel was occafionally alter- nated with camphor, and the tincture of opium with asther. Blifters were applied, and glyfters of caftor oil frequently given. Thefe applications were made in concourfe or fucceffion; and increaf- ed or diminifhed in ftrength, according to the judgment formed of the ftate of the excitement, at the time. For a fortnight he feemed to get bet- * Some cafe* of dyfentery will require much more than this quantity. It is to be recollected however, that the laudanum was weaker, perhaps one third, than what is commonly ufed in Europe. N 98 CASES, cCC. ter; at one time, the purging rather decreafed, and he had no blood in his ftools. But from his mouth not being affected, fo as to produce an in- creafed flow of faliva, after having ufed an uncom- mon quantity of mercury ; from frequent ficknefs and vomiting ; his always lying on the right fide; fome degree of fillinefs and anxiety ; an occafion- al flufh of the cheeks ; and his having no appear- ance of getting better upon the whole; I conclud- ed, although there was no apparant enlargement, that his liver was difeafed.* The medicines, how- ever, were continued, with a view of fupporting the excitement, with as much equality as poffible. He continued nearly in the fame ftate as at fir ft de- scribed, until the 14th of November, when his pulfe (which had varied throughout from 64 to 108, with intermiffions occafionally) increafed in frequency to 120. His tongue became very dry and gloffy. On the 15th, together with his other fymptoms, he had a fevere hiccup, and intermif- fion of the pulfe after every 7th or 8th beat. On the 16th the hiccup was fevere and inceffant; his pulfe 116, and intermittent; he had no power in his extremities—and at ten o'clock P. M. he died. * By difeafe of the liver is meant, that ftate in which it is incapable of performing its functions, whether itconfiftin in- flammation, fuppmation, induration, enlargement, Sec. cases, Sec. 95 In tedious illnefs, patients naturally get dif- gufted with their medicines in the courfe of fome weeks, or their attendants become negligent. Although both thefe circumftances happened, in fome degree, in this cafe, the directions were upon the whole obferved with much punctuality. From the beginning a cure was not expected. For*in every fimilar cafe, of between twenty and thirty that were opened by myfelf, and fome by Dr. Yates, the appearances of local difeafe were fo much alike, that I can now almoft venture to pronounce, from the fymptoms, in what ftate the vifcera will be found, upon diffection.. In this cafe, I was fo certain the liver was difeafed, that it was mentioned in the daily report fome time before his death. Upon diffection, there were found feveral abfceffes in both lobes of the liver, communicating with each other, and con- taining, in all, about one pound of matter, of a thick confiftence and white colour. On the upper furface, there were five or fix ulcers, com- municating with the abfceffes. The edge of the right lobe, a part of the colon in contact with it, and part of the diaphragm, at its origin from the cartilages of the ninth and tenth ribs, were all fphacelated. The inteftines, omentum, &c. were adhering throughout. Are flufhed cheeks a fymptom common to perfons, whofe vifcera are difeafed, whether of IO^ cases, Sec. the thorax or abdomen ? I have frequently ob- fervedit in both. CASE XI. Thomas Kellan, aged 28, was-ad- mitted into the General Hofpital, at Calcutta, on the 2d of October, 1796, with dyfentery of five weeks Handing, accompanied by pain in the region of the liver. He had the ufual fymptoms of griping, tenefmus, and a difcharge of blood ; generally lay either upon his right fide, or in a fitting pofition ; in the latter of which he found moft eafe. He was frequently fick, and vomit- ed. His tongue was white and furred ; and his pulfe 104. Four grains of calomel, and one grain of opium were given every hour. One ounce of mercurial ointment, and half an ounce of calomel were rubbed in. On the 4th, he was eafier, and had flept well. His tongue and pulfe remained as before. The ointment was ordered to be rub- bed in, morning and evening, and the pills to be contiuued* ; he was allowed' eight glaffes of * In the commencement of this cafe, two rru'ftakes were made : one in not giving draughts at night, and the other in not rubbing the ointment at fhorter intervals. CASES, &c. IGI wine in the twenty four hours*.—Eight o'clock P. M. he had flept much during the day ; pulfe 120; he was in other refpedts much as before.— 5th, his pulfe was 120, and he complained of weaknefs. He had fix or feven ftools, without blood ; and was much inclined to dofe. He complained of confiderable pain, and burning fenfations, in the region of the liver. A blifter was ordered to be applied; and two grains of opium, with eight grains of calomel, to be given every hour. He was allowed twenty glaffes of wine in the twenty four hours.—6th, he had tak- en ten dofes of the opium and calomel. Was much vomited and purged, and had fome degree of fever during the night j- ; but was then bet- ter. Pulfe 108. The pain in the region of the liver was fomewhat relieved. A pill of one grain of opium and four of calomel was ordered to be taken every hour ; a draught with one hun- dred and fifty drops of tincture of opium, to be given at eight o'clock P. M.; and to be repeated at twelve. The ointment was continued.—7th, he flept well, and had only two ftools. Had taken feven pills, and the draughts ; pulfe ico. ■- ----------- - ■■■'■■' ..........* * This quantity was by far too little. In a cafe like this, a wine glafsful every hour, would not have been too much. f In confequence of the irregular exhibition of the pills. This frequently happens, when pills are given in the day, and difcontinued at night; or where draughts are not given at night, in lieu of them. 102 CASES, &C. The pills, ointment, and draughts, were conti- nued.—8th, he was confiderably better ; had five or fix ftools. He had taken eleven pills, and the draughts. The pills, ointment, and the draughts reduced to 100 drops, were continued* —9th, he had taken ten pills, and one draught ; had fome ftools yefterday, but none laft night. Pulfe 100 : no ficknefs. The medicines were continued.— 10th, having begun to get indiffer. ent about taking his medicines, they were varied, in order to humour him. Inftead of the pills, a mixture confifting of half an ounce of tincture of opium, and one pint of water, was given, in divided portions, in the day. This was again alternated with pills. Blifters were repeatedly, applied, and the draughts were continued ; but the pain and burning fenfations over all his ab- domen ficknefs and vomiting ; frequency of ftools with blood ; fmallnefs of the pulfe, &c. feemed to be rather increafing. On the 14th, the tincture of opium in the mixture was increaf- ed to an ounce and a half, to one pound of wa- ter, of which he was ordered to take an ounce every half hour ; the ointment was omitted, and the draughts continued. On the 15th, he faid that he had been eafier the day before ; but, hav- ing become irregular in taking his draughts, he was frequently purged and griped at night. From that period till the 23d, the opium and calomel, from two to four grains of the one, and CASES, &C. 10^ from fix to ten grains of the other, were alter- nated with the mixture ; the ointment was rub- bed occafionally ; and the draughts, with from 60 to 100 drops of tincture of opium were giv- en at night, or 3 or 4 grains of opium, which- ever he feemed inclined to prefer. From the 23d of October, to the 18th of November, he appeared to be fo much better, that, although confident of the exiftence of much internal local difeafe, I was not without hopes, that it was of fuch a degree as to admit of a reproduction of parts. His pulfe varied from 80 to 96. The dofes of medicines were confiderably diminifhed. Camphor, four grains every two hours, was al- ternated occafionally with the calomel and opi- um. Glyfters, with one ounce of caftor oil, were fometimes given every hour, or every two hours ; and two pounds of decoction of bark, with an ounce of powder, was given in the day. The ointment, and calomel pills were gradually di- minifhed, to two drachms of the former, four times in the day ; and two grains of the latter, every two hours. His ficknefs and vomiting Mill recurred. The burning fenfations of the abdomen continued. And he was fenfible of a feverifh exacerbation every third day.—Nov. the 17th, the pills were omitted, and the other medicines continued.— 18th, he had not taken any of his medicines the day before. Complain- 1C4 cases, S:c. ed of the offendve fmell of his breath. This was evidently occafioned by leaving off the medi- cines. Being tired of all thofe to which he had been accuftomed, I thought it might be of ufe to try the effects of hepar fulphuris, to remove the offenfive fmell of his breath, and prefcribed one drachm three times a day. The other me- dicines (viz. decoaion of bark, glyfters, and draughts) were at the fame time, defired to be continued.—20th, he had frequent ficknefs, and vomiting ; much purging, and great thirft. No appetite ; and a fenfe of burning heat in his ftomach and inteftines. Common flowers of ful- phur had been given, inftead of the hepor ful- phuris. They were defired to be omitted. Two pounds of decoftion of bark, with half an ounce of aether, was given, in the courfe of the day ; and the draughts were repeated.—22d, his fymp- toms continued as before. There was an evi- dent enlargement of the right lobe of the liver ; but no perceptible undulation. From that pe- riod, he had two pounds of decoction of bark, with two hundred drops of tincture of opium, in the day ; the draughts occafionally at night; calomel, caftor oil, and other medicines were alfo given, and alternated, fo as to prevent, as much as poffible, his being difgufted with a fame- nefs of treatment. But the fymptoms were ra- ther increafing in violence. 1 he purging became cases, Sic. Ioh more fevere, with blood in his ftools; ficknefs and vomiting more frequent ; he complained much of heart-burn ; and had fometimes feverifh paroxyfms, which feemed to be of a quartan type. There was, from the beginning, a flufh in both cheeks, like thofe of a confumptive perfon. He complained of infenfibility of the back, and weaknefs of the extremities. From all thefe cir- cumftances, and from no increafed flow of faliva having been produced by the mercury, I conclud- ed that there was fuch a degree of local difeafe, as to render the cafe incurable, by any treatment that was poffible, in fuch a fituation, to be pur- fued. It was, however, perfifted in, with as much regularity as was practicable. He conti- nued gradually finking, until the 2d of December, when he died. Upon diffection, the left lung was found ad- hering ftrongly to all the neighbouring parts. Its fubftance was unufually dry, hard, and yel- low ; and appeared as if it had not, for fome time, tranfmitted blood, or performed its proper functions The liver weighed about five pounds*, was confiderably indurated, but had undergone no fuppuration. The other abdominal vifcera were adhering, in fuch a manner as to form but one mafs; with the exception of the fpleen, which * The average weight of a found liver, I behtve, may he about three pounds and an half, or perhaps fomewl at more. 106 casks, &c. had a found appearance.—The ccecum, colon,_ and rectum, were ulcerated throughout their whole extent. The ulcers were, in many places, an inch in diameter ; and had penetrated the two inner coats. It is fomewhat remarkable that, in between thirty and forty cafes of dyfentery which I have feen opened, there was not, in a fingle in- ftance, any of the fcybala mentioned by authors, as a fymptom of that difeafe. The uncommon quantity of mercury that was here ufed, without being followed by any affecti- on of the mouth, was a fufficient proof that there exifted alefion of organs, which, if curable, re- quired the application of flill higher powers than thofe that were employed. Even in external lo- cal affections, it is now well known, that a cure depends more upon the fupport of the general ex- citement, than upon local applications. The cure then, of internal local difeafe, were it even poffible to apply local remedies, muft ftill be per- formed by the application of powers, calculated to fupport the general excitement. We have yet, perhaps, no adequate idea of the degree of power, that may fometimes be re- quired, to produce this effect. But it is very certain that, while in fome cafes by far too little, in others by far too much of ftimulant power is applied. Mercury, for inftance, in cafes of dy- fentery, is generally ufed in too fmall proporti- cases, &c. to? ons, while in venereal cafes, it is by much too freely given. Half a grain of calomel, or lefs, given every two or three hours, will in a fhort time effect a cure in ordinary cafes of chancre, gonorrhoea, or even a certain degree of fyphilis. In thefe cafes, there is feldom. any great degree of organic lefion, at leaft of thofe organs which are moft effential to life. It is only when fome of the primary organs are in a ftate of local dif- eafe, that a great and long continued application, of high ftimulant powers, becomes neceffary, in order to re-produce health. Of this, dyfentery is one of the moft familiar and fatal examples. The diminution of the medicines that was made at one period, upon the profpedt of the pa- tient being better, was injudicious. Although, in fuch a cafe, no plan would probably have fuc- ceeded, a perfeverance in the regular application of high exciting powers, would have given him one chance of recovery. The offenfive ftate of his breath, of which he complained on the 18th of November, was evi- dently occafioned by the fubduclion of the medi- cines. This is a fymptom of indirect debility, as well as falivation, purging, fweat, or any other effect of an irregular application, or fudden fub- duction, of mercury. That thefe effects are fo frequently produced, by the ordinary mode of ex- 108 ' cases, Sec. hibiting that medicine, ought not to furprife us. It is alfo obvious that if, when given at random, this and other medicines of high ftimulant pow- er fo frequently produce good effects, their falu- tary effects, when applied according to juft prin- ciples, may be expected to furpafs any thing, of which we can yet form an idea. CASE XII. John Cluff, aged 30, was admitted into the General Hofpital, at Calcutta, on the 18th of November, 1796, with a dyfentery of fome days ftanding. He had inceffant calls to ftool, paffed blood, with fevere griping, tenef- mus, and prolapfus ani. His thirft was intenfe ; and he feemed in dreadful agony, from lancinat- ing pains. Six grains of opium, and eight grains of calomel, were ordered to be given every hour ; a glyfter, with three ounces of caftor oil, and three ounces of warm water every hour ; and half an ounce of mercurial ointment to be rub- bed in, four times in the day. A bottle of Ma- deira, in two quarts of barley water, was pre- fcribed for drink. At twelve o'clock, A. M. he had taken two of the pills, and feemed eafier. cases, Sec. IOo In confequence of a confutation,the pills were or- dered to be omitted, and two ounces of the follow- ing mixture to be given every half hour ;—viz. Sal. Cathart. Amar. ten drachms, Crem. Tart. two drachms, Tart. Emetic two grains, water one pint. A draught, with one hundred drops of tincture of opium, was ordered at eight o'clock, and another at twelve. November the 19th, after having taken the mixture, he was both vo- mited and purged. Thefe operations continued occafionally during the night, and were not en- tirely flopped by the draughts. His pulfe was 92, tongue foul, and thirft intenfe ; he complain- ed of great pain acrofs the umbilical region ; and paffed blood in his ftools. The mixture was ordered to be repeated; the ointment and glyfters to be continued ; warm fomentations to be ufed; and three draughts, with one hundred and fifty drops of tincture of opium in each, were ordered to be given at night, at intervals of three hours. No- vember the 20th, he was much better. His tongue, however, was foul. The glyfters did not feem to produce much effect. The mix- ture, ointment and draughts were ordered to be repeated ; and the glyfters to be difconti- nued.—21 ft, having, on the evening of the 19th, taken his three draughts at once, in the courfe of yefterday, he became rather confufed; and was diffuaded, by oneof his comrades, from tak- II* CASES, &c. ing the draughts the night before as prefcribed. He appeared much confufed ; but the purging was lefs fevere. The mixture, ointment, and draughts, with one hundred drops in each, were defired to be repeated. 