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NATIONAL LIBRARY OF MEDICINE
Washington
Founded 1836
U. S. Department of Health, Education, and Welfare
Public Health Serrice
PLAIN
ELEMENTARY EXPLANATION,
O* THE
NATURE AND CURE OF DISEASE,
Predicated upon facts and experience $
PRESENTING A VIEW
Of that train of thinMng which led to the Invention
or THE
PATENT, PORTABLE,
WARM AND HOT BATE.
4—4S
By Samuel K. Jennings. t- Y/*> v
RICHMOND:
FEINTED BY RITCHIE & TRUEHEART.
18X4.
V
DISTRICT OF VIRGINIA, to wit :
BE IT REMEMBERED, that on th«
L. S. twenty-fifth day of January, in the thirty-
eighth year of American Independence,
Samuel K. Jennings of the said district, hath deposi-
ted in this office, the title of a book, the right where-
of he claims as author, in the words following, to wit:
'«A plain elementary explanation of the nature and
" cure of disease, predicated upon facts and experi-
" ence ; presenting a view of that train of thinking,
" which led to the invention of the Patent, Portable,
" Warm and Hot Bath. By Samuel K. Jennings."
In conformity to the act of the Congress of the United
States, entitled
that the skin is often as hot or hotter in this, than in
an intermittent ? I answer, that in every case where
there is much prostration, the skin is so far deprived
of excitement, thai the moisture necessary for con-
ducting off the heat which is eliminated from the sys-
tem, is not supplied. And as a bottle filled wilh boil-
ing water, and kept properly dry, will retain its heat,
K
34.
much longer than another which is continually mois-
tene»h though both are within the same temperature,
so a fever with a dry skin, is always marked villi
preternatural heat. But it shall be found that altho'
the surface is hot, the vessels of the skin and cellular
membrane are collapsed, and therefore that the heat
is not the result of an increase of action on the sur-
face. Moreover it is a fact, that by an application of
cold water by 'affusion, or by the means of a wet
sponge, the accumulated heat may be speedily evapo-
rated, and that it will require a length of time, pro-
portioned to the degree of existing debility, before a
similar accumulation will again be collected; con-
sequently it cannot be the result of a preternatural
heat at all. It must, therefore be a mere retention
of such portion of this prine'jslc, as is necessarily eli-
miiva«/Kl; so long as life caii be preserve;], although
the quantity present iirthe system, taken in the ag-
gregate is less than natural. So that I am at liber-
ty to assert, that with the exception of cases of sim-
rJe inflammatory fever, and those* which particularly
concern the skin, as scarlet fever, measles, small-
pox, &c. the more feeble the excitement in fever, un-
til death commences, the hotter the skin will appear
to be, at certain intervals.
Fever, which in the commencement may be con-
sidered strictly rcrafetent, if improperly managed or
neglected, frequently degenerates into a cantinucd
S3
form.* This change is wholly the result of increas-
ing prostration. And if the remote cause be armed
with sufficient power, and continue to act upon the
system long enough to produce a certain degree of
exhaustion, the mode of fever which takes place un-
der such circumstances, will be continued from the
beginning. In consequence of the great debility, so
gradually brought about in this case, the common
enemy gets more complete possession of the out-posts
of the system—that is, a more extensive collapse of
the extreme vessels takes place. The whole stock of
moving power is contracted into narrower limits.—
The action of the vessels within those limits is there-
fore perpetually more or less above par. But the
great mass of collapsed vessels, maintain such a per-
petual and effectual resistance against the feeble ef-
forts of the system to maintain its balance, that no-
thing is gained. And in fact this grade of fever might
more properly be considered, a state of great exhaus-
tion of vital energy, than that of great febrile action
at all. If the sensorium can maintain its functions,
until the hurtful agent pass away, or till by rest and
management, the necessary adaptations can be ac-
complished, the patient may recover. But if the
hurtful power of the remote cause continue its pres-
* Is it not ftrange, that phyficians ftiould for ages have wit.
neffed the transition of difeafe, out of one form into another, and
yet doubt of its unity!
36
sure, until the sensorium is sufficiently exhausted, it
necessarily terminates in death.
If the remote cause be more gradually applied, so
as to give longer space, for effecting an appropriate
adaptation, and of course more fully to exhaust the
struggling powers of the system, a form of fever
will ensue, very similar to the foregoing, but with a
more entire abandonment of the surface, assuming
the shape and appearances, which are commonly call-
ed typhus. And it mis! be more or less gravid or
mild, according to the power of the remote cause.—
And if much improper evacuation be effected, there
will speedily follow, a subsultus tendinum or a ner-
vous twitching of the muscles.
Such is the gradation and appearence of disease, as
it occurs under the influence of ordinary remote cau-
ses, throughout the course of the seasons. Some
other modifications will be considered each in its ■
proper place.
I have chosen to commence my explanations of
fever, by a consideration of its appearances in the
form of an ordinary pleurisy, because this is unques-
tionably the simplest form of disease ; and because
in my apprehension, it affords a key, for an explana-
tion of the chilly state of fever, in whatever season,
or by whatever remote cause it may be produced.—
And if I mistake not, by this method an easy and na-
tural explanation of disease in any of its forms, is
37
furnished. But this will more fully appear, when I
consider the method, proper to be pursued, for effect-
ing a cure.
Before I enter upon this part of my work, that I
mky he distinctly understood, it is necessary to give
a brief exhibition of my view of the modus operandi*
or the manner of operation, of some of those medical
agents, which I have found to be most useful; and
Jay down some instructions, by which to predicate an
appropriate intention in any given case.
To prescribe judiciously, it is necessary, first to fix
upon some definite object, which ought to be, accom-
plished, and then select such an article, or preparation
of medicine, as is known most certainly and safely,
to produce the object proposed.
Fob, instance, it might be proper to know whether
any case under consideration, should be referred to
the standard of predisposition with accumulated pow-
er, or the contrary. Then if the case occur in win-
ter, or in a healthful season and region, if the pati-
ent have always enjoyed good health and vigor, and
if he were suddenly affected with chill and languor,
with dull heavy pain in the back and limbs, &c. there
would be very little hazard, in venturing upon an o-
pinion, that such a ease should be considered an in-
stance of " predisposition with accumulated power.',
To judge still more accurately, of the probable
quantity of accumulation present, euquiry should be
made, respecting the temperature of the weather,
38
the duration, and circumstances of the exposure ; the
quantity of cloathing; and the various artificial
means which may have been used, to counteract the
influence of cold. The patient's skin should be care-
fully inspected, iii order to judge of the probable ex-
tent of the collapse, which may have taken place.*
And special attention should be paid to the state of
the pulse, to judge of the quantity of excitement pre-
sent in the system, and of the probable degree of pow-
er, which is likely to be exerted for the restoration
of a balance.
In a case of this description, it is obvious, that the
intention ought to be in some way, as expeditiously
as possible, to restore a return of excitement to the
surface, so as effectually to drive the common enemy
from his possessions, and then extinguish any remain-
ing accumulation of vital power, which might be
found afterwards to prevail.
In the case occur in a sickly season, or in any plaee
when some alarming fever for the time being prevails.
