'MJf'X ;,'*«»«« m MS ^. iitill: lMm: mm^-. -ar I^^W^^?:;.-^^''.--:-:---*: ^ " ?' :i*i t""^ • : '•" r' " " ■"■'■■ •' >'"!" : ''i.:.» St!' ].ty ■"» /I * •iih- I T AN ESSAY ON THE WOEf-EXISTENCE OF MALARIA; ESPECIALLY AS A CAUSE OF INTERMITTENT AND REMITTENT BILIOUS FEVERS. READ BEFORE THE Central i&rtncal ^octets of (Georgia, DECEMBER 3, 1828. BY ALEXANDER JONES, M. D. PRINTED AT THE GEORGIA COURIER OFFICE. 1.829- VKtF INTRODUCTION. Having, during the last year, been led to the investigation of the following subject, a right under- standing of which, I believed to be of very great importance I was induced to draw up my observa- tions and reflections, and read them befire the Central Medical Society of this State. The doctrine advanced, being contrary to the received opinions on the subject, caused soveral of my friends to request their piibJicatiin. With this intention, I forwarded a copy to the Editors of the American Journal of the Medical Sciences, requesting its publication in the February No of that periodical. It was not long before I received a letter from Dr. Isaac Hays, one of the Editors, informing me, that it appeared to contain some facts incorrectly stated, and which, if omitted, might so weaken the doctrine maintained as t cause me to withhold its insertion in the Journal. He also stated, he would return it for revision, with marginal notes, as soon as an opportunity offered, hoping to have it returned in time for ins< rtion in the May ?io. of the Journal. In his remarks, Dr. Hays professed no other motives than those of candour, and a wish to have the pap r, he said, to be as credit- able as possible. I received the communication; accompanied with a letter to me, on the 19th Febru- ary, frni Dr. Hays. I found the communication interspersed, not so much with memoranda and references} as with strong opposition to the doctrine «v advanced in it. Dr. Hays stated in his letter, that his duties, as one of the Editors of that Jourri .1, compelled him, " unhesitatingly, to ptace himself in the position of a staunch mi ismatist" Whether this was done from a conviction of the reality of the miasmatic doctrine, or from a wish merely to raise an ordeal through which my paper was to pass into the columns of the Journal, is left for himself and the public to decide. Relieving the doctrine of miasma is one taught and professed, not only by a majorit of the Kditors of the Journal, but likewise by the teachers in the Medical School, under whose patronage this periodicnl has been so usefully and so long conducted, it is not wonderful, that »»ch stron ay No. ol the Journal. Now, it never came back to my hand* till the 19th February. In order for it to have re ched Philadelphia by the 1st March,I should have had to have mailed it, here, on the morning of the 21st; thereby only allowing me two days to J ave replied to all the objections and arguments, that couid be suggested against it by the most erudite. v and industrious miasmatist. I likewise thought that if] should have returned my paper to Dr. Hats with the necessary replies to his strictures, probably a fondness for the favorite theory would have caused him to have raised furtiker objections, and rejoined answers to my replies, thereby creating a M. S. con- troversy. To prevent such a result, 1 determined to publish my paper in its present form, and submit it to the public. Whatever its werits, or demerits are, I am willing they should be ascribed to me. It has been impossible for me, in the limits of this (intended) short treatise, to include every thing, which could be said in favor of my doctrine, or to reply to all which could be said against it. Suih prolixity, if necessary at pre ent, would fill a large octavo volume. The subject, however, at a suitable period, will be renew- ed, and pursued in all its ramifications. I have included Dr. I lays' strictures in an Ap pendix, and annexed tne proper replies. A. JONES, February 25th, 1829. AN ESP AY, &c. The doctrine of miasmatic exhalations, causing intermittent and bilious fi vers, is one that has been believed for many years, by physicians, almost universally. Yet the modusoperandi of these exha- laiions, in the production of fiver, has never been explained on satisfactory principles, nor ever will be, for one grand reason, viz: that n« such deleterious miasmatic exhalations, so destructive to health, exist, except in the imaginations of speculative theorists. Those who believe in the doctrine, in its extended sense, (and there are but few who do not,) have entirely failed to tell us what it is : What its proper- ties are : What kind or combination of things, or aerial substances it con ist of: (a.)* YYha circum- stances are capable of producing it: v here or on what part of the human system it makes its first morbid impression. One will tell you that it is the product of stagnant w.iter and mud -another, of marshy ground ; all yvithout any proof. Because they meet yvith intermittent fevers there, this invisible, incom- prehensible something, must be the cause of them. Some tell us this " spirit moving cause" makes its fir-t feverish grasp on the lungs, and is carried into the circulation : Others contend, it first moves upon the Schneiderian membrane, and there leaves its pestilential sting; and other knowing ones, declare it is enveloped in the saliva, and carried into the stomach, and there, vipi r-like, fixes its poison, which is conveyed from thence, by sympathy, or otherwise, to every part of the body, or -ystem. Noyv, all these hypotheses have, ever since I h ve paid j.ny attention to the study of medicine, and reflected much on the subject, appeared to me to be * See the Appendix. absurd and untenable. 1 am disposed, from various causes, to den if the existence, in toto, of what is term- ed marsh, or pond miasma, or poison, and called, by the Italians, Malaria. As the latter is an appellation of very general use, 1 shall in future adopt it in my discussion. All the proof that is offered, or relied on, by the advocates 1 f this doctrine, is the similari- ty if diseases in .