An Historical 
Dissertation 
Concerning the 
Malignant Epidemical 
FEVER 
of i 75 6. 
With fome Account of the Malignant 
Diseases prevailing fince the Year 1752, 
in Kjdderminjier. 
JAMES JOHNSTO NE, M.D. 
7" 
fadum annum etiam Dii iempejlatibus & morbis infigni 
C. Tacit. A. L. XVI, 
Ss fji.cn a|»a avail tctvtai pd'Kiara., hypcra, te 
®'aTet tcrri Toiaiv ifyTpotcnv, iwUuifoi conn elclcicti, xcni oxccnx. pcyu* 
tofifaixs fycfni, » p.cyuh»i /3?w*£«;. 
Hippocrat. de Diaeta Acutor. 
LONDON: 
Btinted for W. Johnston, Tn St. Paul's Church-Tard, 
M DCC LVIII. 
(Price One Shilling.) T O 
Do&or Robert Whytt, 
Profeflbr of Medicine in the Univerflty of 
Edinburgh, 
AND 
Doctor Thomas Short, 
Late Phyfician at Sheffield, 
This Practical Eflay is humbly Infcribed $ 
As a Monument of unfeigned Efleem, Refpe&, 
and Friendfhip-, 
By, 
Gentlemen, 
Tour moji obliged. 
end mofi humble Servant, 
James Johnftone. PREFACE. 
AS accurate defcriptions of difeafes have been long *, 
and now are univerfally judged,, among the heji 
methods of promoting the healing art \ 1 have 
ventured to make this hiflorical ejfay public, upon a pre- 
emption that the obfervations it contains, may be ufefully 
applied in treating fevers of the malignant clafs, which, 
of late years, have been uncommonly prevalent in many 
parts of England. 
It has bten my cuflom, fmce I have been engaged in the 
practice of medicine, to write down Jhort memorandums of 
the cafes of moji of my patients, labouring tinder fevers, 
and other difeafes ; that I might have it in my power to 
confider thofe which were moji remarkable at my leifure : 
From a great number of fuch cafes, the defcriptions and 
obfervations in the following trail are deduced and com- 
piled. 
In treating of the cure of malignant fevers, I lay 
down no fanative precept, which I have not, in my fphere 
of practice, experienced abundantly ufeful, and generally 
fuccefsful. Fhe cautions which I enter againfi known 
praHices or remedies, are alfo drawn from a repeated 
obfervation of their mifchievous effelis. 
* 'icrropnjv <rop>j; yxp Soxsu HrjTfixv; asfi<pvii non rvmxor. Demo- 
grit. de Nat. Horn. Vid. Epitt. Hippocrat. VI 
PREFACE* 
Some theoretical reasoning and inferences, however un- 
fat able to an hiftorical piece, I have added, with a view 
of rendering the nature of malignant diforders more gene- 
rally underfeed, than perhaps they are by many, who will 
be under a necejfty of treating them: And alfo further to 
recommend thofl rules, of the utility of which I was pri- 
marily convinced by obfervaticn, to thofe who demand evi- 
dence of a different nature. Many practitioners love to 
know, that a peculiarity in practice is rational, as well 
as, in faCt, fuccefsful, before they make it their own.— 
Both in converfation, and in reading, I have frequently 
met with phyficians, who treated the words putrid and 
malignant as unmeaning and unfeientifeal terms ; to ob- 
viate this, and another very dangerous prepoffeffwn, fre- 
quently brought from the fchools by younger practitioners, 
that all, or mef fevers, are merely inflammatory, thelafl 
part of my Differ tation dr opt from my pen.. 
In a word, I have thrown together, in a narrow com- 
pafs, and with all poffible plainnefs, feveral important 
experimental truths, which I hope may be of fervice in 
preparing many fucceffully to combat thefe terrible difor- 
ders, in fituations and circumftances fimilar to thofe I have 
deferibed. The great frequency of malignant diforders, 
occafioned, among other dreadful evils, by the continued 
d'earnefs of corn, renders information of this kind, at pre- 
Cent, but too feafonable. 
Before I have done, I beg leave briefly to mention the 
following circumftances, which the diftance of my MS. at 
this time, prevents me from inferting as a fupplement to the 
biflory. PREFACE. 
The intenfensfs and long continuance of the frofi* with 
which the prefent year fet in* almoji entirely put a flop 
to the continuance of the malignant fever with us.—But* 
in other neighbouring villages and market towns, it has, 
fince the fpring hitherto, been very frequent, in places that 
were little offeMed with it laft year.—The families of the 
poorer fort of people univ erf ally are mo (I fuhjedi to it.- 
And it is cbfcrvable, that the fever* in feme places, firfi 
broke out in the parifh work-houfes* and from thencefpread 
among the neighbouring people with great malignity.— 
Wherever it has appeared* it has given very apparent and 
fatal evidence of its infedlious nature,—In the beginning, 
mojl per Jons fioiver, and are giddy* fick* and faint •, the 
head-ach is not fo fevere* nor fo much complained of as in 
the fever laji year and a delirium is by no means fo ge- 
neral a fymptom* and* when it happens* feldom or never 
fierce* and but of fhort continuance.—Moji people are fei~ 
■zed with a loofenefs* which* if profufe* is not without 
danger.—The palate and glands are of a crimfon Jlsining 
colour ■* the tonfils are very early befet with aphthous 
fpecks * the tongue is parched* foon becoming black and 
dry ■* livid and brown petechia* and broad vikices of the 
fame colour* very frequently appear upon the breaji and 
back \ the fweat and floats fnell intolerably foetid ■* the 
patient’s weaknefs is excefilve; and the fever runs on to 
the length of three weeks* before there is any fenfible 
amendment.—ln this fever I have ever cbferved the worfi 
of confequencesfollow the ufe of bleeding.—Thofe few per- 
fans who recovered after the lofs of blood* efcaped always 
with imminent'and apparent hazard of life. As the fick 
were very little delirious* and were excejjively inclined to PREFACE* 
faint 9 it was neceffary to prevent the bofenefs from run- 
ning to any great heighth by the ufe of puh. ccrt. chacd- 
rill. and extract or deco El. lign. campechenf. and red Port 
wine mulled with fpices. There was moreover room for 
m earlier ufe of the hark, and that in larger dofes in fub'- 
fiance, than formerly . Alfo, a freer ufe of wine became 
more neceffary to fupport the patient's Jirength and vital 
force.—In moji other refpedis, the fame treatment which 
left year was neceffary, was equally proper} and generally 
fuccefsfuf in treating the malignant fevers of the prefent 
year. 
Kiddcrminfler, Dec. i, 
l7S7‘ AN HISTORICAL 
DISSERTATION, &c. 
TH E borough 5f Kidderminfler, fituated in 
52 Deg. 26 Min. N. Lat. is an inland 
market-town of the county of Worcefter, about one 
hundred miles W. from London; and at leaft fixty 
miles diftant from any fea. The inhabitants of this 
place are generally employed in the worfted and filk 
manufactory, and are fuppofed to amount to four 
thoufand and upwards. They are many ‘of them 
lodged in fmall nafty houfes, for the moft part crou- 
ded with looms and other utenfils. A confidefable 
part of the town is built acrofs fome low marfliy 
and boggy ground, which extends itlelf from N. 
to S. for feveral miles above and below the town. 
Thefe low grounds are frequently overflowed by the 
fwellings of the river Stour, which runs flowly, in 
the fame direction, and empties itfelf three miles S, 
of us into the Severn. The ftagnating water left by 
thefe inundations, rifing into the air, in putrid moift 
vapours, and blown full upon the inhabitants of the 
town by S. W. and N. Winds, cannot but co-ope- 
rate with a long courfe of moift and rainy weather, in 
producing putrid malignant diforders. In fadf this 
place has been very remarkably liable to fuch dif- {orders, long before I became acquainted with it, as 
well as fince. 
The {timmer of the year 1752, and the greateft 
part of the autumn, was moft remarkably cloudy, 
hazy, and rainy-, and yet more inclined to warmth 
than unfeafonably cold.—The winter and remaining 
part of the year, was, if any thing, (till more wet 
and rainy •, as likewife was the beginning of the 
fpring 1753. Thefrofts were few and of a very fhort 
and, in general, the winter was warmer 
as well as more moift than is ufual. In the fummer, 
a great number of infects of the beetle kind, de- 
voured the tender buds of trees. This moift and 
warm ftate of the air, quickly produced a low 
miliary fever -, which began to appear foon after the 
fummer folftice in 1752, and continued very frequent 
in this place, and in others of our neighbourhood, 
during the remainder of this year. 
This fever chiefly attacked per ions of both fexes,. 
of a bloated habit of body, and who were habitually 
.opprefled with low fpirits, and inadive in their man- 
ner of life i lying-in women were alfo very fubjed 
to it. 
In the beginning of the fever, after {hivering, they' 
became very hot and reftiefs; and complained ot 
great ficknefs and lownefs of fpirits. Red or white 
chriftalline miliary eruptions appeared on moft parts 
of the body; and at all times of the difeafe, but moft 
happily at the about the height of the diforder, 
moft perfons became comatous, deaf, ftupid, or mild- 
ly delirious.'—Few began to recover before the 20th 
day, and many not till much later-, a diarrhoea car- jrsed off fome, and, if profufe, funk the ftrength of 
all; great coftivenefs encreafed the delirium. A 
gentle laxity, amounting to one or two ftools in the 
day, was always ferviceable.—A breathing gentle 
fweat of a peculiar fmell was neceffary for recovery ,j 
a profufe one was rarely ferviceable , fometimes a fa- 
tal fymptom. The urine was extremely uncertain in 
its appearances.—-The cralfamentum of the blood, 
tho’ fometimes covered with a thin bulf, was gene- 
rally loofe in its coherence and texture. It was high- 
ly neceffary to keep up the patient’s ftrength and a 
moderate perfpiration during the courfe of this fever, 
by gentle warming diaphoretic and antifeptic medi- 
cines 5 fuch as Conf. Cardiac : Pulvis Contrayerv. 
comp. Rad. Serpentar ; Camphire, Sal Succini, and 
Spir. Minderer. When the patient’s ftrength was 
greatly funk, fmall dofes of the bark,, in decoftion, 
extracft, or a fine powder, made a very advantageous 
addition to thefe medicines •, and contributed greatly 
to the patient’s recovery, by fupporting the vis vitte, 
and the falutary cutaneous excretions , yet it did not 
in any refped fhorten the ufual courfe of thefe fevers, 
as in others it fometimes does. Blifters alfo were 
found highly ferviceable, both by the copious drain, 
and tlye ftimulus they occaftoned. To thefe medi- 
cines, diluting and fupporting drinks were joined; 
and under fuch treatment, patients who had not been 
weakened by much bleeding, or any extraordinary 
purgation, generally recovered. 
About Chriftmas this miliary fever difappearedj 
but early in the new year 1753, was fucceeded by 
another fever, in which the of the blood was ft ill more refolved than in the former fever: this alte- 
ration Teemed to be owing to the continuation of the 
extreme moifture of the atrpofphere throughout the 
winter. The malignant fore throat, which frequent- 
ly occurred in the winter 1751-2, andfometimes in 
the Jaft fummer, was now more frequent and more 
general than ever. 
An unaccountable and infenfibly increafing languor, 
iownefs, fluttering, weaknefs, faintnefs and often 
vague rheumatic-like pains of the limbs, little at- 
tended to at firft, were the beginning fymptoms of 
this fever •, and were attended with a low, foft, quick 
pulfe, which became more low and unequal in the 
progrefs of the complaint. 
fudden yery great if the diforder was unhappily trea- 
ted, either as inflammatory by cooling falts and 
bleeding, or as rheumatic, by mercurials, gnaiacum, 
jand alcaline falts. Many coniplaiped of a pain, which 
they laid was like to a rawnefs or excoriation at the 
ftomach; with giddinefs, flight ficknefs, and an in- 
ceffant craving or fenfe of want and void about the 
yuecordia.—Some had a propenflty to loofe ftools and 
profufe hurtful fweating; Tome bled at the nofe \ 
others coughed and fpit bipod : fome complained of a 
flight pain in the throat *, and in thefe the arch of the 
palate, uvula and gjands, were of a dark livid colour; 
others, without any fenfe of pain, had the fame ap- 
pearance, which Teemed for the moft part only owing 
to the natural colour of the blood fhining through 
the vefiels; for the gums, lips, caruncula lacry- 
rnalis, were of the fame colour. The tongue was 
rarely furred, but generally of a red ciqmfon colour *, tkc fick complained very little of third;. The fweat and 
.breath of the Tick had a ftrong, offenfive, putrid fmclL 
The fick were languid to excels •, and by the leafL 
motion, or much fitting up, were ready to fmk into 
fainting fits. In fome of the word cafes, livid pe- 
techias, large livid vibices, and dark brown co- 
loured fpots, appeared fcattered over the trunk of the 
body and the limbs. Refpiration, and the faculties 
of the brain, were little affeded or altered, unlefs the 
patient was near the point of death. Far from any 
excretion being critical in this diforder, it was found 
that much fweating itfelf funk the patient’s ftrength 
too much. This fever had no other natural period 
of increafe, excepting what was owing to infufficient 
or improper treatment: and a critical change in the 
patienfs favour did not happen till they were put under 
a proper method of cure, which very foon gave appa- 
rent relief, the beginning of their recovery. The 
medicines which produced this happy effed, were 
fuch as, with regard to the folids, ad as aftringents, 
and incraffate the fluids; viz. the mineral acids, Elix. 
Vitriol. Spin Vitriol. Spir. Nitri, and the bark, 
which was given in fubftance, in frequent and large 
dofes; finding its preparations by no means fo ufeful 
and happy in their effeds. To thefe a liberal ufe of 
red Port was added, which was extremely ufelul, 
alone as a cordial, and when diluted as a drink.— 
The tendency of the blood to diflblution, in this ill- 
nefs, was fo great, that every thing in the Jcafi: at- 
tenuating, was not only not to be depended upon, 
but was in many unexpeded inftances hurtful. Thus 
I perceived that Spirit. Mindereri, and other neutral felts, and faline lixiviums, which are now very in- 
difcriminately ufed by too many pradlitioners, greatly 
promoted the fymptoms ; and mere diaphoretic heat- 
ing medicines, unlefs liberally joined with the bark, 
were very little more to be trailed. Indeed the hu- 
man fluids feemed univerfelly in a more perfed ftate 
of refolution at this time, than I have ever known 
them. Yet circumllances frequently required the 
application of blifters, which by their ftimulus and 
difcharge, produced very happy effeds : I ufed con- 
dantly to infped the ferum of, the veficated parts, 
and found it generally of a deep muddy green ; and 
m proportion as the patient’s amendment went on, 
and the fluids were altered by the life of proper medi- 
cines, the ferum became gradually more of a yellow, 
or fine ftraw colour. This method of viewing the 
ferum, by blifters drained from the cutaneous veftels, 
feemed to me no Ids ufeful in thefe diforders, in 
which I never ventured to let blood, than the infpec- 
tion of blood emitted from the veins, is in thofe cafes 
which admit of that evacuation *. 