If the patient have gradually declined, so as to have
been lingering under a sense of weakness, for a consi-
* In making the inveftigation here propofed, I never fail to
pay as much regard, to the ftate of the veins as they prefent them-
felves to the eye, as I do to theftate of the artery, for determining
its force, &c. In cafes of obftinate collapfe, the veins cannot be
filled by tying on a ligature in the way it is done in ordinary
blood letting .
> 39
derable time before the symptoms became serious, and
especially if there have been a daily disposition to be
near the fire, or within the influence of the rays of the
Sun, it may be safely concluded, that this is a case of
predisposition with exhausted power. In order to
judge of the degree of debility present, and of the
extent of the conquests made by the common enemy,
all the foregoing enquiries ought to be made, and if
possible a still more accurate attention should be
paid to the state of the pulse, that any change which
may be expected may be properly understood.
In a case of this description, it must be obvious, that
the first intention should be, to regain possession of
the out-posts of the system, and in some way to hold
them, till the necessary strength can be recovered,
and healthful excitement established.
If the case under consideration should have passed
beyond the stage of predisposition, and the fever have
actually formed, some additional circumstances come
into view.
In every case of fever with accumulated power, we
necessarily have an instance, in which the quantity of
excitement rises above par, and the excess above ordi-
nary excitement, m ill be in proportion to the existing
accumulation. If such excess be great, there may be
danger of a pernicious lesion, or a destructive stretch-
ing or rendingof some of the vessels important to life.
And the degree of this danger may be known, by the
40
tension of the artery, by the difficulty disposition in the system to determine its powers to
some one weak point—there is a proportionate dispo-
sition tc r.handon others. In every such case, the in-
tention should be to equalize excitement, throughout
all the vessels of the system.
In every case of disease, so long as there is suffici-
ent energy in the system to sustain the shock necessa-
rily attendant upon it, one leading intention should
be, to.remove all feculent matter, as often as it accu-
mulates sufnch-niJy to irritate the system. The skin
and mouth should therefore be carefully washed a«
often as there is need. Arid the bowels should be
aided with appropriate cathartics.
After disease has progressed so far, that the sys-
tem is much enfeebled in its powers and movements,
it frequently becomes necessary, to afford the aid of
some artificial stimulant. In such case, the intention
should always be, to institute an artificial balance of
excitement, u]^m a grade commensurate to the seve-
ral peculiarities of the ease; Cwikavoring to bring
the artificial arrangement, to a stale, as nearly ana-
logous to that of health, as circumstances will admit,
and then carefully to maintain it, till by suitable nou-
rishment and sufficient time, real health may be re-
covered., Each of these various intentions, should be
45
irsncd as often as the existing state of thhigs makes
t necessary and proper, without regard to the name
or duration of the disease.
Remedies or medical agents are useful and valua-
ble, therefore j ust so far only, as they can be depend-
ed upon with certainty, for the accomplishment of any
proper intention in the cure of diseease.
I shall consider those proposed, in connexion with
such practical observations, as may enable the reader,
definitively to judge wherefore, when and how far,
each of them should be employed.
I shall not regularly pursue, the classification com-
monly ohserved by wliters on materia medica, but in-
troduce each article, in that form aud order, in
which it is present, before my own mind,
Blood-letling is a remedy by which excitement is
completely placed within the control of art. I have
considered the blood as one of the natural stimuli,
upon which life depends. By loss of blood, therefore,
excitement is reduced, and that in proportion to the
quantity lost, except only in certain cases of depres-
sion, in which through an engorgement of some of
(he vessels, excitement is confined. In such a case,
loss of blood to a certain extent, may be followed by
an immediate increase of excitement. But when
there is no such depression, it must universally follow,
that by loss of blood, excitement for the time being,
will be diminished. Therefore, when excitement runs
so high, as to produce lesion, or threaten to produce
46
it, and especially when, through the violence of the
assault, time is not allowed for the trial of other al-
ternatives, blood-letting should be employed. And
upon the same intention it may be repeated, as often
as the case may require.
When there is good reason to believe, that the e-,
nergies of the system are sufficiently active, to pro-
duce a speedy and effectual re-action, so as by one u-
ni versa! struggle to ree over all (he posts which may
have been been taken by the enemy—then as a copi-
ous blood-letting produces great momentary suspen-
sion of excitement—by this suspension, excitability is
accumulated to such a piteh, that the system is charg-
ed for an effort by which it finds an immediate balance*
or an approxiamation towards a balance of e xcitc-
ment. This is often effectually done in the time of
the predisposition, or early stages of fever.*
Also when there is a morbid generation of vital pow-
er, or when there is an obstinate infiamatory determi-
nation to some particular organ, or part of the sys-
tem, it may be frequently repeated for the purpose of
producing and maintaining a state of debility, till by
time and management, the morbid action may be made
to subside, and a complete balance can be established.
One of three intentions therefore ought to direct,
the use of the lancet. To reduce excitement in or-
* The blood glows on the surface, after s uch an instance of
blood-letting, by the same laws, which produce that effect after
using the cold bath, in an appropriate way.
47
der to guard against threatened lession—Indirectly
to produce a new action thro' the accumulation of vi_
tal power—Or to induce a certain degree of direct
debility, in order to render the system more manage-
able, that is, more susceptible of any counteracting im-
pression which may be intended.
Note..---That although a copious blood lettingtaken froma
large orifice, has the most effectual tendency for the moment to in.
uce an accumulation, yet it mult follow that by lofs of blood, i«
the end, thtre will be a commensurate loss of vital power.
Whatever excitability or vital power is, it must in some way
be generated in the system. And if the system be robbed of its
moit efsiiitial nourishment, it must fail to generate this power in
natural quantity. And therefore altho indebility induced by blood
.etting, comparatively speaking, is always of a direct kind—yet it
would be absurd to suppose, that a continued accumulation of vi-
tal power, would follow a great aud repeated lofs cf blood. It
thould therefore be remembered, that when great lofses of this fluid
havebeen sustained, such management will be requisite, as has a
tendency to replenish the loss ; at the same time, that artificial
stimulants are used, to supply the place of a natural one, so im-
portant as the blood. For altho' the system is truly said to be,
in a stateof accumulated power, and therefore needs the balancing
influence of an appropriate stimulant, yet opiates, ardent spirits,
and the like, must not be relied on, without-the addition of suita-
ble nourishment, otherwise the system will sink into a stateof in-
direct debility, and that of the most dangerous kind. Under such
circumstances therefore, whether brought about by accident, or by-
sudden or long continued hemorrhage ; wine, soup, sago, and the
like, ought always to be used at proper intervals, between the re-
petitions of the necessary opiate doses.
48
Puking is a remedy which reduces morbid excite-
ment, and has a very strong tendency in many cases,
by the storm which it raises, to balance the motions
of the system. It may be used to evacuate the sto-
mach, when at the same time, there is good reason
to suppose, there is an induced accumulation of vital
power. In fact, when there is much exhaustion of
vital power, emetics fail to produce their intended ef-
fect. On the contrary, they increase the .debility
of the intestines, and produce colliquative diarrhoea"
In most cases, where blood-letting is proper, an
emetic* might immediately follow the loss of blood
with advantage. By the bleeding then, is brought
about a diminution of excitement—of course an ae-
mulation of vital power. The circumstances which
make blood-letting necessary, commonly forbid the
use of ordinary stimulants, which might otherwise
be employed, for preventing any morbid accumulati.
on. By the painful nausea and convulsive motion of
the stomach and abdominal muscles, the desired ex-
penditure may be frequently and safely produced.