22d, he was again dif- fuaded, with the beft intentions however, from taking his draughts ; in confequence of which his confufion increafed, and he ran about the ward, in a ftate of confiderable derangement, all night. I reprefented to his friend, who had with-held the medicines through kindnefs, the danger of perfevering in fuch conduct; and en- treated that he would exhibit the dofes exactly as they were prefcribed, which he afterwards punctually did. But in order to enfure a com- pliance, I thought it beft occafionally to vary the remedies, and to ufe fuch as fhould fall in with the prejudices of the patient and his friend. Accordingly one drachm of jallap was immedi- ately given. The warm bath was defired to be ufed three times a day ; and after the bath, two drachms of mercurial ointment to be rub- bed in each time.—When the operation of purg- ing fhould commence, after the exhibition of the jallap, a pill, confifting of four grains of opium, and fix of calomel, was directed to be given every hour; and to be continued through the night, in lieu of the draughts.----23d, in the courfe of CASES, &C. 11 t the preceding day and night, he had taken nine pills, confifting of four grains of opium and fix of calomel each. He flept well ; had little purg- ing ; and was free from pain. He only complained of weaknefs and thirft. The pills were re- duced to two grains of opium, and four grains of calomel, every two hours. The ointment was continued ; and the bath and glyfters omitted.— 24th, he was better. He ftill paffed fome blood by ftool, and had a difficulty in making water. He complained that his mouth was fore. Thefe fymptoms I judged to have arifen, either from the fubduction of ftimulus the day before having been two great, or the patient having neglected to take the quantity that was prefcribed. The medicines were defired to be continued ; and the patient was particularly enjoined to take them reo-ularly.—25th, his mouth was lefs fore, he had fewer ftools, and no blood in them ; his fkin was moift and his pulfe 80.—26th, pulfe 88, and fmaller. Purging and griping continued. By miftake, he had no pills during the night. This fully accounted for the alteration fince the day before. He was ordered to have a quart of de- coction of bark, with two hundred drops of tinc- ture of opium, to be taken in divided dofes through the day. Two drachms of mercurial ointment, and one drachm of calomel, were rub- 112 cases, Sec bed in four times in the day*. On the 27th, he was rather better ; the medicines were continu- ed ; on the 28th, he was much the fame ; the decodtion, with two hundred drops of tindure of opium, was continued.—He did not always take the whole of the decoction ; but generally more than two thirds of it. The ointment was diminifhed to one drachm four times in the day ; and two draughts, with eighty drops of tincture of opium in each, were ordered to be given in the night.—29th, he had taken the draughts and flept well ; had only one ftool; pulfe 84;— tongue clean ; he felt fome degree of oppreffion about the pit of the ftomach ; a blifter was appli- ed ; the ointment was omitted ; the decoction of bark, with tincture of opium, was ordered to be continued ; and the draughts to be re- duced to fixty drops. From that period, he continued to get better. The ftimuli were in- creafed, or diminifhed, according to cir- cumftances ; and on the 12th of December, he was difcharged without any complaint, except- ing a little griping at times. At his own requeft, he had a fmall phial of tincture of opium, and fome pills, with directions how to take them, if * On the 26th and 27th there was an omiflion, in not pre- fcribing draughts or pills, fufficient to fupport the excitement in the night. cases, Sec. i ii required, before he could join his fliip at Dia- mond Harbour. When, in confequence of confutations, as happened in this cafe, cathartics were exhibited, I endeavoured fo to manage them, as regularly to fupport the excitement; and to prevent, as far as poffible, the ftate of indirect debility, which con- ftitutes vomiting and purging, by exhibiting other flirnuli, on the commencement of thefe opera- tions. But this is generally very difficult to ac- complish, principally from the ideas, which pa- tients traditionally imbibe, of the utility of thefe operations. According to the hitherto uncertain ftate of the art, it is not furprizing that confultations, in which, to ufe the words of an elegant writer," learned phyficians neutralize their plans,*" fliould feldom be productive of benefit to patients. They are too often fcenes of mutual complaifance, in which he, who has moft to gain, facrifices mod of his opinion. This has been a fubject of much re- gret to fenfible men of the profeflion; and fuch fcenes have confequently been avoided by many of them. It is no mean proof of the truth of the medical principles, afferted in thefe pages, that * Aikin's Letters to his Son. 114 CASES, &c. two perfons, who thoroughly underftand them, will differ, but in a very finall degree, in their ap- plication to practice. In this refpect, I have known a coincidence fo perfect, that it could, in no other manner, be accounted for. Their general adop- tion, then, would baninh that vulgar adage, which, at prefent, not undefervedly attaches a degree of ridicule to the cultivators of the healing art," doc- tors differ." In the report of the 24th of November, it is ob- ferved, that the patient had a difficulty in making water, and a forenefs of the mouth, which were judged to have arifen, either from the fubduc- tion of ftimulus, on the 23d, having been too great, or his having neglected to ufe the quantity prefcribed. This is not hypothefis; but a clear induction of facts. It is certain, that a difficulty of making water, is a fymptom that a'rifes from a ftate of indirect debility, whether that fucceeds the exhibition of cantharides, opium, or any other ftimulant power. It is alfo true, that it may be cured by opium, the warm bath, or cantharides. The general mode of applying blifters is fuch, as often to induce that ftate ; and is therefore im- proper. Blifters of a fmall fize, frequently repeat- ed, will produce a regular excitement, like fuccef- five frictions of mercurial ointment. But they ought not to lay on the fkin ten or twelve hours; cases, Sec. "5 nor fo long as to be fucceeded by vefication, which is a ftate of indirect debility. Neither is it necef- fary fhat they fhould be applied, in preference, to any particular fpot. For, although they make the firft, and a fomewhat greater impreflion, upon the part, with which they come immediately in con- tact ; yet, to whatever part of the body they are ap- plied, their action will extend to every other. The action of ftimuli upon the excitability, may be compared to an electric fhock, which, fcerningly at the fame inftant of time, affects every perfon in company,—the neareft and the moft diftant from the phial. When the modus operandi of the one is afcertained, we may expect to afcertain the mo- dus operandi of the other. In the preceding, as" well as in many other ca- fe?, medicines were often exhibited improperly ; fometimes from omiffions in prefcrlbing, fome- times from negligence or miftakes of attendants, and fometimes from the prejudices of the patient. With any number of patients, there cannot be much difficulty in prescribing, according to the old plan of practice, which con fills in giving cer- tain fixed dofes of medicines, in every difeafe, whatever be its de ;ree. Bat juftly to proportion the application of ftimulant powers, to the ex- hauftion of the excitability of each patient, re- quires more exertion of judgment and confedera- tion, on the part of the practitioner, and a ftric- ter conformity with directions, on the part of the \i6 CAsES, &C patient, and of the attendants. It is evident then that, in an hofpital, it requires an unufual degree of exertion to apply thefe principles to practice, in from thirty to forty bad cafes of difeafe, daily. But it is their introduction only that is difficult. Once generally admitted, their application would be attended with as much facility, and certainly with more pleafure, becaufe with more fuccefs, than any routine of empiricifm. CASE XIII. Isaac Hudson, aged 30, was admit- ted into the General Hofpital, at Calcutta, on the 31 ft of October, 1796, with the following fymptoms .• Pulfe 132, and fmall. He had for fome time feverifh paroxyfms, at 11 o' clock, A. M. and 1 1 P. M. which continued between two and three hours. Tongue foul ; fkin hot ; his bowels were quite irregular, fometimes extremely loofe, at other times exceffively coftive. He had a cough, with hoarfenefs ; and pains of the bones and joints. Together with thefe com- plaints, he had chancres of a fortiiiyht'? ftand- ing.—One grain of opium and one grain of calo- mel were prefcribed every hour; and two drachms of mercurial ointment were ordered to CASES, Sec. I 17 be rubbed in, three times in the day. Novem- ber the ift, pulfe 96. The fever and purging continued. His pains were rather lefs fevere. His tongue was very white. Ten grains of calo- mel were given every three hours. On the 2d, his pulfe was 92. He had taken four dofes of the calomel. His tongue was lefs foul. Eight grains of calomel were ordered every three hours, day and night.—3d, pulfe 88 ; he had taken eight dofes of the calomel. He had a fore throat and hoarfenefs, with an incipient fpitting. The calomel was omitted, becaufe it was deem- ed highly probable that he would not have taken it, if prefcribed. Three 'grains of opium were given every hour. And three drachms of oint- ment were ordered to be rubbed in, three or four times in the day.—4th, his mouth and throat were very fore, and he fpit fome blood ; from whence it was concluded, that he had omitted to take his medicines, or that he had ufed them in an irregular manner. A blifter was applied to one of his cheeks ; two grains of opium were giv- en every two hours ; and a glyfter, with one ounce of caftor oil, was ordered every two hours. He was allowed four glaffes of wine in the day. On the 5th, his mouth became very fore, and there was fome increafed flow of faliva. A blif- ter was applied to the other cheek ; the pills and glyfters were continued ; and he was allowed fix n8 cases, Sec. glaffes of wine.—6th, his mouth became exceed- ingly fore, and his face more fwelled. He had no ftool ; a blifter* was applied to his breaft. Thepillswereorderedtobe continued, and a glyf- ter, with two ounces of caftor oil, to be given every fecond hour.—7th, he was much in the fame ftate ; the medicines were ordered tobe con- fined. On the 8th, he had fome difficulty of breathing, his pulfe was exceedingly fmall, and he had fainting fits. Upon enquiry, it was found that he had lately neglected to take the medicines, which he himfelf confeffed. In order to enfure compliance in this refpect, a change was made in the medicines. He was put into the warm bath three times in the day. The glyfters were con- tinued. And he had three draughts, with one hundred drops of tincture of opium in each, at regular intervals in the night. 9th, he was better; his pulfe was 108 and ftronger. Cough lefs fevere ; and fwelling of the face abated. The bath, and glyfters were ordered to be repeated ; and a draught, with forty drops of tincture of opi- um, to be given every hour.— 10th, he was much in the fame ftate ; the medicines were con- * Among patients, upon whofe veracity there is not much dependence, I prefer in thefe cafes, the ufe of blifters, up- on this principle, that they cannot deceive. cases, Sec. 119 tinued.—nth, his breath was very foetid, and tongue much fwelled ; which evinced that he had beenirregular in taking his medicines. A blifter was applied to his neck, and the other medicines were continued—12th, he was rather better; the medicines were continued; and two drachms of ointment were ordered tobe rubbed in, twice aday.* — 1 4th, his mouth continued very fore, and he complained of weaknefs; one drachm of ointment was rubbed in three times in the day, and the other medicines continued.—15th, he feemed better, but complained of weaknefs ; fome blood was difcharged from his mouth and fauces; he did not permit the ointment to be rubbed in, the day before- The ointment and glyfters were continued ; and he was enjoined to ufe his me- dicines regularly. The following mixture was given,—decoction of bark two pounds, powder of bark one ounce, tincture of opium one hun- dred and fifty drops; the whole of it was order- ed to be taken, in divided portions, in the day. The draughts were continued as before. From that period, he got gradually better. His mouth became more or lefs fore, in the exact proporti- on of the regularity, with which he took his me- * This was too feldom. Wherever mercurial fri&ions are neceffary, they ought to be ufed at leafl four times in the day : and it would alfo be attended with advantage to repeat them at night, 120 cases, See. dicines. By that fymptom, I could detect his irregularites. He continued, for fome time, fubject to purging, and flight paroxyfms of fe- ver occafionally. But, by a perfeverance in the fame plan of treatment, diminution of the me- dicines, he remained, on the 13th of December, free from complaint, excepting a flight forenefs of the mouth. And on the 14th, when I difcon- > tinued attending him, he was in an advanced ftate of convalefcence. This is one of thofe cafes, which fliew that fore- nefs of the mouth, and falivation, do not arife from the action of mercury, when regularly appli- ed, and gradually decreafed ; but that thefe, and other fymptoms of indirect debility, arife in con- fequence of its irregular application, or fudden fubduction. This patient, like many others, was fo fenfible of the truth of the above obfervation that, after there was a neceffity for ufing the warm bath, he took his medicines with much regulari- ty, until he became convalefcent. He was, from repeated experience, convinced that the forenefs of his mouth increafed, upon the fubduction of the mercury, opium, or warm bath. From the beginning, I was doubtful of a recov- ery. For, a fmall and quick pulfe, hoarfenefs and difficulty of breathing, and the very irregular ftate of his bowels, indicated that fome degree of local cases, Sec. 2 21 •affection, both of the thoracic and abdominal vif- cera, had taken place. From the iffue, however, it appeared that they were of fuch a degree, as to admit of a regeneration of organs. CASE XIV. Abraham Jackson, aged 23, was admit- ted into the General Hofpital, at Calcutta, on the 15th of November, 1796, with dyfentery of a few days ftanding.—16th, he had four dofes, con- fifting of ten grains of calomel each, through the night. Pulfe 100; tongue white; fkin hot. There was a confiderable quantity of blood in his ftools. Ten grains of calomel and four grains of opium, were ordered to be given every three hours ; and a glyfter, with two ounces of caftor oil, every two hours. On the 17th, he was rather eafier; but had been much griped through the night.* The glyfters gave him eafe. The pills were intended to have been continued through the night; but as it was not particularly expreffed in the report, they were not given.—The pills were omitted ; a glyfter was given every hour ; and common infu- * Griping, purging, and reflleffnefs, are frequently pro- duced under a courfe of opium, or mercury, in confequence of the dofes not being properly repeated through the night. xzz ca T:s, Sec. fion of fenna, with two grains of tartar emetic, in fmall dofes, frequently repeated through the day. Draughts, with eighty drops of tincture of opium, were defired to be given at bed time ; and to be repeated, according to circumftances, through the night.—18th, he was rather better. One grain of opium and four grains of calomel were given every fecond. hour. Two drachms of mercurial ointment were ordered to be rubbed in, four times in the day. The glyfters and draughts were con* tinued.—19th, he had taken only one draught; and his head became confufed towards morning *. He was much griped. Pulfe 80. The draughts were omitted, from a conviction that he v/ould not take them. The other medicines were continu- ed ; and warm fomentations applied to the abdo-» men.—20th, he had not flept well, and was much purged and griped. The pills were omitted ; and a folution with ten drachms of falcatharticus ama- rus, and two grains of tartar emetic, was given, in fmall dofes, through the day.—21ft, from this period, he had a quart of decoction of bark, with one hundred drops of tincture of opium, daily ; one drachm of mercurial ointment was rubbed in, * It cannot be too often infifled on, thit thisfymptom ari- fes from medicines not being properly repeated. It is what frequently happens, in the ordinary way of exhibiting opium ; aiid for wh:;-:; the medicine itfdf i, by no rcuans to blame. cases, Sec. 123 four times in the day; and three draughts, with fixty drops of tincture of opium in each, were given at intervals during the night. He continu- ed to get better. On the 28th, he was fo well, as to afk leave to go to town.