^K;-^." I? NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Serrice H AN ESSAY ON THB CANINE STATE OF FEVER; BY NATHANIEL CHAPMAN, OF VIRGINIA, HONORARY MEMBER OF THE PHILADELPHIA MEDICAL AND CHEMICAL SOCIETIES. Juvenis arcum flectere tentat Ulyssis. PHILADELPHIA: PRINTED FOR THE AUTHOR, BY HUGH MAXWELL, COLUMBIA-HOUSE. 1801. ^ &-j&0-7*~ tSL^U^KsT-* /f*~ /? ^^c au, £~*S' c~> A- ^ AN INAUGURAL DISSERTATION FOR THE DEGREE OF DOCTOR OF MEDICINE; SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN EWING, S. T. P. PROVOST, THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, ON THE EIGHTH DAY OF JUNE 1801. TO BENJAMIN RUSH, M. D. PROFESSOR OF THE INSTITUTES, AND OF CLINICAL MEDICINE, IN THE UNIVERSITY OF PENNSYLVANIA, " THE SYDENHAM OF AMERICA;" THIS ESSAT IS INSCRIBED, AS THE GENUINE TRIBUTE OF RESPECT, ESTEEM, AND GRATITUDE, FROM AN OBLIGED AND AFFECTIONATE PUPIL, THE AUTHOR. TO RICHARD PETERS, JUNIOR, ESQUIRE, AND TO MR. THOMAS BIDDLE, THIS ESSAT IS ALSO INSCRIBED, AS AN ASSURANCE OF THE FERVENCY OF MY FRIENDSHIP, AND OF MY HIGH CONSIDERATION. THE AUTHOR. I have always thought it a greater happiness to discover a certain method of curing, even the slight- est disease, than to accumulate the largest fortune; and whoever compasses the former, I esteem not only happier, but wiser and better too. SYDENHAM. INTRODUCTION. CREDULITY is the ignis fatuus of science. It sheds an attractive, but delusive glare, which diverts from truth and philosophy. In no science is it of more pernicious tendency than that of medicine, and no where does it more abound. The annals are little more than the records of falsehood, and the mo- numents of superstition and ignorance. To scrutinize existing opinions, is held to be scepticism; and an at- tempt to controvert them, intolerant heresy. He who is orthodox in medicine, must close his ears to the dictates of Reason, and " listen with credulity to the whispers of Fancy," andthe phantoms of imagination. These remarks are peculiarly applicable to the dis- ease which will constitute the subject of this Essay. To detail the various opinions and speculations that have been advanced, would be recounting the ca- prices of the human mind, and offering insult to the dignity and philosophy of the science I profess. A ( vi ) Some of them were mere ephemera, the short lived beings of the day, who scarcely existed before they were consigned to eternal oblivion. Ostendunt terris, hunc tantum fata, &c. " Fate shew'd them...but so quickly drop't the scene, " 'Twas straight forgot that they had ever been." While others sustained an existence till superseded by theories equally absurd and untrue. From the collision which attended this clashing of opinion....this warfare of theory, was sometimes emitted a spark which illumined for the moment. But it was the temporary meteor of the night..... It vanished before any definite conclusion could be drawn; and left the subject in augmented dark- ness and obscurity. In examining, therefore, the opinions of my predecessors, I shall be excused if I sometimes betray scepticism, and often doubt and he- sitation, in admitting them. At this enlightened sera, when science is pervaded by the illuminating rays of reason and philosophy; error is to be rejected, though sanctioned by the continuance of custom, or fortified by hosts of antiquated authorities. Although the formidable and mysterious nature of the disease, early arrested attention, and solicited the inquiries of the speculative philosopher and prac- tical physician, it remained, till of late, the confessed " opprobrium medicorum.', The various efforts to explore its dsedalian intricacy were baffled, and in- vestigations, often repeated, only lead to indefinite re- sults and unsatisfactory conclusions. From the expe- rience of our predecessors, we derive little, either to conduct the elucidation of its pathology, or direct its ( vii ) cure. Their writings contain numerous facts and ob- servations, but perplexed by their diversity, and con- founded by their contradiction and obscurity. The horror excited by the alarming aspect of the disease, and the apprehension of its communication by dissec- tion, have occasioned a timidity highly unfavourable to its successful investigation. To professor Rush, " the medical veteran of the western world," whose labours have contributed more largely than those cf any other, to the improvement of medical science, and the consequent amelioration of the sufferings of mankind, we are indebted for having advanced a the. ory which so completely explains the various pheno- mena of the disease, that there seems to be wanting nothing further upon the subject. It is not, however, universally assented to. An ingenious but unsuc- cessful attempt, has been recentlyjnade to controvert it.* To give it support by some additional argu- ments, and by those which have already been em- ployed, presented in a different view, will be the lead- ing object of the following pages. It may be thought, that I have not entered into the discussion of some particulars, so fully as their importance required. But as almost every point has been treated copiously by voluminous writers, I did not view it necessary to notice them further, than was subservient to the consideration of the particular the- ory which I vindicate. To the reader, some apology is necessary, for the crude and imperfect execution of this Essay. I * The pamphlet entitled, an •' Examination of Professor Rush's Arguments," &c. by Dr. Mease, is what is alluded to. ( viii ) must plead the trite excuse, of the shortness of the time allowed for preparing a Thesis; the inexperi* ence of extreme youth, and the employment of pur- suits highly unfavourable to happiness in composi- tion, or success in scientific research. Nothing but a compliance with an indispensable duty, imposed by an institute of the university, could have induced me thus prematurely to have published it. To the o/3ix, a dread of water. Although this term conveys a true description of the symptom, it should not be employed. To de- rive a name from a single character of a disease, is always improper. It misleads, by fixing attention upon a casual appearance, to the neglect of more im- portant considerations. In this inquiry, I shall assume the liberty of call- ing the disease the canine state of fever. This term not only associates it with the other states of fever, but particularly designates it, by the expression of its most uniform remote cause, namely, the canine virus. Nesologists have divided this fever into different species, according to the animal affected; but as I consider it precisely the same, whatever may be the subject of its aggression, I shall not admit the distinc- tion ; nor do I conceive the difference supposed from the varied mode of its origin, to be better founded. There is but one remote cause of disease, which is stimulus; and it is immaterial, whether the morbid or irregular excitement, be induced by the canine virus, or the usual remote causes of fever. * The Hydrophobia seems to resemble the case of a man, who slums a draught which was before found naiueous, or shrinks from a pain al- ready experienced. cullek's clin. lect. p. 169. HISTORY OF THE DISEASE. 