One of three intentions, therefore, ought in every
ease to. preside over the administration of an emetic
Either to shock the system, with design to overwhelm
any morbid action present—To evacuate the sto_
mach—Or to extinguish any morbid degree of vital
power, from time to time generated in the system.
* Emetic medicines, are such as excite vomiting. Ipecacuana
perhaps is the best article of this class. To be given5'hi-dose;
from 5 to 30 grains.
49
Cathartic remedies, should be used with an in-
tention to evacuate the intestines. And as there
are in use,* various articles, of different powers,
some one should be ^chosen, or such a combina-
tion of two or more, whose known powers, may
most accurately meet the intention. In robust cases*
with violent morbid excitement, some drastic dose
should be preferred, as jalap and calomel. If any de-
gree of engorgement, is justly suspected to have taken
place in the liver or mesentery, a dose or two; of
articles still more drastic may be profitably used ; as
aloes, gamboge and calomel comb,iued. Afterwords'
in ordinary eases, castor-oil or rheubarb with saltf,
alternated with doses of calomel, may answer the in-
tended purpose. If the case be chronic, but marked
with sufficient vital power. Alkaline.* medicines may
be combined or interspersed with other cathartic me-
dicines. If the bowels are inflamed or the patient
much exhausted, olive oil, cold drawn caster-oil,
manna, cream of tartar, Rochelle salts, tamarinds, or
maguesia, &c. ought to be preferred. In cases of in-
fants, rheubarb with magnesia warmed with a little
essential oil of anise, or when this might be too sti-
mulant, a little olive oil, or manna, or an infusiou of
rose leaves, ought to be exclusively used.
In the progress of fever, it is necessary to pay strict
Cathartics, are purging articles.
* Alkaline medicines, fuch as fait of worm wood, fait of tartar,
fait of amber, foda, &c.
G
BO
attention to the state of the bowels. Irritating mat»
ter, retained in the alimentary canal, might keep up
a feverish action, when every other arrangement has
been made, favorable for a cure.
Diaphoretics, or sweating medicines, ought to be
used, when the intention is, to restore excitement to
the surface; and when the system at the same lime
can safely be placed under the influence of an artifi-
cial stimulant. Perspiration can be induced on the
system, when in two different states. In a state of
direct debility through the loss of blood, or through
the sedative agency of cold, if not too long continued,
certain gently stimulant means, especially when aided
by heat, will excite the system, producing an increase
of arterial action, which will ultimately extend its in-
fluence, to the extremities of the capillary vessels.—
The arterial action thus artificially raised, will ne-
cessarily, for a time transcend the action of the veins.
During the continuance of this want of balance, ex-
traordinary moisture will be exuded—that is, perspir
ration will be continued.
Again, if the energies of the system are entire, and
the organization of its vital parts is sound, by the
agency of similar means, with the aid of some additi.
onal heat, a profuse sweating may be effected upon
the principles laid down in the foregoing remarks up-
on the skin. By the power of the preternatural sti-
mulant, used for the purpose, indirect debility is in*
Si
duced. But as the heart and arteries'are held under
the influence of this artificial agent, the failure of
power will first be perceived in the absorbent system.
Hence it follows, that a sweat induced io this way,
sometimes produces morbid effects. The exhaustion
of vital power, through the stimulant agency of the
means employed, and the loss of circulating fluid,
through the profuse perspiration which is induced,
may co-operate, so as to prostrate the system, as low
as an excessive loss of blood would have done. Be-
sides, in bringing about this state of things, any
weak branch of the blood-vessels will be endangered j
and Mhen it is accomplished, the system may be left
in a state of predisposition with exhausted power-
Diaphoretic medicines, therefere, ought to be used
with the same circumspection, and for the same pur-
pose as any ordinary cordial, except only when the
intention is to raise excitement on the one hand, and
at the same time deplete the fluids of the system on
the other, so as to institute and establish a new acti-
on. If this intention be judiciously managed in the
forming stage of disease, it is frequently effectual in
correcting the morbid action at once. Very great
accuracy of judgment, however, is necessary to guard
against mistake. And, therefore, heavy sweats ought
never to be given in this way, except by the hand of
experience.
li
Antimoniai. preparations,* have commonly been
considered as important diaphoretic agents. For
many years I have not used them with any such in-
tention. In my opinion I hey are valuable, chiefly oil
account of their efficacy in extinguishing the vital pow-
er of the system. Hence it is, that they are always
pernicious in those cases of fever, which are marked
with sufficient energy. 'For the same reason, they
are always pernicious, in those cases, with great
prostration ; in which, instead of inducing any thing
like a "diaphoresis, they are followed by collaquative
(h'arrh'oea. Whenever they produce diaphoretic ef-
fects, it is done in the following manner:—The sud-
den extinction of vital power on the stomach, produ.
efes general debility, diminishing the action of the ab-
sorbents on the surface, by which the arterial action
over-runs that of the veins, producing diaphoresis.
Mercury is become a very fashionable medicine.
As it exists in the form of calomel, it is a valuable
cathartic, when the intention is to evacuate the bow-
els, and at the same time sproducc an increased dis.
charge of bile—an effect, which in ordinary cases is
so completely produced by this article, that it might
alitiost claim the dignify of a speeific. But it so im-
periously extinguishes vitarpower, that it is utterly
inadmissible, in every case of great prostration. In
• Antimonia! w'nf. tartar Tactic, are the two most commonly
in ufe.
53
that grade of fever, in which the energies of life are
exhausted down to the state of typhus, a single dose
of this agent, has in many instances, produced an un-
conquerable colliquative diarrhoea. V/hen there is
a disposition in the system to direct a morbid deter-
mination upon the liver or mesentery, well regulated
repetions of calomel, will be found highly important.
By procuring an extinction of energy on those parts,
for a sufficient length of time, aiding the intention by
blood-letting, and other cathartic doses when neces-
sary, such morbid determination is most effectually
corrected. And this will the more certainly be done,
when the repetitions are made, once every sixth hour,
which is about the period, during which, calomel
maintains its stimulant power.
In eases of bilious pleurisy, and ordinary bilisus
fever, in which there is need of disarming the system,
of that portion of power, which is exerted in main-
taining a morbid determination upon the liver and
other viscera, large doses of calomel, daily repeated,
hxvc often been found highly important, if not indis-
pensable. In these cases also, if an appropriate dose
were repeated once every sixth hour, the intention
would be more speedily and effectually accomplished.
The same mode of administering this remedy, would
also be found most effectual in that form of located
disease, which is commonly called billious cholic.—
And here it should be remembered, that aged persons,
and such as ore prematurely worn out by intempe-
H
ranee, as well as all those who are prostrated by dis-
ease* have too little vital energy remaining, to bear
the exhausting powers of large doses of Calomel.—
For want of this precaution, life might be lost by a
single dose.