—29th, having com- mitted exceffes the day before, he had pains and other feverifh fymptoms. His pulfe was above 100. He was ordered to have a mixture of fal catharticus amarus ; and the draughts were re- peated* 30th, he had a fevere paroxifm of fever in the night, and perfpired profufely* Pulfe 100. Two grains of opium and fix grains of calomel, Were given every fecond hour. Two drachms of mercurial ointment were directed to be rubbed in, every three hours*. December the ift, he per- fpired profufely, and had a paroxyfm of fever in the night. Pulfe 100. Three drachms of oint- ment, with one drachm of calomel, were ordered to be rubbed in, four times in the day. The pills were continued. And three draughts, with 6o drops of tincture of opium in each, were ordered to be given, in the courfe of the night.—2d, he was worfe. His pulfe was 112; he had a parox- yfm of fever, and fome purging in the night. The ointment was continued. A pill, with four grains of opium and eight grains of calomel, was given * It was a great omiffion, at this time, not to have giver. draughts, or pills, through the night. I24 cases, Sec. every fecond hour in the day ; and three draughts, with eighty drops of tincture of opium in each, in the night. On the 3d, he was better. Pulfe only 100. On the 4th, his pulfe was 96, and his mouth a little fore. 4th, 5th, and 6th, his medi- cines were continued ; he was better ; and had no fever. On the 7th, having difcontinued his medi- cines the day before, his mouth became very fore, and an encreafed flow of faliva commenced. The pills wereordered to be reduced to fixgrains of calo- mel, and three grains of opium ; the draughts to be repeated ; and the ointment to be omitted. But as I had no reliance on his taking the pills regular- ly, a quart of decodion of bark, with a hundred drops of tindure of opium, was ordered to be ta- ken in the day, to prevent his mouth from becom- ing exceffively fore.—8th, did not take the pilh on account, as he faid, of his having fome diffi- culty in fwallowing them ; but took the decodion and draughts; pulfe 100; his mouth continued fore, and the flow of faliva increafed. Three drachms of mercurial ointment were ordered to £,e rubbed in, four times in the day ; and he was informed that, if he did not allow it to be repmlar- jy applied, his mouth would become much forer. The decodion and draughts were continued ; and the pills omitted.—9th, he fpit freely ; and feem- ed much better. The decodion and draughts were continued ; and the ointment omitted. From that period, he was convalefcent. And on the 14th of cases, Sec. 12c; ^ December, when I difcontinued attending him, he had no complaint, excepting the forenefs of his mouth ; which, however, was rapidly decreafing. When the medicines were increafed to a due degree, as on the 3d of December, the patient fpeedily got better ; and had he continued to take them with regularity throughout, he would have got well much fooner. He had however taken a fufficient quantity, to be fucceeded by an increafed flow of faliva. And after that fymptom occurred, he was confidered as out of dan- ger. In the foregoing cafes, in general, the ftate of the pulfe has been noted with fome care. The pulfe in all its degrees of quicknefs, flownefs, weaknefs, irregularity, and intermiffion, may be confidered as a kind of thermometer, by which, together with the ftate of other functions, fome judgment may be formed of the ftate of the ex- citement. A deviation from health in the ftate of the pulfe, is one of the moft conftant fymp- toms of indired debility. But the fureft crite- rion vet known, by which to eftimate the degree of exhauftion, is the effed produced, by the fti- mulant powers, applied for the cure. When the effects of the mercurial ointment were not deemed fufficiently powerful, calomel i_\S cases, Sec. was added. The ointment ufed war, the ftrong* eft; but the quick-filver was not always fuffici- ently triturated. It is almoft unneceffary to ob- ferve that, in dangerous cafes, mercury may at the fame time be ufed, both internally and exter- nally, with advantage. The explanations annexed to the cafes will, perhaps, appear unneceffarily copious ; and, in fqme parts mere repetitions. But that was deemed the moft familiar, and therefore, in fome refpeds, the beft mode of illuftrating the fubjed. Examples will often place inferences in a clear point of view, when they might not be obvious from general reafoning. BQ)pvr-.?r*'sw-m*mmmavmjmmur*j\»wnt n»i _. POSTSCRIPT, By C. MACLEAN. T J_ HE preceding cafes, it will be obferved, are not particularly feleded from fuch as termi- nated happily. Thofe only that were deemed moft inftrudive, in illuftrating particular points, have been chofen. Many more of equal impor- tance might have been added ; but the publica- tion would thus have become too voluminous. None of them are offered, as approaching to per- fed examples ; but merely as conveying a ge- neral idea of the mode, in which, according to our opinion, the principles of the dodrinc fhould be applied to pradice, Although opium and mercury are the me- dicines, upon which we have placed moft depen- dance, in difeafes of high degree, as being more intimately acquainted with their powers ; it is conceived that the dodrine, properly underftood, embraces the whole range of the Materia Medica. It does not admit, indeed, of any other effect being produced, by the application of any power in nature, to living bodies, than an increafe or I2{J POSTSCRIPT. diminution of the vigor, with which they per- form their proper functions ; i. e. an increafe or diminution of their excitement. With a view to the excitement folely is every medicine what- ever prefcribed. And when the means employ- ed are unfuccefsful, the failure fhould be attri- buted to a want of judgment in their application, rather than to any error in the principles them- selves. It ought not to be overlooked that, in moft of the foregoing examples, the difeafes were thofe of the greateft exhauftion, occurring among a fet of men ffoldiers, mariners, &c.) poffeffing robuft conftitutions, and accuftomed to the ap- plication of high degrees of ftimulant power. In difeafes of warm climates, in general, the ex- hauftion is much greater than in thofe of cold climates. Perhaps too, in the former, the me- dicines lofe much of their ftrength, before they come into ufe. So that a material difference will be required in the pradice. Another caution that deferves to be attended to, in all countries, is to guard againft the application of cold, dur- ing the operation of high exciting powers. For, when the fmalleft degree of indired debility hap- pens to take place, fro n irregularity in the ap- plication of thefe powers, the application of cold, or, to fpeak more corredly, the fubduction of POSTSCRIPT. Ijn heat, will increafe the exhauftion, and add to the force of the difeafe. The ftrenuous and authoritative manner, in which this dodrine has always been oppofed, renders a knowledge of its application to prac- tice difficult to be obtained, even by thofe who thoroughly underftand its principles. The laws of mechanics may be perfedly well underftood. But if a body of artificers, who had from time immemorial conduded the operative part, in to- tal ignorance of thofe laws, were unanimoufly to declare, tl that the principals might indeed be " both ingenious and juft, for aught they knew, ' but that they were dangerous in their applica- " tion to pradice," it is certain that the pub- lic would for a time, be deceived by the repre- fentations of thefe workmen ; and the principles of mechanics, however juft or applicable, could not generally be reduced to pradice, until the deception ceafed. Moral truths may be perfed- ly well underftood by a few ; but the ignorance, prejudices, and paffions of a great majority of the human race, will long retard their complete application to pradice. Medical truths however have only to combat the prejudices and interefts of a particular, and but a fmall body of men. It may therefore be permitted to hope, that their application to pradice, cannot be much longer delayed. R T^o POSTSCRIPT. Those who have admired, and thofe who have oppofed the new medical principles, without being mafters of the fubjed," muft have been equally unfuccefsful, in their attempts to apply them to pradice. By every fucceeding cafe of failure, the admiration of the one would be di- minifhed, the oppofition of the other confirm- ed. The objedion, therefore, is very juft, that " attempts to apply the principles of the " Brunonian Dodrine to pradice, may be dan- gerous, in ignorant hands." In other words, men cannot apply to pradice principles, which they do not underftand.—Let us fuppofe a per- fon, wholly unacquainted with the laws of liv- ing bodies, applying powers to them; how can he be expeded to produce a given effed ? Over- looking the immenfe variety of degrees, between the ftate of health, and the higheft ftate of ex- hauftion, he would probably prefcribe one grain of a folid medicine, when he fhould have pre- fcribed twenty ; or twenty, when he fhould have prefcribed but one ; he would give twenty drops of a fluid, when he fhould have given two hun- dred ; or two hundred, when he fhould have given but twenty. He would repeat the medicine but once or twice in the twenty-four hours, inftead of every hour, or every half hour, according to the duration of its adion. He would ufe the ftrongeft powers, inftead of the weakeft ; and POSTSCRIPT. I3I theweakeft inftead of the ftrongeft. He would not make any diftindion between the delicate fe- male, and the robuft male frame ; between child- hood and youth, and youth and old age ; be- tween recent and long ftanding difeafes. He would not even know how to make allowances for inveterate habits. In fuch hands, no fuccefs could be expeded, any more than from a me- chanic, who fhould employ equal powers to raife unequal weights. He might fometimes in- deed be right by chance. Far otherwife is it with him who applies prin- ciples to pradice. He calculates, combines, and proportions his powers, according to known laws ; and applies them, in fuch a manner, as to produce certain and given effeds. Nor is the pradice of medicine different, in this refped, from any other art, which is founded upon principle, and re- quires a certain degree of mental exertion. In the preceding pages, fome things may ap- pear doubtful, the arrangement occafionally inac- curate, and the whole requiring illuftration. Was it not even too late, I fhould not think myfelf at liberty, without the approbation of my ingenious, and efteemed friend. Dr. Yates, to make any material alterations in the text. But, in the mean time, it may not be improper to offer fuch re- marks, as have been didated by fubfequent re- ,n POSTSCRIPT. fledion, and may perhaps lead to an arrangement fomewhat different, if ever an opportunity ihould occur of revifing the fubjed. In the firft place, difeafes of accumulation, or of dired debility, appear to be even more rare than we have fuppofed them. For if, to a body in a ftateof accumulation, the ordinary ftimuli be applied, a difeafe of exhauftion will immediately enfue. But a body can never long remain in a ftate of accumulation, without having the ordi- nary degree of ftimulant power applied, and fometimes even more. The accumulation, which is produced by the abftradion of heat, food, or the mental paffions, if it be not immediately re- moved, by the gradual re-application of thefe powers, will be converted into a ftate of exhauf- tion, as foon as the ordinary exciting powers, which fupport the healthy ftate, are again appli- ed. It is evident, then, that accumulation of the excitability, from the abftradion, or diminution of one or more ftimuli, muft foon terminate in the re-eftablifhment of health, by the gradual re- application of thefe powers, or in the eltablifh- ment, of a ftate of exhauftion, or of indired de- bility, by their fudden and exceffive re-applica- tion. But it is difficult to fuppofe, fuch a com- plete abftradion of heat, food or mental ftimuli, as to occafion death, without the irtervention of POSTSCRIPT. I33 fome ftimulant power, converting the ftate of ac- cumulation into a ftate of indired debility. When food and drink have been long with-held, even a draught of water will exhauft the excitability, and occafion death. Let us fuppofe a perfon travelling through a fandy defart, under the fcorching rays of a vertical fun. If he was pre- vioufly in a ftate of accumulation, from the ab- ftradion of the ordinary ftimuli, that would im- mediately be converted into a itate of exhauftion*. And a continuance of the abftradion, would flill farther add to the exhauftion, until it terminated in death. When heat has beenlong abftraded,and to a confiderable degree, a degree lefs than that which conftitutesthecommontemperature,fudden- ly applied, will produce mortification, or the death of a part. The cafe of the Roman mother, fo aptly quoted by Brown, will exemplify the fame principle, as applied to the mental ftimuli. The ftate of torpor in which fome animals remain, during the winter, and the manner of their re- f ufcitation in the fpring, even in a lower degree of temperature than that in which they became torpid, at the fame time that it affords a beauti- ful explication of the principles of this dodrine, * This follows as a confequence from Prop. V. I. although not fo dated in the text. J~4 POSTSCRIPT. feems to fhew, that death does not take place, from the mere abftradion of heat, or from ac- cumulation of the excitability. In this ftate of prolonged fleep, while refpiration is languidly performed, the other fundions are diminifhed or entirely fufpended. Thus in a two-fold manner, the excitability is accumulated, the fufceptibility of impreffion is proportionally increafed, and a degree of heat lower than that under which tor- por took place in autumn, will produce healthy excitement in fpring*. It feems very difficult to conceive, how death can ever take place from mere accumulation. For while excitability re- mains, a due application of exciting powers will produce healthy excitement ; and when it is ac- cumulated in an unufual degree, it is only requir- ed that a diminution of exciting powers, propor- tionate to the accumulation, or to the fufceptibi- lity of impreffion, fhould be made, in order to produce the higheft excitement. But in every cafe, in which death feems to take place from ac- cumulation, it is eafy to conceive, that it really happens from exhauftion. For, in the higheft degrees of accumulation, for inftance,when a liv- ing body is nearly frozen, the fmalleft degree of exciting power, although greatly below the force * This idea is, in part, taken from Dr. Girtanner. POSTSCRIPT. T-r- of the ordinary ftimuli applied in a ftate of health, will be difproportionate to thefufceptibility of im- preffion, and will therefore produce a ftate of ex- hauftion. And the farther fubdudion of heat, will increafe the exhauftion fo produced, until it ter- minates in death. Upon the whole, it may, I think, be concluded, that death never takes place diredly from accumulation ; but always from ex- hauftion of the excitability. The ftate of accu- mulation,then,when itdoes not terminatein health by the gradual re-application of exciting powers, muft always terminate in a ftate of exhauftion, . by the application of exciting powers, difpropor- tionate to the ftate of the excitability. Scurvy therefore, and the other difeafes which have been mentioned as arifing from the abftradion of fti- muli, would feem to be all difeafes of exhaufti- on or of indired debility. In proof of this, every cafe, that I have met with at fea, refembling what has been defcribed by authors under the name of fcurvy, yielded to mercury. It was fo certain a cure, that I never thought of ufing any other rerriedy. Nor did it at all, when properly ex- hibited, increafe the debility of the patient. The reafon why mercury has fo often been found inju- rious in fcurvy, is, that it has feidom been given in a proper manner. The falivation, of which au- thors complain, as being fo eafily excited, would never occur, if it was exhibited in fuch a manner, T 36 POSTSCRIPT. as regularly to fupport the excitement. It is now perfedly known, that this and every other fymp- tom of indired debility, which fucceed the ufe of mercury, arife from the fubduction, not from the immediate adion of that medicine. But where falivation adually takes place, after the applicati- of mercury, or other ftimulant powers, many fads concur in fhewing, that but a fmall degree of organic lefionexifts; and if a patient, in that ftate, ever dies, it muft be from fubfequent mifmanage- ment. The