1 HE curiosity commonly entertained, of in^ quiring into the antiquity of diseases, excites a regret that the early notices should be involved in such con- tradiction and uncertainty. The result of researches instituted to establish the precise sera, when canine madness made its appear- ance, has lead to nothing determinate or satisfactory. All attempts to ascertain the point at this remote pe- riod, must be fruitless and abortive. s The disease is not mentioned by Hippocrates. Cselius Aurelianus* is the first writer who treats upon the subject; and from his having entered into a long discussion of the question, " Whether Hydrophobia was a new disease or not?f" it is probable that it had arrested little attention before his time. It is asserted by Plutarch and Le Clerc, that the disease originated * C Aurelian. lived in the time of Tragan and Hadrian. t C Aurelianus, p, 226. ( 12 ) in the time of Asclepiades ;$ but there is undoubted authority of its more remote antiquity. In the Iliad, || the figure of canine rage is repeatedly employed, to illustrate the vehemence of turbulent and exasperated passion ; which fixes its prevalence at least as early as the time of Homer. Respecting the occurrence of diseases at different periods, there exists some diversity of opinion; but the weight of authority decidedly inclines to the affir- mation of the question. The ancient writers were especially of this opinion. Thus Celsus, Pliny, Bar- chusen, Plutarch, Dio Cassius, Claudinus, not to mention others, have either given descriptions of new diseases, or acceded to the opinion. The small-pox, measles, lues venerea, sibbins,&c. are confessedly of modern origin: and Glison assures us, that the ricketts had not appeared above thirty years antecedent to the publication of his treatise upon the subject. This question admits of a wide scope of speculative inquiry ; but in a practical view, its decision is of no importance. In its particular relation to canine madness, there can be no great difficulty in forming a conclusion. Those animals wfa» are subject to the disease, w&*cA have existed at all times, and doubtless must have been equally liable to its attack.* % Asclepiades practised medicine in Rome, about the sixty-second year of the Christian aera. || Iliad, lib. ix. lin. 237', et lib. viii. et xiii. * I am aware, that it is a received opinion, " that throughout the scale of animated nature, a general law prevails, whereby certain diseases be- long to certain animals exclusively." Thus it has been asserted, and ge- ( 13 ) From the earliest accounts, has been the opinion of the disease affecting only that class of animals comprehended in the genus canis. It has indeed been asserted, that it sometimes spontaneously occurs in other animals, and particularly in the species of the ge- nus felis. Thus it has been observed by Morgani, that cats are not unfrequently the subjects of its attack: and Aurelian takes notice of its occurrence in leo- pards. Boerhaave seems also to accredit the accounts of its underived origin in domestic poultry; but such instances are considered as anomalies of the general law of the disease. This opinion, though sanctioned by the almost unanimous voice of writers, appears to me to be one of the numerous errors interwoven with this subject. It originated in ignorance, and has nerally accredited, that the small-pox, syphilis, &c. are not communicable to any other class of animals except the human species. But the fallacy »f this conclusion is proved by some recent facts. The following extract sufficiently establishes the position I have assumed: " A peasant of the county of Essex, seeing a great many children carried off by the natural small-pox, was desirous of inoculating his two hoys j one nine, the other twelve years of age. Not being able to employ a surgeon, he collected the scabs of a child then sick of the disease, pow- dered them, and sprinkled the powder upon slices of bread and butter. The two sons eat them, and gave a bit to the house-dog. They had a mild small-pox, and got well without any remarkable accident. The dog re- mained sick for two or three days, drinking a great deal, and refusing to eat; on the fourth day he had a very decided variolous eruption ; on the ninth, the pustules were full ripe, and dried up, and fell off like those of the two children. An English author says, he has observed the same epi- demic in a flock of sheep, the greater part of which were affected, and consmunicated it to two cows, one of which died. The.symptoms that manifested themselves in these animals, in the course of the disease, were in every respect the same as are observed in the human species." BULLETIN DE LA. SOCIETE PH1LOMATI QUE, 8iC B ( 14 ) been perpetuated by a blind attachment to authority. To suppose a disease peculiar to any class of ani- mals, is not only unphilosophical, but unwarranted by fact and observation.* That it more frequently occurs in the canine species, I am not disposed to deny. I do not, however, admit that it is ascribable to an idio-syncracy of their ceconimy favouring pecu- liarly its generation, but to the greater exposure of dogs to its productive causes. Perhaps also, too great a latitude is given to this belief. It may equally oc- cur in other animals; but from their remote connec- tion with us, the disease eludes our observation ; while, from the domiciliated habits of dogs, it must attract attention in every instance. It is singular, that almost every circumstance, connected with this disease, has been the subject of dispute; and that authors have altercated not only upon the more abstruse points, but have differed about the most obvious facts. Among the points of controversy, none has excited more attention than the question, " Whether the disease can be induced in the human species by any other cause than the virus of a rabid animal ? Although it is denied by far the greater number of modern writers, yet it appears to me, that its spon- taneous production is so well attested, as scarcely to be wanting of further confirmation. Facts, in sup- port of the opinion I have embraced, are numerous and conclusive. Boerhaavc relates a case of malignant fever, brought on by exposure to the rays of the sun, as- * Vide Note pages 12, 13- ( 15 ) sisted by the intemperate use of spiritous liquors, in which the hydrophobic affection occurred to a very great degree.* Salius Diversus, saw Hydrophobia occur in a pestilential fever.f It is taken notice of by V. Sweiten, as succeeding to dysentery.$ Meade mentions it as symptomatic to a palpitation of the heart, " to so great a degree as not to differ from that of true Hydrophobia."j| Sauvage informs us, that he saw a malignant fever accompanied with an aversion to fluids. § Dr. Coste remarks its happening in the sixth day of a putrid fever ;** and Dr. Trotter, its frequent appearance in the typhus fever, in the British navy.|f In the yellow fever, it was observed by Dr. Griffitts,JJ and it has occurred more than once in the hydrocephalic state of fever, in Philadel- phia.|||| A well marked instance is related by Mr. The- don, of Berlin, attending pneumonic inflammation. The most remarkable case, however, is recorded by Mr. Innes, as consequent upon an inflammation of the stomach.