-imilar situations of country, assum* ing *'a!aripetually taking place, without our having the power to remove it as a cause, or obviate its tffects, not only upon the pa- tient, but upon all wh attend him. We know, however, that by re-establishing perspiration, with an equilibrium of the system generally, the patient often recovers, which, we suppose, could not happen, if malaria was a primary cause, constantly present and operative. It has been supposed by some, that stagnant water yvas a peculiar source of malaria, because, on agita- tion, it is known to emit certain non-respirable gases, especially hydrogen. To this I yvould repl., that such collections of water emit this gas free\y,(r) in the winter m 1 spring, as well as at other times, yvhen all agree, that malaria is either absent or dormant. I will, f r the present, recur^o my proposition last stated: " That collections of wat r in warm climates, a> e unhealthy, in proportion to the evaporation from their surjaees. The difference between the evapo- ration from still and running water, is very great.— If water be permitted to stand exposed to the sun in an op*'n vessel, the evaporation goes on more rapidly th hi if the same quantity of water yvas kept agitated for the am. length of time, (s) Thus water cour- ses, whose currents are rapid and agitated, never give rise to sickness like those yvhich are stagnant and deep; because the eva oration in the first in- st i s is inconsiderable, while in the latter, it is very great, especially in hot weather. Ttiws the healthi ness of a stream may be determined, in a great degree, by the rapidity of its current. It may be as ed, why it is, that malaria fev is are very | reva- lent on the Champagna di Roma, when it is an extended plain, and out little water visible on its surface \(t) I will reply, by stating, t. at evapora- tion goes on very rapidlv from the surface of ground yvhich is continually moist. This is the case with the plain in question ; it is surrounded on all but one side, with very high mountains, many of whose tops areeoverel with snoyv the greater part bf the year. The natural tendency of the superabundant moisture deposited about these mountains would be to settle in this plain, which mav, at some period of creation, have tormed the bed of a lake. The earth, th refore, must always possess great moisture, and a great deal of humid vapour necessarily exhale from its surface, and at night, or in cool seasons, condense and be pre- cipitated again. The same may be remarked with regard to the Pontme Marshes >outh of Rome. In neither of the above mentioned places does vegetable putrifaction take place, or exist, in sufficient abun- dance to give rise to the diseases prevalent on them. It will be recollected, that the Malar tans make three thinrs necessary tor its production, viz: Heat, mois- ture, and veg. table putrifaction. Now, if yve can prove that malaria fevers can be produced wi hout the presence of either one of these agents, their theory falls to the ground. If they say such disease can be produced with heat and moist re, or by vegetable putrifaction alone, yve have only to name those two celebrated malaria districts of Italy, and the fenny counties of England, with other places, to show that vegetable putrifaction is not a necessary agent in the production of these fevers. Professor Carter, of New York, an accomplished scholar and interesting tourist; informs us that the Campagna di Roma, has very little vegetation growing on it, except the common Broom, (u.) which is short, and not very liable to putrifaction, being a yvoody, perennial plant, or shrub 18 The vegetation on the Pontine Marshes, is also short and scantv : In neither of those places can yve sup- pose vegetable decay to be an agent, or the origin of disease. If it is said that heat and moisture are alone competes to create the disease, the ground is aban- doned a* d my theory admitted in part, at least as respects agents ; temperature and moisture being important words in my doctrine. An eminent scien- tific man admitted to me that he had a regular attack of Tertian fever after being caught in the rain, when his system yvas excited ; and would have, at another time, experienced another attack, had he not went to bed, applied warm rocks to his feet, and drank some warm beverage. Now, there is no truer principle in Philosophy, than if certain causes, under certain circumstances, produce certain eff\ cts, the same causes, under similar circumstances, will al- wa\ s be ad' quote to produce the same effects, unless counteracted bv some countervailing agent. Why, is it unreasonable to suppose that moistu, e, in vari- ous conditions of temperature, applied to the systloisture is capable of being floated to a very considerable dis- tance in the air, equally as far as the Malarians have concluded miasma could be wafted. I have never yvitnessed a north-east, or east wind, to prevail long at a time in our climate, yvithout augmenting disease; and in my practice, e of intermittent and malaria fevers, in locations and situations, where the stoutest believers in malaria cannot trace them to any such source, occurring frequently on healthy elevations, remote from all possible infections, swamps, or ponds, (x.) Our westyvardly winds are always healthy, because they are dry. We know, during very dry years, or summers, our country experiences more health.— The same occurs during constant wet years, (y) If the year be dry, the temperature of the air is uniform; and the same occurs if it be wet. In the latter case, a constant fall of rain, without interm.ssions of hot or dry weather, keeps the air at sich a cool, uniform standard as to prevent the human frame from be- coming so much relaxed, to be again exposed to chilly damps The evaporation is also inconsidera- ble under such circumst, nres. North-east winds, on the sea coast, are healthy to the inhabitants on it, because it is charged yvith saline effluvia ; bu before it reaches the interior, it loses this quality .and be- comes fresh water vapour. Whether it is merely deposited by the air on the ground, or is absorbed by vegetation, is impossible to say; but we are convin- ced of the ch.