complaints, therefore, againft mer- cury, in fcurvy, and other difeafes, are not juftly to be attributed to the medicine, but to the abufe of it. There does not feem much difficulty in accounting for the bad effeds, which have arifen from the abufe of mercury in that difeafe. As the proper principle, upon which that and every other medicine fhould be exhibited, as not being underftood, the mode in which it was applied in fcurvy, muft neceffarily have increafed the exhau- ftion, or converted the original ftate of accumu- lation, into a ftate of exhauftion ; and the viciffi- tudes of weather, that ufually occur on board of fhips, would increafe fti 11 farther the exhauftion. It is in this way, and upon the principles explain- ed in the text, that cold proves fo injurious, dur- ing the application of mercury, or other high ex- citing powers, when they are unfkilfully exhibit- ed. Scurvy, in fad, appears to be a difeafe mere- POSTSCRIPT' I37 ly general, and in its origin of flight degree ; at nrft arifing from the fubdudion of nouriffiment, and the mental ftimuli, and afterwards increafed by an exceffive, or irregular application of other exciting powers, and a continued negation of food fufficiently nourifhing. Accordingly, the gradual re-application of food fufficiently nou- rifhing, and of the mental ftimuli, is alone, for the moft part, fufficient to Cure the difeafe. It is upon the principle of the gradual re-application of nouriffiment, that vegetables have been found at firft preferable to animal food. And this fad it was, if the above reafoning be right, that led to the error, committed in the text, of confidering fcurvy as a difeafe of accumulation. With refped to the excitement and excitabili- ty, a more elegant and juft arrangemenc of the propofitions might, no doubt, have been made. This defed, however, is not of matciial import- ance ; as the principles of the dodrine are ftill fufficiently intelligible ; and every one, who un- derftands them, as they now are, will be able to judge what they ought to be. An early and fincere admirer of this dodrine, for whofe judgment I entertain a refped, hav- ing expreffed fome doubts in regard to the nou- exiftence of difeafes of exceffive excitement, and requefted me to re-confider the fubjed, a defer- 13S Postscript. ence for his opinion, and a wifh to place the matter in a clearer point of view, induce me to enter upon a detail, which feemed at firft un- neceffary. As the entire rejedion of difeafes of exceflive-excitement, is a great deviation from the original dodrine, and one of very confidera- ble importance in its influence upon pradice, I fhall endeavour, by flating the grounds of it at fome length, to obviate all reafonable objedions to the theory. In this place, it may be proper to obferve, that medical fads, as they have been called, are too often nothing more than a loofe relation of circumftances. A fad, properly fpeak- ing, muft be fo evidently true, that every man, poffeffing found organs, may difcern it. And the general fads, or principles, which are induc- tions from partiu!ar fads, may alfo be difcerned by all men of ordinary capacities, who will take the trouble of going through the neceffary fteps in reafoning. But where are the fads of this defcrip- tion, which prove that fome difeafes arife from what has been called, by Brown, a ftate of ex- ceffive excitement, and, by others, a ftate of plethora ? If they can be produced, I wifl with much readinefs acknowledge my error, in having: denied the exiftence of fuch a ftate. Un- til that happens, however, there is no good rea- fon why it Ihould be taken for granted, upon mere ipfe dixit. As in medicine, much ufelefs POSTSCRIPT. *39 controverfy might have been avoided, by attend- ing to accuracy of expreffion, it may not be im- proper to explain the fenfe, in which the term " exceffive excitement" is here underftood. Excitement is meant to exprefs the vigor, with which the fundions of life are performed, in all their different degrees. But the fundions of life can only be performed in a due, or in a defici- ent degeee. To fay that they can be performed in an exceffive degree, is as great a contradidi- on in terms, as exceffive virtue, or exceffive joy ; the one is vice, the other pain. When ftimulant powers are applied in due proportion, the ex- citement is at the degree which conftitutes vi- gor, tone, or health. But when they are ap- plied, either in a deficient or an exceffive de- gree, the power with which the fundions of life are performed, i. e. the excitement is diminifhed. That power confifts in a pleafant, eafy, and ex- ad ufe of thefe fundions ; which is certain- ly not enjoyed in the difeafes, that have been referred to a ftate of exceffive excitement. When a degree of ftimulant power, higher than is ne- ceffary to the ftate of health, is applied, the func- tions of life will be performed with more than u- fual vigor, before they fall into a ftate of indired debility ; but never with exceffive vigor. The adion of the fibre may be exceffive, but its power cannot.—If we trace the progrefs of the living 14^ Ff-'TSCRIPT. ' functions, in a perfem expofed to the adion of high ftimulant powers, it will be found, that their vigor is firft increafed to the higheft point, and afterwards diminifhed in a degree proporti- onate to the excefs. But*if thefe powers be gradually fubduded, that diminution vyill not take place ; or if they be re-applied, it will be removed ; unlefs the excefs has been fuch as to occafion the deftrudion of organs. It will not, I believe, be denied, that the headach, ficknefs, &c. which arife after exceffive drinking, confti- tute a ftate of indired debility, which might have been prevented by the gradual fubdudion, and is to be removed by the re-application of ftimu- lant powers. That a certain quantity of fpirits, a ride, &c. will remove thefe fymptoms, xis a fad that is known, almoft to every one. After exceffive walking, or dancing, that ftate of in- dired debility conftituting fatigue, is not imme- diately induced. It becomes more fevere the fecond and third day, unlefs, by a certain degree of walking, or dancing, or the fubftitution of other ftimuli, in the intermediate time, it be prevented. After fuch an excefs, reft is exceed- ingly injurious.*—It is equally true, that the de- * Dean Swift's mode of taking exercife, but in fomewhat lower degree, was good. The regulation of exercife and the paffions, is at pre fait almofl totally i.cglected, in the cure cf POSTSCRIPT. 14] lirium, fever, &c. which arife from exceffive cxpofure to the fun, from opium, aether,* mer- cury, or any other ftimulant power, applied in too high a degree, depend upon indired debi- lity ; and that they may be prevented by a grad- ual redudion, or cured by a proper re-applicati- on of the fame powers, or of others equivalent in force. None of thefe fymptoms occur, during the adion of the exciting powers; they always commence after thefe powers lave been with- drawn. If this be denied, it muft be fuppofed, that medicines lie dormant in the body for fome hours, after having been taken ; and then, all at once, begin to ad. But headach does not in- ftantaneoufly follow the application of fpirituous liquors ; delirium, or fever, the application of opium, or the folar rays; vomiting, theapplication of tartar emetic ; falivation, the ufe of mercury ; purging, the exhibition of cathartics ; fweat, of fudorifics ; nor vefication, the application of a bliftcr, or of fire, to the fkin.—On the contra- ry, thefe fymptoms always appear fomtime after the application of the exciting powers ; and may be prevented by a gradual redudion, or cured by a judicious re-application of the fame powers, or difeafes. They are fubjeds which feem to be yet but little undeiflood, although their importance to health and to morals are evidently gi^ai. I4i POSTSCRIPT. of others equivalent in force ; excepting, indeed, when the force of the noxious power has been fo great, as to produce an immediate lefion of or- gans. Let us take a familiar cafe, as an exam- ple. Suppofe an arm, or a leg has been expofed to the adion of fire, no perfon, in his right fen- fes, would think of plunging it into cold water, or fnow, or applying ice. It is a fad well known, that ardent fpii its, vinegar, and other ftimuli of high degree, are the proper remedies ; and that, if applied in due time, and in fufficient quantity, they will prevent the inflammation, vefication, pain, and fever that would otherwife enfue. If the principle be eftablifhed, in one cafe of excef- five application of ftimuli, it muft equally apply to all. Every fad concurs in proving, that the bad fymptoms which arife after an exceffive application of the ftimulant powers already men- tioned, or of others, depend upon a ftate of in- dired debility, not upon fuch a ftate as that of exceffive excitement ; and that they are to be prevented or removed by the proper application, not by the fubdudion of ftimulant powers. If, to a perfon in health, a very high degree of heat has been applied, as in expofure to the rays of a burning fun, would it not be as danger- ous to remove him fuddenly into a cool, or even a temperate atmofphere, as it would, in the cafe POSTSCRIPT. 14-} oFa perfon, who had been expofed to a high de- gree of cold. In the one cafe the fad is uni- verfally admitted, and the principle applied to pradice : Why not in the other ? Is it more difficult to comprehend that, after an application of extraordinary ftimuli, a fudden fubdudion of them fliould produce indired debility, than that the fame effed fhould follow a fudden re-applica- tion of the ordinary ftimuli, after they have been for any time withheld ?—Upon principles equally clear, the excitability in the one cafe, would not be accumulated ; in the other, it would be exhauf- ted. Hence it is evident, why cafes of coup de foleil are fo frequently fatal. I fhould think my- felf ading with equal propriety, in fuddenly fubduding, not only the high ftimulant power of the folar rays, after having been for fome time applied, (at leaft without fubftituting ano- ther ftimulus nearly as powerful, and then gra- dually reducing it) but farther taking away a quantity of blood, and diminifhing all the ordi- nary ftimuli, as in plunging legs nearly frozen into hot water, giving a po.und of meat to one who had been long falling, and farther apply- ing, to perfons, in thefe ftates, opium, sether, or brandy. It is much to be regretted that, in this, as well as in many other cafes, praditioners who are not themfelves convinced of the efficacy of blood-letting, fbould think it incumbent up- 144 POSTCSRIPT. on them, from a falfe defire'of reputation, or a regard to intereft, ' to put it fo frequently in practice. It is very true, that a conformity with the common pradice is fafeft in a prudential view. For, if a patient dies of peripneumony, without the formalities of bleeding and purging, he willbefaid to have loft his life, in confequence of thefe omiffions. But if he dies, after they have been duly performed, it is only from the neceffity of his fate. Peripneumony, in reality, is feldom a dan- gerous difeafe, until, by blood-letting and other debilitating means, inflammation and adhefion of membranes, fuppuration, and dropfy are pro- duced.—Has a perfon ever died in a ftate of ex- ceffive vigour ? No, nor ever will. No danger, then, need be apprehended from fuch a ftate. If it be a certain fad that opium, judicioufly repeated, will prevent or cure thofe very fymp- toms, which an unfkilful application of it may have produced ; if, by the proper exhibition of mercury, that medicine may be given, not only without producing falivation, but fo as to cure it; if the ficknefs and headachs that occur, after exceffive drinking, may not only be prevented by a gradual diminution of the excefs, but may be cured by the application of a certain degree of the fame power. If, I fay, all thefe be fads (and POSTSCRIPT. I45 they will be found fo by thofe who will give them a fair trial) the inevitable conclufion is, that all the difeafes in queftion, depend upon a ftate of exhauftion or of indired debility, and are to be cured, by the application of ftimulant powers, in a degree proportionate to the exhauftion. From the general ignorance and negled of this dodrine, the beft adapted of thefe powers, to particular cafes and degrees of difeafe, have not yet been well ascertained. But in proporti- on as it is more generally received, phyficians, inftead of random empirical prefcriptions, will apply powers to living bodies, according to known principles, and with a view to particu- lar effeds. They will confider the living body as a whole, upon the ftate of which depends that of every particular part ; and they will de- fift from the hopelefs talk of prefcribing for ftrangling fymptoms. They will co-operate in difcovering the relative powers, the duration of their adion, and the beft method of exhibiting, every fubftance that can be employed in medi- cine. While, in difeafes of the higheft degree, they will all probably employ the moft diffufible ftimuli, as opium, aether, camphor, volatile al- kali, mercury, &c* ; in the lower degrees, each * The powers ofarfcnic and other fubttancescalkd poifons, are by 110 means well afcertained. But w: hive implements enough, if weknew how to ufe them. I46 POSTSCRIPT. may with advantage give a preference to his fa- vourite medicine. And if he applies it, fo as to fupport the excitement, health will be re-produc- ed, whether he ufes bark, or wine, falts, aloes, or gamboge ; caftor "oil, rhubarb, or cream of tartar. Nothing perhaps has contributed more to increafe the confufion in medical dodrines, than the inaccurate language and loofe reafoning, with which the cultivators of the art have found it neceffary to veil the abfurdities of their fyf- tems. The divifion of caufes into proximate and remote, is a remarkable inftance of this* It fliews evidently that, in medical reafoning, power has uniformly been confounded with cause. Many powers may combine to produce one effed ; but it is not any one of thefe powers, but the fum of the whole, that conftitutes the caufe of that effed. Thus, exceffive heat,* fa- tigue, bad news, noxious air, may all combine to produce a ftate of indired debility. The caufe of this ftate of indired debility, is not exceffive heat, fatigue, bad news, or noxious air ; but * It is always to be underftood, that excefTive heat, or other ftimuli applied in excefs, relates to the ftate of the ex- citability, nst to any particular flandard of heat, or any degree of other ftinulant powers. postscript. 147 the fum of all thefe powers. Again, indirect debility, in its various degrees, is the caufe of all thofe fymptoms which conftitute difeafes, depending upon that ftate, each of which has, in nofological fyftems, obtained a particular name. But, as there can be nothing intermedi- ate between a caufe and its effed, and as there can only be required one caufe to produce one effed, remote caufe is evidently a grofs contra- didion in terms. To fay that any of the powers, the application of which will produce a ftate of indired debility, is a caufe of fymptoms, which are confequences of that ftate, appears to me as great a perverfion of reafoning, as it would be to affirm, that a man dies becaufe he has been begotten. The one event undoubtedly precedes the other ; but they are not in the relation of caufe and effed, as thefe terms are generally un- derftood. Another circumftance, which has contri- buted to prolong the public delufion, in refped to the uncertainty of medical principles is this. Theory and hypothesis, I hope and believe more through ignorance than defign, have been very generally confounded under the common name of opinion ; as if it were impoffible, that principles fhould exift, becaufe they have not been difcovered by fyftem makers ; that, as all 145 POSTSCRIPT. medical fyItems which have hitherto been framed are erroneous, there cannot be a true one in na- ture ; or that man alone is that curious compofi- fion, that " fortuitous concourfe of atoms," which nature, in a frolickfome mood, had ex- empted from the operation of laws, fixed, im- mutable, eternal.