§$ But notwithstanding the numerous well authenti- cated cases of the spontaneous occurrence of Hydro- phobia, it is still doubted, whether it has ever existed as an idiopathic affection: While it is admitted tha£- the terror of water has often attended diseases, in- * Van Sweiten, Comment, on Boerhaave. p. 143. f S. Diversus De Fevre, p. 362. \ V. Sweiten, vol. xi. p. 144. fl Meade on Hydrophobia, p. 81. § Sauvage Nosology Meth. v. i. p. i!54- •* Med. Comm. v. ii. p. 476. ff Med. Nautica, p 301, XX Rush's Inq. vol. v. p. 214. |j|| Ibid. 214. §§ Edin. Med. Essay, vol, 1. p. 226. ( 16 ) duced from other causes than the canine virus, it is contended, that such cases should be considered only as symptomatic. This reasoning is perfectly correct; but it applies with equal force and aptitude to every instance of the disease, in whatever manner induced ; for in no case should the aversion to water be considered as the idi- opathic affection. The primary disease is a fever, and the Hydrophobia, but a casual symptom. With equal propriety might the aversions to air, to light, to aliment, which are so frequently the concomitants of fever, be considered as the original disease. Much mischief has pervaded medicine by naming diseases from a single character; but the remark more particu- larly applies to the canine fever. It has always di- rected attention to this accidental symptom, and to- tally diverted it from the actual disease. In addition to the facts which have been related, the opinion of the power of the human system to ge- nerate the disease, is fortified and supported by nu- merous authorities. Aretceus decidedly conveys this opinion in the following passage....." Alia millena " eorum, quae in homine sunt, eandem speciem cum " exterioribus causis obtinent: succi corrumpentes " (interne et externe : morbi quo que medicamentis) " perniciosis assimiles; et a medicamentis talia vo- " munt, qualia ob febres vomere solent."* Ccelius Aurelianus, also says, " Est prseterea pessibile, sine " manifesta causa hunc passionem corporibus in- • Aret&is de caus et sign morb. ( 17 ) " nasci."* Boerhaave believed it to be producedmost commonly by derivation, yet " it appears," says he, " both from history and observation, to have arisen spontaneously in some acute diseases."! It is expressly asserted by Van Sweiten, that Hy- drophobia has arisen in human bodies, " without any t received poison from a mad animal," and in corrobo- ration of the opinion, adduces an instance of the dis- ease being excited in a man by a paroxism of passion, to such a degree, that he fell " into apparent suflbca- u tion, even at the thoughts of mere mentioning of " water: and soon after perished perfectly raving, " having first vomited up a uniform green and bilious " matter. "J I shall omit the mention of the different animals which have been enumerated by authors as exclusively capable of receiving and propagating the disease ; for I hold the distinction to be unfounded; and consider the capacity to be possessed in common by all; not excepting man.Jj Hill Milium...........■wmEpjtWii ilnin hi ifinliilltl 1 I iniiiwiniiliiliiii in with timmW&mm&m Mil ilim|nhiiiliPij f wlfiunL§ An inquiry now offers of much more importance: It is to ascertain the manner of the communication of the disease. For if we accredit the assertions con- tained in the records of medicine, there is no poison * C Aurels. Accut. Morb. 219. f Boerhaave, Apb. 1130. | V. Sweiten, Comment, p. 143. vol. i. $ Sauvage, Diss. Sur. la Rag. § Arnold, p. 183. ( 18 ) more contagious, or so diversified in the manner of its communication, as the canine virus : But the be- lief in its contagiousness seems to have been unwar- rantably extended by the ancient physicians, as many of their assertions have been contradicted by more accurate inquiries, while others yet remain insulated, and without the confirmation of subsequent observa- tion. This diversity of the mode of communication is so great, that it is difficult to arrange them, and still more to comment upon them with precision. The disease is said to have been imparted by the breath; * by the slaver taken upon the lips or tongue, as biting off a thread which had been used in mend- ing a rent in a garment made by the bite of a mad dog ;f and, likewise by kissing a rabid animal. J It is said to be received by a scratch made by the claw of a mad cat ;|| and by a wound inflicted with an instru- ment which had been employed years before in killing a rabid animal. § Instances are also related of its having been conveyed by the saliva^aken into the sto- maeh*i%M by eatingiJJ8,e^ffssh^-|;,t.and,jnilk of animals which have died of the disease; and lastly.by dissec- tion. In the detail that I have thus given of the varied avenues by which this virus is said to assail the system, * C Aurel. Aretaeus, Boerhaave, f C Aurel de Morb. Acct. lib. iii. Hildanus, Obs. Chirug. p. 62. Hamilton on Hydrophobia, p. 22. X Palmarius et Shenkius, Obs. Med. p. 848. jj Hildanus Ob Chirurg. p. 62. § Schenkius, Ob. Med. p. 848, •* Palmai ius de Morb. Contag. p. 367. ff Fernilius ( 19 ) I have noticed many asserted facts, which I am per- suaded should be viewed in no other character than fabulous traditions of credulous ignorance. It is well known that the flesh and milk of infected animals have been eaten with impunity ; and that dis- sections have often been performed without any mor- bid consequences. The universal escape of the at- tendants upon the subjects of the disease, who are exposed to every source of exhalation from the bo- dies, argues strongly against the possibility of the communication by the breath, or any other vehicle of contagion. Reasoning from analogy, there could be no hesitation in denying the fact, of the disease being imparted by the saliva taken into the stomach ; since it is ascertained that other poisons exert no operation when swallowed, as that of smallpox,* syphilis, \ vi- per,f &c. It has lately been demonstrated by expe- riment, that absorption does not take place from an entire surface ; || consequently, the tales of Palmerius, Shenkius, &c. respecting the communication by kis- sing, and the deposition of the slaver upon the skin, must be considered as fabulous and unfounded. Upon the whole, it appears sufficiently established that the disease is rarely or never communicated but by the bite ; and that no other caution is necessary in the intercourse with the subjects of its attack, than to guard against the bite of the infected animal, and to avoid the contact of the slaver or saliva with an ulcer or abraded surface. * Rush's Inq. Append p. 7. f Hunter on the Venereal. J Meade's Works, p. 37. |j Rousseau's Inaug. DeArt, published 1800, U. P. ( 20 ) It is time to be done with the idle fictions of our predecessors. They have swayed already too long. Let us now think and observe for ourselves, and di- recting our inquiries by the lights of philosophy and reason, which have lately illumined the science of medicine, we shall arrive at certainty and truth. The unfounded tales upon the subject of the com- munication of the disease, have led to much mischief. They have excited a timidity and cautious solicitude, which have prevented, not only the exercise of those attentions, towards the unfortunate sufferers which humanity inculcates, and the successful treatment demands, but they have operated to retard the progress of the investigation of the disease. There is no circumstance connected with this subject, of greater curiosity, of more mysterious complexion, and difficult explanation, than the length of time which the virus will often remain in the sys- tem in a state of inactivity. It is not, however, without analogy. Insta nces are related, in which the variolus matter existed in the system for months without producing its effects.* But such instances are of rare and anomalous occurrence. This is not the case with the canine virus. It observes no cer- tain or determinate period in its attack, for the dis- ease has appeared in all the intermediate periods, from the third dayf to an indeterminate length of time. Ccelius Aurelianus, says, a year or more.J Galen informs us, that he saw a case which appeared after • Rush's M. S. Lrct. f C. Aurelianus, Accut. Morb. p. 219. J lb. p. 219. ( 21 ) a year;* and Dr. Meade, one after eleven months.