-.tige. Rivers, which overflow tlieir banks, are always 20 unhealthy, as pools of standing yvater are left in many places and a moist earth to be dried and evaporated bv the sun. and which is agaii. condensed in the form of dew or fog, ov r a much greater extent of country th n is inundated, (z) It is supposed b some, that the offensive smell crea- ted by vegetable decomposition, is an evidence of the presence of malaria : this, however, is untenable and unsupported by fact. Diseases have b« en frequently, no doubt, charged o such causes without grounds. We know, that yvhenever disease appears, the | eople are always solicitous about t e cause, and physicians are generally anxious to satisfy them yy ith some solu- tion. A pile of potatoes, or a heap of coffee, or per- haps a feyv putrifying apples, or turnips, may be charged yvith the production of the most ravaging diseases. r*uch physicians fail to tell us how many piles or masses of vegetables have been knoyvn to rot wthout producing disease. Neither do they prove to us that such diseases would not have pre- vailed, had no such decayed vegetables been knoyvn at the time. Malignai t fever may be generated in damp, confined and hot lanes, among persons of sc nty provisions, and filthy lodgings, and once it has been excited, be propagated, by an infectious quality given to the atmosphere, by morbid human effluvia, when a few rotten vegetables in a hole or cellar have nothing to do with the matter. I would not, however, be supposed to be favorably disposed towards such accumulations, because decency would dictate their removal. Offensive odours are not necessarily unhealthy:—Musk, Assafcetida, and Sul- phuretted Hydrogen, the odour of the Pole Cat, and various other things, emiting almost insupportable smells, are not considered as capable of produ. ing fevers. Animal putrifactions are rot considered unhe dthy, except they arise from their vast accumu- lation in sepulchres, although they emit odours more offensive than decomposing vegetables. One reason why putrifying vegetables have so frequently been 21 charged with the production of disease, is, that it always occurs freely when heat and moisture are present—one to relax the skin, and the other to cluck perspiration: it is, therefore, censured instead of the real cause, (a) I am firmly of the opinion, that if those persons who live on ponds, or marshy situations, were cloth- ed in thin flannels next their skins, they would escape disease much better; and even in the section of country where I live, those who wear flannels thro5 the year, are less obnoxious to the fevers of the climate, than those who do not. I have myself. experienced the benefits of flannel as a protective— I have, ever since 1822, wore flannel during the win- ter ; but would take it off in the spring. In the sum- mer of 1827, I had an attack of intermittent fever, terminating in remittent bilious fever: it was brought. on by wearing very thin clothing and exposure to night air. In returning home, 10 or 12 miles, at night, after visiting a patient, a cool wind spran up; I became chilly, and in two hours had a regular par- oxysm of an ague. The following fall I put on flan- nel and improved in my health : The following May I took off my flannel, directly after which a moist spell of weather came on. and I had a regular attack of a very severe intermittent. I put on my flannel again, and had no more disease till August, when I put on thin clothing, and by ex| osure to a damp N. E. wind, had one slight paroxysm of intermit- tent. Now, in the last case, the attack would have been more severe, as intermittents were more preva- lent in the country at that time, but for the protec- tion afforded by the flannel against moisture. Flan- nel shirts, or shirts of a thin material, one half wool and the other cotton, with very thin outer clothing, t am confident, is the healthiest summer dress in any climate, and could be worn with comfort when the ski'i became a little accustomed to t. In long spells of damp yveather, or during the damp cool nights of autumn, thin flannel sheets are more healthy than 22 ftny other kind. If these things were attended to. especialh in weak constitutions, we should not meet with so many cases of pulmonary disease, rheuma- tism, dysentery, and other complaints arising from checked perspiration. The cause why a country possesses more health whiie uncleared an i uncultivated, than in an op- posite condition, I think may be explained in some degree by one fa. t, viz :—We know the leaves of trees and shrubbery absorb a great deal of moisture. A plant may be sustained in a flower pot a long time, by simply sprinkling its leaves. If the ends of vines are immersed in water, the yvhole plant is invigorated and thrives. A string tied to a cucumber vine, having the other end im- mersed in a cup of water, is known to sustain the whole plant in dry weather yvithout any other appli- cation of water. We Know that collections of water yvhich are surrounded with trees, are less deleterious to health, than if cleared to their shores, in conse- quence of the trees, or their leaves, absorbing the moisture thvt would otherwise be carried through the atmosphere. (jlreen trees remni ing in cleared grounds, injure vegetation under and around them, by attracting and absorbing the moisture, that w aid otheryvise reach, nourish and sustain shorter vegeta- tion. Hence we infer, the ground near such trees is not injured by their shading it, but by absorbing the moisture in its wonted descent. Th'is we suppose a country in a state of wilderness to be healthy, as lews and fogs are absorbed by the trees before they reach the earth, and the evaporation during warm weather, is very small,in consequenc ol nothing, comparative- ly, remaining in contact with the rays of the sun to be evaporafed. But it is quite different in an old, or cultivated country: The deyv, or fog whirh is here precipitated, descends to the ground without inter- r. ption—The vegetation also being inadequate to absorb it, it remains to be re evaporated by the following morning's sun. The