A salivation, produced by the use of mercury, is
deemed an important remedy, in the cure of disease,
in some of its forms ; especially those, which affeet
the glands of the system. The mode of its operation
in this respect, may therefore deserve remark.----
When the system is permanently placed under the
power of this agent, its first effects upon the blood ves-
sels, are obviously inflammatory, in so much, that in
many cases, the intention would be defeated, if the in-
flammatory appearances were not put down by blood
letting. It would seem, that by this article, a pecu-
liar disease is induced upon the blood vessels, which
probably acts with equal power, upon every branch
of the arterial system, beginning at the centre, and
speedily progressing towards the surface. From this
circumstance arises its efficacy in breaking a morbid
determination of excitement.—It compels the actions,
to assume an equable determination, upon every part
of the system. It would seem also, that the irritation,
which is first excited in the artery, continues to pro-
gress, till by the ordinary communication, it passes o-
ver to the vein, and produces an increased action in
the secretory vessels. And this effect, in order of
time, takes place, after the arterial action has in
SB
some degree subsided, so that the arterial acti-
on is diminished, at the same time that the ac-
tion of the absorbents is increased. And in this
stale of things the deobstruent* effects of mer-
cury, probably, are accomplished. The salivary
glands as well as the whole mass of glandular vessels,
are equally roused into increased action, but as the
secretion which is accomplised by those glands, is des-
tined for the lubrication of the mouth, this obvious
circumstance, together with their size and number,
conspire to induce a belief, that mercury is armed
with a specific power, of producing salivation.
If this view of the subject be correct, then it will
follow, that some appearanee of salivation is necessa-
ry, to prove, that the glandular system is sufficiently
roused, to meet the intention—And that the degree of
salivation induced, may always serve as an indication,
of the degree of extraordinary secretion, which may
be going on in the whole train of glandular action.
When disease is cured by the agency of mercury, it
must be accomplished by some one or all of the fol-
lowing effects. By its tendency to exhaust vital pow-
er, large doses given in the commencement of disease,
sometimes immediately extinguish any morbid accu-
mulation, and hasten the restoration of the balance of
excitement. I have seen this effect completely ac-
* Deobstruent. Having the power to remove obstruction, or
according to an old opinion—Having the power to resolve viscidi-
ties,
as
eomplished, without any extraordinary catharsis.* By
the same mode of operation, when given in appropri-
ate doses, and repetitions, it meets and extinguishes
any local accumulation of vital power, on any one of
the viscera, and corrects the error, by an indirect ef-
fect, which in some degree operates like topical blood-
letting. Or, by its imperious sway in exciting equable
action, first exerting its powers upon the artery, and
presently also upon the vein, it gradually brings down
the whole mass of excitement, to a point, from which
a healthful action may commence, and progress in
safe convalescence, towards a complete recovery.
And one of the best advantages attendant on its use,
in this—that in the order of its operation, the action
of the absorbents is greatest, after the stock of ener-
gy present in the system, has been considerably ex-
hausted. It is possible, however, that this order is in-
verted, when the application is made externally by
way of friction, and therefore, in most feeble cases,
the application by friction should be preferred.
Coid is frequently employed as a remedy, and with
very good effect. The great certainty with which it
corrects the pain, attendant upon external inflamma-
tion, is known to every one. Upon the great sedative
powers of this agent, is predicated one of the leading
principles of this essay.
The application of cold will never fail for the time
Catharsis, purging.
57
being, to diminish excitement,/and that in proportion
to the extent, and continuance of the application.—•
Much has, been;said of late, of its great utility, in
the cure of fever, in hot climates. And when judi-
ciously employed, there can be no doubt of its power.
In every form of fever, with dry hot skin, it is use-
ful at proper intervals, to cool and moisten the sur-
face with a sponge or cloth, wetted with water, or
with spirit and water, or with spirit alone. By this
method, artificial moisture is furnished, and the heat
retained upon the surface, is quickly evaporated.
In certain cases of malignant fever, where the re-
mote agent is so awfully stimulant, as to threaten a
fatal extinction of vital power, it may often, perhaps
ahvdys be useful in the commencement, not only to
subduct from the natural stimuli of the system, but
also to secure frequent suspension of excitement on
the surface, by copious affusions of cold water. Re-
gard must be had, however, to the subsequent re-ac-
fion of the system. For if the surface long remain
in a collapsed state, some fatal determination upon
the brain, or lungs, or mesentery, might be the con-
sequence.
And here by the way, I would lay down an infalli-
ble rule, by which to judge of the propriety of using
the cold bath.
When the system feels dull and heavy, with some
sense of giddiness of the head, and especially if this
state of things conies on without any known cause,
such as intemperance, loss of sleep, and the like, it
53
may be taken for granted, that there is present, sonic
stimulant agent of considerable power. JJmlcr such
circumstances, the bowels should first be satisfacto-
rily evacuated. Then U the dullness and giddiness
remain, the bath may be tried. If the application be
appropriate, in a few minutes after wiping and pulling
on ordinary cloathing, a glow of heat will be felt on the
surface, and the veins on the extremities will be fill-
ed with blood. But if a collapse of the surface should
follow the experiment, and a chillness long remain
it may be taken for granted, that there is already so
much debility prevalent, that the necessary re-action.
cannot take place. And in every sueh instance, re-
course should be had to the fire, to correct the ill ef-
fects of the intended remedy. When this experi-
ment fails, it would always be prudent,to avoid every
kind of labor or exercise ; in fact, to keep in bed,
until the sickly agent so pass away, or the system so
avail herself of her usual adaptations, as to recover
ordinary strength. But more of this in the sequel.
Having advanced thus much upon some of the
most powerful agents, commonly in use, for the cor-
rection of morbid excitement, I now proceed to no-
tice some of the remedies, which are most valuable
in controuling the system, when debility prevails.
Debility, through loss of blood, is best corrected
by giving immediately, an appropriate dose of opi-
um, and repeating it once for eyory sixth hour.—
Opium is always stimulant, and is durable in its ef-
fects. Hence, also, the danger which almost inevi-
tably attends its use, in cases where too much excite-
ment prevails, as also, when given without previous
and sufficient evacuation in the time of predisposition
to disease. And hence the benefit which has some-
times been gained, when the system by art or other-
wise has been placed in a favorable state. By rous-
ing the energies of the system, and compelling the
whole mass of vessels, with one consent, to perfoi ui
the necessary motion, in the course of a few hours,
the lost balance of excitement has been recovered,
and a severe attack of sickness effectually prevented.
In cases of fever of a low type, small doses of opi-
um, are sometimes indispensable. Here the intenti-
on is to sustain the feeble powers of the system,
whilst she is laboring to bring about the necessary
adaptations, and to enable her to sustain the pressure
of the remote cause of her disease, or to hold up her
sinking head, till the sickly agent pass away. But in
this state of things, the greatest circumspection is
necessary to guard against an unappropriate produc-
tion of excitement. All avoidable filth must be re-
moved, the intestines must be continually kept in pro"
per condition, and the most suitable nourishment re-
gularly supplied, such as the best wine, tapioca, sago,
whey, soup, &c.