-f- The result of Dr. Hamilton's elaborate research into this question, has been, the affixing the tenth day as the earliest, and nineteen months as the latest period of its appearance, from the reception of the bite. There are, however, cases recorded, where the attack was protracted to the extent of twenty, if not forty years, but they are derived from apocryphal autho- rity, and impose but little credibility. The most com- mon period of the attack, according to Aurelian, Meade, and Hamilton, is from twenty to forty days ; and it is more than probable, that where the interval has been longer than a few months from the reception of the bite to the appearance of the disease, that it is induced by some other remote cause. There have been many causes assigned for this variety in the pe- riod of the attack, such as the contiguity of the part bitten, to the salivary glands, or its sensibility; the fe- rocity of the animal which inflicts thebite, orthe period of the disease in the animal that bites; the irritability of the habit, &c. &c. but no definite or satisfactory solution has yet been advanced upon the subject. * Comment, ii. in i. Prorrhet. Hippocrat. f Meade's Works, f8. C HISTORY OF THE SYMPTOMS. 1HE symptoms of the canine fever are so nu- merous and diversified, that I shall not enter into a minute consideration of them, but content myself with the mention only of the more prominent and com- manding appearances. At an indeterminate time from the reception of the bite, the virus discovers its having taken effect, by pain and uneasiness in the part wounded; which is followed by darting lancenating pains throughout the body, but more particularly about the region of the stomach, with weight, heaviness, and pain of the head. These symptoms are accompanied or suc- ceeded by a sense of coldness, palid face, chills, fre- quent yawnings and stretchings, pains in the bones, nausea, loss of appetite, great lassitude, languor, de- bility, pain in the back and extremities, low spirits, anxiety, uneasiness of the extremities, with an inapti- tude to muscular exertion. A fever, with heat, flush- ( 23 ) ings of the face, thirst, perversion of taste, flatu- lencies, irructations, pain about the scrobiculus chor- dis, a burning sensation in the stomach, and vomit- ing, follow the other symptoms. The pulse, at this time, generally indicates great irregularity of the ar- terial system, being tense and chorded; the pain about the prcecordia is increased, the respiration is difficult, oppressed and laborious, with other marks of pneumonic conjestion and inflammation ; accom- panied with delirium, and sometimes " rage and fu- ry." The disease being aggravated by a recumbent or horizontal posture, the patients generally sit up, but if they lie down, great inquietude and uneasiness is evinced by tossing and restlessness in bed. The countenance is often ghastly ; the eyes staring, red, wild and inflamed, expressing strongly the excessive excitement of the system. The sleep, which is rarely obtained, is of short duration, and disturbed by frightful and alarming dreams. There are fre- quently violent and irregular affections, such as pal- pitation of the heart, with spasms, and convulsions of different parts of the body, accompanied with a pulse quick, unequal and irregular, but tense and chorded. In some instances a remarkable difference in the pulse of the two arms has been remarked. The heat is sometimes ardent, and diffused over the body, but in other instances confined to particular parts: thus the extremities are often cold, while the body is pre- ternaturally warm, et e, contra. Such are the phenomena of the early stage of the disease. The succeeding, is marked by an in- crease of the foregoing symptoms, and is followed ( 24 ) by a sense of tightness and stricture, about the throat and fauces; which occasions the pain and difficulty of deglutition, especially of fluids; and from the re- collection of the pain attending former attempts to swallow, such an aversion is induced, that the sight of fluids, or any transparent object, which renews the association, creates the most distressing emotions, and often spasms and convulsions. The sensibility of the system now becomes so exquisite, that it cannot bear the slightest impression; light is painful to the eyes, the air of ordinary tempe- rature produces the sensation of coldness, when inspi- red, and the slightest noise, er even a blast of air, will excite convulsions. Vomiting, at this period, fre- quently occurs, in which a glutinous, brown, bilious matter, or porraceous bile, is discharged.* It is impossible to contemplate the situation of a subject of the disease, at this stage, but with emotions of horror and regret. To an increase and aggrava- tion of all the symptoms, is added, an aspect expres- sive of horror and despair; the muscles of the face are distorted, the eyes fierce, " dismally wild, red, and inflamed," with the pupil much dilated, gaping of the mouth, lolling of the tongue, which is dry and rough, with a collection of froth about the mouth. These symptoms are attended with great heat and thirst, which, however, cannot be allayed, for the very sight of water excites horror and convulsions, and often madness. * Boerhaave, p. 165, Meade, p, 7$, ( 25 ) At the moment of phrenzy, attempts will be made to spit the frothy slaver which is collected about the mouth, upon the attendants; but at placid intervals, a solicitude will be expressed that it may be avoided. This froth now becomes extremely troublesome, and in the abortive attempts to expel it, which are incessantly repeated, there is heard a peculiar noise, which a prepossessed, or excited imagination, would compare to the barking of a dog".* At this ad- vanced stage of the disease, the tendency to spasms and convulsions is greatly increased, and frequently dysury and strangury occur,f accompanied with false vision, dulness of sight, and sometimes actual blind- ness. The spasms which pervade the whole system at this period, sometimes attack the muscles subser- vient to the movement of the lower jaw, inducing an involuntary grinding of the teeth, which has been re- presented as a disposition to bite. The system becoming exhausted, the pulse is weak and intermittent, the extremities are cold, with clammy cold sweats, and attended with sighs, hiccup, \ convulsions, and death. Such are the symptoms of the ordinary progress of the disease, but they are varied in different sub- jects, and diversified as in other diseases. Thus, in some instances, from the commencement of the attack, the system is prostrated by the force of the impression, and the pulse will indicate little de- rangement. There is also considerable variety in • Hildanius, p. 365. and Meade. f Meade, Lister, and other writers, take notice of the " venetri fre- ^uens crectio cum seminis involuntarii jactu." ( 26 ) the maniacal affection; sometimes it occurs at an early period, and continues, with temporary intermis- sions, through every stage of the disease; while in other instances, the unimpaired enjoyment of the senses has been possessed to the last. The aversion to fluids, which has been held as truly characteristic of the disease, is not an universal concomitant. There arc many cases related, in which it did not exist; nor does it observe uniformity in the period of its occurrence. It is sometimes manifest- ed at an early stage, but in a majority of instances, it does not occur till towards the close of the disease. The notices of the state of the pulse in this dis- ease, are