night air in an old 23 settled country is always found more damp and' unhealthy than in a forest. Indians always become unhealthy on their cleared lands. A hunlsman may sleep out at night yvith perfect impunity, in an un- cleared country, when it would be hazardous, if not death, to do it in a cleared, or old country, in our climate, (b) I know the Malarians may ask many apparently imposing questions, and seek out some few exceptions to the general tenor or rules of my doctrine. I v* ould advi-e such to recollect the old adage, that "there are no general rules without exceptions;" and merely putting one head to work to find out isolated facts, or singular cases, to rebut general rules, is an unfair method of meeting honorable argument. I know, a great many instances of collections of water in duck ponds, mill ponds, r:in ponds, with a host of other ponds, ivaters and rotten vegetables, maybe adduced as givi ig rise to sickness. I must beg; of the A la- rians to recollect, that whenever they speak of ponds, rivers, lakes, fogs, dews, vegetable putrifaction, (which requires moisture for its process,) that they are speaking of things, which I admit, produce sick- ness, more or less, by the influence of moisture, evaporated from, or connected with these various modifications of humidity. Whatever credit, or discredit, the foregoing merits, it is all my own. I am conscious that the existence of malaria has been denied before ; but T never knew it till since I proposed and mentioned the foregoing theory to some friends.* I never read any paper, in which it is denied until a day or tyvo back, when I sayv a paper on the subject, by a Doct. Collins, of Louisiana. ' fter this essay had been read to the Society, in Milledgeville, (c) ! searched, (in what few authors I had in possession,) in vain, for something to aid me in the investigation. I had, therefore, no * The first lime I made ihis theory krmwn, was last spring, when I mentioned it in conversation to a friend, &c 24 other helps or resources to draw from, but my own observations and reflections. I am sensi le ot this imperfection. But the more I have reflected and investigated this important subject, the greater has been the multiplication of facts, in support of my doctrine, 'the short limits of this essay will not alloyv me to go farther into reasonings on it at pre- seiit, or to anticipate the attacks on what may be conceived its vulnerable points. I lso am convinced tha I have not only to contend yvith long established errors (d) on this subject, but against an almost im- pregnable rampart—the prejudice of pre-conceived opi ions. I am consoled, however, with the reflec- tion, that I am not the first who have approached eiror, however highly protected under learned autho- rities, or scholastic dogmas, or intolerant prejudice. If I were, the enslaving errors of Galen—the me- chanical philosophy and humoral pathology of Poerhaave and Svlvius, which so long sat, incubus- like, upon the genius of our profession, and spell-bound i' in he icy embraces of superstition and prejudice, had still been believed, and I left the victim oj tyran- nizing error. Reflecting on the foregoing as the only rational causes of intermittent fevers, I have been led, by Btep>, to mlieve tha- the periodi al nature of these fevers could be account d for, on the prnciple of collapse of the skin and reaction, or in oth r words, that the pyrexia and apyrvxia of intermittents, are nothing more than reaction and collapse. Ft r instance, when a:i ague is first experieucedj the skin turns pale—the finger nails and lips purple—the extremi- ties suffer yvith cold, and a shivering seizes the whole frame. This preternatural coldness continues longer or shorter, according to the vigour of the constitution and the facility of the organs to react. When reac- tion is accomplished, the hot stage is formed, which creates an engorgement, or congestion, if I may use the term, of the cuVmeous exhalents, in turn, wh ch can only be relieved by spontaneous perspiration, 25 yvhich is very profuse. When this congestion of the superficies is relieved by perspiration, the necessity of its continuation ceases, or its propelling cause dis- continues. The skin, however, from being taxed with this great over-action, falls into a state of collapse, and ceases to perspire as effectually, as if the perspiration was checked by moisture. The system, in this state is left to regain its energies. The blood, however, fails to find its healthy passage by the skin—a pro- pulsion inwardly again recurs—reaction ensues—is sweated off, and a collapse follows : thus exhibiting the regular paroxysms of an intermittent fever, yvith all its attendant phenomena. In fact, all fevers which arise from checked perspiration, particularly remittent fevers, exhibit the same routine of reaction and collapse. I never have seen what might be called a perfect continued fever—all of them have remis- sions and exacerbations. The ohly difference be- tyveen the latter fevers and intermittents, is, that in the latter, or intermittents, the intermissions, or re- missions, are more complete ; or in other words, the collapse and reaction exist longer and are more dis- tinct. I consider them all fevers of the same family; but they occur generally under three heads, viz :— Remittent, Intermittent, and an intermediate grade, called chills and fevers, where chilliness is scarcely perceptible, and, apparently, heai and fever existing at the time the chilliness is said to be felt. In our practice this year, we have met with a form of fever, which yve think might, yvith great propriety, be denominated congestive fever, or congestive typhus. It prevailed almost entirely yvith the blacks.—It is marked by the folloyving symptoms : Dry hot skin ; red tongue, though sometimes white or foul; at the beginning, sometimes a chill is felt; pain not very acute any where, but commonly complained of in the abdomen, head and back, accompanied sometimes yvith nausea and vomiting ; the pulse never very strong or full, but commonly small and quick ; the urine scanty and red; the faeces dark, fetid, or natural 26 in their color; the mind frequently wandering.