This malignant fever was very often (tho’ not con- 
ftantly) complicated with, and in general bore great 
analogy to the malignant fore throat which at this 
time prevailed very much in many parts of Eng- 
land.* - . 
* In one family, which was moft feverely and totally affefled 
by this fever, and where it continued long after the general difpo- 
fnion in the atmofphere no longer favoured its produftion, the fe- 
verity and continuance of the diforder were attributed to a dead 
putvified dog, which had been frnothered under a heap of wool, 
and, during the fpace of a twelve-month, diffufed over the dwel- 
ling houfe of this afflidled family, the moll putrid ftench I ever 
felt; the caufc of which remained fo long undiscovered and un- 
known. This extraordinary and new diforder, is called by 
Dr. Fothergill *, The fore throat with ulcers. By 
Dr. Huxham -f, in his lad publifhed difcourle. 
The malignant ulcerous fore throat: Dr. Le Cat, of 
Rouen f, very jultly calls it, A gangrenous fore 
throat:, feeing thofe white (loughs, with the colour 
and appearance of pus, were in reality gangrenous 
efchars, which when call off, left behind them pitted 
fears; the lading vediges of lofs of fubdance. This 
difeafe has of late years appeared in feveral parts of 
America, and in the north of France, and in Britain, 
almod at the fame time; but chiefly in low moift: 
fituations, and after a long courfe of cold damp wea- 
ther. Children, efpecially thofe of a lax habit of 
body, were mod generally affedled by it; yet not 
folely, for adults, fuch efpecially as had a thin acri- 
monious blood, were obferved to be very fubjeeff to it, 
at any time when the diforder prevailed ; and often 
at other times to relapfes: Indeed lax veflels, and a 
fcorbutic acrimony and thinnefs of duids, condituted 
that habit of bodyy which (eemed mod eafily and 
frequently to produce this diforder. I have known it 
more than once produced by the internal and external 
ufe of mercury: Strong purgatives, and the frequent 
* Dr. Fotherglll’s feafonable treadle appeared, I think, about 
the end of the year 1748. And gave lb much information of the 
nature of this difeafe, and the method of treating it with fuccefs, 
as proved the means of refeuing the lives of numbers from that 
certain death, which a difeafe, of itfelf dangerous, and made more 
fo by wrong methods of cure, quickly caufed. 
f A DHTertation on the malignant ulcerous fore throat, by 
Dr. Jofeph Huxham, 1757. 
% Phil, Tranf. Yol, 49. Part 1, Pag, 49. for 1755. life of aloetics, have certainly had the fame effect y 
and in treating this diforder, fuch things cannot be too 
much avoided *. 
The appearances of this diforder were far frohi 
being the fame, but varied greatly in different pa- 
tients and conftitutions, not only in appearance, but 
alfo in the degrees of danger. 
In many, nothing more appeared, befides a high 
fcarlct or livid colour of the tonnilise, uvula, and ve- 
lum pendulum palati: This happened fometimes with, 
and fometimes without much fwellmg of the glands 
about the throat and neck, and without any confi- 
derabie pain or difficulty in deglutition ; the pain, as 
the diforder gains ground, always abates. The fe- 
verifh heat is very great, and the patient is extremely 
low, and vaftly reftlefs, during its noClurnal exucer- 
bations. In this fituation, the patient’s danger is 
very great, efpecially under improper or infufficient 
management: For the livid appearance of the fauces 
becomes deeper coloured, and inclining to black, 
the patient’s body breaths an offenfive cadaverous 
finell.—At laft, when death is at hand, refpiration 
becomes unexpectedly difficult, quick, and penpneu- 
* If the phenomena in a falivation are compared with the ap- 
pearances in the ulcerated fore throat, the cleared: analogy and 
iimilitude will appear. For in the artificial, as well as the natural 
diforder, we obferve, a low putrid fever attended with a foft ur> 
cheating pulfe, a fti.nk.ing breath, copious {pitting, white aphthous 
ulcers in the glands, tongue, gums, cheeks; the glands of the 
head and neck are fwelled; fometimes haemorrhages and bloody 
ftools appear, This famenefs of phenomena at once fhews 
us the true Hate of the fluids, viz. their diftblution in the angina 
maligna, and direds us to the ule of the bark and mineral acids, 
as remedies to incraflate the fluids ; and to avoid mercury, alcaline 
Halts, and attenuants in general, cane pejus et angue. monic; the face has fomething of a livid hue, the 
neck is fwelled and livid •, and the pulfe is fluttering, 
fmall, unequal, and intermitting. 
In others, the tonflllas, being conftantly more or 
lefs fwelled, are of a livid, inflamed, fhining colour, 
and give the patient the fenfation of a pricking or 
pungent pain, which is of fliort duration, for the 
moll inflamed parts of the tonfillse change into white 
broad fpecks, or floughs, of the appearance of fat, 
with which the back part of the palate, as well as the 
glands, is often covered •, the fpecks alfo are often 
obferved about the tongue, cheeks, or gums, and 
fometimes extend deep into the asfophagus or trachea 
arteria. With thefe appearances, the difficulty and 
pain of fwallowing, are often much lefs than one would 
fuppofe, from the tumefadion and colour of the parts 
about the fauces. This anginous fever was not al- 
ways, though often, attended with cutaneous erup- 
tions; and thefe, for the moil part red, were fometimes 
alfo of the chriftailine miliary kind, broke out firft, 
and the diforder in the mouth and throat feemed fre- 
quently only a confequence of their fudden retro- 
ceffion. Under fuch circumftances as thele, timely 
and proper care prevented all danger; but if the fever 
was allowed to run on a week or more, or is in the 
mean time unhappily treated only with attenuants and 
coolers, or evacuations, the diforder rapidly gains 
ground, the febrile nodurnal exacerbations become 
more and more fevere, the floughs fink deeper, and 
fpread wider, and darken in their colour: the crafis 
of the blood more and more broken, occafions 
diarrhseas and haemorrhages *, and, at laft, the pa- tient is feized with a*ftraitnefs and fliortnefs in breath- 
ing, and dies *. 
Very often white Houghs or fpecks, fimilar to the 
above, will appear in the mouth and throats of chil- 
dren and adults, without any remarkable feverifhnefs 
either preceding or attending them. This is the 
loweft, and mildeft, and fafeft degree of this diforder; 
which, excepting fome degree of feeblenefs, and low- 
nefs, and fometimes a little pain, is attended with 
little inconvenience, and no danger -f. 
Daftly, the tonfillas are fwelled, inflamed, and 
befet with fpecks at the fame time, and afterwards 
fuppurate ; when this happens the pain is very great, 
and, with the fwelling, continues after the white 
fpecks have difappeared, till the abfcefs be broke. 
This indeed is a troublefome circumftance enough, 
but very remote from any danger. And in the ma- 
nagement of fuch a mixed cafe, it is much fafer, as 
Dr. Fothergill obferves, to run the rifk of a harmlefs 
fuppuration, than to incur any greater mifchief, which 
evacuations may eafily occafion.-—lndeed, when the 
angina maligna was properly treated, the throat be- 
came thereby more painful; and this, with a firmer 
and flower pulfe and a breathing perfpiration, was no 
inconfiderable fign of recovery. 'For as this diforder 
generally began wdth fome degree of erifepelatous in- 
flammation, and degenerated into a gangrenous dif- 
pofition; by a proper ufe of internals and external ap- 
* Ulcera tonfillarum in infantibus periculofa Ulcera pro- 
■Terpentia circa fauces, graviora & rnagis acuta, ut plurimum fpiran- 
di difficultatem inducunt. 
f Ulcera in tonfillis extra febrem fada, fecuriora funt. Hip- 
pocrat. de Dentitione Liber. plications, the motion and confidence of the blood 
being reftored, the difpofition in the throat became 
again in fome meafure inflammatory, by the reflora- 
tion of motion in the vefiels of the parts, or by the 
effort of life to call off the floughs. 
In the mildeft fpecies of this diforder, a cure was 
eafily effeded by external applications alone; fuch 
as detergent and antifeptic gargles of tindure of 
myrrh, oxymell. fimplex. fpir. of vitriol, with cyder 
or water ; and fumes of diftilled vinegar boiled with 
powder of myrrh and honey ; camphorated epithems 
under the throat were extremely ufeful. 
In the more fevere and dangerous fpecies, whether 
fo naturally, or rendered fuch by a wrong ufe of me- 
dical inflruments, not only thefe externals were ne- 
cefiary, but alfo the internal ufe of mineral acids in the 
patients drinks, with camphire, myrrh, confed. car- 
diaca, and the bark; in children who refuted the 
bark by the mouth, I injeded it by glyfters, and 
found it anfwer my expedations as well this way as 
in the other. I foon perceived, that neither the ex- 
trad, nor tindure, nor even the decodion, unlefs 
extremely ftrong, were equally to be depended upon 
as the fubflance of the bark in this diforder *. And 
when given in a fine powder, to the quantity of 
half a dram to an adult, once in two or three hours, 
* Dr. Sydenham ftrongly recommends the bark in the aphtha;, 
a diforder in its nature very analagous to the fore throat with ulcers. 
V. Swieten, at firft doubtful of his remedy, was by its happy effedls 
convinced of the truth and merit of Sydenham’s obfervation. Com- 
ment. Vol, 3. But fo far as I know, the bark was firft publickly 
recommended for the malignant fore throat, in a paper publifhed 
in the Gentleman’s Magazine, November 1751, by the celebrated 
Dr. Wall of Worcefter, as the pra&ice of the faculty there. was more to be depended upon in the word cafes, 
than any other remedy •, though in many cafes it was 
not neceffary. Nor was it lefs effectual when the 
glands were much tumefied, in removing (with the 
affiftance of external applications) the tumefatftion, 
than the doughs. A fadb which will now be hardly 
doubted, fmce we find by unexceptionable authority, 
the bark has been found ufeful in removing fimpie 
fcrophuious fweilings, as well as in healing the ulcers 
of fuch a habit of body *. Befides thefe medicines, 
ted Port wine was ufed with fuch liberality as is un- 
exampled in any feverifh diforder, and yet with fuch 
advantage as fully juftified its ule. Dr. Fothergill 
obferves f, that the free ufe of aromatick medicines 
made' the pulfe flower in this diforder than it was with- 
out them. Wine had the fame effects, the pulfe be- 
came flower, and loft that /oft which 
fhewed how weak the impelling force of the heart was 
without fuch affiftance. It was moreover very ufeful 
jn keeping the body from being loofe, which was 
highly neceffary during the procefs of cure at leaft, 
and when this did not luffice, it feemed fafer to ufe 
the powder of cafcarill. with Jign. Campechens. and 
tormentilla in decoftion, than to have recourfe to the 
opiate aftringents. I obferved that the air of a warm 
chamber was at all times neceffary to aid the operation 
pf thefe medicines *, without which the diforder either 
gained ground, or the patient fuffered a relapfe into a 
ftate from which he was juft recovering. Indeed 
* See the Art. 18 and 26 of Vol. 1. of Medical Obfervations 
by a Society of Phyficians in London, 
f See Dr. FothergiU’s Account of the Sore Throat with Ulcers. relapfes were very frequent in this illnefs, but 
none were more fubjeCt to them than children and 
adults of a weakly and highly fcorbutic habit of body. 
Thefe relapfes often ended in a real phthifis. Riding 
abroad and affes milk were the bell; remedies for re- 
moving and preventing this cataflrophe. In fine, 
this difeafe differed effentially from moil other putrid 
continual fevers, which under any method have a cer- 
tain and determinate period to run, in this-, viz. from 
whatever time patients labouring under the angina 
maligna began to be properly treated, that was the 
patient’s critical period, for from that time the difor- 
der began to decline, provided the patient’s ftrength 
had not been irrecoverably funk; and no afthma with 
intermitting pulfe, arifing from a polypus, or from a 
deformed cheft, produced contra indications which 
made every precaution ineffectual. Convinced that 
all evacuations, except moderate perfpiration, were 
hurtful during the courfe of this diforder, I was cau- 
tious of allowing ftrong purges to expel the reliquiae 
morbi, even alter a recovery; and lam not perfuaded 
there is any thing befides a little rhubarb, or floras 
fulphuris, or cremor tartari, neceflary, which may be 
combined with the piluh gummos. myrrh, and the 
bark. 
From an attentive companion of the different ap- 
pearances in the angina maligna, with a diforder 
treated of by that excellent yet obfcure writer, Aretaeus 
Cappadox, in his firfl book De Morb. Acutor. Sig- 
nis, Caufis, et Curatione, Cap. IX; the firfl: of which 
js entitled T«y ehxuy. The fecond.  ruv x.a.Tu rv)v tpugvyfcc hmjthxm ttocSuv. * Struck With 
the refemblance of circumftances, I cannot but think 
with M. G. Severinus, and Dr. Huxham, that thefc 
diforders are in fadt of the fame kind; proper allow- 
ance being made for the difference, which the temperate 
heat of our climate, our peculiar method of life, and 
the differences of our conftitutions and difeafes, will 
neceffarily occafion. The defcriptions Hippocrates has 
left us of the pleurify and peripneumony do not more 
agree with thefe diforders as they occur in modern 
practice, than the angina maligna correfponds in moft 
* The following paftages, will fupport what I have advanced 
concerning the analogy of this diforder and the angina maligna of 
our times, but as peftilential difeafes are in general more fevere in 
countries lying near the equinoctial line, than in thefe northern 
climes, fo alfo this peftilential affedion of the throat, by fome of 
its effeds and fymptonjs mentioned by Aretaeus, and omitted in this 
citation, feems to have been feverer than ours. Dr. Fothergill 
has juftly obferved, that the fame diforder, about a century ago, 
raged with greater feverity in Italy and Spain, than it has at all 
done with us. But degrees of greater and lefs do not alter 
the genus of any thing. “ Ulcera in tonfiliis hunt, ali- 
qua familiaria, mitia, non laedentia: aliqua aliena, peftifera, 
necantia. Mitia quidem funt munda, exigua, nonalte defeenden- 
tia, non inflammata, doiorem non excitantia, Peftifera funt lata, 
cava, pinguia, quodam concreto humore glbo, aut livido, aut nigro 
fordentia. Id genus ulcera a,<p§ca nuncupantur. Si concreta fordes 
altius defeenderit, affedus ille et eft, et vocatur. Si 
interius in os depafeendo i'erpit, ad collumcllam ufque pervenit, ip- 
famque exedit, et linguam etiam occupat, et gingivas, et fraena, 
ideji dentium alveolaj : Dentefque labefadantur et denigrdcunt : In 
collum etiam phiegmoneerumpit: atque ifti, hand ita multis diebus 
poft phlegmone, febribus, faetore, inedils confumpti intereunt. At 
ii in pedusper aiteriam id malum invadat, illo eodem dieftrangulat, 
Pulmo et cor neque talem odoris faeditatem, neque ulcera, neque 
faniofos humores fuftinent, fed tuffis fpirandique difficultas enaf- 
citur.” De Morbi Acut. Signis et Cauiis Lib. i. Cap. IX. “Si 
ab his, (ulceribus) fanies ad interiora deftillat. celeriter partes, 
etiamfi integrte erant, ulcerantur ; celerrimeque ulcera interius de- 
pafeendo ferpunt atque hominem perimunt.” Medicamentis 
igni fimilibus quo depaftio coerceatur, et cruftae decidant, utendum 
praecipio. Ea vero funt, alumen cum melle, Galla, Ballauftium.” 