60
Other stimulant articles, less durable and power
ful in their effects, are sometimes also found useful
and necessary, such as essence of pepper-mint, com-
pound spirit of lavander, gum camphire, Virginian
snake-root, Russian castor, vitriolic ether, volatile
salt, &c. Each of which, is to be preferred, accord-
ing fo the particular state of the case. If the disease
have been produced under circumstances which in-
duce great exhaustion of vital power, opium is gene-
rally inadmissible, whilst some one or more of those
articles, which are less durable and more diffusive
in their effects, are absolutely necessary. On the
contrary, if debility be induced under circumstances
which mark the presence of accumulated power, opi-
um is one of the best agents yet known in the medi-
cal world.
Blisters, rubifacients and sinapisms, have also
been found highly important in maintaining a centri-
fugal determination of excitement, as often as very
great debility prevails ; as also in abstracting from
any point of irritation, by exciting an equal or great-
er degree of irritation upon the surface. It has been
hinted in the preceding part of this work, that pain
has influence in extinguishing vital power. This is
true, but when a degree of pain is excited, by an ir.
ritating cause, which is not sufficient to overwhelm
the rising energies of the system, it often serves no
other purpose, than to invite a long continued and
distressing determination of vital power upon the part,
61
Hence it is, that when blisters ate much needed in
the decline of fever, a small application, will do xevy
little good towards balancing the system, whilst they
produce the most troublesome effects. The blistered
part often becomes inflamed, and is very difficultly
healed. Whereas a large blister, say eight by ten,
or ten by twelve inches, very commonly extinguishes
any superabundant stock of vital power, secures a de-
termination of excitement, to the surface, and termi-
nates the disease. Some remarks explanatory of this
association of appearances, which constitute what
physicians call the blistering point, will be made
when I come to state the method of curing a case of
inflammatory fever.
Cixcos.v or Peruvian bark, vitriolic acid, and all
the train of tonic agents, act as stimuli on the sto-
mach, and rouse the arterial system, at the same
lime that they effect an expenditure of vital power.
Stramonium and cieuta, of the vcgitable kingdom,
and arsenic, lead, and cuprum ammoniacum, of the
mineral, appear to extinguish vital power, without
effecting any very evident increase of vital motion.
Iron, in all its various shapes, produces an in-
crease of excitement, and if given in any case where
inflammation prevails, or where disease has located,
itself, it is universally pernicious.
62
Heat is a very powerful medical agent, and ad-
mits of a more universal application than any other
yet discovered. I have said that heat is the necessa-
ry and universal ally of life.* This view of the sub-
ject, will meet the approbation ef every man of com-
mon sense. In explaining the appearances attending
a pleurisy, I have attempted to prove, that there must
necessarily be a deficiency of heat, in every instance
where there is a deficiency of excitement. Facts may
be adduced, affording irresistible evidence of its
truth.
Having tried the experiment an hundred times over,
without meeting with one exception, I assert that in
every ease of fever with exhausted energy—and in all
cases of direct debility, artificial heat in an appro-
priate degree, brings pleasurable sensation to the pa-
tient ; and may be so managed, as to produce cordial
effects. I will add, that in almost every case of pre-
disposition to fever, it may be pleasantly and usefully
employed.
In all cases of debility, whether directly or indi-
rectly induced, there is a prevailing inclination to an
introversion of exeitement. Heat applied to the skin
most effectually counteracts this tendency, and pro-
motes a centrifugal determination. When the sur-
face is abandoned through want of excitement, the
skin collapses and seems to lose its natural elasticity.
* See a note, under the cure of typhus fever.
65
Heat artificially applied, corrects this inconvenience.
In some instances it may seem at the first to produce
a transient effect only; but by careful and well timed
repetitions, it will at length become durable. The
system artificially replenished with this principle, is
presently enabled, to generate a more competent sup-
ply for itself. Hence it is, that in every case of
debility, it acts as a cordial, and produces manifest in-
crease of hilarity. But as an excessive portion of
wine, or any other cordial, might stimulate too much,
and induce a morbid degree of indirect debility, so
also an excessive application of heat, might produce
similar effects. In all such cases, therefore, special
regard should be paid to the feelings of the patient.
There are some remarkable aud important advan-
tages attending the use of this cordial, which no other
can possibly claim. In every case, where properly
used, it produces a full effect, without imposing any
improper stress upon the central vessels. So that in
securing the most pleasant diffusion of excitement, it
offers no injury to any of the organs of life ; ordina-
ry cordials, on the contrary, are dependent upon the
struggle which they may excite in the heart and
central vessels, for any and every centrifugal effect
Which they may produce.
Again, at the same time, that heat by its stimulant
power, invites excitement to the surface, it softens
*snd expands the kin, in a way preparatory to receive
the returning the blood. Ordinary cordials must ae-
64
complish the effect, by compelling the feeble system}
if indeed it can be done, to assume an action suffieU
ent, not only to resume all those branches which it
had abandoned, because it was not able to maintain
them ; but also to overcome, all the power of the
common enemy, that is, all the resistance of an al-
most lifeless collapse of the vessels on the surface,
possibly one fourth part of the system.
It is true, there have existed insuperable difficult
ties, to forbid the use of this agent, by any method
heretofore known. But by the aid of my portable
apparatus, any such difficulty is now perfectly cor-
rected, and the application of heat can be made with.
such precision, as fitly to meet the most accurate in-
tention.
I have said, that "in maintaining excitement, vi-
tal power is expended''—and of course that« cxtraor.
dinary excitement, must produce a preternatural ex-
tinction of vital power." In any case of predisposi-
tion with accumulated power, therefore, it must be a
very important acquisition, to have a remedy at hand,
with which, such expenditure can be speedily and
safely accomplished. Heat is this agent. By rais-
ing an intense degree of excitement on the surface,
every necessary effect can be produced, with the ut-
most safety. This is sufficiently evinced, by the
foregoing remarks, upon the influence of heat in a
summer's day.
I have said that pain also has a considerable effect,
in expending vital power. By an intense degree of
65
the pain of heat excited on the surface, together with
the concomitant increase of excitement in the vessels
of the skin, most instances of pre-disposition with
accumulated power, may be certainly and safely cor-
rected. It is known, that the skin is not easily in-
jured in this way, and the strong determination to the
surface, which is secured by this method, most effec-
tually guards the system after the process is ended.
Again, other powerful remedies when once admi-
nistered, are gone beyond the reach of controul, and
must have their full effect, whether judiciously or in-
judiciously administered. But if too much heat has
been administered, it is perfectly within our reach,
to check its influence, by an immediate application
of cold. Besides, if it should be found on trial, that
through the influence of heat, the blood-vessels are
too much excited, blood-letting may almost univer-
sally be safely employed, to correct this effect.
Again, in cases of gout, rheumatism, spasm, colic,
&c. when there is a morbid determination or location
of excitement, heat affords a safe agent, by which
to correct the determination of power, and maintain
a sufficient degree of excitement on the surface, till
the system shall succeed in obtaining a balance.
There is one other circumstance which so imperi-
ously requires the use of this agent, that it must not
be omitted.