-- What is most remarkable in this disease, is the uni- form heat and dryness of the skin—exacerbations not confined to any particular part of the day, but generally occurring every other day.—It is very tedious and unyielding in its progress, continuing sometimes fr weeks, yvithout much alteration except increased debility. The causes yvhich produce remittent and intermittent fevers, also give rise in a more aggravated form to this congestive fever ; for it evidently takes place from checked perspiration. For its treatment, I must reier the reader to the Transylvania Journal of Medicine, as my co-partner, Doct. Hubbard, has forwarded to that periodical a detailed ncceunt of this fever, &c. I should have mentioned, that the difference in time, as to recur- rence of the paroxysms in intermittents, in different individuals, at different seasons, is owing to tne differ- ences in constitutions, and even in the same consti- tution at different seasons ; or in other words, the difference in the powers of reaction, in those various cases I do not know that the foregoing theory can give rise to any very important indication of cure. One thing, however, I yvould remark, that from trials made, and from some facts ascertained, I am of the opinion that string sudorific medicines, may be used in many cases of fever, in combination yvith, or simul- taneous exhibition of cathartics. I have cured some cases of intermittents by the administration of castor oil, and red pepper tea alone; but it yvas in youn" subjects, nnd before local and internal congestions had formed. I knew a family yy ho yvere in the habit of giving salts to their negroes, combined yvith red pepper tea, and generally yvith success in intermit- tents The adoption, however, of such a practice would require discrimination, particularly in the selection of cases. 1 he object to be accomplished by offering thisthe^ ory to the public, is to excite them to the use of what si \ conceive important means of guarding themselves against our summer and autumnal diseases :—1st. By guarding against the presence ind influence' of moisture as far as possible, by suitable dress—by draining ponds, marshes, lagoons, and all collec- tions of yvater yvhere practicable—let the air of a country become comparatively dry, by such means, where it has been da np, and an improvement of health is almost sure to follow. The piney woods, with sandy soils, are always found healthiest in «ur climate, because the atmosphere in such places is driest, the sand and vegetation readily absorbing the moisture, (e) The 2d object is to excite the atten- tion of the profession, to the state of an important function, (the skin,) and to use more freely and fre- quently, those remedies yvhich are calculated to restore it to a healthy state, such as the various sudo- rifics in use—The red pepper, or capsicum, we be- lieve, will, when its properties and effects come to be better known, and its past merits established, prove an important article of the Materia Medica. APPENDIX. (a) " What do we know of Electricity, Galvanism, Magnetisn.. Sec but from their effects ; and yet who doubts their existence 1 We know the effects of malaria."—Hays. J answer*, that we know a great deal more of the nature and quali- ties of those things, than is pretended to be known, of malaria. We know the Electric fluid and Galvanism, have heat and light com- bined with them. We know they affect the nervous system when applied to our frames. We can always detect their presence by proper instruments. Who has ever explained so much with re- gard to miasma ? I ask again what is it ?—What particular organi- zation of the human body does it first operate on? We know there are many things only understood by their effects ; but they are very unlike what malaria is supposed to be—they have certain fixed laws, by which their effects are always regulated. With these laws, We can make ourselves very familiar, as they never vary ; such are Magnetism, Galvanism, Chemical affinities, &c. Not so with the supposed something, or no'king, miasma ; it has no laws or regular modes of producing uniform effects. It is made the cause by some of one, or more diseases—by others, of as many hundreds, without any informing us of the laws by which it acts, much less of the qualities of the substance itself. (b) " It is no evidence of the non-existence of malaria, that it cannot be detected by the eudiometer, any more than that electricity can- not be detected by the thermometer, is an evidence of the non- existence of electricity."—//. A strong conclusion this. Now, Dr. M'Culloch, the great advo- cate of malaria, says miasma consists of certain gases, or a " com- pound of Nitrogen, Oxygen, Hygrometric vapour, and a basis of a deleterious character." Assuming this untenable statement to be the fact, which seems to be conceded by most miasmatists, I would ask Dr. Hays, if the eudiometer would not be more likely to detect theii presence in an undue proportion in the atmosphere, than for a thermometer to detect the presence of electricity ? There can be no analogy between the two. If he had said, the failure of the eudiometer to detect certain gases in the air, which miasmatists de- nominate malaria, was no more proof of their non-existence, than the failure of an electrometer to detect electricity in the air, was proof of its non-existence, there would have been some reason in his analogy. The miasmatists are unfortunate in supposing malaria to consist in the poisonous gases above named, when their total incapacity to produce fevers of any grade, is known to every chemist who has worked in these gases,and that, free of any inconvenience, in Laboratories, where we must believe these aerial substances are more concentrated, than they ever are in a state of nature—other- wise the eudiometer would be competent to their detection. The probability of their diffusion and rapid dispersion in the air, where thev may be supposed to be formed, is strong testimony against the offensive eiistence of any undetected aeriform poison, called mal» 29 r.a. Milan.;, says liio Editor of the Southern lit-vi^.v, "is bfiievc ' r . Orfila and Volta, to consist of certain gases ; but from the very nature of the case, we may consider the question decided in the negative, by the want of positive testimony. Our eudiometers an. so delicate, that some regular result would have been obtained by the accurate experimenters who have engaged in the investigation, were this the path of discovery; bnt it is now, we believe, univer- sally admitted, that the air of the most pestiferous marsh, or j:jnt>lt .s composed of precisely the same imponderable materials, mingled in precisely the same proportions, with that which is to be found in the most favorable and healthy positions." See page 174 Southern Review, article Malaria. (c) " Moisture may be essential lo malaria, as a dry air is to electricity."