Aretaei De Morb. Acutpr. Curatione, Lib, i. Cap- IX. Edit, 
Boerhaav. refpefts with the ofB<u & of Aretasus. The an- 
tient as well as the modern diforder chiefly attacked 
children of both fexes; and both appear to be equally 
concommitants, fymptoms or effects of putrid and 
peftilential diforders of the worlt and moft malignant 
kinds. 
The fine fummer weather we enjoyed in 1753, ab- 
folutely removed this malignant febrile conftitution, 
and the gangrenous fore throat.—Thefe diforders were 
feldom or never met with in the years 1754 and 
1755— And other maladies arifing from an inflam- 
matory vifcofity in the blood again appeared : But no 
epidemic of any general note happened till the year 
1756- 
The fummer weather of 1755, upon the whole, a 
wet one, was extremely variable; fometimes very hot, 
and fometimes very cold. In the beginning of No- 
vember happened that dreadful earthquake which laid 
Lisbon in ruins, which fhook the whole Atlantic 
ocean, which was felt from Africa to the remotefl: 
coafts of Europe; and affedled lakes, ponds, and 
rivers throughout the Britifh ifles in a very remarkable 
manner. Precifdy at the time which correlponded 
with the general, commotion, in a profound'calm, the 
waters of Severn, and fome fifh-ponds in our neigh- 
bourhood, were tolled and agitated, in a manner very 
extraordinary to the fpedtators. This winter was 
throughout exceflively rainy and open, with extreme- 
ly little froft: One of our principal ftreets, and the 
low grounds lying N. and S. of us, were overflowed 
with water almoft the whole of this time; yet, 
excepting a dyfenteric flux, which about Chriftmas was pretty common, no difeafe had generally prevailed 
hitherto fmce 1752-3.-—In February 1756, the wea- 
ther began to be very fine, and continued dry, ferene, 
and warmer than is ufual at that feafon, to the mid- 
dle of March—The trees began to put forth leaves 
and flowers in abundance—But the buds were nipt, 
and the flowers, with the hope of fruit, abfolutely 
deflroyed, by a hidden alteration of the weather 
about the middle of March, which from this time 
continued uncomfortably cold, and extremely va- 
riable almoft to the end of May-, being by turns 
cloudy, frofty, fnowy and rainy to excefs.—ln the 
beginning of fummer, a great number of large beetles, 
not unfrequently the harbingers of epidemic illnefles, 
devoured the frefli Ip routing leaves. The whole fum- 
mer and beginning of autumn continued extremely 
wet and rainy.—Fruit was never more fcarce.—The 
feafonable maturation and gathering in of the corn 
crops, was obftru&ed by the long heavy rains.'—The 
dearth of corn encreafed very faff.—And a dangerous 
malignant, contagious fever, which firft appeared in 
April, was now become very epidemical, not only 
here, but in many other parts of the W. and N. W. 
of England. September was dryer, and gave time 
for gathering in the diminilhed and damaged crop.—- 
In Odlober, the weather ftill continued dry, ferene, 
and frofty.—Our fever was greatly checked in its pro- 
grefs and frequency The meafles at this time went 
throughout town and neighbourhood.—The children 
commonly got over the ufual courfe of this diforder j 
but vaft numbers died tabid of its confequences. The 
chin-cough fucceeded the meafles.—From the begin- riing of November to Chriftmas, the weather was Very 
foggy, cloudy, hazy, rainy, and without troll—Our 
malignant fever appeared again with renewed force, 
and continued very frequent throughout the remain- 
der of the year. But the long continued frofts, which 
began with the prefent year, gave an effedual check 
to its progrefs; and it has but very rarely appeared 
fincethat time. Aphthous ulcers, and the malig- 
nant fore throat, have, fince this fever fet in, been 
more frequent, than in the three former years; but 
have not had any thing like a general courfe, and 
have only re-attacked perfons formerly fubjed, or 
fome few others greatly difpofed by the frame of their 
bodies to produce fuch diforders. 
The fever which prevailed during this remarkable 
year, was very evidently contagious, for whole fami- 
lies were either all-together, or one after another, 
feized with it. Thofe that vifited or nurfed the fick 
in one houfe, often carried the diftemper along with 
them to other places, and were feized with it them- 
felves.—Others, on the contrary, who never came 
near the Tick, were affeded with the fame kind of 
fever. It prevailed chiefly in poor families, where 
numbers were lodged in mean houfes, not always 
clean, but fordid and damp. It feemed to affed fuch 
poor families moll, where there was reafon to think a 
fufficiency of the neceffaries of life, on account of the 
dearth, had for fome time been fcantily fupplied j yet 
the other poor perfons, given to the intemperate ufe 
of malt liquors, and ardent diddled fpirits, were 
obferved to be very much liable to its influence ; And 
not a few perfons in eafy circumftances of life, wrere 
affeded with this fever like others. No time of life was entirely exempted from its violence ; for children* 
who were otherwife little liable to it, were frequently 
infeded by their parents, and underwent the fame 
dangerous fymptoms as they. Perfons from ten to 
fifty years of age, feemed more fubjecl to it than 
others: And very old people much lefs than thofe in 
any other ftage of life. Women in general were 
more liable to it than men -, fuch a!fo of that fex as 
were of a pale and fallow complexion, and had the 
menftrual flux in any degree lei's copious, and ob- 
ftruded: thofe who approached that period of life 
when this evacuation naturally flops, or were in ly- 
ing-in circumftances, efpecially if at the fame time of 
a lax and cachedic habit of body, were in general 
the frequent fubjccts of this diftemper.—lt is no new, 
and certainly a very juft oblervation, that perfons 
who have fine dark brown eyes, are more than others 
fubjed to epidemic fevers, as they were in fad to 
this.—Thofe of either fex, who had laboured under 
any low or flow diftemper, proceeding from a fcorbu- 
tic acrimony of blood, and from lax veflels and 
nerves; fuch as had been greatly weakened by a great 
Jofs of the falutary and nutritious humours, or la- 
boured under a fulnefs of bad juices, from any caufe 
whatever, were all very liable to this diforder.—It 
happened in this, as in many other difeafes of the 
fame nature, that an exceeding fear to catch, and 
uncommon care to ftiun it, prepared only fuch 
anxious perfons to receive it, with more than or- 
dinary danger.—Natural low-fpiritednefs, and un~ 
eafmefs of mind, though not proceeding from 
any fear of this diftemper; but grief, anxiety, dejec- don, or folicitude, from any caufe whatfoever, were 
obferved to have a great influence in difpofing thofe 
wh© laboured under them to catch this diforder ; on 
the other hand, ferenity and joy in general, and a 
magnanimous negled of fuppofed danger, were among 
the beft prefervatives from it. 
In many, this fever was preceded by certain 
fymptoms, which leemed to indicate that its caufe 
had been for fome time lurking in the conftitution, 
before it appeared in its genuine form. I was infor- 
med by many I had occafion to attend, that they had 
for many weeks, or perhaps months, laboured under 
an uncommon depreflion of fpirits, which they could 
not account for, and felt their ftrength gradually 
abate, with great laflltude, and very often a great 
pronenefs to faint away, till the time this fever ap- 
peared with its proper fymptoms.—The leizure of 
others was more fudden, lets connected with predif- 
pofmg conftitutional caufes and forerunning fymp- 
toms. An intercourfe with perfons labouring under 
this difeafe, for the moft part could be traced, and 
there was no reafon to doubt, but that they generally 
caught it by contagion, which is fudden, and ex- 
tremely uncertain in its attacks. 
There was great variation in the fymptoms of this 
fever, arifing from the different conftitutions of the 
patients ; and ftill greater in the degree even of thofe 
fymptoms which were uniform in their kind : This 
makes it neceflary to arrange thefe feverer and milder 
attacks, into feparate departments ; beginning with 
the fevereft, that this may ferve as a meafure, with 
which the reft may be compared. i. During the firft and fecond days after the fir ft 
attack, mod: perfons were by turns chill and hot, and 
fhivered very much—Though, in very many, the 
heat which followed the find: horror and chilnefs, did 
not abate till the end of the fever. Very fevere pains 
about the joints, and efpecially in the final! of the 
back, and forenefs in the bones, are generally com- 
plained of more at this time ,than any other of the 
fever. Great faintnefs and oppreffive weight about 
the prsecordia, unremitting reftieffnefs and watchings 
attended thefe beginning fymptoms as well as the fol- 
lowing. After the fecond or third days, a head-ach 
and naufea, more or lefs complained of from the be- 
ginning, encreafed into a continued vomiting of every 
thing that was offered either as food, drink, or medi- 
cine, efpecially any thing of this kind that is di{agree- 
able and foetid, was certainly thrown up, and encreafed 
the patient’s uneafinefs.—-Along with the vomiting 
the patients complain of a kind of painful fealding 
heat at their ftomach, which is encreafed by every 
thing fwallowed down. Others feel every thing to 
flop at a certain part of their ftomach, and giving 
great uneafinefs till rejected by vomiting. After the 
ftomach is emptied of its contents by the firft efforts 
of vomiting, very little is thrown up befides what is 
drank, fometimes indeed the rejected matter conti- 
nues more pituitous and bilious, and, in fome, green 
as verdigreafe. This violent complaint is generally 
preceded and attended with obftinate coftivenefs, and 
the fick are greatly troubled with eradiations and bor-. 
borygmi: But no fymptom is more complained of, 
at this time, than the head-ach, which abfoiutdy prevents all compofure and reft, and makes the pa- 
tients difmally pronounce often too truly their own 
fate, viz. that they muft either be diffracted or die, 
*—This vomiting and cephalalgia were always molt 
fevere when the body was moft coftive, and was not 
eaiily moved by glyfters and fmall dofes of rhubafb—■ 
And very feldom yielded to this or any other method 5 
and when this was the cafe, a fatal prefage might 
with great certainty be formed concerning the event 
of the difeafe. The pulfe was, from the beginning, 
very fmall, quick, and unequal, and became ftill lower 
and more unequal in the continuation of the difeafe.—- 
The tongue fometimes is furred and black, often of 
a red inftamed crimfon colour, although moift at the 
beginning •, as the diforder encreafes, becomes torrid 
and parched.-—The face is fluihed, and often, by the 
ftrainings j blood is plentifully forced from the no- 
ftrils, but without relieving the patient.—About the 
7th, Bth, or 9th days of the difeafe, the head-ach be- 
gins to abate, and the patient becomes confided ; the 
urine becomes pale and more limpid than ufual.—The 
vomiting, hitherto unconquerable, ceafes of itfelf, 
and every drink, and every naufeous medicine, is as 
certainly retained from this time, as things of this na-r 
ture were before thrown up.-—The patients, now 
light-headed, think themfelves better, and are often 
thought fo by unexperienced obfervers ; but the 
rium encreafes, the eyes look wild, and often red, and 
a fubfultus tendinum, phrenfy, and perpetual tolling, 
come on; the tongue, if not before, becomes now 
parched, chopped, and dry ; the patient, before 
thirfty, is no longer defxrous of, and refufes drink j the urine grows more limpid ; the pulfe more irre- 
gularly quick and low; urine and ftool, extremely 
foetid, are involuntarily emitted; the face becomes 
ghaftly, funk, and livid, and is diftorted into 
a hundred different ghaftly forms, by the fpafms 
of the mufcles : fmall livid petechise are diffeminated 
over the Ikin: the arch of the palate, in the begin- 
ning of the difeafe, of a crimfon colour, now becomes 
livid and excoriated, and fometimes, before death, a 
gangrenous blacknefs arifes deep from the oefopha- 
gus, and fpreads to the glands and palate. The pa- 
tient fweats profufely, and is feldom cold till death is 
at hand. An abominable cadaverous ftench in his 
breath, perfpiration and ftools, is offenfive and dan- 
gerous to the attendant. The patient’s voice is re- 
markably deep, low, and trembling, when any voice 
at all can be heard. Death happens for the moft part 
about the 12th, 13th, or 14th days, and fometimes 
later, if the patient’s pulfe remained full, and his 
ftrength was great. 
This fever, however generally fatal, as above dr- 
cumftanced, did not prove conftantly fo. For, in fome 
few fingular inftances, where the vomiting and head- 
ach admitted of fome mitigation in the beginning; 
the body was moderately open ; the pulfe remained 
full and conftant, and the breathing fweats and pa- 
tient’s ftrength were kept up ; The Tick, alter re- 
maining a long time trembling, convulfed, fenfelefs, 
comatous, delirious, as it were in dreadful equipoife, 
upon that narrow line which feparates life and death, 
would begin to recover after the 20th or 25th days; but for months would continue in a very weak con- 
dition. / " 
2. Others, attacked with this fever in a degree lefs 
fevere, complained in the beginning of fhivering, in- 
terchanged with heat; of laffitude, weaknefs, lan- 
guor, pains and forenefs in the back and limbs.—The 
pain in the head, and naufea, were generally com- 
plained of by thefe patients ; but as the firft was not 
fo remarkably fevere and conftant as to prevent fleep 
and reft entirely, fo a retention of every thing was 
not prevented by the laft; as happened in the worft 
ftate of this difeafe. The pain in the head was much 
lefs acute, and attended with fome ftupor, with a 
ftnging voice in the ears; which often-changed into 
deafnefs, and ended in a coma.—The naufea and vo- 
miting were eafily removed by adminiftring a gentle 
emetic in the beginning, which for the moft part 
operated downwards, as well as by vomiting.—A na- 
tural, or artificial loofenefs, procured by mild purga- 
tives and glyfters, was found very fpeedily effeftual 
in removing the cephalalgia : The Tick were fome- 
times reftlefs and watchful; others dofing and difpo- 
fed to fleep.—Some were feized with remarkable 
faintnefs, giddinefs, and dimnefs of fight, upon at- 
tempting to watch or fit up, who found their fpirits 
very good in a lying pofture.—Others bore an eredl 
pofture very well, and feemed to elapfe eafier, in fome 
inftances, from very dangerous fymptoms, than 
others who were too clofeiy confined to their beds. 