After debility has long prevailed in the system, by
whatever cause it may have been induced, the col-
lapse of the vessels of the surface becomes so obsti-
66
nately fixed, that in iuany cases, no agent heretofore
known, has been found sufficiently powerful to effect
its correction. In obstinate bowel complaints, for in-
stance, the skin is universally dry and hard, as if its
vessels, which in their natural stale must necessarily
be tubular, had shrivelled and become impervious.—
The skin, therefore, loses its elastic feel—becom es
habitually and obstinately pale, and through its pri-
vation of circulating blood, is disarmed of its power
*o resist the cold.
When things have remained a long time in this
condition, another additional mischief is done. As
the system, in its astonishing powers for adaptation,
can effect the return of the whole stream of arterial
blood, sent into an amputated limb, though robbed of
all its ramifications, below the point of amputation :
As it can enlarge the lesser branches of the artery
when by the operation for an aneurism, one of its
principal trunks is divided, and a part of it removed;
so also the arterial blood, destined for the support of
the surface, will ultimately find a return by a shorter
passage, and the skin will be left never to be reco-
vered, but by some extraordinary agent.
It may perhaps be feared, that a frequent use of
heat, the only remedy upon which any rational calcu-
lation for a correction of this error can be made, may
induce debility. My experience warrants the asser-
tion, that the contrary is true. An excessive per-
spiration induced in this way, as well as in any
other, might have this effect, but an appropriate apr
67
plication always invigorates, increasing hilarity. A
lale truly valuable publication on Surgery, by Dr.
Dorsey, of Philadelphia, volume 2d, page 29th, fur-
nishes a qoulalion which gives strength to my asser-
tion. " The warm bath" says he, " is used with
views, partly analogous to those, which guide the
practitioner in the employment of venesection. It in
duces a state of faintness and relaxation, under which
the reduction may be attempted with advantage. The
weakness produced by this remedy, is temporary, and
is not attended by any subsequent debility."
By the bath, though performaned with water,
there is no loss of vital fluid. A preternatural ex-
pansion is given to the vessels of the surface, and by
heat they are stimulated into increased action. The
circulating blood is invited from the centre to the
skin. The intestines, therefore, by being partially
deprived of excitement, are for a time relaxed.—
And when the bathing is ended, the blood again re-
turns to its natural equilibrium, without any subse-
quent inconvenience. And if no consequent debil-
ity is to be feared, when the bath is of suffici-
ent temperature and duration to produce relaxation*
surely there can be no danger from a judicious ap-
plication of the remedy in any\case.
It should be remembered, however, that when
there is an extensive congestion, the vessels involved
in the centre of such an almost lifeless mass, must
be very partially supplied with excitement. A sus-
pension, or a great diminution of action, therefort,
68
whether produced by blood-letting, or by abstraction,
might induce a speedy gangrene. But in all such
alarming cases, none but a skillful physician, can be
a competent judge of the proper method of treat-
ment.
Having taken a view of such medical agents, as
more particularly concern my work, I now proceed
to give some additional practical observations, in a
review of the same grades, which are laid down in
the foregoing explanations.
And first, inflammatory fever in the form of an or-
dinary pleurisy, is ushered in by a predisposition with
accumulated power. It occurs in the healthful sea-
son. Aud cold alone, or cold combined with fatigue,
may almost exclusively be considered as the remote
cause.
In this, and indeed in every case, it must be the most
desirable object, to avoid the predisposition. And the i
more especially so in this, because in all ordinary
circumstances, it is absolutely practicable. For this
end, it is necessary to guard against too much expo-
sure to the weather, especially if damp and moderate-
ly cold. But if such exposure is inevitable, the sys-
tem should be supported by a comfortable meal.—
And for a day or two, cider, wine, and ardent spirit
should not be used, except by such as are in daily ha.
bits of using them*; and at night, before going to
rest, special care should be taken, to secure an effec-
* A very pernicious habit this, which ought to be abandoned.
69
tual warmth at the fire. If, however, ordinary mea-
sures fail to produce a glowing excitement on the sur-
face, or if an unusual length of time is required, to
become warm in bed, on a nice inspection, it shall be
found, that a collapse of the skin has already taken
place. The roots of the hairs will be elevated, in a
way resembling the skin of a goose plucked of its fea-
thers, and a ligature tied on the arm, as in ordinary
blood-letting, will not distend the veins. These appear-
ances universally indicate a forming predisposition*
If a stretching, yawning and chilliness, with a dull
or heavy aching in the loins and limbs attend, the
predisposition is complete ; and without the interfer-
ance of art, a fever may be confidently expected.
To correct this state of things, let the patient re-
tire to bed, and receive an intensely hot bath. The
pain of heat, and the increase of excitement upon the
surface, in most instances, will sufficiently extinguish
the accumulation of vital power, to restore a balance.
It sometimes happens, however, in making this ap-
plication, that, although a favorable determination
is given to the excitement, yet in consequence of the
great accumulation of power, too much stress is im-
posed upon some one weak point. In most instances,
th e brain, through the delicacy of its organization,
is first sensible of this kind of increased action. If,
therefore, the bathing produce considerable head-
ache, whether a predisposition is readily induced or
not, blood-letting ought to be performed without de-
TO
lay.* And at the close of the process, some suitable
cathartic should be administered, as jalap and calo-
mel in robust cases, or calomel in a moderate porti-
on, followed by some agreeable cathartic dose, in ca-
ses which are more delicate.f
Sometimes too, when the accumulation is very
great, a single course of treatment, is not sufficient,
completely to remove the predisposition—-when this
is the case, more or less of the symptoms stated above,
will still be felt, the next one or two succeeding days,
and will mark the necessity of a repetition of the
practice, with more or less decision, and repetition,
as the case may require.
These instructions respecting the correction of the
predisposition, are the more important, because it is
within the reach of the most ordinary capacity, to
understand and execute, all that is necessary, for pre-
venting an attack of inflammatory fever. Whereas,
after the fever is formed, it may sometimes require
the most accurate judgment, to manage the patient
in safety. To the people at large, the superior im-
portance of my system, will be evident, chiefly in this,
and this chiefly concerns the public. Who, in his
* It is commonly prudent, in robust cases, to let blood about
the time the bath is fairly getting into operation.
f In robust cases, say calomel, lo grs. jalap, 15 to 30 grs.—
I» delicate cases, calomel, 4 to io grs. and oil or some other
suitable article three hours afterwards.
71
senses, will suffer a painful course of sickness to come
upon him, when it may so pleasantly and certainly be
prevented ?
If, however, through neglect or accident, the fe-
ver should be formed, the symptoms heretofore des-
cribed, as marking the state of predisposition, will be
more evident. The chilliness will increase, and be at-
tended with a pain in the back and limbs, and with
difficult and quick respiration, thirst, &c. If these
appearances are not immediately corrected, a pungent
pain commonly will strike the breast.