—H. What proof has the miasmatist of this, beyond bare assertion ? If it is, it is also essential to our doctrine. (d) " I do not know how the mere corrugating the skin can ren- der the muscles rigid."—H. Neither have we asserted it.—The text explains itself. (e) " Of course, where vapour is condensed, caloric is given out. During the day the evaporation cools the atmosphere; its conden- sation at night warms it." See Wells on Dew.—H. This theory is contrary to the experience of every person who has lived in South-Carolina or Georgia. The temperature of our nights, is several degrees cooler than our days; in our summer months, from 12 to 3 o'clock, P. M. includes the hottest part of our days; it is at this time evaporation goes on most rapidly. Accord- ing to the above doctrine, 3 o'clock in the afternoon, on a summer's day, should be the coolest part of the 24 hours, and our nights, from 12 o'clock to day-break, should be the hottest, when condensation is greatest. It is a notorious fact, that on our summer nights, when we have scarcely any condensation or fall of dew, our night air is always warmest. If any heat is given out, under such a condition, it is only latent. (f) "No doubt exists that fever may be produced by suppressed perspiration; but it is not proven (neither have we assumed it) to be the only cause of fever. If each disease could be produced by a single cause only, we should stand a considerable chance of dying of old age."—//. Grant it.—We have not contended for any such vagary. Moist vicissitudes, acting on the human frame in various states of excite- ment, we have made the causes (not cause) of those diseases which the most sensible miasmatists ascribe falsely to malaria; such as intermittent and remittent fevers. We have not, like McCulloch with malaria, made a Pandora's box of our theory, and made dis- eases issue from it, that might as soon be expected to drop from the moon or stars, as to start up out of a swamp, a stagnant pool, or gutter. We know, the diseases, which we state are produced by the above causes, are often brought about by intemperance, improprie- ties in diet, with other internal exciting causes, &c. (g) " Less liable, but not exempt. Putrifaction takes place. le=s tidily in salt than fresh water : evaporation goes on equally from ^oth."—H. The experience of the inhabitants of the low settlements, or sea coast of Georgia and Carolina, -s widely different from this state- menti Many of them quit their residences and remove to the sea coast, or to the islands surrounded by salt water, where they nnjoy comparative, if not entire exemption from those diseases, said to be produced by malaria. We do not deny, nor does the admis- sion of the fact prove any thing, that evaporation goes on equally from both kinds of water. (h) " The miasmatist could not possibly have a more valuable fact."—H. It is at their service. (i) " It may require all the heat of the summer months to gene- rate malaria, and in the fall to produce its ravages." Of this, theie is not the smallest proof. (j) Malaria, it is said by some, exists only in union with moisture, *>r is dissolved in it." No proof at all of this. If moisture be so important, it is a brace to our theory. (k) " At night, when the moisture is condensed, the malaria may be more active."—H. Mere supposition.- -If any result happens, it is a cooler and more moist atmosphere, very likely to check perspiration. (1) " They may be in a current of air from a malaria district.-— We know it may be wafted miles."—H. [So may moisture.j Of they may be affected by a check of perspiration, as you have cor- rectly stated." [Well said.] "Thus they are exposed to two causes "—H. [Admit it; but malaria is not one of them.] (m) " Heat may destroy malaria."— H. So said, but not proven. It may also destroy or dissipate moisture. (n) " See McCulloch."—H. I know what he imagines or says ; but ho is wanting in proofs. " Malaria may be generated" [and felt also, I suppose] " in situations where you would not suspect it. It may be wafted by currents for miles." The very same may confidently be asserted of moisture. (o) " This certainly works both ways, and the miasmatist may *ake advantage of it, as well as his adversaries."—H. He is welcome to it. (p) "The Hollander, amidst his fogs, is a healthy, robust man; '.he Italian, in his (comparatively) dry sky, is puny."