—It will be difficult, without the aid of infpiration, to reconcile affertions of fuccefsful pradice, with a confeffion that it is founded upon conjedure. It will be equally dif- ficult to account, with decency, for an oppo- fition to a dodrine, of which the fundamental propofitions are either felf-evident fads, or in- dudions from numerous fads ; of which every propofition has an evident relation to every other, and the whole to every part. It might rather be fuppofed that the contention would be, who fliould apply the principles moft corredly to pradice. To the ridiculous and vague objedions, found- ed on the alledged danger of giving large dofes of medicines, the following remarks, it is pre- fumed, will be a fufficient reply. From the principles of the foregoing dodrine, it refults that, in every difeafe, a fum of ftimulant power equal, or nearly equal, to that which has pro- duced the difeafe, muft be applied, in order to effed a cure. It is only when the fum of the POSTSCRIPT. J49 powers fo applied exceed that, which has produc- ed the diftafe, that the medicines can do harm. In that cafe, and in that cafe only, they will produce a difeafe more dangerous, becaufe high- er in degree, than that which had previoufly ex- ifted. Hence it appears that, while in difeafes of the higheft degree, as plague, dyfentery, and fevers, more efpecially in thofe cafes in which organic lefion has taken place, the common dof- es of medicines is merely fporting with lives, in difeafes, deviating but little from health, they, for the moft part, exceed the juft proportion. While, in fome cafes of the former, from four to five hundred drops of tindure of opium will be too little, in fome cafes of the latter, the ufu- al quantity of from twenty to thirty drops, will be too much. Indeed in cafes, deviating but lit- tle from health, thofe high ftimulant powers are unneceffary, and ought not to be ufed. Thefe conclufions will appear fo evident, to all who underftand the principles of the new dodrine, that it would be fuperfluous, and might feem im- pertinent, to dwell longer on that fubjed. In like manner, itis evident whencethedifputes, which have ariien among phyficians, refpeding the virtues of particular medicines, have derived their fource. From want of juft principles as a guide, the fame power which proved ufeful IJO POSTSCRIPT. in the hands of one man, from a particular mode of application, has been found injurious by o- thers, from a different mode of exhibiting it. Hence the virtues of the peruvian bark, fince its firft difcovery, have been extravagantly ex- tolled, and as unreafonably decried. Hence hemlock, which was fo fuccefsfully ufed by the judicious Dr. Stork, entirely failed with other praditioners, and unjuftly loft its reputatation. Hence eledricity, which, applied according to principle, I will venture to affirm, will be found a power of fuperior efficacy in the cure of difeaf- es, has been greatly negleded ; and when fuc- cefsful, has only been fo by chance.* And hence, more recently ftill, the inconclufive dif. putes concerning the effeds of opium, and other fubftances of high ftimulant power, applied to living bodies. One of the moft egregious miftakes which has been made, refpeding the dodrine of life, re-. mains ftill to be mentioned. It has been under- ftood, or rather mifunderftood, to confift entire- ly in the exhibition of opium, brandy, and wine, * I have fome opinions regarding eledricity, as applied to living bodies, which I fhall take an early opportunity of verifying, or difproving by experiment. If they prove true, it will throw much light on the principles of the doctrine. POSTSCRIPT. 151 in every cafe, and with no difcrimination. To thofe who know it better, it muft appear evident, that thefe fubftances have no more relation to the principles of the dodrine, than any other pow- ers, that may be applied to the excitability. The free ufe of them, in a ftate of health, is even contrary to principle. But the laws of nature, as they refped living bodies, would feem, in the ordinary routine of cuftom, to have been nearly reverfed. In a ftate of health, for the moft part, too great a fum of ftimulant power is applied ; in a ftate of difeafe, generally too little. Suppofe opium, brandy, and wine annihilated, the dodrine would remain entire. Provided the excitementbe fupported, itmattersnotby what powersit isdone. It is evident, then, that thofe, who have refted their oppofition upon objedions to any particu- lar medicine, or the dofes of medicines, could not have underftood the fubjed. Indeed to un- derftand is to believe in it. As foon will eyes, in a found ftate, be unable to diftinguifh light from darknefs, as a mind capable of comprehend- ing the terms, can difbelieve the fundametal pro- pofitions of the dodrine of life. If this be true, can it be denied, that the dodrine has, by all its opponents, been either prejudged or mif- underftood ? 1-2, POSTSCRIPT. This is not a queftion of party ; but a conteft between truth and error. It is not the judgment, dignity, or charader of this or that individual, that is in difpute ; but the truth or falfhood of a dodrine, whofe principles embrace every put of animated nature. Whether difcoveries have been made by a man named Brown, or a man named Cullen ; whether they have iffued from the obfcurity of a cottage, or the elevated defk of a profeffor, is of little confequence to the world. But it is of effential importance, that they fhould know the nature and extent of the difcoveries. It is high time to bring the queftion to an iffue. If the dodrine be true, it behoves thofe, who confider themfelves as multis experimentis eruditi, avowedly to embrace it; if falfe, they fhould, by reafoning, or a comparative trial, undeceive the rifing generation, whofe minds are rapidly re- ceiving the infedion. A TREATISE ON THE ACTION OF MERCURY, UPON LIVING BODIES; AND, ITS APPLICATION FOR THE CURE OF DISEASES OF INDIRECT DEBILITY. By CHARLES MACLEAN, if PHILADELPHIA: Printed by WILLIAM YOUNG, Bookseller, No. 52, Second-Street, Corner of Chesnut-Strekt. m,dcc,xcvii. ADVERTISEMENT. 1 HE fallowing " TREATISE," is ra- ther a Hiftory of the Manner in which Mercury has been applied, upon Principle, for the Cure of Difeafes ofjndired Debility, than a firid logical Difquifition. This mode was chofen in order to afifcrt my Right, fhould the Theory hereafter be univerfally applied to Pradice, to fuch Share of the Merit of the Dif- covery, as may appear to be juft ly due. It is hoped that, in the prefent Form of the Trea- life, the Proofs, although more diffufed, will not be found lefs convincing, than if adduced in a more regular Series of Propofitions. A TREATISE, IN enquiring into the adion of mercu- ry upon living bodies, no attempt will be made to inveftigate its modus operandi, of which we are totally ignorant. It is the effeds, whether falutary or noxious, that fucceed the application of that power to living bodies, which will form the fubjed of confideration. Whatever be the mode in which mercury ads, like every fubftance in nature, it can pro- duce no other effed upon living bodies, than to increafe or diminifh the power, with which they perform their proper fundions;—in other words, to increafe or diminifh their excitement. All the fubftances in nature, which are capable, when applied to living bodies, of increafing or diminifh- ing their excitement, are denominated ftimulant or exciting powers. Should it, then, appear ;-.'-, * A TRVATISE that mercury will increafe or diminifh the excite- ment,__that it will both produce and cure difeaf- es of indired debility,—may we not, nay, muft we not conclude that it is a ftimulant or exciting power ? This theory I had adopted in 1789; fince which period, I have applied it to pradice, in ma- ny cafes, and with confiderable fuccefs. The • firft trial was made upon myfelf. In January, 1789, on the paflage from Bengal to England, having been feized with a quotidian intermittent fever, tartar enietic, and afterwards bark, with now and then a cathartic medicine, were, as ufual, exhibited. Under this mode of treatment, I daily became weaker, and in the courfe of three "weeks, during which the fame plan was perfifted in, my legs became ^edematous, the parox) fms of fever more fevere, and I could, with difficulty rife out of bed. The evacuant and antifeptic plans were now entirely abandoned ; and between two and three drachms of mercurial ointment, were rubbed up- on my body, at bed time. The alteration, which this fingle rubbing produced, was equally unex- peded and falutary. I flept the whole night ; and in.the morning, awoke in a gentle perfpirati- on, without fever, or pain, any difagreeable fymptoms, excepting ecdemaar.d general debility, ON MERCURY. \^J remaining. The ointment was rubbed in, three or four times ; and I had no return of fever. My mouth was not affeded; and I fpeedily got well. The iffueof this experiment made a deep impreffion on my mind, and determined me, in future, to ufe mercury, in every cafe of inter- mittent fever. Having obtained a flight know- ledge of the Brunonian dodrine, I thought my- felf in the ftate of the benighted traveller, to whom Brown, with fo much juftice and elegance, compared himfelf, upon the firft difcovery of his dodrine. *** " veluti viatori, ignota re- *' gione, perditis vise veftigiis, in umbra nodis " erranti, perobfcura qucedam, quafi prima diur- cc na, lux dcmum adfulfit*." I inferred that mercury, in common with many-f other medicines, was a ftimulant power ; and would, therefore, be ufeful in all difeafes of indired debilitv. As, according to the fame principles, it appeared that other fevers differed from intermittents, only in degree ; and as mercury was found a certain cure for intermittents ; I thence concluded that fevers, whatever their nofological diftindions, were the proper cafes, by which to fubjed the theory to fai ther proof. One of the firft inftances, in which an opportunity of trying the pradice in other * Elementa Mcdicince. f All, according to the prefent ideas. ,;* A TREATIS'E fevers occurred, was the following.—'Having made a voyage to Jamaica, in the interval of two voyages to Bengal, I was, early in 1790, on a vifit to my friend, Dr. Hedor Maclean, of Ruf- fel Hall, in the parifh of St. Mary's. During myrefideneethere,an European book-keeper upon the plantation, by name----Macmillan, was feiz- ed with typhus*, or the common yellow fever of that country. When I firft faw him, he was comatofe and picking the bed cloathes ; he had got fome purges, and had been taking bark. His pulfe was quick and fmall; his tongue black and furred ; and he was fuppofed beyond the poflibi- bility of recovery. I reprefented to Dr. Maclean the good effeds produced by mercury, in other cafes of fever, and requefted that he would permit it to be tried in this ; to which, with a liberality, not always to be met with from eftablifhed praditioners, he readily confentedf. About an ounce of ftrong mercurial ointment was immediatly rubbed on the patient's body. * It is almoft unneceffary to obferve that nofological diflinc- tions are totally disregarded, as incompatible with the princi- ples of the new doctrine. Generic names are, for conveni- ence, fometimes retained. f This gentleman had been a practitioner of reputation. But had then retired from the exercife of his profeffion, and refided on his eflate. ON MERCURY. I 59 But, as in typhus, this was a new experiment, I did not choofe wholly to truft to the mercury ; and therefore defired that he might be allowed a wine glafsful of Madeira every hour*. The next day he was ftill infenfible ; but fat up in bed, and fearched, as it were inftindively, for the Madeira bottle. When it was given him, he would not confent to part with it ; but held it firm, between both hands, as if fomething, upon which depended his exiftence. The oint- ment was again rubbed in, by guefs, twice in the day,—the quantity about half an ounce each time; and the wine was continued. ^ He was perceptibly getting better. The fame treat- ment was perfevered in ; and at the end of five days, from the commencement of it, he walked in the verandah, in a ftate of convalefcence. It was fometime, however, before he entirely loft the fatuitous look, which has been noticed as a fyptorn of yellow fever. His face was a little fwelled, and his gums flightly affeded by the mercury. During convalefcence, he took wine and b.irk freely. * This is but a fmall quantity of wine in typlius fever--- In fome cafes it may be neceffary to give three or four bottles, in the twenty-four hours. In others, wine, in any quantity, is not fufficiently powerful. Rccourfe m.uft then be had to Che more diffuiible ilimuli. \6o A TREATISE Thisrecovery,although it appeared furprifing, was ftill only regarded as accidental. The idea of ufing mercury in fevers was treated, by the generality of medical men, as an extravagant chi- mera ; or, at beft, a mere ebullition of Bruno- nianifm, which they had learnt, at fchool, to con- fider as heretical.* But thefe rebuffs by no means difcouraged me from profecuting my refearches, as will appear from the following remarks, ex- traded from a medical journal, which I kept in the year 1790 : " Mercury is univerfally allowed to cure lues " venerea, All writers on hepatitis concur, in ex- " tolling its virtues in that difeafe. I have ex- " perienced its efficacy repeatedly in intermittent " fevers, once in typhus, twice in gout, and once " in bleeding difcharges. A cafe is related in the " London Medical Journal of 1786, (page 413) " of obftruded menfes, cured by calomel. Af- cC fedions produced in irritable habits, by the " tranfplantation of teeth, have alfo been cured * From this it may be inferred, how well the doctrine has been underftood, by thofe who have pretended to lit in judg- ment on it. The ufe of mercury as a ftimulant power, refults as an obvious inference from the medical principles of Brown. But not more fo than tartar emetic, or falts. He did not perceive thefe inferences himfelf: from whence it will appeaV, that, inftead of pufhing the confequences of his doctrine too far, he did not extend them far enough. OX MERCURY. 101 r< by mercury ; and hence, thefe difeafes have, " in mv opinion, very erroneoufly been fuppofed " venereal." This conclufion, which is certainly not juft, muft have been produdive of the moft difagreea- ble confequences. The very idea would feverely wound the feelings of delicate and modeft females; among whom difeafes, from the tranfplantr.tion of teeth, have moft frequently arifen. Befides the injury to the conftitution, from an exceffive ufe of mercury, fuppofing thcdifeafe to be venereal. In that difeafe, mercury is ufually given, in much lar- ger quantities than is neceffary, and very feldom in fuch a manner, as to produce the beft pof- fible effeds. In fad, ulcerations produced by the improper exhibition of mercury, may be cured by fuch an application of the fame power, as to fupport the general excitement.—The fame jour- nal proceeds thus: " At it muft be allowed that mercury, like ev- " ery other powder, can have but one uniform " operation upon living bodies, it may fairly be " concluded, that all the difeafes, which it cures, " are of the fame kind. And as fome of thefe are " certainly difeafes of debility, the reft muft be " difeafes of debility alfo". 1 infer therefore, * This propofition, although of eafy comprehcniion, docs not feem to be -emiall;, itTiderllood. li means tl... all difeal- f62 A TREATISE " with as much confidence as analogical reafoning. " can juftify, that mercury is ufeful, in every dif- " eafe of debility f. But I would not be under- " flood to prefer it in every cafe, nor totally " to rely upon it in any. For, even in lues " venerea, where it is generally a certain cure, " it often requires the aid of other ftimuli, par- " ticularly opium, wine, and bark ; or to be al- '' ternated with them, when from habit, it begins " to lofe its effed." The following cafe, extraded from the fame journal, is the inftance alluded to of gout and bleeding difcharges, being cured by mercury. " Mrs. E----B----, of Kingfton, Jamaica, " aged forty years, had been accuftomed to live " freely, and was fubjed to frequent attacks of " gout. Having been occafionally at her houfe, " fhe fometimes afked my advice. In the courfe " of a fhort fpace of time (for fhe was fubjed es, which can be cured by the fame powers, muft depend up- on a fimilar ftate of the body, by whatever powers that ftate may have been produced. Thus the matter of fmall-pox, and the powers which produce dyfentery, and typhus, muft occa- fion a fimilar ftate of the body, differing only in degree ; for they are all cured by the application of the fame powers, dif- fering only in degree. f It fhould have been incl'ireS debility. Thefe obferva- tions were originally written for my own amufement, without any intention of publifhing. ON MERCURY. 163 ** to frequent paroxyfms) fhe was cured of two " attacks of gout, by mercury, opium, and the " warm bath ; but mercury was the principal " power applied. On the 8th of Auguft, 1790, " fhe complained of an inceffant menftrual dif- " charge, alternating with a difcharge of blood " from the piles. Thefe fymptoms fhe faid had " commenced feven weeks before, occafioned, <4 as fhe thought, by fear; and, for fome days, u had been accompanied with headach, pain of " back, loins, and other feverifh fenfations.