At this stage of fever, blood-letting is a practice
perfectly philosophic, and ought to be repeated,
as often as the pain returns. In performing this
practice, if the veins do not fill on tying on the liga-
ture, the patient should first be placed in bed, and the
bath put into operation. When the veins begin to
fill, blood may be let, until the pain abates, and the
bathing may be continued until a free perspiration is
induced. Some suitable cathartic as in the predis-
positio n, may be administered, and the patient may
take half an ounce of a cooling solution once every
third hour.* Early the next morning, the bath may
be again put into operation, and the cooling solution
may be continued. And as often as the fever rises,
and the pain returns, the same treatment may be re-
* As a cooling solution—Take fait petre, 40 to 60 grs. cream
of tart. 60 to 90 grs. tart, emetic, 3 to 6 grs,, water, o^e pint 5 a
table-spoon full is the ordinary dose,
72
peated, with some diminution in extent and seve-
rity, according to the abatement of the disease.—
Where this mode of practice is judiciously employed,
the most satisfactory result will rapidly take place.
I have frequently cured a forming pleurisy, by a sin-
gle course, that is, in twenty-four hours. But that
kind of accuracy, which always makes the best prac-
ticable defence, requires some experience, in as much,
as it considerably depends upon an intimate acquain-
tance with the pulse. Such, however, is the accumu-
lation of power in this grade of fever, that after se-
curing a centrifugal determination to the excitement,
blood may be let, till the jjpainful symptoms abate,
without any hazard. To the physician, I would say,
that blood may be let till the tension of the artery-
subsides—until the morbid excitement is sufficiently
subdued.
By blood-letting, febrile action is subdued for the
ime being. By pain of heat, and increase of excite-
ment on the surface produced by the bath, the sys
tern is safely and pleasantly disarmed of its accumu.
lated power. By the operation of a cathartic, and
the subsequent use of the cooling solution, the heat
and central vessels, are continually disarmed of any
excess of vital power. And by maintaining a balance
of excitement from the commencement of the cure
the necessity of blistering is avoided.
If the disease is not much corrected by this kind
•f management in two or three days, a physician
4 a
should be eallcd in, as greater accuracy might after-
wards be required to finish the cure. But in all or-
dinary cases, it will produce decisive effects in the
course of two or three days, and therefore, if very fa-
vorable appearances do not take place in that length
of time, it may be concluded with certainty, that the
case is really a bad one—that the lungs are much in-
jured,and that severe blistering and accurate manage-
ment is necessary for finishing the cure. In this
event, the blisters which may be applied, should be
made to abstract from the internal irritation, to an
extent commensurate with the severity of the disease.
The blister should be large—if a grown person, say
eight by ten, or ten by twelve inches square.
And whether the case should assume such serious
appearances or not, the same course of treatment
should be continued, taking care, from time to time,
to adjust the quantity of blood to be lost, an4 the ex-
tent and severity of the bath, to the strength of the
patient.
The ordinary practice in this grade of disease is,
to let blood without taking any adequate measure to
disarm the system of its accumulated power. It fol-
lows, therefore, that after a little, she rallies herself,
and a second or third—sometimes a fourth bleeding
is found necessary, in the course of the first twenty-
four hours. The cause which makes such repetition
necessary, is obvious. Almost an entire dependence
is placed upon the loss of blood, for a twofold intent!-
K
n
on,- that of putting down the morbid excitement, and
that of disarming the system of its accumulated pow-
er. As if the principle » that by a subduetion of
stimuli, vital power or excitability is accumulated,'*
were entirely forgotten, A fortunate circumstance,
however, has saved the lives of thousands, who other-
wise must have perished, through the destructive
tendency of such absurd practice. A blistering point
is discovered ! Happy discovery. , Let me enquire,
therefore, what it is, that constitutes the blistering
point ?
By the loss of blood, as often as the energies of the
system are sufficiently rallied to produce a paroxism
of fever, the action of the healthful vessels is reduced,
so that for the time, the power with which they pro-
pel the blood into the weakened branches, is not suf-
ficient to increase the disease. The injured vessels
therefore, have an opportunity given them, to reco-
ver their natural state, and appearances are very
flattering. After four or five days, however, and
sooner if the blood-letting be too much extended, it is
commonly found, that those happy effects, which at
first accompanied the loss of blood, are no longer pro-
duced. For the moment it may reduce the action?
but presently every ill appearance recurs—the pulse
contracts its diameter, and becomes more frequent;
the tongue becomes dry; the skin sallow; and the
extremities hard, dry, and hot; thirst increases ; ex-
pectoration is more scant and difficult; and the pati-
ent grows more and more restless. To me the cause
7B
of all these distressing appearances is plain. A
state of things similar to the predisposition, is arti-
ficially induced. By every repetition of blood-letting,
the action of the system is reduced more and more
below par; till at length, a collapse takes place to
such an extent, that nothing short of an application
to the skin, of a sufficient power to produce and main-
tain a centrifugal determination, can possibly save
the patient. When this state of things is obviously
threatened, the practitioner has arrived at the blis-
tering point. A point at which he ought never to ar-
rive, if he can possibly avoid it; in as much, as it
universally implies a loss of the balance of excite-
ment. Not that I would be understood to say, blis-
ters arc useless, and may be wholly laid aside. But
they should be wholly confined to an intention, either
to correct a very obstinate morbid determination,
or to abstract from great irritation. And if the
system be properly managed from the commence-
ment, the blistering point will not be found, ex-
cept only for one of these two purposes. Similar
management, with some additional considerations,
will be proper in every form of inflammatory fever.
Pheenitis, or inflammation of the brain, is known
by a violent pain in the head ; an inability to bear
light or noise ; great restlessness, together with the
ordinary appearances of disease, as already noticed in
inflammatory fever.*
* In this form of difeafe, the pulfe is fometimes fa fmall, that
an ordinary jud ge might doubt the propriety of letting blood,
f6
In this case, blood should be let freely, and as of*
ten as the violence of the symptoms make it necessa-
ry. Measures should be taken for maintaining the
surface, as in pleurisy, observing to defend the head,
by making cold applications as frequently and as ex-
tensively as it may be found agreeable to the patient,
especially, during every application of the bath.—
Drastic cathartics should be daily administered. And
in cases of great violence, the intestines should be
continually under their influence for two or more
days.* The feet of the patient should be kept care-
fully warm, and if the pain be obstinate, a large blis-
ter should be drawn upon the back of the neck.—
Ljght should be excluded, and silence constantly ob-
served. In every case of this description, so soon as
it is ascertained that a few repetitions of blood-let-
ting, bathing and cathartics do not bid fair to subdue
the disease, a physician should be called in without
delay.
Hepatitis, that is an inflammation of the liver
may be known by a dull pain on the right side, under
the shorter ribs, extending into the right shoulder j
sometimes affecting both sides, and felt in both shoul-
ders, with great costiveness and dejection of spirits.
* Aloss, 60 grains, gamboge, to grains, calomel, 20 grains.
The whole may make 24 pills j 3 to 6 may be given once in 6
hours, according to the violence of the cafe.—To be followed
by a dofe of oil or fome gentle cathartic when difcontinued.
/ I
Other appearances are such as commonly attend
simple inflammatory fever, except that the pulse is
commonly less tense, and the appearances generally
less violent.
In this case the treatment will also be similar.__
But the blood-letting will not he as frequently neces-
sary. The same kind of drastic pills noticed in the
preceding clause, will be highly useful, to be daily ad-
ministered, as long as there is occasion. If the vio-
lence or obstinacy of the pain makes it necessary, a
large blister should be applied over the region of the
pain ; and calomel should be freely used after the
manner heretofore laid down.