—H. It is said, owing to the damp atmosphere of Holland, lift* is de- tracted one half; and even M'Culloch includes that country as one of his malaria districts—he likewise affirms, that a dram of any stimulating liquor has a tendency to prevent the action of malaria in Holland When we take into consideration, the manner of living among the Germans—their stimulating diet of onions, leeks, garlic, with their exressive use of tobacco in smoking ; all of which deter- mine to the surface and prevent the action of moistuc on their systems, which is likewise aided by their thick woollen dresses, •Hversally worn, it is not surprising, under sucb circumstances, t$ 31 laid them a healthy people, although enveloped in damps and fogs, Itnly has, comparatively, a veiy damp atmosphero ; particularly so when put in competiliou with many other pans of the world. This is not strange, when we view the situation of that country, surround* od on two sides by the sea, and checkered with many fine rivers, which flow through fertile vallies, interspersed with extensive tracts of swamp or marsh lands. It is not wonderful that the Italians, in such a damp country, half clad and half starved, should be a sickly puny race of beings. We might here ask the miasmatist, why it is, in a country like Holland, where Dr. McCulloch states malaria exists so fieely, as frequently to be carried over to England on an east wind, it has so little effect on the " healthy, robust Germans," who are immersed in it—while in Italy, which Dr. Hays says pos- sesses " comparatively a dry sky," the people should be so puny and sickly, seeing, as Dr. Hays and Dr. McCulloch assert, moisture is essential to the propagation of malaria 1 (q) " No fact is better established than the difficulty, and fre- quently the impossibility of curing fever patients in a malaria dis- trict, during the malaria season. The moment they go into the night air a relapse takes place." [Because perspiration is again checked.] " In Italy, when the peasants who migrate from the mountains to the malaria districts, during harvest, as laborers, are attacked with fever, they are instantly sent home" to a drier atmos- phere.—" Experience has proved that recovery is almost a miracle if they remain."—H. Such experience differs very widely, from that held by Dr. Hays' countrymen, and particularly the Southern physicians of the United States, where miasmatists locate as much malaria, as in any other part of the Globe. We have no hesitation in saying (as we know the experience of every Southern physician will bear us out in it) that hundreds of cases of intermittents, produced as all miasmatist; agree, by malaria, are cured every season, at the very spot where they are contracted. Hundreds are cured by a simple emetic, or purge, acting revulsively on the skin, or at most, with a few doses of quinine superadded. Many are cured with red pepper tea do- mestically prescribed. All stimulants act more or less upon the skin, as every sudorific is m< re or less stimulating in its properties. Of the other kind of fever, bilious remittent, it is cured more than nine times out often, and that in the very tract of country where it is generated. It is true, relapses are liable to occur among us in these diseases, but it is not from a re-application of malaria, (which ought never to cease acting, if it exist,) but from irregularities in diet, or exposure to a damp air, by which means the perspiration may again be suppressed after it had been restored. The cases which terminate fatally, or linger in an uncured state, are generally those that labor under visceral engorgements, or glandular derangements. They are not killed, nor kept sick by an excess, or the constant presence of malaria. (r) " What evidence is there of this V—H. Take a stick, and go to a pond of standing water, in Georgia or South-Carolina, in December or Januaiy, and stir the bottom well, 32 md heat and moisture, with vegetable remains, generate miasma."—H. Heat and moisture are important to our theorv ; at least their vicissitudes or alternations. Vegetable remains have never been proven to emit any thing more than certain gases, of which Azot or Nitrogen is the princioal. These gases, as we before observed, have never been found offensive, when diluted with atmospheric air, nor to cause fevers in any state of concentration. (w) " The miasmatists would adduce this in their favor."—H. They are welcome to it. *' Genista includes both furze and broom, and Mr. Carter might have taken bite species for the other. #3 {z) " Does not the N. E. wind pass over malaria districts 1"—H, It passes over very moist places, such, perhaps, as are termed, by miasmatists, malaria districts. (y) "The miasmatists have always cited this as proof of the exis- tence of malaria."—H. This is very strange. We cannot for our lives see what proof this affords of the existence of malaria ; because very wet, or very dry years are salubrious : ergo, it is proof of the existence of mala- ria. Admirable conclusion ! If moisture be such an excellent vehicle for the union with, and conveyance of, malaria, we should strongly suspect its presence during very wet summers. (z) " This again, the miasmatists quote as favorable."—//. They are at liberty to do so ; it applies more in favor of our docurine than theirs. (a) " That it is something more than heat and moisture, which produces fever, is proved by the fact mentioned by Dr. Currie, in his medical reports—that it is a common practice among experienced seamen, on the coast of Guinea and other warm climates, when exposed during the night to a breeze from the marshes, to wrap their heads in a sea cloak, or other covering, and sleep fearlessly on deck with the rest of the body uncovered."—H. We have only stated that these diseases prevail most frequently, when heat and moisture are present in a great degree, and alterna- ting ; not that they are alone competent to produce diseases under all circumstances, independent of the peculiar state of the excited, or relaxed condition of the system. We know very well, that annoint- ing the body or skin over with oil is said, not only to be a protective against the plague, but against malaria fevers, although the face, saliva, lungs, &c. are left exposed. We also know oil repels mois- ture, and is a very great protective against its effects. In the case above mentioned, the sea cloak, wrapped over the head and proba- bly the shoulders, might have afforded protection against moisture. The writer before quoted on malaria, or the reviewer of Doct. McColloch's woik in the S. Review, page 180, combating the idea advanced by McCulloch, that animals are liable to malaria diseases, makes the following remarks in conclusion :—" If our author should press us with tbe apocryphal statement concerning the protection afforded by breathing through a silk handkerchief, or a folded man- tle ; or the advocates of the gastric pathology urge upon us the proverbial advantage of stimulating the stomach with ardent spirits, or smoking ; we reply thai there is equally weighty evidence to establish the preventive influence of oil applied over the lohole cuta- neous surface, while the lungs and stomach are left unprotected."