Towards the 10th day the patients became delirious, 
or comatous; the delirium in this cafe was neither 
raging nor conftant; In moft cafes, the patients nerves trembled all over-, nor was this a very bad 
fign; certainly the fubfultus tendinum was much 
more ominous. The pulfe was very variable in this 
illnefs, but moft generally was higher and fuller in 
the beginning, than towards thcheighth ; the tongue 
was generally moift and white, though frequently of 
a erimfon colour, and, at the heighth, dry : the 
urine, in the beginning, often turbid, fometimes 
with a fedirnent, more generally clear and high co- 
loured -, became at the heighth clear, yellow or ftraw- 
coloured, and continued fo after the crifis, without 
fedirnent. If more perfectly limpid, a fubfultus ten- 
dinum was fuperadded to the other fymptoms. Many, 
though not every one, had the skin all fpotted with 
fmall crimfon-coloured or livid petechias, which ap- 
peared at no certain time of the difeafe —ln feme few 
others towards the heighth, a critical eruption of 
white, watery, or cryftalline, and red miliary exan- 
themata appeared upon the skin : Thefe were at- 
tended with a copious fweat of a peculiar fmell, which 
it was neceffary to fupport. In fome, at the height 
of the diforder, the palate was excoriated and of a 
erimfon colour.—ln fome the tonfils were be let with 
aphthous Houghs.—ln others the back part of the pa- 
late, tongue, glands, and uvula, was all covered 
with one continued aphthous cruft; this foon returned 
when feraped off, and the fiefti beneath was perceived 
to be livid and raw. With miliary eruptions, or 
thefe appearances in the throat, loofe ftools funk the 
patient’s ftrength more than in any other circum- 
ftances. About the 15th day the fever was generally 
at its heighth. The lick was very rcftlefs and deli- Hous, or perfectly ftupid, with tremors or fublultua 
tendinum. Upon thefe fymptoms, a rigor fupervenes, 
and ends in cool moderate fweatings ; and compofure 
and refi: follow : This proved for the moll part a fa- 
vourable cribs; even where fenbble perfpiration was 
hardly promoted, the recovery commenced from this 
time; the puife became flow and full* the fenfes re- 
turned, the Tick flept regularly, the body was folu- 
ble, and foon after an appetite for food difpofed the 
Tick to eat. The miliary eruptions were critical to 
the few that had them; the flat livid petechias ap- 
peared at all times of the diforder, and were fympto- 
matical only. 
3. But many had the good fortune to be feized 
with this fever, much more favourably than thole 
who were attacked as in No. 2. Some fuch were 
fuddenly feized with a dyfenteric flux, of putrid, 
bloody, and ferous ftoois, voided with great pain; 
this arofe, for the moll part, from the taking in of 
the contagious effluvia by fuch as attended the lick *; 
and by this fudden effort of nature, the poifon was 
expelled •, and under proper care extended its dire 
influence no further than the prims viae. 
Many were feized with a flight chilnefs, with 
rheumatic pains all over the body, but very wan- 
dering, and of fhort duration ; the fick had little 
thirft *, but Were univerfally low, weak, and had 
towards the evening an increafe of flcknefs and head- 
* In this manner I was infe&ed myfelf, and from me a near 
relation received the diforder the next day, —— Want of reft, 
great fatigue and cares, feemed to be the caufes vvh/ I was how 
infe&ed rather than before this time, having long been expofed to 
the fame external caufes in my attendance upon the lick. ach, but neither fevere nor conftant: Some were fei- 
zed with Jhort fits of fevere coughing.—The pulfe 
at firfl; full and hardifh, became of itfelf in a few days 
foft and undulating and low. -Many bore an ere6t 
pollute very well; others became giddy and faint by 
it ; others were feized with heat and weaknefs creep- 
ing infenfibly upon them, attended with lownefs, 
want of appetite, laflltude, and reftleflhefs, and with 
fome degree of giddinefs, ftupor, and head-ach in the 
flighter degree. All then univerfally complained of 
lownefs ; which was always encreafed by bleeding •, 
tho’ fometimes the pains and cough feemed to require 
it, and the fulnefs of the pulfe to allow of it; And 
the diforder, though flight, feemed to run on a longer 
time, in confequence of this evacuation, than in 
others, who with fpeedier fuccefs in the fame circum, 
fiances were eafily cured, by having the body kept 
folubleby glyfters and rhubarb; and by encouraging 
perfpiration, with gentle antileptic and cordial me- 
dicines joined together. Perfons in this way were 
feldom confined in bed, though their weaknefs often 
required them to lye upon it, and to keep themfelves 
in a clofe room. 
In every degree of this diforder, lownefs, debility, 
reftleflhefs, naufea, head-ach; a general propenfity to 
a coma or delirium; the foetor, and contagious na- 
ture of the excretions, feemed to be its diltinguilhing 
and chara&erifing fymptoms. Refpiration was in 
few cafes affefled till the near approach of death; 
excepting in the winter, when the putrid fever was 
often complicated with peripneumonia and pleuritic 
fymptoms; yet thefe bore bleeding lefs than is ufual. and the bnfF, or fize upon the blood, had a very pe- 
culiar faffron hue, from the mixture of red or ferous 
globules. 
This fever was undoubtedly of the putrid continual 
kind, and, excepting that exacerbation which hap- 
pens in all fevers during the nocturnal hours, was 
without any regular and alternate remifllon that could 
be obferved. Its duration was uncertain-, thofe who 
were affeded in the worft maimer, often died before 
the fifteenth day ; yet few began to recover till that 
time, many not till after the twentieth, or twenty- 
fifth days of the difeafe. The crifis was not atten- 
ded with any large evacuation of any kind.—An irre- 
gular pulfe, univerfai tremblings, fpafms, reftleffnefs, 
delirium, a deep coma, and profound infenfibility 
and ftupor, with a funk almoft Hippocratic counte- 
nance, were the appearances which characterized for 
the moft part the turbse criticse in this malady. The 
trembling generally ended in a cold rigor, after which 
a gentle fweat, and a bilious ftool or two fucceeded; 
from this time the pulfe became fuller, flower, and 
more regular; the patient, for the moft: part, became 
fenfible the fame day, or the next, fometimes in- 
deed later; the tongue caft off its black and gan- 
grenous parched cruft, and a fine coloured new flefti 
appeared under it: After a crifis, the natural re- 
turns of ftrength were extremely flow, and it was often 
a month or more from the turn of the fever before 
they could creep abroad, and much longer before 
they compleatly regained their former ftrength. 
The common prognoftic figns in other fevers, were 
many of them applicable to this, but none more. than that general maxim, by Cclfus tranflated from 
Hippocrates; * “ NetVue ignorare oportet in acutis 
morbis fallaces magis notas effe, et faluiis et mor, 
tis.” 
If, (as in No. i.) the head-ach was exceffively 
fevere, and the vomiting fucli as no art could quell 
in the beginning of the diforder -f, and the patient 
complained much of borborygmi and flatulent 
.eru&ations; and the tongue, pretty early in the dii- 
cafe, became black and parched; from fuch fymp* 
toms, the patient’s danger and death might with 
great certainty be foretold. And though I was not 
fo happy as to meet with an opportunity of fatisfying 
my curiofity, by opening any body dead of this fever, 
I am perfuaded the obflinacy and concatenation of 
thefe dreadful fymptoms (No. i.) arofe entirely from 
fpots {battered over the internal furface of the fto- 
mach and fmall guts, at firft erifepeiatous, afterwards 
gangrenous, and at iafl truly fphacelous. 
In this opinion I am confirmed, by the analogy or 
rather identity of the diforder I have defcribed, with 
that which raged in the beginning of this century at 
Hall; and aifo at Rouen in 1753. In the dead of 
thefe fevers, the ftomach and fmall guts were found, 
by the anatomical induftryof that glory of the medical 
* Hippocrat. Aph. § 2. Art. 19. Celfi. Lib. 11. Cap. vi. “ Si- 
'* quidem etiaro fpes interdum fruftratur, et moritur aliquis, de 
quo medicus fecurus prime fuit, Qumque medendi caufa reperta 
“ lent, nonnunquam in pejus aliquibus vertunt. Neque id evitare 
humana imbecilitas in tanta varietate corporum poteft.” Ibid. 
•f “ Vomitnm cum fingultu per totum fere morbi curfum obfer- 
“ vayimus icthalem. In nonnullis fimefti ominis, liquidi vel cibi 
‘‘ aflumpti, iterum leviore motu corporis, in os, cum inunaure et 
c‘ borborygmc, cruftatio, vifum fymptpma,” art, the late Dr. Hoffman, and the celebrated Dr. Le 
Cat *, perfectly fphacelated. 
On the contrary, when the above fymptoms were 
milder, and the vomiting efpecially could be kept 
within bounds, and the fymptoms were fuch only as 
are mentioned in No. 2, 3, there was in general, from 
a proper treatment, the greateft probability of amend- 
ment. 
A fpontaneons opennefs or loofenefs was from the 
beginning a falutary fign, and freed the patients from 
a great deal of danger, abated the pain in the head, 
and the vomiting; by this means alfo the ferocity of 
the delirium was abated, and fometimes totally pre- 
vented : About the crifis, bilious ftools were always 
of the moll fignal relief to the patient, and inftru- 
mental in the recovery. In fome indeed the flools 
were watry and bloody, like the walkings of flelh, 
and though ufeful to the patient in abating fymp- 
toms, did not always fecure a recovery. This alfo 
was fometimes the cafe, when that evacuation was ra- 
ther the effedt of art, than the fimple effort of unaf- 
fifted nature j but in this cafe it feldom failed to abate 
fome of the molt dangerous fymptoms, even to thofe 
patients in whom the violence of the diforder, or the 
* “ Vidi imprimis hoc cam fmgultu per aliquot dies in 
“ viro honorato, in quo inftituta poft mortem fe&ione, hepar in 
** concava parte plane putridum nigrum, inllar picis, necnon in 
« diaphragmate, duodeno et parte pylori, fphacelofa comperuit 
f* corruptio.” Hoffman. M. Syft. Tom. 2. p, 81. Obf. De Febre 
Maligna petechizanti. An. 1609 et 1700 Hals Epidemica. Dr. 
Le Cat obferved in the villous coat of the cefophagus, ftomach, 
and fmall guts, chriftalline eruptions, inflammatory and gangrenous 
fpots, in thofe who died of the malignant fever of 1753> at Rouen. 
Phil. Tranf. Vol. 49. Part. 1. Page 49. latenefs of the remedy, rendered it in the end ineffec- 
tual. Indeed, as the feat of the difeafe was not folely 
in the primae viae, an evacuation from thence could 
only give partial relief. 
The urine, in this diforder, was for the moft part 
too fallacious a fign to be depended upon.—lt was, 
from the beginning of the fever, high coloured, and 
even fettled with a white or crimfon fediment.—About 
the height it became conitantly clear, and ftraw-co- 
loured, or yellow, and continued fo *; and the pa- 
tient’s recovery went on well, without any fymptom 
of relapfe, or other inconvenience refulting from, or 
connected with, a want of fediment at this time. 
But a urine perfectly limpid, or nearly fo, was, be- 
■* Thefe phenomena of the urine, though clalhing with the ob- 
fetvations of antiquity, concerning the appearances of urine in 
their fevers, may perhaps be reconciled therewith upon the follow- 
ing principle. In continual fevers of the inflammatory clafs, a cri- 
£s is moft probably brought about, by a refolution of the too denfe 
particles of our fluids, analagoustothat which fometime, carried to ex- 
cefs, caufes malignant, putrid, petechial fevers: Of this refolution of 
the blood globules (fo as to caufe the return of health in inflamma- 
tory fevers) a fediment in the urine is an effeft and fign. In pu- 
trefactive fevers, the blood is ftill more melted down, and mixed 
in the urine, gives it that turbid appearance, fometimes with, 
fometimes without fediment; which appears generally in the very 
beginning of fach fevers, giving a very dubious omen of their 
event; but a turbid urine /hews a greater degree of diflblution in 
the humours, than a mere fediment, which muft be heavier than 
thofe particles which remain mixed in the urine. A clear yellow 
urine, at or after the height of thefe fevers, is rather then a falu- 
fary and promifing appearance in them ; fhewing the contexture of 
the blood is as much infpiflated, as the health of the individual 
requires, and that the diflblved and diflblving parts of the fluids, or 
the morbific matter of thefe fevers, in other words, is- thrown off, 
or altered; But thefe are only my conjectures concerning a 
fad which is very certain ; and was obferved by Hoffman at Hall. 
Hoc. citat. in the Epidemic of 1700. fore the height of the diforder, always a fign of de- 
lirium, or approaching fubfultus tendinum. 
The generality of perfons who recovered from this 
fever, had rather a gentle increafe of perfpiration about 
the crifis, and a few days after, than any remarkable 
profufe fweatings.*—Thofe who died, fweat much 
more profufely than the generality of thofe who re- 
covered from this illnefs.—Such indeed as had the 
fkin rough with miliary eruptions, could neither bear 
the alvine evacuation fo well, and required that a 
pretty plentiful fweating fhould be fupported; the 
fweat of fuch perfons has always a peculiar foap-like 
fmell. 
The miliary chriftalline eruptions, gave great re- 
lief to the patients; and their repulfion, or falling 
back, was dangerous.—The flat, livid, petechial fpots 
are rather a confequence of the general refolved 
Hate of the blood, than in any refpedt critical j yet it 
is much better for thefe to appear upon the (kin, than 
to be fcattered over the villous coat of the prims 
vis, where they may become gangrenous and 
mortal. 
Some who had been moft feverely handled, had, 
after the crifis, a numerous eruption of angry jfuppu- 
rating boils all over the body.—Towards the crifis 
blifters dried up, but after this was happily over, 
they began to run again plentifully.—When the 
ftrength was funk very low, a kind of gangrenous 
vibices were often obferved in the bliftered parrs, 
which eafily fuppurated off: Gangrenes of the hips 
happened in fome, occafioned by the long preffure of 
the body upon thofe parts. *The natural returns of the menfes, in the courfd 
of this diforder, did no apparent good; and in wo-< 
who, in child-bearing circumftances, lay ill of 
fever, the early and entire ftoppage of the lochia, 
did no vifible harm •, and they often recovered very 
well from circumflances of great danger. One of 
thefe women had lain ill of her fever one week before 
fhe was delivered of her child •, and began to recover 
in two weeks more after her delivery.—The cafe of 
another woman feems alfo not unworthy of particular 
notice : She had got over the acme of this fever in its 
moft alarming circumftances, and was now in the de- 
clenfion of her diforder, yet was not perfedlly fenfible, 
and had her fauces all covered over with a white 
aphthous cruft •, fhe could not fit up without fainting 
away; in this very low condition, fhe fuffered an 
abortion of an embryo about five months old; which 
I faw trembling and palpitating juft as it came from 
her body *, the fecundine could not be extradited, be- 
caufe of the tendernefs of the umbilical cord; and it 
was not thought proper to ufe any other method of 
extraction in her circumftances.—-And till that came 
away putrified, fhe loft a confide rable quantity of 
blood j which again rendered her cafe ambiguous.— 
But after that time fhe flowly recovered her ftrength, 
and is now well. 