— *' Her ftomach was very irritable, and could bear " nothing liquid in the morning, excepting wa- ft will often happen that the prejudices of pradi- tioners, as well as of the multitude, will render the choice of one medicine more eligible than that of another, when there is no difference in other re- fpeds. The circumitance of calomel being fuc- ceeded by purging led, by chance, to a proper pradice. But I cannot admit, with Dr. Rufh, that it was " the triumph of a medical princi- ple." The difeafe would have been cured by any mode of treatment capable of fupporting the ex- citement, in fuch a manner as to admit of an ac- cumulation of the excitability. That the opinion is erroneous, needs no other proof than this fad, that, in all difeafes, a cure will be better effeded, when the medicine is re- peated at fuch intervals, as not to produce purg- ing ; but to fupport the excitement in a regular manner. A cure will alfo be performed, by the external application of mercurial ointment, with- out producing purging, as well as by the internal exhibition of calomel. Neither is falivation, fweat- ing, or an increafed difcharge of urine, neceffary to the cure. On the contrary, thefe fymptoms, all of which in their different degrees depend up- on a ftate of indired debility, fhould, as far as pof- fible, be prevented. Salivation is, no doubt,, an unequivocal proof of the original difeafe having been removed ; for, being itfeJf a difeafe of indi- Z r:s A TREATISE red debility, occafioned by the fudden fubdudion of mercury, or its repetition at improper intervals, it cannot co-exift with any other difeafe. Al- though, therefore, in difeafes of very high degree, falivation is jfo far a defirable fymptom ; yet as the difeafe, if not incurable, may be cured with- out it, it ought as far as pradicable, to bo avoid- ed. There are however, two conditions neceffary to this. The firft is, that the practitioner fhould know the principles, and the manner in which they are to be applied to pradice : the fecond, that the patient fhould conform exadly to his diredions. When thefe circumftances happily concur, accor- ding to any fads, that are yet known, there is not a fingle difeafe of indired debility, in which an organic iefion has not taken place, that may not be cured, without producing either purging, or falivation*. * Two ingenious papers, on the ufe of nitric acid in the cure of difeafes, were, fome time ago, publifhed at Bombay, faid to be written by Dr. Scot, of tfi3t place. Upon peru- iing them, I was led to inftitute fome experiments with that medicine. For reafons unneceffary to mention, they were not completed. But there were fufficient grounds to infer, that Dr. Scot's ftatement of its effects was faithful, and not over- charged. In chronic cafes of difeafe, of every kind, it pro- duced good effects ; and, in feveral cafes, after the nitric acid was laid afide, a very fmall quantity of calomel was fucceeded by falivation. The inference ia obvious. It prefaced an ef- ON MERCURY. 179 On the contrary, all evacuations, in fo far as they exceed the degree that takes place in the heal- thy ftate, are fymptoms of indired debility; and ought therefore to be avoided. From the cafes annexed to the " View of the " Science of Life," and from the preceding ac- count of the application of mercury for the cure of difeafes of indired debility, as well as from the hiftory of fome hundred cafes which have feet upon the mouth, fimilar to that which arifes from mer- cury ; and, if a confiderable degree of falivation feldom en- fued, in the cafes in which I tried it, that probably arofe from its not having been given in fufficient quantity.—The ingenious author of the papers alluded to, it is hoped, will find leifure to trace the analogy, between mercury and nitric acid, more in detail ; and to give his ideas to the public in a lefs perifhable fhape, than a news-paper effay. The difcovery is the more entitled to our refpect, as it was the refult of rea- foning, not of accident." Perhaps the large quantity of fluid, neccffaiy to dilute the acid, may bean objection, where the | lefs bulky preparations of mercury can be ufed with more convenience. But it will often be found a pleafant drink : and may, with advantage, be alternated with the preparations of mercury. I ufually began by giving from fixty to a hun- ched and twenty drops, of highly concentrated acid, in a < uart of water, in the 24 hours. i3o A TREATISE come within my knowledge, t think mVfelf war- ranted in drawing the following CONCLUSIONS : I. That mercury applied to living bodies, in due proportion, will increafe the excitement, and thereby cure difeafes of indired debility, 1n their various degrees. II. That, applied in an exceffive degree, or in an irregular manner, it will induce a ftate of in- dired debility, in its various degrees. III. That this ftate is indicated by ulcerations of the throat, forenefs of the mouth, falivation, purging, fweat, an increafed flow of urine, fome- times ftrangury, and coftivenefs, &c. IV. That in the exhibition of mercury for the cure of difeafes, all thefe fymptoms fhould, as far as poffible, be avoided. V. But as in difeafes of high degree, in which large quantities of mercury are required, it will for the moft part be difficult, and often imprac- ON MERCURY. 181 ticable to conform to prescriptions, with the neceffary exadnefs ;* it is much fafer in fuch cafes, to run the rifque of producing thefe fymp- toms, than to give fuch an under proportion as not to remove the difeafe. VI. That the duration of the adion of each dofe of mercury, upon the living body, appears to be not lefs than one or more than two hours. This, however, is not confidered as a point yet eftab- lifhed, with fufficient precifion. VII. But whatever be the duration of its adion, fuch exadiy is the period at which the dofes fhould be fucceflively repeated, fo as to fupport, in a regular manner, the excitement. N * If in the application of mercury, the judgment of the phyfician, and the punctuality of the patient, fhould even co- operate in enfuring a perfect conformity to principle ; the intervals of fleep will often be fufficiently long to occafion a fore mouth, an increafed flow of faliva, griping, purging, or any of the other fymptoms of indiiect debility. Few pa- tients, under a courfe of mercury, according to the ufual mode of exhibiting it, entirely efcape thefe fymptoms. But in proportion as the principles and practice here inculcated are better underftood, it will be more in the power of practi- tioners and patients, fo to regulate their conduct, as to pre- vent, for the mod part, thofe difagreeabie occurrences. 182 - A TREATISE vm. Ulcerations of the throat, forenefs of the mouth, falivation, purging, ftrangury, coftivenefs, &c. arife, not from the immediate adion of mer- cury, but from its irregular application, or fud- den fubdudion*. IX. When, in confequenee of an injudicious ap- plication, or fudden fubdudion of mercury, thefe fymptoms of indired debility occur, they may be cured by the fame, or other exciting powers, applied in a degree proportionate to the exhaufti- on of the excitability. X. Mercury may, upon thefe principles, be giv- en in much greater quantity, and with much bet- ter effed, than could have been done, according to the old mode of exhibiting it ; and without producing falivation, or any other fymptom of indired debility. * If any one affects to doubt this fact, let him take one grain of calomel every hour, for twenty or thirty hours, and then ftop. He will find that his mouth does not become fore while he is taking the calomel, at regular periods, but fome hours after having left it off; that the forenefs will continue to increafe for fome time after having defifted from taking the medicine ; and may be diminifhed, or removed by a proper re- application of the fame power. ON MERCURY. 183 XI. As, in the cure of thofe high degrees of ex- hauftion, conftituting dyfentery and fevers, mer- cury has been found to be one of the moft ufe- ful medicines ; and as plague is a difeafe, de- pending alfo upon a very high ftate of exhauftion, it is inferred, that mercury will be found pro- portionally ufeful, in the cure even of that pef- tilential and fatal diforder. XII. Every cafe of difeafe, in which an increafed flow of faliva fucceeded the ufe of mercury, ter- minated in recovery. XIII. Every cafe in which ulceration of the gnms, fauces, and tongue, or a difcharge of blood from thefe parts took place, without being accompa- nied or fucceeded by an increafed flow of faliva, terminated in death. XIV. In all the cafes, which, under thefe circum- ftances, terminated fatally, extenfive local dif- eafe of the abdominal or thoracic vifcera, or both, was found upon diffedion*. * In a word, infinitely the worfl in the Calcutta Gen Hofpital, and perhaps in all India, I opened, during the 11 iS4 A TREATISE XV. From all rhefe fads I conclude, that lefion of particular organs, fuch as to render them unfit for the performance of their proper fundions, is the ftate which conftitutes an incurable difeafe, unhealthy months of the year, the body of every patient that died under my charge. The appearances were recorded on the books of the Hofpital. In every cafe, there was an extenfive lefion of fome of the primary organs. Several li- vers weighed each between five and fix pounds, and one near- ly eight. Some of them contained above a pint of thick pus ; and that which weighed near eight pounds, contained above a quart. In fome cafes, cartilaginous, in others boney fubftances, were found in livers, in which there were no traces of recent fuppuration. They feemed to be concretions form- ed from purulent matter. There were generally, in thefe cafes, ulcerations of the ccecum, colon, and rectum. In one cafe of fever, the fubftance of the fpleen was quite diffolved. It had the appearance of dark coloured mud, without a fingle trace of a blood veffel remaining. The moft urgent fymptom, in that c.fe, was a raging thirft. The trer.tnvrt, in every inftance of difeafe of high exhauftion, was conducted on the fame plan that was purfued in the foregoing cafes. And I have the fatisfaction to fay, that I did not lofe a fingle patient, who came under my charge in the incipient ftage of difeafe. But as it is not my defign to fet my own judgment in com- petition with that of any other perfon, I will only affirm, il.at the practice refulting from the principles of the new doc- trine, was in general infinitely more fuccefsful, than the com- mon mode of practice, in like cafes, has ever been in my own hands. That of Dr. Yates, and Mr. Brydie, founded upon the fame principles, was attended with undeniable fuccefs. ON MERCURY. I85 when the foregoing principles are fkilrully ap- plied. XVI. To what degree a lefion of organs, of primary importance to life, may take place confiftently with the re-eftablifhment of health, is a point that is by no means afcertained. We have now, how- ever, one criterion by which to judge, with tole- rable accuracy, when organic lefion adually ex- ifts. . The profecution of this fubjed, conduded up- on the principles which have now been explained, may be attended with important advantages to the pradice of medicine; and it is hoped will not be negleded by thofe, who wifh to exercife their in- telledual powers upon fubjeds of real importance. A a A DISSERTATION ON THE SOURCE OF EPIDEMIC A N 0 PESTILENTIAL DISEASES; IN WHICH IS ATTEMPTED TO PROVE, BY A NUMEROUS INDUCTION OF FACTS, THAT THEY NEVER ARISE FROM CONTAGION, BUT ARE ALWAYS PRODUCED BY CERTAIN STATES, OR CERTAIN VICISSITUDES OF THE ATMOSPHERE. By CHARLES MACLEAN. ^ WHITEHALL: Printed by WILLIAM YOUNG, Bookseller, No. 52, Second-street, corner of chesnut-strelt, 1797- " Science has much to deplore from the Multiplicity of " Difeafes.—It is as repugnant to truth in Medicine, as " Polytheifm is to Truth in Religion. The Phyfician who " confiders every different Affection of the different Syftems " in the Body, or every Affection of different Parts of the " fame Syftem, as diftinctDifeafes, when they arife from one " Caufe, refembles the Indian or African Savage, who con- " fiders Water, Dew, Ice, Froft and Snow, as diftinA Ef- " fences : while the Phyfician, who confiders the morbid " Affections of every part of the Body (however diverfified " they may be, in their Form or Degrees) as derived from te one Caufe, refembles the Philofopher, who confiders Dew, " Ice, Froft and Snow, as different Modifications of Water, " and as derived limply from the Abfence of Heat. Cj* See en Account of the Bilious Yellow Fever, By B. Rush M. D. Pa:j 177. DISSERTATION ON THE SOURCE OF EPIDEMIC AND PESTILENTIAL DISEASES, &c. '■————a—~—----------- J[N endeavouring to promote knowledge, it may fometimes be as ufeful to corred ancient errors as to promulgate new difcoveries. In medicine, dodrines of the greateft importance have been handed down from generation to generation, which altho' demonftrably falfe, have never once been called in queftion. The fuppofed exift- ence of contagion in plague, dyfentery, and fe- vers, appears to me, to be a very remark- able inftance of this propenfity in man, to purfue the beaten trad, however unprofitable or unfaie. Is not this condud often the effed of felfifhnefs, chooling to avoid the rcfponfibility of innova- 190 on the source of Etidemic tion ? And is it not for the fame reafon, that erroneous dodrines generally remain longer unapproved, in proportion to the extent of their influence upon pradife ? However that may be, it is certain that contagious matter has, in all ages, been confidered, by the multitude, as the caufe of plague, dyfentery, and fevers,—by far the moft deftrudive difeafes that affed the human race. And this hipothefis, upon the belief of which muft have depended, and may yet depend, the lives of millions of our fellow-creatures, feems to have been implicitly afiented to, by every phy- fician, from Hippocrates to the prefent day. Although I had long entertained doubts up- on this fubjed, it was not till very lately, that I was led to confider it, with particular attention. Upon perufing Dr. RufiVs publication on the yellow fever, which defolated Philadelphia in 1793, all my former doubts recurred, with ten fold force; and the hiftory of that epide- mic, ferved to complete my convidion, that no general difeafe, which affeds a perfon more than once during life, can ever be communicated by contagion. But as this term may be varioufly underftood, it may not be improper to give a defini:ion of it in this place. Contagion I conceive to be—a fpe- cific matter, generated in a perfon affeded with t'iii^aie, and capable of communicating that par- AND PESTILENTIAL DISEASES, &C. 19I ticular difeafe, with or without contad, to ano- ther. Was it a matter of mere idle fpeculation to in- quire into the truth of this hypothefis, not lefs refpedable from its antiquity than from the uni- verfality of its adoption, I fhould have been en- tirely filent. But the frequent recurrence and great mortality of epidemic and peftiJential dif- eafes, in many parts of the globe, render it an objed of the moft effential importance to afcer- tain, whether they are ever contagious. That they never arife from that fource, I fhall endea- vour to prove, in the following manner :— ift—By fhewing that confequences would ne- ceffarily refult from the exiftence of contagion in epidemic a^d peftilential difeafes, which do not adually take place. 2cjly.