few and imperfect. Physicians, deluded by the false opinion of its spasmodic nature, have devo- ted little attention to the examination of the state of the arterial system. But in those instances where it seems to have attracted careful observation, it is very generally described as irregular, with other indica- tions of febrile action. Admitting that cases have occurred in which the pulse was regular and undis- turbed, yet it forms no objection, as the same thing has been often noticed in other malignant fevers ;* it is to be attributed to the force of the attack pros- trating the system, or the remark has probably been made from an unacquaintance with the different mor- bid states of the arterial system ; for upon no subject * Dr. Rush, treating of the yellow fever, says, " it frequently came on with a weak pulse; often without any preternatural frequency or quick- ness, and sometimes so low as not to be perceived without pressing the artery at the wrists." He ascribes it to the remote cause acting with so rrvuch force upon the arteries, as not to admit of their being excited mt« quick and convulsive motions. ( 27 ) in medicine, does there exist more error and igno- rance, than that of the pulse. Even at this time, its frequency is considered as the only state affording a diagnosis of fever; when, from its liability to be influenced by diet, exercise, the passions of the mind, and many other causes, it really furnishes the most equivocal and uncertain indication. The following states of the pulse, have been no- ticed in this, in common with other malignant fevers, which strongly indicate the analogy. 1st. A hard full pulse,* such as occurs in pleu- ritic and other states of inflammatory disease. 2d. A pulse quick, hard and irregular.-J- This pulse frequently occurs in yellow fever. 3d. JA pulse quick, small, hard, trembling and • " In the morning I was sent to bleed him; the people about him thought that he had got a cold. When I came, I found him feverish, with a hard full pulse." Nours's case. Phil. Trans, of the year 1737, 8. No. 445. '• He complained of some pain in the wounded eye, and in his head; appeared to be rather dull, and listless, with a slight fever, and other symptoms usually attending a cold, and it was believed that his complaint originated from that source only." The pulse is thus noticed : Pulse about 100—In the evening 110—Mid-night 120. Complained at the same time of dysury. King's case, Med. Sep. vol. 1. p. 281. f " His pulse was quick, hard, and irregular, and he had strong pal- pitations of his- heart. His tongue was white, but did not appear dry." Bellamy's cane. " About three days after cicatrising the wound, the child was seized with a fever, disordered pulse, and palpitation of the heart." Lister's third case, Phil. Trans, vol. Hi. p. 2S1. X " His pulse was quick, small, hard, and irregular. His eyes had a particular keenness, and all his motions were quick and vehement; hi* pulse was also quick, and sometimes trembling and irregular." Bellamy's c«se. ( 28 ) irregular, indicating inflammation of the viscera. It has been frequently remarked in malignant fevers* and especially in the phrenitic state. 4th. A pulse strong, but intermitting.* This state of the pulse commonly occurs in pestilential fevers, and indicates, perhaps, most strongly, disease of the arterial system. 5th. A pulse full, quick, hard and tense. This pulse is commonly observed in the pleuritic, mania- cal, and in open cases of yellow fever. It strongly indicates inflammatory action.f 6th. A pulse uncommonly frequent, without much tension. This state occurs in chronic, malig- nant fevers. In the remarkable case of chronic hy- drophobia, related by Dr. Arnold, the pulse is noticed at 125 and 128 strokes in a minute. In Lister's case the pulse is noticed as " trembling and disturbed," and in another stage of the disease, he adds, " that he had now a violent fever upon him, with a quick pulse." Phil. Trans, vol. Hi. p. 277. * " His heat was much increased, and his pulse intermitted every fifth or sixth stroke, but on the right side only." lb. 2d. case, p. 280. " His pulse was then much stronger than the over night, but inter- mitted in the right side only, as before. " His countenance was somewhat more ghastly, yet his veins very full, as in initio, et augmentis febris. lb. 280. " His heat was very great, and his pulse very high, and intermitted then in both wrists. lb. 281. f" His pulse rather full and quick, though not remarkably so ; his coun- tenance strongly marked with anxiety. The next day, " pulse quick and hard." His face was much flushed, and his eyes staring and watery. Complained of the buzzing of flies before him." Babington's case. " Pulse 120 in a minute; his breathing laborious, his tongue moist, and covered with a white mucous ; his respiration was frequent, irregular, and laborious." Haighton's case. " His pulse imparted to the fingers the same kind of quick and tense stroke, which is common in the open forms of yellow fever. Case of Oakley's boy. Rush's Inq. vol. v. p. 220. ( 29 ) In the very interesting case communicated by Mr. Johnson, the pulse is described, in the first stage of the disease, as being " quick and hard." It is again no- ticed, as being at an hundred and fifteen strokes in a miquie, with " an unusual tremor in it." At a suc- ceeding period, it is noticed at an hundred and four strokes,accompanied with a " white and foul tongue, and the fauces red." At a more advanced stage, it arose, after the use of the pedeluvium, to an hundred and twenty strokes, and at the same time his eyes are described as " dismally wild, red, and inflamed." It is impossible to review the history of this case, with- out blushing for the fallacy of medical opinion. It has marked an sera in the theory and cure of hydro- phobia. From the want of success in the treatment, by limited and insufficient bleedings, professor Ru- therford, who attended the case, was induced to re- linquish the theory of inflammation, and to embrace the opposite doctrine. He made this revocation publicly. Enslaved by the weight of professorial authority, physicians have servilely, and unconditionally, embraced the doctrine ever since. It was reserved for my illustrious pre- ceptor* to break the shackles of this imperious preju- dice, and straighten the crooked and perverted con- ceptions upon this subject. Of the appearance of the blood drawn in this dis- ease, our knowledge is extremely limited. It has been rarely noticed : but what is collected from the casual mention of writers, is highly favourable to * Dr. Rush. D ( 30 ) the opinion of the febrile nature of the disease. In Bellamy's case, the blood discovered " slight traces of size,with serum,remarkably yellow." It is noticed by Meade as " thick and black." That drawn in Lister's second case, " was well coloured, but very bimwk" f/tt'(y^ Dr. Rush says, that it was uncommonly sizy, in the case of Oakley's boy. The blood taken from admi- ral Rowley's son appeared a " little inflamed, and somewhat sizy." In Mr. Bathier's patient " it was rather thick, long of separating, the serum tending to viscidity, and greenish." I am informed by Dr. Spence, an eminent physician of Virginia, that the blood drawn in a case of the disease under his care, was " highly inflammatory." In Johnson's case " the blood was not sizy, but abounded with serum, the crassa- mentum of a florid scarlet colour, and its texture loose," which is precisely what we should suspect in a case of such malignity. The sizy appearance of the blood is very generally, but erroneously, sup- posed