Bleeding was more generally hurtful than fervice- 
able, by finking the patients ftrength, and encreafing 
the vomitings, and haftening the delirium and con- 
vulfive twitchings of the tendons.—The cruor was 
loofe in the coherence of its globules, and eafily 
broke.—Sometimes it was covered with a buff or fize, but with this the broken globules were fo in- 
termixed, as to give it the appearance of a faffron 
tinge.—The ferum was of a dark dirty colour, be- 
twixt green and yellow.—Such ferum and cruor I have 
feen very exadlly imitated in the blood of perfons who 
laboured under the jaundice. 
In this diforder then it appears, that the larger par- 
ticles of the blood, the red globules being broken or 
divided, are confufeclly mixed with the ferum and 
lymph, or the thinner pellucid parts of our fluids, 
by fome putrid ferment, either fpontaneoufly produ- 
ced in the body of the individual, or received from 
fome other perfon by contagion. But as the great 
bufinefs of fecretion, and fome other of thofe wonder- 
ful operations, which fupport animal life and health, 
are principally carried on in the fmalleft veflels; and 
depend mainly upon fuch a condition of our fluids, 
and the fmall arteries ; that the red globules do not 
pafs into the Idler feries of capillary arteries, which 
ought only to admit the difcoloured pellucid part of 
our fluids •, fuch as the ferous and lymphatic arteries 
are * : It will not feem furprizing, that a lofs of 
* Upon the’credit of Levvenhoek’s obfervations, it has been long 
believed, that one globule of red blood is compofed of and divifi- 
ble into fix ferous globules, and it has been prefumed that a ferous 
globule was compofed of fix lymphatic ones, &c. This doftrine 
is called in quellion by Dr. Haller, in the refults of fome microfco- 
pical obfervations, publifhed Vol. IV. of the Tranf. of Gottingen. 
He fays no globules finaller than the red ones can be feen, nor does 
he think it can be known, that the union of fix yellow globules 
conftitutes one red one : but it is only a plain inference to i'uppofe, 
from his not feeing the component parts of the ferum and lymph, 
in his obfervations, that the lymph and ferum confift of finaller par- 
ticles, and enter finaller velfeis, than red globules ordinarily do ; 
This Dr. Haller allows. Indeed, lymphatic arteries have been de- 
mon lira ted, iplb fafto, by M. Ferrein, Mem. de I’Acad, des Sci- 
en. 1744. health fo quickly enfues upon fuch a confufipn of the 
different component parts of our fluids, as appears to 
have happened in the fever we have defcribed. In 
common inflammatory difeafes, it is fuppofed the 
globules of a vifcid cruor cannot pafs the fmall capil- 
lary arteries, which ufually tranfmit Angle red glo- 
bules.—-In fuch diforders as thefe, the attenuated glo- 
bules of a difiblved or partly putrified cruor, for that 
is the cafe, pafs into ferous and lymphatic veflels 
they ought not to enter, and in them are flopped 5 
hence the vital, animal and natural fundions are 
Ilrangely difturbed; hence alfo fpots and ftigmata, 
and other analogous appearances in thefe diforders, 
feem to arife.—ln the pradice of medicine, it is of 
the lafl confequence to diftinguifh obftrudions of this 
nature, ab errore loci, from thofe which are occa- 
lioned by a vifcidity of the mafs.—-In that cafe, mere 
attenuating diflblving medicines, and heaters, unlefs 
aflbciated with fuch things as powerfully check pu. 
trefadion, are certainly very obnoxious. The medi- 
cines which, in all ages, have fucceed belt, are fuch 
as be only in a very moderate degree warming, and 
yet aftringent; fuch as preferve the confidence of our 
fluids, powerfully corred putrefadion, promote per- 
fpiration, and fupport the vis vitae. 
In this putrid fever it was not only neceflary care- 
fully to keep thefe intentions in view, but no lefs ne- 
ceffary to avoid every fcope, which led into inten- 
tions incompatible with thefe. Thus it often hap- 
pened in the beginning of thefe fevers, that the ap- 
pearances, far from declaring the genuine nature of 
the difeafe, feemed rather more of an inflammatory of rheumatic nature.-—And for fuch it might eafily be 
miftaken by an nnattentive obferver. Ihfe&ion being 
a fhaft which will imperceptibly penetrate the hardieft 
conftitutions; vifcidity of blood, the peculiarity of 
fuch conftitutions, will remain in its ufual ftate, at 
leaft in fome degree, for a few days after the firft at- 
tack ; but certainly, in this cafe* we are not to fink 
the patient’s ftrength, by letting blood, in order to 
remove a fizinefs, which by the aftion of the malig- 
nant poifon upon it, will every day be more and more 
fubdued, and refolved into a putrilaginous ftate, from 
which reafon and experience require the phyfician to 
ufe his endeavours to preferve it: And if bleeding 
can feldom be ufed in any great quantity, when the 
blood itfelf has an inflammatory appearance-—** much 
lefs can it be at any rate proper, when the fize is not 
tenacious* but cf a biuifh lead colour* and fiudtuating 
confidence; -when the craftamentum is tender, and 
many of its particles remain confufedly mixed with 
the ferum and lymph, and leaving a footy-like pow- 
der at the bottom of the difti. 
For the moft part, from the beginning of our fe- 
ver, I found the pulfe however quick, generally too 
low and foft, and fluttering, and the proftration of 
ftrength too great, to admit of venasfe&ion ; indeed 
the bad fuccefs I had feveral times feen the confe- 
* Every one knows how generally Sydenham treats almbft every 
fever as inflammatory; yet in the febrile conllimtion of 1673, 74, 
73, he obferves, that the blood had conftantly an inflammatory or 
pleuritic cruft ; yet he found it would not admit of repeated bleed- 
ing with fafety ; and though he was fomewhat perplexed at firft 
with this difeafe, he at laft refrained from that evacuation, and de- 
pended upon glyfters and bliftering, to divert the force of the dis- 
order from the head; §. 5, cap. 2. Oper, Sydenham. quence of this evacuation in patients, who notwith- 
ftanding had fymptoms which Teemed to require it, 
and the bad afpedt of the blood itfelf, taught me that 
bleeding was neither generally ufelul as a remedy in 
this fever, and but Tcldom as a preparative for other 
remedies which were proper. Bleeding never relieved 
the preffure at the praecordia, the inquietude, and 
vague pains of the Tick, or the fixed pain in the head ; 
on the contrary, it increafed many of thefe fymptoms, 
brought on a lownefs and irregularity of the pulfe, 
and dejedtion of fpirits, and haftened the delirium, 
which was afterwards infuperable by any treatment.— 
Thus, in a general way, it v/as hurtful to fubftradt 
any great quantity of the vital fluid but if the pa- 
tient complained of fevere pleuritic ftitches, and 
breathed ftrait, a fmall quantity might then be let 
with fafety and advantage j as I experienced in thofe 
pleurifies, which in the winter feafon began to be fu- 
per-added to the ordinary fymptoms of this fever. 
If bleeding was judged unneceflary, the firft and 
moft fundamental operation to be underwent, was 
to walk from the ftomach to the bowels,, the pu- 
trid lymph and bile fuppofed to be lodged there, by 
a di(agreeable tafle in the mouth, a naufea, vomiting, 
and head-ach, or giddinefs j fymptoms which were, 
in a greater or leffer degree, univerfal in the beginning 
of the fever •, and feemed to be among the moft im- 
mediate confequcnces of fufeepted contagion : The ab- 
lution of this primary fomes of the difeafe, was at- 
tempted before any thing elfe was done j either by 
giving the patient plentiful draughts of chamomile or 
carduus teas, in weak and mobile habits, where greater irritation might have done harm.—To thole £ 
little ftronger, a dram of the tinCture of ipecacuan. 
or the fame quantity of the oxymel of fquills was 
given. When the conftitution was ftill more robulf, 
and there feemed a necefiity for fomething more ef- 
fectual, I ordered a grain of emetic tartar, and at moll 
two grains, to which was joined a fcruple or half a 
dram of vitriolated tartar.—Otherwife, a grain of eme- 
tic tartar was mixed with a little oxymel fymplex, or 
oxymel fciltit. in a draught.-—But whatever the in- 
gredients were, I found it of the greateft moment to 
give thefe emetics only in very fmall and refraCtory 
doles.—For nothing more was intended than fuch a 
gentle acceftion to the contraction of the ftomach, as 
enabled it more effectually to rejeCt its contents.—The 
more violent irritation, and drainings, which ftronger 
doles would neceffarily occafion, would defeat the 
original intention of allaying the naufea, by creating 
perhaps an inflammation in the ftomach itfelf; for 
fymptoms feemed to ihow, in many bad cafes of this 
diforder, that fomething of this kind really exifted. 
On this account, that the emetic, even in thefe fmall 
dofes, might aCt with the leaft poffible irritation, I or- 
dered the dofe to be mixed with a pint of warm water, 
which was drank off by glafsfuls at fmall intervals. 
Thus I always found the ftrainings were extremely 
gentle, nay fometimes eafter to the patient than the 
more natural efforts *, the fordes were in a greater 
quantity pumped up from the ftomach and the ope- 
ration of the emetic was more determined down- 
wards, for bilious fordid ftools generally followed, 
and gave the patient very great relief.—His vomiting was, in a great meafure, taken away, arid the head- 
ach abated. The French call this method of giving 
emetics, Etnetique en Lavage. In this manner M. 
Le Cat fays, emetic tartar v/as given in the malignant 
epidemic fever at Rouen 1753, (which much referm 
bled ours) with very great advantage. After the ope- 
ration of the vomit is finilhed, the patient can ufe no- 
thing better to fettle the ftomach, and quiet its 
than fpir. nitri dulc, in mint water. 
As this fever did not admit of bleedings to be ge- 
nerally ufed, and yet was fo extremely prone to attack 
the brain, I ordered glyfters very frequently to be in- 
jected *, fometimes every day, at other times once in 
two days, as circumllances required ; thefe were con- 
tinued very near to the heighth of the diforden—-And 
it was proper to ufe them from the earlieft attacks of 
the difeafe, efpecially if the patient was coftive. The 
evacuation by ftool, and the eafy vent of flatus; the 
relaxation of the bowels, by the warmth and mollify- 
ing qualities of the ingredients injected by glyfters, 
were certainly of the greateft benefit to the lick ; 
and, by relaxing the coats of the abdominal 
veffels, and the defeending aorta, the motion of the 
blood is facilitated downwards, the veffels of the brain 
being in confequence lefs diftended : Hence the tor- 
turing pains of the head are eafed, the fick are difpo- 
fed to reft, and feel their ftrength refrefhed. If the 
putrid feces are long retained in the great guts, they 
will unavoidably feed the difeafe, by a reforption of 
fome of their moft putrid parts into the blood-veffels $ 
the evacuation of what is thus baneful, by means ill other refpe&s fo falutary, is no fmall recommendation 
of glyfters * . But their ufe is improperly confined 
either to evacuation, relaxation or dilution merely \ 
for antifeptic, antifpafmodic, ftimulating, analeptic 
or febrifuge medicines, may be very advantageoufly 
adminiftered in this way, when the patient’s perverfe- 
nefs, or any difeafe feated in the ftomach or cefopha- 
gus, hinders the ordinary manner of giving them : 
And as there is a ftrong reforbtive power in the great 
guts, and a high degree of irritability and quick fen- 
fation, from the nerves diftributed to the bowels; the 
bark, mofch, aflafcetida, camphire, myrrh, and fa- 
line bodies, may be thrown up into them, with the 
fame medicinal views and conlequences, as when they 
are given at the mouth itfelf. 
But it was alfo necefiary, at due intervals, to give 
fome gentle eccoprqtic, in order to diflodge the pu- 
trefenc matter from that large portion of the intefti- 
nal tube, which the operation of glyfters could not 
fo perfectly reach.--r-With this falutary intention, rhu- 
barb, in very fmall dofes, as five, fix, or eight 
grains, was added to the other proper medicines, fo 
* The judicious Sydenham, in treating of the comatofe fever of 
1673, &c. which did not bear bleeding, although the blood, in 
the beginning of the difeafe, had conftantly a glutinous or phlogi 
flic appearance, depended very much upon the frequent injeftion of 
lenitive glyfters : “ Illud ftuporis phenomenon, omnino indicabat, 
continue reputcnda eJTe enemata, quibus materia febrilis, qure ita 
prompte caput petebat, ab eo divertentur; quin & venasfediom 
repetite, quam ssgr'i tulit propria hujus morbi natura, fubftitueban 
tur ilia, atque ejus penfabant defeftum.” Porro judicabara Epif- 
paftice. Vide Sydenham Oper, §. 5. cap. 2, De Febre Coptinu«e 
An. 1673, 1674, 1675. ‘ 1 as to procure one or two lax ftools daily *. Thus the 
offenfive and putrefent juices, fuch as corrupted 
lymph, bile, chyle, and putrid feces, which cer- 
tainly augment thofe dreadful Symptoms that confti- 
tute the danger of malignant levers, were expelled the 
body, without finking the patient’s ftrength, or fup- 
prelfing perfpiration. It was conftantly obferved, that 
the delirium came quickly on, if the patient’s body 
was not preferved perpetually open, either by this 
means or by glyfters: I judged it belt to ufe them 
both alternately for this purpofe, till the diforder was 
pall, or arrived at its height. But I never ventured 
to ufe any of the more vehement or active purgatives, 
which diffoive the crafis of the blood, hop perfpira- 
tion, and greatly exafperate the febrile fymptorns; 
and againft the ufe of fuch, as well as againft large 
dofes even of rhubarb, I would caution others, fuch 
being as certainly pernicious, as the former gentle me- 
thods are faiutary, and approved by reafon and 
perience. 
However highly neceffary Stwas, to keep the cloaca 
of the human body open, that the fordes, which are 
depofited there, and which are generated from the 
accefs of the atmofphere to our ingehed food and li- 
quors, might be freely evacuated ; yet this is but a 
part, and a fmali one, in performing that great bu- 
* The following form, or fomething like it, was what I fre- 
quently ufed in purfuing this intention- 
jj:, Pulver. Rhei ppt. Gr. v x. Sal. Succin, 
Myrrh aa Gr. v. Pulv. Cortic. Peruvian. 3i. 
Aq. Cinnam. ten. 3x- Aq. Cinnam fort. Syr. 
£roci aa 3 ii. M. Hauft. pro re nata fumend. •linefs, the cure of malignant fevers : For the con- 
fidence of the mafs of blood itfelf is to be corrected {- 
the feparation of its morbid incorrigible particles to be 
encouraged, and the excretion thereof by the kidneys, 
but efpecially by the fkin, is to be promoted. 