— By fhewing that the exiftence of con- tap-ion, has always been taken for granted in thefe difeafes, not only without any proof, but even cantrary to the evidence of numerous and con- vincing fads. odly__By pointing out the real fource of fuch epidemic and peftilential difeafes, as have ufual- ly been reputed contagious ; viz. a certain ftate or certain viciflitudes of the atmofphere, toge- / ipj ON THE SOURCt OF EPIDEMIC ther with the cafual application of other powers, producing indired debility*. I—Consequences would refult from the exif- tence of contagion, in epidemic and peftilential difeafes, which do not adually take place. If a perfon be affeded with any contagious difeafe, it will neceffarily be communicated to every other perfon who comes within the infec- tious diftance f, and is not at the time labouring under fome difeafe higher in degree J. But it is well known, to every one converfant in the fub- jed, that in plague, dyfentery, and fevers, a ve- ry fmall proportion only of thofe, who come within what may be fuppofed to be the infedious diftance, or even in contad with the fick, is feized with thefe difeafes. In the moft univerfal epidemic, it does not appear that a tenth part of the whole inhabitants of a city, has ever been, at * When any reference is made to general medical princi- ples, in this Differtation, they are underftood to be thofe of th- Elementa Medicinae Brunonis, with the modifications of that do trine, contained in the preceding " View of the Science of Life." f By infectious diftance, I do not mean to exprefs any de- finite fpace, but merely the diftance at which contagion is fuppofed to aft. X Vide prop. viii. View of the Science of Life. AND PESTILENTIAL DISEASES, &C. 193 one time, affeded. But let it be fuppofed, that eve- ry fixth perfon might have been feized; is it credi- ble that the remaining five fixths were, either, not within the infedious diftance, or were at the time, labouring under fome difeafe higher in de- gree, than the prevailing epidemic ? If it even be admitted that, in a terrible peftilence, one half of the inhabitants of a city, may pa.TiMy be affeded, the fuppofition that the other half could efcape, if the difeafe was contagious, would be more extravagant ; for the greater the number affeded, the lefs chance muft any individual have, of being exempted from contagion. Allowino-that one perfon in ten may not have been within the infedious diftance; and that one in an hundred may have been labouring, at the time, under a more fevere difeafe, than the prevailing epidemic ; fuch is the exad proportion that would efcape. The reverfe, however, is probably true. But whatever may be the proportion of the num- ber feized, to thofe that efcape, it cannot be doubted that the application of powers, which produced the difeafe, in the perfon firft affeded, is adequate to produce the fame eifed, in all thofe, who are fubfequently feized. As the fad cannot be denied, that a great majority have efcaped, after contact witii perfonj ill of difeafes fuppofed to be contagious, attempts may perhaps be made to account for it, by fup- IQ4 °N THE SOURCE OF 11TDEMIC pofing a certain peculiarity of confiitution, which exempts from, or difpofes to difeafe. Is it the many, who efcape, that have this happy peculi- arity of confiitution ; or the few, who are feized, that are fo unfortunate as to poffefs it ? The former are evidently too numerous to admit of fuch an hypothefis. The property muft, there- fore, I conclude, be given to the latter. But a child, here and there, is exempted from fmall- pox, although expofed to its contagion. In order to preferve a confiftencv, this fad muft be accounted for, by the fame, or another peculi- arity of confiitution. Peculiarities of confti* tuiion, then, exempt from contagion in one cafe, and difpofe to it in another : and thus a term, which in reality means nothing, may be made to account for any thing. For my own part, 1 mult confefs my inability to comprehend any other peculiarities of confiitution, or idiofyncrafies of habit than what are conftituted, by the differ- ent degrees of health and difeafe,—fhe different ftates of the excitability. It appears, therefore, wholly unneceffary, for any purpofe that I know, to fuppofe that, in epi- demic and peftilential difeafes, contagious matter is generated in thofe individuals who are firft feiz- ed, and from them communicated to others; un- lefs indeed, it be determined, at all events, to take the exiftence cf iV.ch a p.wcr for granted. AND PESTILENTIAL DISEASES, &C. [ 195 It is a well known law of nature, that fmall- pox, meazles, and other general difeafes, which are unquestionably contagious, occur, in the fame per- fon, only once during life. It is alfo acknow- ledged by every author, who has written upon the fubjed, that plague, dyfentery, and fevers af- fed the fame perfon, as often as the powers which produce them are appied. Dr. Alexander Ruffel, affirms of the plague " the having had this diftem- «c per once, does not prevent the contrading it " again. I have feen inftances of the fame per- " fon being infeded three feveral times, in the " fame feafon." A fimilar obfervation is made by Dr. Rufh, refpeding the yellow fever of Phila- delphia. Cafes of reinfedion," fays he, " were " very common during the prevalence of this fe- ver/' Small-pox, meazles, and other general difea- fes, which occur only once during life, never dif- appear, until the whole of thofe who have been within the infedious diftance, and were not, at the time, labouring under fome difeafe higher in de- gree, have received ihe infedion. As thefe dif- eafes are very mild*, children fometimes refift the power of contagion, from the fuperior force of * They are not difeafes of exceffive excitement, but of in- dired debility, and generally of a low degree. ' 106 ON THE SOURCE OF EPIDEMIC other difeafes, although they may be fo flight as to efcape common obfervation. I will venture to af- fert that no perfon, in perfed health, ever was, or can be expofed to the power of contagion, without receiving the fpecific difeafe, which that contagion produces; excepting in fmall pox, mea- zels, &c. when the perfon has previoufly the dif- eafe. Plague, dyfentery, and fevers, then, as they are not fubjed to the fame law, would, if they were contagious, never difappear. The conta- gion, meeting with no obftacle from other difea- fes, feverer in degree (for there are few indeed of that defcription) would exercife an unlimited and fatal fway. No perfon could efcape. Thofe, who once recovered would, again and again, be feized. Infedion would proceed, in a continued circle, un- til the whole human race was extinguifhed. 2. The exiftence of contagion in plague, dy- fentery, and fevers, has uniformly been taken for granted, not only without proof, but even con- trary to the evidence of numerous and convinc- ing fads. It is well known, that, in hofpitals, camps, and fhips, a very fmall proportion only of thofe, who fleep within a fhort diftance of, are frequent- ly in converfation, or even in contad with, \ er- AND PESTILENTIAL DISEASES, &C. 197 fons ill of typhus, dyfentery, or fever, is feized with thefe difeafes. So far from infedion being invariably communicated in this manner, no in- ftance of it has ever been diftindly traced. If fuch cafes had ever been recorded, we muft either rejed them as falfe, or abandon one of the funda- mental axioms of philofphy. For, whatever has happened once, muft happen often ; it muft hap- pen always, in fimilar circumftances. But in the fituations alluded to, thefe circumftances con- ftantly occur, and the alledged effeds do not fol- low. It is not fair to conclude, that dyfentery is contagious, becaufe one perfon happens to be tak- en ill, while in the neighbourhood of another, who has got the difeafe. If the conclufion was juft, all within the infedious diftance, not labour- ing under a difeafe higher in degree, would be fimilarly affeded. They would have the difeafe with as much equality of force as children have the fmall-pox. In proportion to the number af- feded, the power of contagion would increafe. It would proceed in a geometrical ratio, diverg- ing from the centre, to every point of the circum- ference, of a city, a camp, an hofpital, or a fliip. It is evident then, that in thefe fituations, a con- tagion, which :.ad the power of producing its pe- culiar dieafe, in the fame perfon, more than once during life, would never difappear. But dyfen- rcry, fevers, and the plague iifdf ceafe, in all I9S ON THE SOURCE OF EPIDEMIC thofe fituations, without having affeded perhaps a tenth part of the community. They ceafe too when they are epidemic, according to fome peri- odical law, which evinces that they do not arife from any cafual and uncertain fource, like the accidental application of contagious matter. The abfurdity of the conclufions which refult from admitting contagious matter to be the caufe of epidemic and peftilential difeafes could not have been overlooked till now, if the exiftence of fuch a fource had not been fo implicitly taken for granted, that even to call in queftion the truth of it, muft, to many, have the appearance of fuccef- five fcepticifm. But I fhall endeavour to deduce my conclufions, from fuch numerous and un- doubted fads, as ought, perhaps, to exempt me from that imputation. During the prevalence of epidemic and pefti- lential difeafes, it is well known, that nurfes, and other attendants upon the fick, are not more liable to be affeded than other people, who un- dergo an equal degree of fatigue. It may per- haps, be faid, that they become habituated to the contagion. But how do they efcape the firft ap- plication of it ? They have not then got the ha- bit. No perfon of that defcription caught the in- fedion from thofe who died, of what was called the jail fever at the black aflizes at Oxford ; a AND PESTILENTIAL "DISEASES, &C. I 99 i_ cafe of alledged contagion fo generally known, and fo frequently quoted by.author?. That the power, which occafioned difeafe at the Oxford aflizes, was not contagious matter, is proved by its producing diarhcea in fome, while it produced fevers in others. And further, no perfon was feized, who had not been diredly expofed to the influence of the noxious air. Specific contagion, I conceive, cannot produce a difeafe lefs uniform in its appearance, than fmall-pox and meazles. But every epidemic and peftilential difeafe, which has hitherto been reputed contagious, affumes fuch various and diflimilar appearances, in differ- ent perfons, that they cannot be the effed of any power, equal and uniform in its operation. The fymptoms are not, in any two perfons, exactly alike. Hence the difference of opinion among the phyficians of Philadelphia, during their late epidemic ; fome afferting that every difeafe had rcfolved it!Uf into yellow fever, while others, cer- tainly with more reafon, affirmed that the difeafes of the city were variou \ No epidemic can become fo general, as to fupprefs all other difeafes; becaufe all men, labouring under dif- eafes of lower degree, are not expofed to the powers which produce an epidemic. The lame p.rfon indeed cannot, at the fame lime, r 200 ON THE SOURCE OF EPIDEMIC have both a dyfentery and a dropfy ;* but every ufual variety of difeafe may exift in a com- munity, even in the time of a powerful epide- mic, altho' the epidemic be the moft general dis- order. The difiimilarity of fymptoms, which occafioned this difference of opinion at Philadel- phia, is, to me, a convincing proof, were there not many others, that the yellow fever of that ci- ty, did not arife from any power, of fuch uni- form operation, as contagious matter. Like wine, opium, or mercury, fpecific contagion muft produce fimilar effeds, upon all men, who are.fimilarly fituated. It muft ad alike in Egypt and in America, in London and in Conftantino- ple. But, according to all accounts, the fymp- toms of epidemic difeafes, in different parts of the world, are very diffimilar ; while thofe of dif- eafes that are undoubtedly contagious, fuch as fmall-pox, meazles, lues venerea, &c. are the fame in all. Wine will intoxicate, cathartics will purge, mercury will falivate in all countries. They will produce thefe effeds, upon almoft all men ; certainly upon all men who are in health. Thofe only, who are in a ftate of difeafe, higher * It is only meant, in as far as they are general difeafts ; for, the local affedlions, which have obtained thefe names, as they occur in different parts of the body, may readily co-ex ift. AND PESTILENTIAL DISEASES, &C 201 in degree than thefe powers can produce, will refift their operation.* But this proportion can- not be one in a thoufand, pethaps not one in ten thoufand. Such alfo may be the proportion that would efcape, from the effeds of a fpecific con- tagion, applied to them. It is common, how- ever, for men in health, to be expofed to contact with the fick, and to efcape. In that cafe, con- tagion, if the difeafe had been cantagious, muft inevitably have been applied ; and without producing its imputed effeds. Was not the typhus fever, by which fo many of the unfortunate people, who were imprifon- ed in the black hole of Calcutta, periffned, at- tended with an endlefs variety of fymptoms ? It does not appear that the difeafe was, in that cafe, communicated to any perfon, who had not breathed the polluted air of the dungeon. Will it be faid, that the Nabob Surajeddoullah had previoufly ordered contagious matterto bein- ferted into the black hole ? If not, whence was it imported, or where generated ? * It is impoffible, with the greateft quantity of mercury that has ever been given, to falivate a perfon, whofe liver is in a ftate of figuration. No quantity of wine will intoxicate a perfon, ill of typhus fever, without having firft cured the difeafe. . C c 102 ON THE SOURCE OF EPIDEMIC In the hiftory of thefe difeafes, I think it may be remarked, that phyficians have been peculi- arly exempted from their influence. Is it that there is a principle of repulfion between medical fkill and contagion ? or is it not rather for this plain reafon, that thefe. difeafes depend upon fome other power, which the phyfician is better able to avoid ? For, will any reafonable perfon affert, that a medical practitioner (unlefs the ftrudure of his body be fuppofed different from that of other people) can vifit a patient ten or twelve times, feel his pulfe, and converfe with him, without receiving the infedion, if the dif- eafe of the patient be contagious, and the pradi- tioner has not, at the time, a difeafe of higher degree ? Phyficians, in perfed health, have at- tended as many patients, ill of difeafes hitherto reputed contagious, as they could vifit in the day ; and yet have efcaped. But it is as abfurd to believe, that a perfon can be expofed to the influence of any power, capable of producing plague, dyfentery, or fever, without being affeded, as that a large quantity of fpirituous liquors, or ftimuli, ftill more diffufible, can be applied to living bodies, without producing a correfpondent effed. If it be at all admitted, that contagion is the caufe of thefe difeafes ; it muft alfo be admitted, that contagion, as in this AND PFiTILENTlAL DISEASES, Sec. 203 cafe, may fometimes be applied, without pro- ducing its effed,—which is impoffible. Another fad worthy of notice is, that aged perfons and children, are both feldoiner and lefs feverely attacked by epidemic and peftilential dif- eafes, than the young and middle aged ; and women feldomer and lefs feverely than men. Now, if contagion was the fource of thefe dif- eafes, the cafe would be exadiy reverfed. Old people, women, and children, being more in the way of contagion, would be more frequently and more feverely attacked. But the young and middle aged, being more expofed to the vicifli- tudes of the atmofphere,—the principal fource, as l fhall afterwards endeavour to fhew, of thofe difeafes, than aged perfons and children, and men more than women, they are confequently more feverely attacked. It has been a puzzling queftion to folve, " why old people and chil- " dren have been lefs obnoxious to plague, dy- " fentery, and fevers, than the young and " middle aged ; and women lefs than men ?" But the folutionwill no longer be difficult, if it fliould be proved that thefe difeafes never arife from contagion, but are always produced by certain ftates or certain viciffitudes of the atmof- phere, together with the application of other powers, co-operating in the produdion of indi- 204 ON THE SOURCE OF EPIDEMIC red debility. For, it is evident that, to the influence of thefe ftates, or viciffitudes, and of thefe powers, the young and middle aged are al- ways more expofed than old people and chil- dren ; and men more than women. Let a perfon, in the height of a peftilential difeafe, be removed from the atmofphere which occafioned it, into one more pure, he will com- municate the infedion to no one. " It has been " remarked," fays Dr. Rufh, fpeaking of the yel- low fever of Philadelphia " that this fever did " not fpread in the country, when carried there " by perfons who were infeded, and afterwards " died with it." In another place he obferves, 'c during four times that it occurred in Charlef- " ton, in no one inftance,according to Dr. Lining, " was it propagated in any other part of the " ftate."* Convincing proofs thefe, that the difeafe did not depend upon contagion, but upon the ftate of the atmofphere at Philadelphia in the onecafe,and at Charlefton in the other. The va- rious ways in which the College of Phyficians of Philadelphia and Dr. Rufh attempted to account for the origin of the contngion, which they fup- pofed had produced the yellow fever of 1793, * Vide an account of the biliou", remitting, yellow kvcrt of Philadelphia, by E. Rufh, M. D. page 157. AND PESTILENTIAL DISEASES, &C 205 mewsintowhatinconfiftenciesthemoftfcnfiblemen may be betrayed, when they attempt to reafon upon faife data. Having all taken the exiftence of contagion for granted, they only differ with refped to the origin of it. The College was of opinion, that it was imported; Dr. Rufh affirmed, that it was generated in the city. A better de- fcription cannot be given of the feveral hypothe- fes, which diffraded the faculty, upon this occa- fion, than in his own words, " public report " had derived it" (the contagion) " from feveral " different Iflands ; had chafed it from fhip to " fhip, and from fhore to fhore ; and finally con- " and 1748 in Charlefton; in 1791 in New u York; and 1703 in Philadelphia."