— The exemption of animals from the influence of malaria diseases, our writer ascribes to the structure of their skins being so very different from man's, and so well protected by nature with coverings.— M Which," says he, " would, therefore, seem to be tbe organ princi* pally acted on by malaria." [By moisture more properly.] "Again," says Dr. Havs, in further confirmation of what he has advanced, " When the United States vessels were anchored at the N. W. part of the Island of Key West, in 1817, the trade, or S. E, E 34 winds prevailed, and the men were very sickly with fevers. The ships were ordered to the S. E. side of the Island, and the crews soun became healthy. When, however, the wind changed to the N. W. the men were again attacked with fever, and they were then removed to their former anchoring place, when the fever. ceased."—H. Ii will be recollected that we have never charged salt'water vapour with deleterious properties. The saline nature of it, we have affirmed, not only rendered it inoffensive, but healthy, and rarelv, if ever, suddenly checked perspiration. But not so with land or fresh water vapour. This difference, I think, may be explained on the ground, that salt, applied in solution, or in vapour, if you please, or in sdbstance, to the surface, is a very powerful stimulant of the skin ; and so far from lessening the action of the skin, actu- ally increases it. Fresh water, 01 vapour, we may suppose have precisely the opposite effects, unless healthy reaction immediately follows their application. Now the Island of Key West is not only Within reach of humidity from the land, but I am told it actually has a number of ponds, or small lakes, marshes, &c. on its surface : it is not wonderful, therefore, that humidity (united with the condi- tion of the crows, suffering from tropical heat) wafted to our ships, should produce such sickness. In confirmation of our doctrine, we think it is stated by Sir John Pringle, on the diseases of the army, that when the soldiers were stationed on some low ground, in one of the West-India Islands, a Dysentery broke out among them ; he found its malignancy always in proportion to the nearness of the water to the surface of the ground, which he ascertained by thrust- ing down a stick or pole. The elevation at which malaria fevers are said to exist, is determined by the height at which moisture cau h> any considerable quantity be supported by the atmosphere. fs) "This might be given in favor of malaria."—H. It is at your service. (c) " See Dr. Bell's paper in the Philadelphia Journal of the Medical and Physical Sciences."—H. We have read Dr. Bell's valuable paper on malaria —We under- stood him as merely bringing forward facts, for and against the doctrine, and leaving his readers to judge for themselves, without himself giving an unequivocal denial to their existence. The doc- trine we have attempted to set up as more rational than malaria, is exclusively the result of our own reflections, be it fallacious or Otherwise. (b) " II is only within a few years that the existence of malaria has been suspected." " See Laucisi."—H. Not within so very few as you might suppose. John Marca Lancisi, was bom at Rome, October 26th, 1654—In 1672, he was created Doctor of Philosophy and Physic—In 1675, be obtained the place of Physician to the Holy Ghost Hospital—In 1684, he was appointed Professor of Anatomy in the College of S;>pieniia— In 1668, Pope Innocent XI. chose him for his Physician, and Chamberlain—He Was also first Physician to Clement XL—He died January 21, lJfZTy—His woriiii were published at Geneva \r\ 35 1719, iu 2 vols. 4to. The first volume contained the following pieces :—" De subitaneis morbbus ; Dissertatio dc nativis deque adventitiis Romani cceli qualitatibus ; De noxiis Paludum ejfluvns." The second contains the following, with o-her oiete> :—• Di»sera- tio historica de Bovilla Peste, ex Campania finibns, an. 1713." 11 Salio importata, Sfc. 1715." Sfc. It appears by ibis sketch, ihat malaria has been advocated for more than one hundred years. In- dependent, on these data, a peculiar constitution of the atmospheie, capable of producing disease, has been believed in from Hippocrates Jo mi. (e) " The miasmatist could not give better advice."—H. Agreed. To conclude, we also agree in many other points, especially as follows:— 1st. " Malaria," says McCulloch, page 276, " is decomposed by heat." So is moisture dispersed, or dissipated. 2d. " It attaches itself to solid bodies, 267." So does moisture. 3d. " Fire and smoke decompose it, 281, 285, 293." So is moisture destroyed by them. 4th. " It is not propagated in crowded places, 292." Because in such places smoke and fire are abundant. 5th. " It is capable of being wafted in a stream of air, 259, 309, 311." So is moisture. 6th. " It acts most strongly in its own neighborhood, 217." So Joes moisture 7th. " Hilly countries are less liable to miasma, than plains." So they are to moisture. 3th. " Miasma is most prevalent in the evening and morning, and less so at noon-day, 274." So is moisture. 9th. " Miasma attends damp air, 270, 272." So does disease 10th. " Fire and smoke a preventive, 281, 285, 292." So ihey are against moisture. 11th. " Miasma is destroyed in a dry atmosphere." So 12th. " Ardent spirits a preventive of miasraatous 281." Because they promote perspiration, and protect us against the effects of moisture. 13th. " Decomposed by the Sun, 276." So is moisture destroy- ed by it. 14th. "A gauze veil a preventive, 299." So it may be against moisture. 15th. " It (malaria) creeps along the ground, 265." So does moisture. 16th. " Malaria attacks, in preference, new comers, 447." Be- cause less accustomed to a damp air. 17th. " Continuous heat alone does not produce malaria, 472.'' Neither does it moisture. 18th. " Malaria exists at all times of the year, and in all countries of the world, 470." So does moisture. fevW, 2i / + I NLM041424085