Purfuing txhefe views, after the emetic had finiflied 
its operation, I always ordered the patient toufe feme 
antileptic fedative. Spiritus nitri dulcis taken to the 
quantity of a tea-fpoonful in mint tea, or mint water, 
every three or four hours, will anfwer this purpofe 
better than any of the neutral faline anti-emetic mix- 
tures, which are generally ordered, and which I alfo 
tried, though with lefs fuccefs than followed from the 
dulcified acids. All thefe liquid fulphurs, for fuch in 
fad are the dulcified fpirits of nitre, vitriol, and fea 
fait, and the anodyne mineral liquor of Hoffman, are 
certainly excellent remedies in malignant fevers of this 
clafs •, they allay that vomiting, which is for the molt 
part encreafed by all other medicines, and corred pu- 
trefadion both in the ftomach and duodenum, and 
alfo counterad the influence of the malignant virus, 
in the vafcular fyftem, by gently incraflating and pre- 
ferving the texture of the blood globules. Sweet Ipi- 
rit of nitre in particular promotes very efledually the 
fecretion of urine, and that of perfpiration.—-In thefe 
refpeds they are greatly preferable to the Ample un- 
compound mineral acid fpirits.—ln a word, thefe dul- 
cified acids pofiefe the excellencies of the molt cele- 
brated alexipharmics *, without their pernicious eflfeds 
* It is a very obvious conclufion, from the excellent experi- 
ments of Dr. AUton and Dr. Whytt, (Med. Elf. Voi. V, and Lit- and qualities •, and that in a very compendious and 
agreeable form. The fait of nitre itfelf has been re- 
commended by fome very celebrated authors in ma- 
lignant fevers; but the effects I have obferved from 
it, have by no means recommended it to me ; though, 
in other1 diforders of the inflammatory kind, I am 
convinced we are unacquainted with a more excellent 
remedy. But, though given in the very beginning 
of thefe fevers, it funk the pulfe, and, without aba-r 
ting the heat, or any other fymptom, the patients 
lownefs and oppreflion and inquietude were increafed 
by it. In fa6l, as this fait is known to refolve the 
blood globules, in the very manner they are refolved 
in diforders the mod highly putrid, it does not feem 
a proper remedy in diforders Amply malignant, but; 
when, as is frequently the cafe, efpecially in the be- 
ginning of fuch diforders, an inflammatory fizinefs is 
combined with and a£hiated by a malignant miafma, 
nitre, if joined with camphire, after the manner of Ri- 
verius *, or with warming apd diaphoretic medicines, 
according to the prefcription and practice of Mead f 
and Hoffman may be given in the beginningx 
of fuch difeafes, with advantage. For thus the 
nature of the diforder being rendered more Am- 
ple, and the method of cure unimbarrafled with 
contra-indications, a recovery will afterwards eafier 
terary Eflay, VoLII.) of Edinburgh, that opium muft be hurtful 
in diforders where it is requifite to fupport the vis vUaj, the vafcu- 
lar energy, and the motion of our fluids. 
* Vide Praxeos Medicas, f.ib. XVII. De Febri Peftilenti. 
f Monita & Pnecepta Medica, p. 24. 
$ J Hoffmanni Med. byit. Tom. 2. p. 77. ad paflim fecr, 
pp§ra fua. be brought about by fuch things as diredtly cdmbate 
the malignancy, as was the method of fpeaking in the 
laft century. 
In the beginning of the fever, the fpirits of nitre, 
frequently taken by tea-fpoonfuls, in mint tea, or the 
patients common drinks, will anfwer every medicinal 
purpofe, and may alone be depended upon: In the 
increafe of the fever, when the vomiting is pre- 
vioufly appeafed, a little camphire may very advan- 
tageoufly and commodioufly be added to the fpirits of 
nitre, in the quantity of a fcruple or half a dram to an 
ounce of the fpirit: One tea-fpoonful of thefe campho- 
rated drops may be ufed once in two or three hours, 
in white wine or cyder whey, or whatever elfe is ufed 
by the patient as his common drink : Every one is 
apprifed of the excelling antifeptic and diaphoretic 
qualities of camphire •, but I have never feen any rea- 
fon for thinking it fo warming as is commonly fup- 
poled. 
About the ninth or tenth days, the lownefs en- 
creafes greatly, and the delirium begins to come on, 
generally with tremblings, fometimes alfo with fub- 
fultus tendinum. I found it at this time generally 
neceffary, to diredt an addition of more warming, dia- 
phoretic and antifeptic medicines to be made, to thofe 
formerly ordered * ; fuch as the pulvis contrayerv. 
comp, radix ferpentar. fal fuccini vol: A large blis- 
ter was for the moft part applied to the back, and 
was kept running by the repeated application of the 
* It was the maxim of Bagllvi Prax. M. L'b. I. cap. xiii. 
** Quo febris magis ad ftatum vergit, eo minus utsndum eft refri- ong. ad veficatoria, till the was pad j and, when1 
fymptoms required, others were applied to the thighs 
and legs. lam fendble, that what is perhaps judly 
urged concerning the attenuating feptic qualities of 
cantharides, may feem a valid objedion againd their 
life in thefe fevers; But in mod cafes, the dimuius 
rather raifed the patient’s ftrength and pulfe, without 
increasing the delirium; and the patients were always 
the better for the difeharge of morbid ferum. Yet, 
in fome bad cafes, I will by no means conceal it, that 
blifters often apparently added to the ferofity of the 
delirium. I frequently tried the bark, both in fub- 
ftance and in decodion; but found it bed to ufe only 
fuch a decodion as I have added at the bottom of the 
page * *, which anfwered every intention that was re- 
quifite in this diforder •, fupported the patient’s 
ftrength, and perfpiration, and checked putrefadion. 
Larger dofes of the fubftance lay heavy upon the fto- 
mach, and checked the falutary excretion of perfpi- 
gerantibus, ne per ea crifis impedlatur.’’ I often tiled thefe more 
warming medicines, as in the following formula about this time ; 
Camphor, por, 3ii- Sacch. alb. 5 fs. contritis 
adde Acet. llillat. vel fpir. nitri dulc. Spir. 
Minder, sii. Pulv. Contray. C. 3ifs* Tinft. 
Serpentar. Aq. Alex. Simpl. 5 Mix- 
tura. Cap. Cochl. ii. oxnni quarta vel fexta 
hora. 
$. Pulver. fubtiliiT, Cortic. Peruv. 3 iii. vel sfs. 
Rad, Serpentar. 3i* coque ex Reft. Deftillat. 
thi. ad tfcfs. Colatur®, cui adde Sal. Armon. 
vol. face. q. f. pene ad Saturationem Pulv. Con- 
tray. comp. 3i- Aq. Cinnam. fort. Sacchar. 
alb. aa si. f. Mixtura de Qua Cap. Cochl. ii. 
tertiis vel quartis horis. ration; yet neither fhortened the courfe more,~riof 
abated thefeverity of fymptoms fowell, as that light 
diaphoretic mixture, which was ufed, and is here re- 
commended, as a preparation of the bark, moft fuita- 
ble in fuch malignant fevers as thefe, in which the 
delirium runs high; and in which nature is to be en- 
couraged and fupported in exerting the force necef- 
fary to bring about a falutary crifis, and a reparation 
of the morbid from the falubrious particles of our 
fluids. This work, fo wholly her own, may be im- 
properly difturbed and checked by large dofes of the 
bark, when the genius of the difeafe is fuch, as not to 
admit of an entire and immediate cure by that noble 
antidote.—But in thefe continual putrid fevers, at- 
tended with a delirium, I have rarely feen the bark 
ufeful as a febrifuge; though in fmall dofes, as a 
ftrengthener, it will produce very good effeefts; andy 
in the decline of fuch fevers, is ufeful in refloring the 
patients health and ftrength. Indeed when aphthae 
began to appear, either as white floughs, or as a 
cruft, or as an excoriation, with a iividity of the pa- 
late and glands, about the height of this fever, then 
larger dofes of the bark, in fubftan ;e, with elixir of 
vitriol, and red wine, were highly ufeful and necef- 
fary; and loofe ftools were rather to be reftrained, for 
they very remarkably funk the patients ftrength, ei- 
ther in thefe circumftances, or after an eruption of 
cryftalline miliary eruptions. 
The fymptoms which required a particular atten- 
tion and treatment, were in the beginning the vo- 
miting, for which, after a gentle puke, I ordered the patient to ufe fpir. nitri dulc. in mint tea* or water* 
or cinnamon water. In order to fubdue this fymp-1 
tom, which was in a great meafure the foundation of 
the patient’s future welfare or difafler, I found an epi- 
themof ther. androm. fpec. aromat. and oil of mace 
and nutmegs, applied to the ftomach, peculiarly 
ufeful. 
The head-ach, and watchfuinefs attending it, were 
alfo extremely troublefome and dangerous fymptoms, 
.at the beginning of the fevered kind of thefe fevers. 
I ordered the fick, for the moil part, to ufe the pedi- 
Juvium, or fomentations of flannels wrung out of 
warm water, to be applied to the feet and legs: And 
a liquid epithem, compofed of camphire, oh Rhodis, 
acet. ftillat. and ipirit of rofemary mixed, was fre- 
quently rubbed about the patients’s forehead and tem- 
ples, and afforded to very many, great relief.—When 
the delirium came on, cupping, bliflers and glyflers 
and fomentations were ufed, with proper internal me- 
dicines before mentioned. If a fubfultus tendinum 
appeared, mufk, caftor, the volatile tindlure of Vale- 
rian, neutralized with fal fuccini, were tried, and 
fometimes with very good effedt, againfl; this other- 
wife fatal fymptom. In many doubtful cafes, where 
the ftupor and delirium was very great, and nothing 
very effedlual had been done earlier ■, I often gave the 
antimonial wine, which, by promoting perforation* 
urine, and ftool, often gave relief, at this time, and 
under fuch circumftances of the difeafe ; but very of- 
ten alfo, its operation was ineffedtual, or produced no 
good effedt upon the patient, that could be obferved. 
Whoever confiders the nature of this excellent and. active remedy, and of others of that kind, will agree, 
that the promifcuous ufe of things of this fort, can- 
not be proper at all times in fevers which have their 
critical periods, nor in all circumftances. For, in 
the antimonial wine, the metalline particles of anti- 
mony are held in a diflblved Hate; and, though 
amazingly fubtile, are of an unconquerable rigidity. 
Hence they retain their activity and force, not only 
in ftimulating the firfb paflfages, but in ailing in the 
fame manner, upon fome of the fineft fecreting veflels 
of the human frame •, hence thofc fmall dofes, which 
do not puke or purge, will operate either by urine, or 
by encreafing perfpiration : How far its effeCt of pro- 
moting a falutary crifis, may be owing only to the 
encreafe of thefe excretions, or to its more immediate 
influence upon the fine canals, which ferve as fecre- 
tory to, or are nearly connected with the nerves them- 
felves, let others judge : In the mean time, the ex- 
cellent effects of antimonial medicines, in chronical 
difeafes of the brain and nerves, gives room for fuch 
a conjecture.-—But, whatever be its primary operation, 
it is certainly, being impertinently officious, if not 
too often dangeroufly fo, to give fuch medicines 
when nature requires no evacuation, or before fhe has 
prepared the matter to be evacuated, and difengaged 
it from its recedes: Coda non cruda funt movenda, is 
flill deferving of our regard. If things of this kind 
are given very early in critical fevers, nature 
will be weakened by the untimely expulfion of crude 
and falutary circulating humours. If, when the bu- 
finefs is going on very well without, great interruption 
be given to the procefs of nature, the patient’s dileafe jbecomesfuddenly dangerous. The helghth and acmi 
of fuch doubtful cafes, as require both a fpur, and 
evacuation, are thofe which require fuch remedies; 
2nd thofe,. in which they will effeCt often what exceeds 
our expectations. I have obferved that tartar emetic 
is very remarkably corrected in its operation, by the 
addition of camphire.—Perhaps the camphire involves 
the diffolved antimony; in the fame manner as the 
glafs of antimony is corrected and fheathed by a co- 
vering of wax, in the preparation of the vitrum anti- 
monii ceratum. However that be, lam certain, an- 
timonial wine and tartar emetic may be given in larger 
/dofes, without offending the ftomach, when joined 
with camphire, than fingle; and camphire feems a 
very proper addition, when an encreafe of perfora- 
tion, and checking of putrefaction, is intended. 
When miliary, cryftalline, or elevated eruptions 
appear, perfpiration is not only to be liberally fup- 
ported by warming diaphoretic medicines, but care 
muft be taken, that the eruptions do not fall back, 
either by rifmg out of bed, and fitting up too long in 
an ereCl pofture; or by any natural or artificial loofe- 
pefs, an evacuation which, under thefe circumftances, 
as vifibly noxious, as in the general it was falu- 
tary. 
Towards the decline, in thefe fevers, the mouth 
was, in many, interiorly covered, fometimes with a 
white aphthous cruft, fometimes with white fpecks or 
Roughs about the glands and palate, rcfembling thofe 
pf the ulcerated fore throat. Thefe were treated with 
detergent gargles of tinCture of myrrh, 
fpir. of vitriol, oxymel fimpl. and the bark in fub- Stance was given internally with elixir or fpirit of 
vitriol, in larger or more frequent dofes than in any 
other condition of this difeafe ; and I found it alfO ne- 
* cefiary to reftrain loofe ftools, which with this ap- 
pearance manifeftly funk the patient’s ftrength; and 
for this purpofe, red wine in the drink and panada 
was allowed; Yet thefe aphthofe ulcers were mani- 
feftly fymptomatic only ; for the fever remained after 
they were removed.—-Whereas in the malignant ul- 
cerous fore throat (1752-3) the depofttion of malig- 
nant matter about the fauces, feemed td conftitute the 
mod effential part of the diforder ; for when the local 
appearance was removed, the fymptomatic fever ceafed 
of courfe: Juft as we fee that low fever, which arifes 
from, and accompanies a mortification of any part, 
quickly ceafes after a feparation of the mortified part 
from the found is effeded. 
The drinks allowed to perfons labouring under this 
fever, were whey made fometimes with cream of tar- 
tar or vinegar, fometimes with white wine; alfo bar- 
ley-water, limonade, wine and water, and cyder and 
Water: For food, I never allowed any thing befides 
panada* gruel, bread and tea, or weak thin chickeii 
broth; and preferved ripe fruits, as damafons, plums, 
roafted apples, preferved cherries, currants, and the 
like. I found it often proper to order the patient to 
ufe white wine as a cordial, and ftrong negus for drink; 
when the loofenefs ran to excefs, negus of red Port 
Wine, or the fame mulled, was permitted ; but the 
general ufeiulnefs of a tendency to moderate laxity* 
made it fometimes proper to avoid this aftringent wine, 
though otherwife of excellent ufe in many putrid fevers. To allay the third, fweet oranges, a dice 
of limon with fugar, or chriftals of tartar might be 
held in the mouth. I never refufed my patients the 
liberty of drinking cold water when they craved it •, 
which about the height they often did very earneftly. 