* In 1 793, the yellow fever appeared alfo in different parts of the Weft Indies.f Attempts were made, in the Iflands, to trace the contagion to the con- tinent. On the continent it was traced back to the Iflands. But why fhould we hefitate to be- lieve, that the fame general caufes which produc- ed unufual viciffitudes of the atmofphere, in the one country, fliould extend their influence to the other ? In the fame year, and the fame fea- fon, the Englifh fettlers, on the coaft of Africa, were fiezed with a fever, which proved fatal to a great number of them. It happened, at this period, that a fhip arrived from Boullam, on the coaft of Africa, at Grenada, in the Weft Indies. And hence the contagion was fuppofed, by Dr. Chifholm and others, to have been im- ported in that fhip. Was it neceffary, it might eafily be fhewn, that thefe fuppofrions were adopted upon very flight grounds. But if the ex- iftence of contagion can be difproved upon gene- * Rufh on the Yellow Fever. f Vide Chifholm on the Malignant, Peftilential Fever, Sec. AND PESTILENTIAL DISEASES, &C. 200 ral grounds, it would be fuperfluous to invefti- gate every particular circumftance in its favour, that may have been haftily affumed as a fad. In Aleppo, according to Dr. Ruffell, the European inhabitants regularly fhut themfelves up, in their houfes, every year, at fome period between April and July. And the rich natives begin to adopt the fame plan, as far as their cuf- toms will permit them to do, without fcandal. From this fad, it appears that the plague occurs at Aleppo, in a fta te lefs or more mild, almoft annually, and that it commences and ceafes at cer- tain known periods. But it has been remarked there that, in its moft fevere ftate, this dif- eafe recurs only at periods of ten years, or there- abouts—a regularity, which cannot, upon any known principle, be attributed to a power of fuch cafual application, as contagious matter. It has farther been obferved of the plague, that " the winter puts an end to it at Conftanti- " nople ; the fummer deftroys it in Egypt." In fad, what epedemic or peftilential difeafe has been known to occur with feverity at thefe peri- ods of the year ? But, in order to account for this, will it be faid, that contagion is deftroyed, both by heat and by cold ? The affertion would certainly be abfurd. Befides the fad can be much better explained. At thefe periods, the body is D d 210 ON THE SOURCE OF EPIDEMIC not fo liable to difeafe, becaufe it is not expofed to the eifeds of heat and cold, drynefs and moifture, tempeftuous and calm weather, fuddenly and frequently alternated. Thefe vi- ciffitudes are moft remarkable in fpring and autumn, which accordingly are the fea- fons, moft fertile of difeafes, . in all parts of the globe. It is a curious circumffance, and much to cur prefent purpofe, that the belief of the Turks in the contagious nature of the plague, has confiderably increafed, fince their communi- cation with Europeans has become more extend- ed. Formerly there was no want of fervants, or relations, to undertake every neceffary office about the fick, the fame as in any common dif- temper ; but now, it is difficult to procure even mercenary attendants. cc I have met," fays Dr. Ruflell, fpeaking of the plague at Aleppo in 1760, " with feveral inftances, even in Turkifh " houfes, where the miftrefs of the family was i: not only ill attended, but even abandoned " through the timidity of her daughters and li flaves. I apprehend the dread of contagion " gains ground among the Mahommedans, in " all parts of Syria, where the Europeans have " much commerce." Mahommed, having pro- bably perceived the bad confequences that would refult from fuch a dread, condemned the belief of difeafes being fpread by contagion, as impious. And tins at lea ft ftxws, that the plague has not AND PESTILENTIAL DISEASES, &C. 211 always been fuppofed, by the Turks, to arife from contagion ; or if it has, that the belief was deemed injurious. With the example of Europe- an credulity before them, the modern followers of Mahommed may, in no long time, put more faith in contagion, than in this law of their pro- phet. But in fuch a renunciation of faith, e- ven a Chriftian will have little caufe to rejoice. If it fliould appear to be only a fubftitution of one error for another, Europeans will not have much reafon to ridicule the former ftupidity of the Turks; nor to boaft of their own fuperior penetration, in intoducing among them a belief in the contagious nature of peftilential difeafes. Physicians, having obferved the dependence of epidemic difeafes upon the ftate of the atmofphere, their uniform appearance under fome ftates, and ceffation under others, could not well reconcile thefe fads with the hypothefis of contagion. But a reconciliation was, at all events, determined upon. The ftate of the atmofphere was made to ad upon the matter of contagion, in fuch a man- ner as to explain every phoenomenon. Is the weather hot, when an epidemic commences, heat gives adivity to contagion ; is it cold, cold is favourable to contagion ; is it dry, the contagion is concentrated ; is it wet, diluted : even viciffi- tudes fet it in motion. But fliould the epidemic 212 ON THE SOURCE OF EPIDEMIC happen to ceafe, during any of thefe ftates of the atmofphere, this may with equal facility be ac- counted for, by afligning to the fame powers, as has frequently been done in medical reafoning, different or even oppofite modes of operation. Let the exiftence of contagion be once admitted as a fad, and there is nothing more eafy than to trace itsorign to fome ideal fource. The moft obvious, and therefore the moft frequently infilled upon, *s contad with fome perfon, ill of the fame dif- eafe. But as the perfon, who happens to be firft feized, could not have received the infedion in that manner, it was found neceffary to refer it to various fources. Even with thofe advantages, however, it was often difficult, and exercifed the ingenuity of the learned, to difcover the origin of particular epidemics. The imputed fources of thofe calamities became at length fo numerous, that it requires little labour to trace the origin of all dif- eafes to fome one, or other of them. If, for in- ftance, it cannot be traced to adual contad, it will probubly be difcovered, that the patient has, at fome recent period, been expofed to the effluvia of rotten hemp, flax, coffee, cabbage, onions, black pepper, or potatoes ; for all of thefe pow- ers have been faid to produce epidemics. But in years, when thefe difeafes are fo highly pefti- AND PESTILENTIAL DISEASES, 8eC. 213 lential, that the effluvia, arifing from a heap of rotten vegetables, might feem too trifling a pow- er to produce fuch important effeds, recourfe may ftill be had to the importation of contagious matter, in bales of goods from the Mediterra- nean ; or, with the ingenious Gibbon, to the gene- ration of it, by fwarms of putrid locufls,in Egypt. Thefe hypothefes, were they not fupported by the authority of celebrated names, are almoft too ri- diculous for refutation. That a parcel of rotten vegetables fhould produce a difeafe, that is con- tagious, and capable of producing defolation and death, over a populous city, ought not certainly to be credited without proof ; and with refped to proof, it does not appear that there is any, excepting that, during the prevalance of epide- mics, vegetables have become putrid. Was pu- trid vegetable exhalation ever the caufe of a con- tagious difeafe, it would fpread in an evident and regular progreflion, affeding firft thofe who are neareft to its fource. There could be no poffibitity of miftaking or overlooking the caufe. But as no fuch progrefs has ever been afcertained, and as it might have eafily been traced, had there been any truth in the opinion, it is every way in- confiftent with juft reafoning to admit, that pu- trid vegetable exhalation can be the caufe of con- tagion.—I mean not to deny, that putrid vegeta- ble exhalation may produce difeafe, but the difeafe IA ON THE SOURCE OF EPIDEMIC will be contagious. There cannot be a doubt that putrid vegetable exhalation is a power, ca- pable of producing difeafe, in its immediate neighbourhood ; but it is equally certain, that it never can occafion an epidemic or piftilential dif- eafe, over a whole country, or city. The pu- tridity of vegetables, and the epidemic difeafes of animals, are piobably occafioned by the fame power, viz. a certain ftate or certain viciffitudes of the atmofphere. That kind of weather or that difpofition of the furrounding elements, which occafions an uncommon mortality among animals and vegetables, will alfo produce an uncommon degree of putrefadion, among thefe fubftances, their dead ftate. Could the hiftory of all epidemic and peftilen- tial difeafes of animals be minutely traced, I am- well convinced it would be found that they have uniformly been attended with correfpondent dif- eafes of vegetables, in that particular part of a country, to which they have been confined. For, as all living bodies are fubjed to the fame laws,* it is evident that any power, which can produce general difeafe in animals, will have the fame ef- fed upon that portion of vegetable fubftances to which it is applied ; and vice verfa. Accordingly thofe difeafes of indired debility of vegetables, * Vide prop. I. View ofthe Science of Life. AND PESTILENTIAL DISEASES, &C 215 known to farmers by the te-ms rufi and blaft, have often been obferved to occur, at the fame time with epidemic difeafes among animals. And the rea- fon why fuch a coincidence has not always been exprefsly noticed, is probably, that the fubjed has not been confidered in this point of view. If fuch a coincidence then fhould be found invariably true, will it be faid that contagion may be communi- cated from animals to vegetables, and from vege- tables to animals ? When particular diftrids of a country, whole nations, or confiderable portions of a continent, are fuffering from a fcarcity of grain, will it be faid that the difeafe of vegetables, which is the caufe of the fcarcity, was produced, not by the ftate of the atmofphere, but by contagion ? In this cafe, how is the contagious matter to be traced? Is it wafted, as it were by a magic influence, from field to field,—over mountains, rivers, lakes, and oceans ? The infedious diftance would, in that cafe, be wide indeed! But I apprehend it will fcarcely be contended, that the epidemic difeafes of vegetables are contagious. And in regard to animals, the opinion does not appear at all more probable ; excepting from the fingle circumftance of their not being rooted to the foil. Would it not be more rational to admit, that the difeafes, in both cafes, as produced by the operation of fome fuch general power as the ftates or vicifli- 2l6 ON THE SOURCE OF EPIDEMIC tudes of the atmofphere, to the influence of which animals and vegetables are equally expofed ? Of the numerous fads, by which this propofi- tion is fupported, it will fuffice to quote a few. As Dr. fcufh's account of the yellow fever of Phila- delphia is, perhaps, the beft hiftory that has been given of any epidemic, it may be often with pro- priety referred to. There was fomething in the " heat and drought of the fummer months," " (T793) " which was uncommon, in their influ- " ence upon the human body. Labourers every " where gave out, (to ufe the common phrafe) in ct harveft, and frequently too when the mercury " in Farenheit's Thermometer was under 84*** u ### T/ne crops of grain and grafs were impair- " ed by the droughts." It appears, from feveral obfervations, that there was, that year, an uncommon calmnefs of the weather. " In the year 1762, the billious yellow fever " prevailed in Philadelphia, after a very hot fum- " mer, and fpread like a plague, carrying off dai- " ly, for fome time, upwards of twenty perfons." Can it be doubted, that thefe ftates of the weath- er will produce difeafe, both among animals and vegetables ? And if the operation of fuch an obvi- ous power, be adequate to explain the phcenome- AND PESTILENTIAL DISEASES, Sec. 2fJ na of peftilential difeafes, what need is there of adopting an idea! one, like contagious matter, to account for them ? Mr. Potter, in a letter to Dr. Rufh, dated from Caroline, county Maryland, ift November, 1793, fays, " it is an invariable maxim here, both among '' phyficians and farmers, that, if the wheat be " damaged by ruft or blaft, a contagious dyfen- " tery is foon to follow."* Previous to the occurrence of every epidemic, fomething unufual, in the ftate of the atmofphere, has always been remarked. A yellow fever ap- peared at Cadiz, after a hot and dry fummer in 1764 ; and at Penfacola, in fimilar circumftances, in 1765. Was the contagion traced, in this cafe, from Cadiz to Fenfacola, by a dired or circuit- ous channel, or was it traced at all ?—That the yellow fever of Philadelphia, in 1793, depended upon »he ftates or viciffitudes of the atmofphere, evidently appears from the following obfervations, communicated to Dr. Rufh, by a gentleman, who refided occafionally in fouthern and tropical coun- tries. He informed him, that he had obferved, in sC the month of July, feveral weeks before the " yellow fever became general, a peculiar and * Page 181. E e 213 ON THE SOURCE OF EPIDEMIC " univerfal fallownefs of complexion, in the face* " of the citizens of Philadelphia, fuch as he had " obferved to precede the prevalence of malignant " bilious fevers, in hot climates." Dr. Dick had . 2 20 ON THE SOURCE OF EPIDEMIC times. Cities are now more commodioufly built; the mode of living is improved ; and every circumftance that can contribute to the pre- fervation of health better underftood. Is it not from thefe changes, in the ftate of fociety, that London, Paris, Madrid,Lifbon, and Marfeilles are now much lefs fubjed to epidemic difeafes than formerly ? And in the progrefs of improvement, may not thefe difeafes entirely difappear ? The inhabitants of Grand Cairo, according to Mr. Savary, are heaped together by thoufands. Two hundred citizens there occupy lefs fpace than thirty at Paris. Thirty citizens at Paris occupy lefs fpace than ten citizens of London. Twenty citizens of Grand Cairo, therefore occupv lefs fpace than one citizen of London. The manner in which the citizens of Grand Cairo are thus crouded together, would alone feem fufficient, in a flagnant ftate of the atmofphere, to produce peftilential difeafes of the higheft degree. The large commercial cities, which have been moft frequently ravaged by the plague, are for the convenience of l'ea ports, built m low and unhealthy fituations. Their ftreecs have gene- rally been irregular, crouded, and dirty. In thefe cities, therefore, peftilential difeafes always commence. This circumftance, togeher with that effed of felf-love, which prevents us from difco- vering the origin of any evil with ourielves, pro- AND PESTILENTIAL DISEASES, &c. 221 bably gave rife to the idea, that contagion was imported in bales of goods, or even in parcels of old clothes, from diftant countries. The Epide- mic of a feafon, appearing generally in feveral places at a time, by enabling the inhabitants of one place to trace it to another, has alfo ferved to ftrengthen th3 fame opinion. But may not fimi- lar ftates of the atmofphere occur in the fame feafon, in Egypt and in Syria, in Damafcus and in Aleppo, in Grand Cairo and in Marfeilles, in Smyrna and in London, in the Weft India Iflands and in .America ? And r» ;1I not thefe fi- milar ftates produce peftilential difeafes of a fi- milar appearance ? The plague, indeed, will ne- ver appear with fimilar fymptoms in London and in Conftantinople, becaufe the ftates or viciffi- tudes of the atmofphere, in thefe two places, can never be exadiy alike. But if it depended upon a power, like fpecific contagion, which muft be the famejn all places, the fymptoms would every where appear with a uniformity fimilar to thofe of fmall-pox. Contagion then, it would feem, cannot ex- plain the' phcenomena of peftilential difeafes, without the affiftance of the ftates or viciffitudes of the atmofphere ; but the ftates or viciffitudes of the atmofphere will explain them, without the affiftance of contagion. Here I will again avail myfelf of the authority of Dr. Rufh, as far as importation is concerned. " The report of 222 ON THE SOURCE OF EPIDEMIC " the College of Phyficians has ferved to con- " firm me in an opinion, that the plagues which " defolated moft of the countries in Europe in < - 2.60 6. - 50 - 75 2. 5° - 80 4-3- 5° Nei Wist.. 3.10 Y3fv I'm * * ARMY * * MEDICAL LIBRARY mgiM»>t*tJ'T ;«■*—•' r*'-' r1^^-^: 50ft) 3wiV, ^'t-'J* '*■■■'' ... i*>.' '' V* V rf. ■' .*. ft.', ., ' V. *' .^'v ."^•<*v' <>s>»Wj.; $s i& life yr wwrni. w* *..i- ■-■*•':.'"<■« •/»•.»* i&jb