to indicate the highest grade of morbid action. This appearance, which is often of casual origin, and always of doubtful indication, never occurs but in dis- eases of inferior grade, or where there has been a reduction of action by depletion. It is in cases only of great malignity, that dissolved blood, with crassa- mentum of scarlet colour, is seen : perhaps it indi- cates the highest grade of diseased action. Having thus given a general account of the symp- toms which are observed in this disease, together with the pulse and appearances of the blood, I shall ( 31 ) now proceed to the consideration of the appearances which have been noticed upon dissection. These, though varied in different subjects, are precisely analogous to what occur in malignant fever. They are, inflammation, adhesions, conjestion, effu- sion, extravasation, gangrene, and unusal aridity of the viscera, and other parts. Upon opening the head, the effects of a copious determination of blood to every part of the contents of the cranium, are strongly manifested*. The inte- * " Dissections generally discover the vessels of the brain distended, the sinus longitudinalis full of fluid blood, not coagulated, as usual in most other diseases of the head ; the brain and spinal marrow drier than ordin- ary ; the pericardium without liquor, the lungs loaded, the arteries full of blood very fluid, and hardly concressible in the open air." Meade, p. 82. " The dura mater contained within its sinuses concretions; beneath this membrane were some bubbles of air. All the vessels of the brain were full of blood, so that the choroid plexuses were black: there was no ex- travasation of serum. The substances of the cerebrum and cerebellum, were rather dry than moist." Morgani, p. 167. " In the meninges, the vessels were extremely distended with blood, and the internal surface of the brain was every where distinguished with bloody points, and a kind of bloody filaments. In the lateral ventricles was a small quantity of serum, and that a little reddish." lb. p. 160. " The vessels of the meninges, both arterial and venous, were immo- derately full of blood, and that, as it was in every other part, very black. In the ventricles of the brain, there was a vellowish water, to about the quantity of three ounces." lb. p. 172. " There was a distention of the pia mater on the surface of both he- mispheres, with a limpid fluid. The quantity of fluid in the lateral ventri- cles at the basis of the brain, and round the spinal marrow, appeared to be somewhat unusual." Ferriar's Med His. p. 205. The following was the result of several dissections, communicated by Mr. J. Fabbroni to sir Joseph Banks. " The Viscera were uniformly healthy, except in one subject, in which the lungs were foui*4 adhering to the pleura; but in all of them, the brain was observed to be more loaded with blood than usual." Lond. Med. Journal, vol. x. ( 32 ) guments of the brain are found considerably inflamed, and the medullary substance either streaked, or mark- ed with bloody points. In the ventricles there is contained a preternatural quantity of effused fluids, of different colour and con- sistence. The vessels and sinuses are uncommonly turgid, and distended with blood ; and between the membranes and interstices of different parts, extra- vasations and effusions frequently occur. In the thorax, the lungs have been noticed in- flamed, and adhering to the neighbouring parts ; but the most uniform appearance, is a state of engorge- ment,* as in pneumonia notha. They are sometimes * " The lungs appeared wonderfully distended and inflamed with the black blood with which they were swollen throughout." Hernand. rerum mex. Med. Thesaur. p. 494. " The lungs on all sides cohering with the pleura, were filled with a mass of concreted blood, which rendered them impermeable, or stuffed up, and when cut into, they appeared as a clot of blood." Bonet. Sepul. Anat. lorn \. p. 342. " The lungs on their whole posterior part, were not only black, but even swollen from the blood, as it seemed stagnated within them." Morgani. " Pulmo pleurae adherens concreti sanguinis molem referebet." Lieutaud, Hist. Anat. Med. torn. i. p. 445. " Pulmones coacervato omni fere cruore incredibiliter plenos." Boerhaave. Aph. 1146, vol. i. " Inter cadaveris.exenterationem, occurit vesi cula fellis bile nigerrima repleta, pulmones conspiciuntur nigri et graveolentes." Lieutaud, p. 515. " In the thorax the lungs, to use the words of Boerhaave, were coacer- vato omni fere cruore incredibiliter plenos, " that is, incredibly filled with almost all the crassamentum of the blood, collected and condensed to- gether," and in their back part, might even be said to be affected with gangrene. Morgani, 171. " There were some adhesions of the pleura covering the right lobe ©f the lungs, to that lining the ribs, on the same side: the left lobe ( 33 ) of a dark black colour, with vesicles upon their sur- face, as if raised by cantharides: inflammatory ap- pearances have been also noticed upon the surface of the diaphram. A preternatural state of the heart has been rarely observed; but the ventricles have, in some instances, been found distended with coagula of blood; and the surface adhering to the pericardium. The arteries are generally filled with fluid blood, so much dissolved as scarcely to be concressible when exposed to the air, and the veins nearly empty. In the abdomen, the stomach bears many marks of diseased action; perhaps more than any other part of the body.f In it, is discovered, almost uniformly, a quantity of dark, grumous, foetid fluid, often pe- was so completely filled with blood, as to have acquired considerable weight and solidity." Ferriar't 2d case. " The left lobe of the lungs was black, with the vesicles full of black blood: the surface in some places, which the blackness had not covered, appeared blistered, or if raised by cantharides." Pbilos. Trans, quoted by Ferriar. In the lungs there was evidently an accumulation of blood, and more in the right side, than in the left. The pleura in its natural state, but the vessels on the surface of the diaphram, seem rather more turgid than usual." Babington's ease. " In the lungs, were found considerable marks of inflammation." Cullen's Clinical Lectures, p. 173. " Lungs much inflamed, and towards the back part, of a livid appear- ance." Rhode's case, from Hamilton, 365. t The following is the result of Morgani's dissections, relating to the stomach: " The stomach once turged with air, and its vessels dis- tended with blood: its internal coat once corrupted, and the others distin- guished with red spots; five times, indeed, a moisture was observed in it: but once much, three times little, once yellowish, once green, once of a yellow colour, degenerating into green, once extremely yellow, once cin- ritious, twice viscid, once not viscid. />• 176. In Ferriar's first case, the stomach exhibited marks of inflammation, '' and vihs half full of a dark fluid." Med. Hist. 20G. ( 34 ) culiarly offensive; its internal surface inflamed, " and the vessels which creep through it, as much distended as they appear when injected." Agangrenous and mor- tified state of the villous coat has been repeatedly re- marked, and a similar appearance has also been noticed in the intestines and urinary bladder. The liver par- takes of the general disease of the viscera. Bar- tholine mentions its being inflamed, and adhering to the other viscera. The gall-bladder is found filled with a bile, dark and foetid. Respecting the state of the organs of deglutition, dissections afford re- sults sometimes vague, and often contradictory. It is, however, sufficiently established, that they are fre- quently affected.