I could not but obferve the mod defirable effeds from 
this indulgence; the lick were greatly rcfrelhed, 
and a gentle diaphorelis was brought on, in con- 
fequence of its ufe. For this reafon, I not only 
barely permitted the ufe of water when it was longed 
after,, but prefcribed the general ufe of toad and wa- 
ter to others. 
The temperature of the air in which the patient 
breathes, mud be rendered as favourable to his re- 
covery as poflible, throughout the whole courfe of the 
difeafe *, for this reafon, it mull be continually re- 
newed, efpecially where the patient or patients are 
crouded in fmall confined places, by opening the 
doors and windows of the apartment, fo as to admit 
the free pafiage of the air this practice, fo neceflary 
in the fmall-pox, is no lefs fo in every fpecies of pu- 
trid fever, but it muft be done fo as not to reprefs 
perfpiration. The neceflity of changing the air in a 
lick room, by fucceflive ventilation, arifes from the 
conftant deftru<sHon of a certain property in that fluid 
by breathing, which renders it afterwards ufelefs ; 
likewile from the atmofphere being filled with the ex- 
crementitious deams which fly off from the patient’s 
body continually, and which putrify in a dagnant un- 
renewed air, and render it truly poifonous, a pabulum 
morbi rather than of life. The phyfician will order 
the room to be kept fweet and clean ; and ftools, and every thing offenfive, to be removed as Toon as pof- 
fible. If the external air is immoderately cold andi 
wet, the room muft be kept warm and dry; and the 
fumes of ambe'r, benzoin, myrrh, and camphire, may 
be diffufed in the room, if fprinkled upon hot iron.. 
Vinegar may be fprinkled about cold, if the weather 
is warm ; and boiled with myrrh or camphire, an an- 
tifeptic fleam will rife into the air which the patient 
breathes, greatly to his advantage ; Thefe fleams will 
preferve the air free from putrefadlion, and will in- 
finuate themfelves by the ablbrbent veflelsof the lungs, 
into the blood-veffels, and will greatly afllfl in im- 
peding the progrefs of putrefadlion in the fluids.—? 
Thefe are the mofl commodious, if not the mofl 
ufeful methods of medicating the air the patient 
breathes ; however, thole w'ho prefer the mineral 
acids, may order brimflone to be burnt; or may raife 
the marine acid very eafily, by putting a certain 
quantity of common fait into a veflel, kept heated 
upon a chamng-difh of coals ; if to this, a fmali 
quantity of oil of vitriol is from time to time added, 
the air will be filled with a thick white add fleam ; 
but both the marine and fulphureous acid mufl be 
difengaged at a confiderable diflance from the patient, 
otherwife their extreme pungency will be offenfive to 
the lungs. 
The fituation and poflure of the body, is in thefe 
fevers a matter of confequence for the patient’s re- 
covery •, yet the fame fituation will neither be equally 
fafe nor fuitable to each individual. In many cafes, 
the debility of the circulating powers is fo great, as to 
render an eredl poflure of the body exremely dan- gerous to perlbns labouring under malignant fevers \ 
as Hoffman has very juftly obferved. And yet on 
the other hand, the judicious Sydenham has ob- 
ferved, that too dofe and early confinement of febrile 
patients in bed, greatly increafes the beat, and pro- 
penfity to delirium and coma •, circumftances no lefs 
to be fhunned.—ln order to avoid thefe inconve- 
niencies, it will be neceffary to allow thofe patients 
who are fo low and weak as to become giddy and 
faint by fitting upright, to lye upon the bed with 
their common deaths on, at ieaft feme part of the 
day, in the beginning of the diforder; by which, 
without incurring any danger of fainting, the febrile 
heat will be kept moderate.-r— But fuch patients as 
upon trial bear an erect fituacion, or fitting poflure 
very well, may be allowed that liberty j which in hot 
weather will be extremely beneficial, in moderating 
the heat, and checking thofe debilitating fweats, too 
apt to appear in the beginning of thefe diforders.—■• 
By this method alfo a moderate loofenefs is more en- 
couraged (than when the patient is confined to bed) 
a circumflance extremely defirable. When I fpeak 
of the patient’s fitting up, I fuppofe him at the fame 
time confined to his room, and under proper medici- 
nal and diaetetic rules * going into the open air, 
ought never to be permitted to any one feized with 
a malignant fever. 
An equal temper of mind, without depreffing fear, 
anxiety and care, is equally neceffary to facilitate the 
falutary efforts of art and nature in conquering thefe 
levers, as it is effectual in preventing their attacks. 
For this reafon, the phyfician will, as much as he can, prevent all occafions of difcompofure to his pa- 
tient, and ought as much as poflible to infufe intq 
him a confidence of his recovery. 
This general treatment was what I experienced 
moft ufefully in the malignant fever I have defcribed. 
•—Nature thus aflifled, generally brought about a fa- 
Jutary crifis, nearly at the fifteenth or feventeenth 
days, i;nlefs the cafe was fatal.—After afaiutary crifis, 
the return of health was extremely flow ; and I found 
it neceffary to affifl the patient’s recovery of ftrength, 
by giving the gum pills, with a decoftion of the bark 
and elixir of vitriol. The food of the convalefcent 
patients confided chiefly of nourifhing broths, and 
animal jellies, foft eggs, tender white meats; fago, 
panada and milk, wine and water. 
To the defcription of a contagious diforder, it is 
very natural to expect fome rules, how infection is 
fcefl: to be avoided, fhould be fubjoined. Thefe, 
which might very properly be deduced as corol- 
laries, from the reflections I lhall make concerning 
the production and progrefs of putrid diforders in 
general in animal bodies, I place rather here, that 
every thing of the preceptive kind may lye together. 
The great buflnefs cf preferving the body free from 
contagion, confifts in preferving the motion of the 
blood free and regular, and in fupporting infenfible 
perfpiration in a regular equable tenor : Fatigue of 
body, and diffipation of ipirits, and an intemperate 
ufe of the non-naturals, mull be avoided: A cold 
Chill damp air, muft be corrected with fires : Wines 
sre neither to be ufed immoderately, nor yet too fparingly: I feldom have known habitual drinkers of 
red wine affeded with putrid difeafes ; this, and the 
acids of limons, oranges, vinegar, tartar, Ipirit of 
nitre, and elixir of vitriol, and the bark, are the beft 
prefervative, as well as excellent curative remedies. 
Bleeding in the plethoric preferves from contagion: 
In the weak, not only thelofs of blood, but alfo the 
ufe of flrong purgatives promotes infection ; whilfl 
a prudent ufe of rhubarb, by hindering a congeftion 
of fordes and bile in the primas viae, cannot but be 
ufeful. Vegetable food, and acefcent liquors, ought 
ever toconftitute a confiderable part of the daily food 
of thofe who are expofed to infedious di'forders. No 
one ought to go abroad, qaore efpecially to vifit the 
Tick, with an empty or a craving llomach; The mind 
muft be preferred in a fearlefs exhilerated ftate, with- 
out immoderate diffipation of fpirits, either by joy or 
grief, Laftly, perfons who frequent the beds of the 
fick, either in vifiting or attending upon them, ought 
to avoid breathing in the atmofphere which is con- 
tiguous to the patient’s body as much as poffible 5 the 
faliva .fliould never be fwallowed in the room j myrrh 
may be held or mafticated in the mouth; tobacco: 
fmoaked; and the mouth may be wafhed with vine- 
gar, or tnfelure of myrrh in water, after finifhing 
thofe offices which duty and humanity require to be 
performed to the afflided, 
I have ufed without referve, the epithets putrid and 
malignant, in this hiftorical defcription, becaufe I 
am perfuaded, they are in all rdpeds as intelligible, 
and have as much a foundation in nature, as any 
terms that have been fubflituted in their place : No. one hefitates to call thole fevers which arife from a 
glutinous fpiffitude of the blood, inflammatory.— 
But as there are alfo fevers that arife from an acri- 
mony and tenuity in the blood; and others which 
partake both of fpiffitude and tenuity, fuch may with 
great propriety be diftinguiffied from the limply in- 
flammatory, by the appellation of malignant, or gan- 
grenous, as any one pleafes.—But as thefe conditions 
of the animal fluids are generally caufed by fome pu- 
trefcence, either fpontaneoufly produced in the body of 
the individual, or received by contaft, inhalation or 
infeftion from others; to fuch the term putrid can- 
not be mifapplied. In the days of Sydenham, it 
feems all fevers were as indifcriminately treated ac- 
cording to the then reigning methods of relifting ma- 
lignancy, as they have lince his time been treated as 
purely inflammatory.—Ferhaps in both cafes with 
equal damage to the Tick, and difrepute to the art. 
For nothing is more certain, than that diforders fo 
differently circumftanced, require a 1 very oppolite or 
mixed treatment i and that a method exaftly fuitable 
to one, cannot be applied to the other two, without 
endangering the patient’s life by the inartificial con- 
fufion. 
The excellent Baglivi, whofe works I efteem and 
admire very highly, tells us, “ Omnes acutas febres 
6C per fanguinis miffionem curare incipio.” It may 
be, his rule was too general, conlidering the liable- 
nefs ot the Roman territory to putrid malignant 
fevers, from the frequent inundations of the Tyber. 
At leaft this conftant practice enables us very well to 
account for his unfuccefsful treatment of thofe fevers in which the blood was florid, <c Obfervavimus iri 
« Xenodochio; omnes fere ab acutis evaflifle, quo- 
« rum fanguini venefedione extrado, crufta alba at- 
ftC que chylofa fuper crefcebat: Contra mortuos, 
«c quorum fanguis valde rutilans erat; five cum fu- 
<e perficie nimium rubicunda.’* Romse aeftivo tern- 
“ pore. Anno 1693 *; 
No one who confiders the hiftory of peftilential 
contagious fevers, or examines whence the fluids 
come to be corrupted, and new mortifications ge- 
nerated, from the afiimilating fermentive pdwer of 
the abforbed fanies produced in topical gangrenes, 
will doubt of the poflibility of the exiftence ot fome 
degree of putrefcence in living bodies.—Perhaps the 
figure, bulk, and primary adion of that fubtile and 
powerful agent, which we call putrefcence, may be 
unknown; yet there are eflfeds, by which its real 
exiftence in living bodies under certain circumftances, 
is as evidently afcertained ;•— as the cohaefion of the 
particles of matter proves there is fuch a power in na- 
ture as attraction,—or the deferent of bodies, and the 
revolutions of the vaft celeftial orbs, fuch a one as 
gravity. Upon thefe terms, though in their caufes, 
and in all refpeds, except in their efteds, unknown 
to us, we reft, neverthelefs, the philofophical folution 
of the phaenomena of the univerfe. 
Putrefcence is generally defined to be a folution of 
the union of the heterogeneous particles, of which 
mixt bodies are compofed,—by this difunion the pro- 
perties of the body are entirely changed,—and a va- 
• Eagliv. Prax, Med. Lib, 1. Cap, XIII, pour flies off into the air, of a moftoffenfivefmeU.—* 
IThis bears no refemblance to the fmell of volatile alka* 
line falts.—Thefe revive; that produces almoft a de- 
lixivium animi.—This vapour aCls upon other bodies 
as a putrefactive ferment.~Even in heaps of focculent 
Vegetables, beginning to putrefy*, if this vapour be 
difperfed, and the plants are properly aired or venti- 
lated, the progrefs of their putrefaction will be en- 
tirely flopt. Moifture and heat are both abfolutely 
neceflary for the promoting of putrefaction in all bo- 
dies. Putrefcence, in refpeCt of its fpreading multi- 
plicative power, is very juftly fuppofed analogous, in 
its operation, to ferments; which diffufe their aCliori 
very wide, excite inteftine motion, and aflimilate into 
their own nature and properties, bodies which are 
fufceptible of this operation *. 
RefpeCting its aCtion upon the circulating fluids of 
living animals, putrefaction has been compared to 
volatile alkaline falts,-—and the rather, as putrid fob- 
(lances, chemically treated, are found to abound With 
volatile alkalies.—Thefe falts melt down the blood 
globules, and prevent coagulation when it is extra- 
vafated. Putrefcence produces the fame effeCl, but in 
a much higher degree, on account of its multiplica- 
tive property as a ferment; In this it greatly differs 
from alcaline fairs; which, in faCl, are found capable 
of preventing the putrefaClion of animal fobftanees -f*. 
But volatile alkalies, and putrefaClion, differ dill 
* See the analogy very accurately purfued in Hoffman's I)iffer- 
tation de Putred. Do&rina & Ampliff. ufu Tom. VI. 
•f See the excellent experiments of Dr. Pringle upon feptic and 
antifeptic fubftanees. more elfentially in their effects upon the folid irritable 
parts of living animals. Volatile alkalies irritate, 
but do not immediately debilitate.—Putrefcence both 
irritates, and inllantly, upon contad, debilitates.—. 
It weakens moll remarkably the force of the heart and 
arteries; and ft ill more that energy, whatever that 
may be, which is derived from the nerves.—This 
fudden debility arifes perhaps from a refolution, or a 
difunion of the component particles of our folids al- 
ready begun.—And yet the fenfible and irritable 
parts, as if directed by fome confcioufnefs, or fome 
feeling, of its deleterious power, with febrile move- 
ments, make an effort to repel or expel it out of the 
body. 
Animal bodies are fo evidently in themfelves prone 
to putrefaction, that few have enquired why they pu- 
trefy ; though it has long been efteemed no incurious 
nor uninterefting enquiry, Why living bodies do not 
refolve into putrefadion as dead ones foon do * ? The 
inceftant motion and agitation of our fluids in the ar- 
terious and venous veflels, is one great caufe of thepre- 
fervation both of folids and fluids from putrefadion : 
When this motion ceafes, even in a few of thefe 
veflels, corruption or putrefadion quickly enfues.— 
And the putrefadive femes is foon difperfed over the 
whole mals of blood, and ads upon it, as a ferment, 
in producing a like inteftine alteration and putredi- 
nous refolution throughout. This evidently appears 
in fphacelations, which, however apt to arife from 
* Sanftorius propofes and folves the problem very elegantly, 
Aph. Lib. I. §. LXXX. “ Caro animata cur vivit Sc non putrefeit 
“ ut mortua ? Qnia quotidie renovatur.” the moft oppofite caufes, by the affirm!ating virtue of 
the putred fomes received into the mafs of blood, con- 
flantly produces a low malignant fever ; which does 
not ceafe till the mortified parts are feparated from 
the living. But mere motion alone will not longpreferve 
our fluids from putrefadion unlefs thofe particles of 
our folids and fluids, which have been rendered acrid 
and almoil putrefcent by their long circulation in the 
body, be fent off, and feparated from the circulating 
fluids, by a due fecretion and excretion of urine, and of 
the cutaneous evacuations *. It is alfo no lefs neceflfary, 
that the perpetual lofs of humours be reftored with 
bland and acefcent food, which will temper the acri- 
mony and putrefcent tendency of the animalized li- 
quors, whilft itfelf is converted into a nouriffiing gela- 
tinous fluid, by the copious admixture of bile, lymph, 
and blood, and by the motion and heat, refolving 
from the adion of the whole organic and. vafcular fyf- 
ftems. 
Hence, if the nutritious liquors ftagnate in any of 
the veflels of the body.—-If the acrid matter, 
ought to be excerned by urine and perfpiration, is re- 
tained in the body.'—Laftly, If the highly animalized 
blood, and bile, be not tempered by the aflumption 
of a fufficient quantity of acefcent food: In fuch cir- 
cumftances, the mafs of blood and bile, and the hu- 
mours to be excerned, being too highly animalized, 
will become fo far difpofed to putrefaction, as is in- 
* “ Si ex ponderatione videris confuetam perfpirabile retineri, 
“ & fudorem vel lotiurn poll aliquot dies non faceflere inde cog- 
“ nofces, retentam prasnuntiare futuram putredinem.” San£t. da 
Ponder. Lib. I. p. 43. See alfo §. 46, 47, 48. ibid. Confiftent with health and Jife; and diforders truly 
putrid, and very certainly malignant, will enfue.—. 
The remote caufes which have been found productive 
of malignant diforders, produce one or other of thefe 
effeCts upon the human body.-—From the experience 
of ages it is known, that a Jong continued moifture 
of the atmofphere, from wet feafons, efpecially in 
fummer and autumn; or from inundations in low 
fenny fituadons; and long lea voyages, efpecially in 
wet hazy weather ; have ever been attended with dif- 
orders, in which the humours wrere evidently corrup- 
ted and refolved *. 
A dearth or fcarcity of provifions, efpecially of the 
alimentary grains; the frequent effeft of intemperately 
wet feafons ; has generally, in every age, been ac- 
companied with epidemic putrid ficknefies. Thefe 
prevail molt amongft the poorer fort of people ; many 
of whom, in thefe times, were almoft half-ftarved; 
at beft, water and animal food bear a greater proper* 
tion in the diet of this neceflitous part of mankind 
than is ufual ; and they are much lefs abundantly 
fupplied with the acefcent or vegetable part of diet, 
fuch as bread, beer, cyder, than is perhaps ne- 
ceflary for the prefervation of health in the labouring 
part of a putrid fever may at any time 
be produced by a long difufe of vegetable food f. I 
lately attended a perfon who had, for a confide* 
* Hippocrat. Aph. §.•5, Art. 15, 16. San&orlus accounts for 
the bad effedts of a tnoill atmofphere, thus; §. If. Aph. VIII. 
“In camolb (acre) prohibetur perfpiratjo, meatus implentur, fed 
non denfantur, bhrx laxantur, non roborantur, &pondusper- 
«« fpirabilis retenti Sc fentitur.” 
p Vide Bcerhaav- de Morbis ex Alcalino Spontaneo Aphorifm. rable time, confined himfelf to the ufe of animal food, 
and water only, with a fmali quantity of rum, to 
prevent the returns of heart-burn, acidity, and gouty 
pains in his ftomach, complaints he had been much 
fubjedf to.—Under this antacid diet a putrid fever in- 
fenfibly crept upon him.—He complained of pains 
about the hypochondria j his breath and fweat ftunk 
abominably; his fkin was much fpotted with livid 
and brown blotches of different fizes ; he was feized 
with a gangrenous livid erifipelas of the pendulous 
part of the palate ; which changed into a white cruft, 
and afterwards feparated from the found flefh like the 
of a mortification.—He with much difficulty 
, got over this putrid illnefs *, but, fince that time, has 
ufed red wine and acefcent liquors. The bile necef- 
fary indeed for animaiizing our ingefta, is, however, 
a poifon, unlefs its acrimony be tempered with a 
conftderable proportion of acefcent food. Animals 
which die of famine, do not perifh for want of blood, 
but are carried off by a truly putrid fever, arifing 
from the poifon of putrefeent acrimony in the blood, 
which gradually lofes its bland gelatinous confiftence, 
and becomes a putrid gore, not feparable into ferum 
and craffamentum *. 
A laxity of veffels, and either too great an abun- 
dance, or a want of the falutary humours, and a 
fcorbutic cachexy of the blood, feem to difpofe the 
bodies of individuals to produce, or receive, malig-. 
* Hippocrat. Aph. §. I. Aph. 4 and 5. San&or. §, 111. 
Aph. 16, 17, 85. and §. 4. Aph. 20, 21. See alfo a cafe in point 
related by Dr. Huxham, in his Diflertation on the malignant ulce- 
rous fore Throat, p. 63. nant fevers : For perfpiration is generally imperfect 
in fuch a flate of the body. But, of all thofe things 
called non-naturals, which flop perfpiration, and 
difpofe individuals to receive malignant fevers *, un- 
eafy paffions of the mind, efpecially fear, forrow, dc- 
fpondency, are of the moft dangerous confequence *. 
Quicker than poifon, they weaken the force of the heart 
and arteries. Appetite and concoftion are languid. 
—The retained perfpiration, in its turn, augments 
thefe difagreeable fenfations of the foul.-—And thus 
too often an indilfoluble and fatal circle is formed, 
dangerous as a caufe in every diforder, but in malig- 
nant fevers efpecially, ominous both as a caufe, and 
as a fymptom. 
To thefe remote caufes, the fufeeption of contagion, 
and of infectious effluvia into the body, muft be ad- 
ded.—Thus fubjefts, by conftitution very little dif- 
pofed to thefe diforders, are fometimes fuddeniy 
feized with them, efpecially if expofed to infeCting 
caufes, when perfpiration, upon one account or ano- 
ther, is flopped and impeded. It is well enough 
known, that the bile and blood of difeafed animals 
will impart the fame illnefs to others f: nor can it 
* “ Inter animt affeflus, ira & pericharia corpora efficiunt le- 
“ viora ; timer & msftitia graviora; CcEteri vero affeftus at his 
“ participantes operantur ; Perfpiratio impedita a quacunque caufa 
“ maeftitiam & timorem facit, ” Sandtor, de Animi affe&ibus, 
Aph. i, 8. 
f By fome late experiments mentioned in an ingenious treatife 
upon the malignant diftemper of the black cattle, by Dr. Layard, it 
appears, that this putrid diftemper has been advantageoufly im- 
parted to Other cattle, by inoculating them, after proper prepara- 
tions, with matter taken from the.ripe boils of young cattle recover- 
ing from the diftemper, and inferted into a wound made in the be doubted, but that the offenfive duelling perfpira- 
ration, putrid ftoois, and critical fores, fend off a 
volatile, putrid, infectious miafma, which, breathed 
into a difpofed body, or mixed with the faliva, and 
fent down into the ftomach, is in like manner perni- 
cious. : . 
The circumftances attending the beginning of mod 
infectious diforders, point out this to be precifely the 
manner and place in which infectious miafmata are 
received, and firft begin to affert their aCtive aflimi- 
lating powers. For, being mixed with the faliva 
and gaitric juices, that putrefaction in them, and in 
the ingefted food, by its means arifes, which Plifto- 
nicus formerly imagined to happened in ordinary di- 
geftion : The fame is quickly propagated in the bile, 
which perhaps, of all the juices in the human body, 
is the moft animalized, and the fitted: fewel for feed- 
ing this putredinous flame; which now inkindled in 
the ftomach and duodenum, diffufes itfelf very Toon 
over the whole body, and by its morbid effeCts, as it 
goes along, gives very evident marks of its pro- 
grefs. 
fhoulder or buttocks of the found bead. When the operation fuc- 
ceeds, the wound fwells, and becomes difcoloured about the third 
day, and the beaft fickens the hxth. A curious regard to intereft 
feems to have been the motive for trying this experiment; But 
Dr. Deidies, from a dcfire of improving fcience, injected the bile 
of perfons dead of the plague at Marfeilles, into the veins of dogs; 
which always died in three or four days, with buboes, gangrenes, 
and other effential marks of the plague about them. Phil. Tranf. 
No. 370. The fame kind of bile, fwallowed by dogs, made them 
only for a little time Jlck and heavy. Dr. Couzier put infefted 
blood into a wound in a dog ; next day the dog died, and the 
wound was fwelled and gangreaed. Phil. Tranf No, 372. In the ftomach we find it firft occafioning weighty 
uneafmefs, lownefs, dejedion, inappetency, averfion 
to food *, and, by its fympathetic adion (by the 
nerves) upon the brain) giddinefs, heavinefs, and 
pain in the head, are complained of*, afterwards it 
caufes naufea, vomiting, and a kind of burning fenfe 
of pain v in the inteftinal tra6t it occafions griping 
pains, borborygmi, a dyfenteric loofenefs, though 
fometimes an obftinate coftivenefs : Laft of all, a 
fenfe of burning heat about the pnecordia; and, af- 
ter death, gangrenous fpots appear both in the fto- 
mach and in the duodenum, and other inteftines. 
Arfenic, glafs of antimony, corrofive fublimate, pro- 
duce fome fuch effeds, and finely that is poifon, 
which ads in any refped like thefe. When this virus 
is abforbed into the ladeals, the chyle and lymph are 
corrupted by it *, and, being received into the blood- 
veflels, and diffufed throughout our mafs of fluids, it 
diflblves that copula, and mutual attradion, which 
ought to fubfift among the partides or globules which 
compofe our fluids.—Hence the blood fometimes 
does not coagulate.—lt is always tender and lefs co- 
herent, and the ferum is almoft of a footy colour, 
from the broken red globules mixed with it. A bland 
gelatinous vifcofity, the charader of nourifhing ani- 
mal liquors, is loft.—Inftead thereof, the putrefied 
fluids become rank and thin.—And here again the 
ftimulus of this fubtile acrimony difplays the moft 
fatal and ruinous marks of its reality and exiftence. 
Now mixed with the blood, and in perpetual contad 
with the moft fenfible and irritable internal furface of 
the heart and blood-veflels •, languid, tremulous, ir- regular motions are produced.—The piilfe vaftly 
quicker than ufual, is not with {landing irregular, 
fluttering, and fmall.—The proper addon of this 
poifon upon the folid parts, Teems to confift 
in producing the moft fudden proftration of 
ftrength, with lownefs, anxiety, latitude, and def- 
peration of life, that can be imagined. The natural 
and proper action of every part is fubverted. The 
weaknefs of the heart, and circulating powers, appears 
from the fudden fainting of fome patients, from an 
credf pollute,' or the leaft exertion of mufcular addon, 
in thefe diforders. Thefe morbid motions continu- 
ing, and the poifon having fpread its addon wider, 
•and multiplied its force more, the broken red glo- 
bules are thruft into lymphatic and ferous veflels.— 
Hence the addon of the brain is difturbed and per- 
verted, the patient becomes phrenetic; though, ia 
many milder cafes, the brain is perhaps chiefly dif- 
turbed, in confequence of that fympathy which fub- 
fifts betwixt the ftomach and brain, by means of the 
eighth pair and intercoftal nerves.—Petechial fpots, 
broader vibices, and at laft true gangrenes, the con- 
fequence of this general error loci, appear upon the 
fkin and internal furface of the membranes, and in- 
teftinal canal. 
If we confider, that the external air has perpe- 
tual accefs to the inteftines, and that the animal 
liquors, and materials to be digefted, are fit fubjedls 
of putrefaddon; we fliall not be furprized, thac its 
addon is chiefly diffufed from, and produces the worft 
and moft: confpicuous effedls in the primae viae. The Celebrated Bartholine, obferved in the bodies of thofe 
who died of the epidemic malignant fever raging at 
Copenhagen in 1652, that the flomach and duode- 
num were always inflamed and mortified *. Hoffman 
obferves, that true petechial fevers often end in a real 
fphacelation of the flomach and parts adjacent -f. 
The diflefHons of the ingenious Dr, Pringle fliew, 
that though the brain is fometimes inflamed and fup- 
purated in thofe who die of malignant fevers, yet the 
inteftines are moft liable to mortify J. M. le Cat, ii> 
thofe ingenious observations which we have already 
cited, concerning the malignant fever raging at 
Rouen in 1752-3, takes notice, that in the dead bo- 
dies of thofe who had been moft delirious during this 
illnefs, no morbid appearances were feen in the 
brain •, only the flomach was ulcerated, its villous 
coat feparated, and an inflammation, with gangrenous 
fpots on the other coats of that organ : In general, 
the villous coat of the cefophagus, flomach, and 
fmall guts, was inflamed, or filled with large miliary 
eruptions of the cryftalline kind \\. 
I could find none of my people difpofed to gratify 
my curiofity, in opening the bodies of thofe who died 
of our diftemper; but, from its great fimilanty to 
that which raged at Rouen, I am perfuaded the in- 
ternal appearances would have been nearly the fame. 
* See Bartlioline cited in. Pringle's difeafes of the army, p. 19’. 
•f Hoffman. Oper. Tom. 11. p. 85. De Febribus Petechiahbus 
veris. 
X Difeafes of the army, p. 3. cap. 6. §. 4. and cap. §. 2. 
(j See this author’s excellent hiftory of the difeafes reigning at 
Rouen, 1752-3, publilhed Phil. Tranf. Vol. 49, part firft. —And, in my patients, I am apt to think the deli- 
rium was often fymptomatic, from the fympathy of 
the brain with the primae vise ; but, in faying often, 
I do not fay always ; as the continuation of the febrile 
impetus might at laft occaflon a kind of inflammation 
pf that part very frequently. From this general rea- 
foning, the aetiology of fymptoms and effects in the 
diforder I have defcribed, will eafily be deducible; 
and it will appear, that, in the method of curing dif- 
tempers fimilar to thefe, every thing muft be fo di- 
rected, that the putrid poifon be eliminated, and its 
operation mitigated, evaded, and counteracted, with 
judgment and care. In order to attain thefe great 
ends, nature, or the vital flrength, mull be properly 
fupported; and the fpontaneous efforts fhe makes to 
throw off the diforder, muft be imitated and promoted. 
For, however fimilar malignant diforders are in an 
jabftraCt view of their nature, one to another, yet ob- 
fervations fhew us the method of curing them is often 
very different. Thus the malignant fever of 1752-3 
was promoted, and the life of the patient endangered, 
by evacuations, gentle purging not excepted.—In 
1756, we find the alvine purgation very falutary. In 
a word, a general knowledge of fevers, however juft 
and accurate, will never fuperfede the neceflity of ex- 
aCl and accurate obfervation ; which alone can teach 
us thole nice but important differences, upon which 
the cure of acute difeafes will ever depend. 
“ Illud ignorari non oportet; quod non omnibus 
54 aegris eadem auxilia conveniunt. Ex quo incidir, 
*4 ut alia atquc alia fummi auClores, quaft fola vendi- “ taverint, pr*ut cuique cefferant. Opoftet itaque 
** übi aliquid non refpohdet, non tanti putare audto- 
“ rem quanti asgrum, & experiri aliud atque 
“ aliud. * ” ' . 
* A. C. Celll Med. L. 3. t. 1. 
FINIS.