* Inflammation, and other effects of morbid action, have been repeatedly noticed. In some cases, appearances of dark, livid spots, have been ob- served upon bodies after death, and more particularly about the neck and throat. " On opening the stomach, the villous coat was found to be generally inflamed in irregular points, and there was an appearance of abrasion, similar to that remarked in Johnson, my former hydrophobic patient." Ferriar's 2d case. " Non tantu oesophagus, sed et ventriculus, et inteslina inflammata rubescebant in alio cadavere." Hernand, rer. Mex. Thesaur. In a dissection of a case, which I attended, the stomach exhibited many marks of inflammation. " It also contained the dark fluid which so frequently occurs in yellow fever." This case is detailed in the medical Repository. * An inflammation of the organs of deglutition, is noticed by Van Sweiten as a very common occurrence. Comment, vol. Hi. p. 561. Meade relates, "that the fauces were greatly inflamed." Fauvry also mentions the "gula being inflamed, and the linea asnera in some measure also." "The fauces were found much inflamed." Philos. Trans, vol. v. p. .369. Inflammatory appearances have also been remarked in the ccsepha^us pharynx, and larynx, by Morgani, Zwingeriii';, and other writers. REMOTE CAUSES IN DOGS. 1. oCANTY or putrid aliment. That the disease is produced in dogs by feeding upon putrid aliment, although denied by Drs. Parry* and Heysham,f is fully attested. The learned Boerhaave, and his ex- cellent commentator, Van Sweiten, are decidedly of this opinion. It is also taken notice of by Young, in his annals,J as being derived from this cause. The following important fact is related by Dr. Mease :||—" At the conclusion of the late war, and before that period, all the horses, and other animals, that died in the city, were carried out and suffered to putrify there; and it is well known, that at this period madness was a most common disease among the dogs, that used constantly to devour the carrion ; but of late it more rarely occurs among them, since the former practice is no longer suffered;" and lam assur- * Parry's Dissert, de rab. Canina. Edin. 1778. f Heysham. Dis. Inaug. de Rab. Canina. Edin. 1777. X Animal food in a state of putridity, is among the most frequent causes of canine madness. " Canine madness chiefly arises from the ex- cessive number of ill-kept and ill-fed dogs. Toung's Annals, vol. xvii- p. 561. jj Inaug. Diss. p. 6. ( 36 ) ed, that during the period of the Potowmac fisheries, where large quantities of fish are suffered to remain in a state of putrefaction, that the prevalence of the disease among dogs to a very great extent, is the uni- form consequence. 2d. Extreme heat or cold. The peculiar aptitude of dogs to receive the disease, during the prevalence of excessive heat, has been often remarked. It had early arrested the observation of physicians.* Hil- lary, considers it as endemial to tropical climates ; f but the extremes of temperature, either heat or cold, appear equally favourable to its production. Van Sweiten relates from iEtius, that it is most frequent in those countries where the violence of winter and summer are equally excessive; and it is unquestion- ably established, that during the intense cold wea- ther in this country, the disease not unusually occurs. There is nothing singular, in such opposite causes producing a unity of effect. Heat and cold, in their moderate application, may have a different operation ; but in excess, the effect is precisely the same; in- ducing a state of debility, which, either direct or in- direct, constitutes the predisposition to disease. 3d. A deficiency of water. The conviction of the influence of this cause has been so generally im- pressed, that it has attracted legislative interposi- tion; and accordingly, provisions have been made in some countries for the supply of water, at the period of deficiency ; J but from the circumstance of the ex- * ^Egineta, p. 74. Otitis, p. 107. Dioscorides, p. 423. f Diseases of Barbadoes. X Mosely on Tropical Diseases, p. 33 ( 37 ) cmptionofthe island of Antigua, from the disease^ where there are no springs, or other sources of water upon the island; this opinion is much weakened, if not totally invalidated. 4th. A pestilential state of the atmosphere. The astonishing influence, and all-powerful agency of cer- tain states of the atmosphere, not yet clearly defined, in the production and aggravation of diseases, has been long acknowledged by philosophical physicians. To Hippocrates we are indebted for having first lead the way in unfolding the doctrine of a certain consti- tution of the atmosphere fitted to the production of particular diseases ; which was adopted by Celsus, pursued by Sydenham, revived by professor Rush, and applied in the interpretation of the recent epide- mics of his country, with the happiest success : and completely established by the elaborate exertions of Mr. Webster. In tracing the history of epidemics, we are struck with the intimate connection of the canine fever, with the train of diseases which mark the period of pesti- lence. Thus, during the plague which raged in Flanders, in 1587, the prevalence of canine madness is particularly noticed. Webster, 167. In the year 1734—5, it prevailed as the concomi- tant of pestilential diseases. lb. 232. In the year 1785, this disease made its appear- ance in the northern states, and raged to a considera- ble extent; which continued in 1786. At this time, t This fact is asserted by Dr. Parry, on the authority of Dr. Samuel Athill, of that island. E ( 38 ) the prevalence of the scarlatina anginosa is mention- ed. It again appeared in 1789, accompanied with various physical phenomena, which mark the exist- ence of a morbid state of the atmosphere. lb. 281, 286. In 1797, it prevailed in Rhode-Island, Massachu- setts, and Connecticut. A malignant dysentery ex^- isted at the same time, in the latter of those states. Med. Repos. p. 549. " In the spring of 1783, canine madness broke out in Hispaniola, and in the month of June in Ja- maica, where it raged until March, 1784. It was said at first, that it was brought to Jamaica from Hispaniola, but experience proved the fact to be otherwise. The common notion, that this disease among dogs, can only proceed from the poison of an external bite, or that it originates in some particular dog from internal disease, and from thence is disse- minated, has excluded the idea of spontaneous mad- ness arising from some peculiar influence in the air. But this influence of the air generated canine mad- ness in the year 1783, in the West-Indies; for it was general, and many dogs were seized with it, that had no communication with others, and some dogs that were brought from Europe and North-America, and that were not on shore, went mad, on their arrival in the harbours of the island."* • Mosely on Tropical Diseases, p. 44. REMOTE CAUSES IN THE HUMAN SPECIES. 1 HESE are numerous. It has been a re- ceived opinion, that the disease is only induced by the application of the canine virus ; but repeated ex- perience shews the fallacy of the conclusion. The following are the most uniform causes which pro- duce it: 1st. The vicissitude of temperature. Dr. Ar- thaud has furnished three cases, brought on by the persons sleeping in the open air during the night. 2d. Wounds in a tendinous part.* 3d. Great thirst. 4th. Involuntary association of ideas.f 5th. Eating beach-nuts.J 6th. Putrid aliment.|| 7th. Spiritous liquors.** 8th. The narcotic stimuli; viz. datura stramonium,§ camphor, &c. * Darwin's communication to Percival. f Percival's Letter to Hey- sham. Rush's Inq. vol. v. 235. | Med. Museum, vol. i. p. 226. |j Trans. Society Phila. '* Boerhaave. § Cooper's Inaug. Disser. ( 40 ) 9th. The bite of a rabid animal. These causes operating upon the system, induce a state of debility, either direct, or indirect, which constitutes the predisposition, or inviting condition to the disease. PROXIMATE CAUSE. This is a subject which has always been invol- ved in darkness and obscurity. To travel back into the records of medicine, to refute, or even notice the various speculations, and opinions, which have been advanced, would be a pursuit, equally useless and un- interesting. It has been fully illustrated by Dr. Rush, that the primary seat of fever is in the blood-vessels, and accordingly, the proximate cause of this state of fever, must be the same as that of others, consisting in a preternatural excitement, accompanied with ir- regular or convulsive action (or the absence of all action from the force of stimulus), but determined to particular parts, according to the existing pre- disposition. I have now come to the consideration of the na- ture of the disease. I enter upon it with uncommon pleasure, as I hope to unfold a theory which will lead to its successful treatment. But before I proceed to the immediate inquiry, I shall take a hasty view of the doctrine which supposes the disease to consist in debility and relaxation. This, I confess, ap- pears to be no better founded, than the many jgjfltts. ( 41 ) hypotheses which have been advanced upon the subject; and, with me, the only circumstance which entitles it to exclusive consideration is, its having been advanced by the high authority of professor Rush, and now ranking among its advocates, the re- spectable names of Mease, Percival, and many others. The principal arguments which have been urged in support of the opinion, are derived from, 1st. Analogy, or the occurrence of similar symp- toms in tetanus. 2d. From the operation of the canine virus, as a sedative. 3d. From the want of success attending the treat- ment by depletion. Before any proof can be deduced from the analogy of the disease with tetanus, it should be established, beyond the possibility of controversy, that the latter disease consists in debility and relaxation ; for if the contrary is made to appear, the whole of the deduc- tions growing out of the position, are totally invali- dated. From an attentive inquiry into the causes and symptoms of tetanus, I am convinced, in contradis- tinction to the prevailing, and received opinion, that it is a disease of violent grade, pervading the whole system, and affecting the blood-vessels, producing fever. This I deduce from the following considerations: 1st. From the causes that produce it, which are acknowledged to exert a powerful agency upon the system, and in their ordinary operation, to induce fe- ver. These are ; the vicissitudes of heat and cold, ( 42 ) marsh miasmata, fatigue, wounds, the bites of poi- sonous serpents ;* and, lastly, the most powerful sti- muli, such as the fdatura stramonium, camphor, hemlock, dropwort, and ardent spirits.:f 2d. I infer it, from its occurring at that period of life, and in those constitutions most subject to fever. Dr. Cullen has asserted, " that although it may attack persons of all ages, yet it appears to attack those of a middle age, more frequently than older or younger ; the male sex, more frequently than the female ; and the robust and vigorous, more frequently than the weak. || 3d. From its symptoms. These are, in the com- mencement, nausea, and vomiting, § which are fol- lowed by breathing short, quick, and irregular, in some instances ; by an increase of heat of the body, delirium; by costiveness, strangury, and sometimes miliary irruptions;** and, where it terminates in death, by cold extremities, and a clammy moisture or sweat, ff 4th. From the state of the pulse. This, in general, is either full and hard, or small, quick, and irregu- lar ; J| but seldom more frequent than natural. In some instances where the disease has proceeded from cold, succeeding to heat, fever, with other marks of inflammatory diathesis, are considerable. |||| 5th. From the blood. The blood, when drawn, rarely exhibits the inflammatory crust, but is gene- * Dr. Barton's M. S. Lectures. t Ibid. f Girdlestone's Essay. || Cullen's Practice, p. 144. § Cullen and Girdlestone. ** Cullen. ff Girdlestone. XX Hillary Obs. p. 224. Chalmers, p. 93, 95. Cullen. Edin. Med. Comm. p. 472. |ji! Hillary. ( 43 ) rally of a looser texture than usual, and does not coagulate as when natural; is of a less florid colour, and is sometimes covered with dark spots.* 6th. It partakes of the nature of malignant fever in the manner, and period of its termination. This, when it ends in death, is some day before the seventh, but in many instances, in 24, 36, and 48 hours; when in recovery, the convalescence, like that of fever, is protracted for three or four weeks, j* Like malig- nant fever also, there is a tendency after death, to ra- pid putrefaction. Dr. Rush relates a case in his lec- tures, of a boy who died of tetanus, becoming so pu- trid, that it was considered unsafe to open him, a few hours after death. 7th. I support it to be a malignant fever from the success which has attended depletion in its cure, and particularly blood-letting. Here, I am aware, the weight of authority is against me ; but it should be observed, that the prevailing theoretical notions upon the subject of the disease, have prevented the em- ployment of the practice, consequently the instances of its success are much limited. But has the oppo- site practice been successful? Let the united voice of physicians, and the common experience of man- kind, declare ! The existing doctrine, then, I hold to be erroneous, for no theory can be just which does not lead to a uniformly successful practice. Although the practice of bleeding in tetanus, has been very generally condemned, yet there are not * Hillary, p. 148, and 226, Ed. Med. Com. p. 472. f Hillary, p. 225. Cullen. ( 44 ) wanting authorities who advocate it, or particular in- stances of its successful employment. The Spanish surgeons in the colonies, employ blood-letting very extensively. * It is recommended by Hillary in cases induced from cold,| and doubtless must be equally proper in every instance of the disease. The prac- tice should in no case be determined from the remote cause, but by the state of the system. It is advo- cated by Chalmers also ; but under the impression of its facilitating the operation of other remedies. The practice, however, does not rest solely upon the recommendation of authority ; its propriety is con- firmed by examples of its success. Mr. Alexander used it successfully in a violent case of the disease, which had resisted other remedies.^ Dr. Currie, of Liverpool, cured a case by it.|| It was employed by Dr. Barton, successfully, in a case which had braved every other means of relief. And Dr. Mackey, an eminent practitioner, in Virginia, employed it in three cases, with the happiest effect. § The propriety of this practice is further attested, by the successful treatment of the diease by other de- pleting remedies, such as the cold bath, emetics, purges, relaxing enemeta, he. the operation of which is precisely analogous to that of blood-letting, only not so direct or effectual. II. From the operation of the canine virus as a sedative: * Mnsely, p. 4