In gastritis, or inflammation of the stomach, as al-
so in enteritis, or inflammation of the bowels, the su-
perior value of the hot bath will always be evinced.—
In these cases, the stomach commonly rejects every
kind of medicine, whilst an alarming abandonment
of the surface, and a corresponding violent introver-
sion of excitement, are threatening speedy destructi-
on. That affection commonly called bilious cholic
may properly be introiluced here, as an instance of
inflammation of the lower intestines, requiring simi-
lar management. The application of intense heat to
the surface, together with a repetition of blood-let-
ting, as often as the pain makes it necessary, aiding
the intention with appropriate doses of calomel, re-
peated every sixth hour with mild injections at the
close of each period $ the cure will commonly be ef-
¥$
fected in a short time. If it should be protracted,
however, and especially if the vomiting or pain should
be obstinate, a large blister should be applied over the
region of the stomach or abdomen.
These reflections upon inflammatory fever, are pre-
dicated upon the supposition, that they occur as the
primary affection, and of course, as having been in-
duced through a predisposition with accumulated
power. But it sometimes happens, that these appear-
ances take place, as symptoms of fever, in different
seasons of the year 5 whether ushered in with pre-
disposition, with exhausted or accumulated power.—*-
It is, therefore necessary, in every instance, to mark
well the quantity of energy which may be present in
the' system, and to adjust the treatment accordingly.
If the quantity of vital power be nearly or quite en-
tire, the treatment should always be decisive. If
there be some degree of prostration, the manage-
ment must be more delicate, as prostration is ex-
tended.*
Intermittent fever, probably has for its prima-
ry remote cause marsh miasmata, which partially
* By ufmg the necefTary vigilance in blood-letting, and other
evacuations, it may be known, whether the fystem generates vital
power in ordinary quantity. Speedy and fprightly re-action af-
ter depletition, always indicates a goodly stock of vital power.—
Depletion followed by a languid pulfation, a collapfed furfacc
and emptinefs of the veins, always evinces an exhausted state of
the fenforium.
f9
disarm the system. The disparity of temperature
between the nights and the days, may be a secondary
remote cause, hastening the production of an accu-
mulation of vital power. Probably vernal intermit-
tents occur in some regions, under the same circum-
stances which produce violent pleurisies in others.—
80 that, whatever other considerations might be as-
sociated with our views of an intermittent, cold has
the most considerable agency in its production.
To prevent the formation of a predisposition to an
ague, therefore, good fires should be kept up every
night, throughout the whole year. The poor Afri-
cans upon our southern rivers, reap the benefit of this
precaution, whilst their masters suffer all the pains of
annual intermittents.*
If, however, such simple means fail to prevent the
formation of the predisposition, the patient coming
under its influence, will have an inclination to yawn
and,stretch ; he will experience some aching in his
back and limbs ; his nails will put on a livid hue, and
his skin and veins will exhibit appearances sufficient-
ly indicative of that collapse, which always attends
the forming slate of fever. He should then be im-
mediately put to bed, and receive a bath of sufficient
extent to correct all these appearances. And this
* Some masters efcape, not by the kindly influence of culinary
niir, but through the deadly agency of {ardent fpirits. The
effect for the moment is similar. But oh ! their end ! their
dreadful end !
*u
should be daily repeated, till such appearances ceasts
to return. If, however, any of the symptoms in-
crease upon the use of the bath, the patient should
be bled, and take a dose of jalap and calomel, or ca-
lomel alone, and after the operation is over, the bath
should* again be used and repeated, as often as the
ease may require*
When no sufficient defence is made for the correc-
tion of the predisposition, and the fever is actually
*ormed, the time of its accession should be anticipa-
ted, by the use of the bath, an hour or two before
the commencement of the ague, to be managed as
above advised. In this form of fever, there is a dai-
ly production of the predisposing eircumstanees, and.
therefore, a proper use of the bath in the time of the
intermission, will have an effect, similar to an effort
to prevent an attack in the first instance of predispo-
sition.
To correct the chilly state, when actually commen-
ced, the bath should be put into operation, and so
soon as the surface is sufficiently heated, to gain the
advantage which may be derived t* the pulmonary
veins through the laws of association, blood may be
drawn from the arm. By a diminution of the vo-
lume of blood returning to the heart, together with
the sudden debility which this practice brings to the
heart itself $ the impulse of blood into the pulmona-
ry artery is diminished, at the same time that the
action of the pulmonary vein is increased. A free
81
circulation through the longs, is speedily produced,
and the chill immediately passes away.
If the bath and cathartic medicines fail, wine and
bark* in the usual way, may be used in time of the
intermission, which, under such circumstances, will
almost universally succeed.
Remittent fever, perhaps occupies an interme-
diate grade, between simple inflammatory and con-
tinued fever. The predisposition is induced by the
heat and poisonous gasses, prevalent in the summer*
These as remote causes, induce debility. Cold indu-
ces a collapse on the surface—and that accumula-
tion of power is thrown upon the central vessels, by
which the storm of fever is raised. The more sud-
denly it is brought about, and the more robust the
patient, the nearer the appearances will be assimila-
ted, to simple inflammatory fever, and the contrary.
The predisposition to this grade of fever may be
prevented by avoiding all excess of labour, diet, loss of
sleep, &c, and by warming at the fire every morning
and evening. After the predisposition is formed, or
the fever has actually commenced, the same princi.
pies and precautions are to be observed, which have
* Perhaps the following is the beft general method of taking
this article :—bark, 1 ounce j cream of tartar, 1 ounce : pow-
dered cloves, 1 dram and a half j ground together, and divided
into eight dofes. Four defes a day, to be taken in time of the
intermiflion.
82
been stated above—remembering only, that as there is
greater precaution, less depletion can be safely borne
than in inflammatory fever. And that the degree of
decision should be regulated, by the violence of the
symptoms in every case.
Bleed and bathe—or bathe and bleed—or bathe on-
ly ; according to the urgency of the case, and the
stale of the surface. Then give calomel and jalap,
or calomel followed by a dose of oil* every day, if
necessary, till the symptoms abate. Afterwards use
the bath in the morning, and a gentle cathartic in the
course of the day for two or three days, gradually
laying aside the practice as the symptoms disappear.
Costixved fever, is ushered in, by a predisposi-
tion, which differs from that of a remittent fever, in
nothing, except only, that the exhaustion of vital
power is greater. The same management, therefore,
will be proper to prevent predisposition, and the treat-
ment maybe similar for curing the fever when form-
ed, remembering only, that there is less necessity of
blood-letting in this, than in the former case—and
that drastic cathartics for the same reason, are not to
be as frequently used.j Thirty drops of the spirit of
* When oil is offenfive, any other gentle dofe may be prefersed.
■j- In this, and fome inftances towards the clofe of remittent fe-
vers, the following is a proper cathartic dofe :—rheubarb, 25
or 30 grains ; manna, 2 drams ; Rochelle or glauber falts,
* drains. The whole for one dore, for a grown perfon, to be
J'nrolved in a little hotwat"-\
83
nitre diluted with a little cold water irw»:y be given
once every second hour, and plentiful dilution such
as chicken water, table tea, apple water, toast and.
water, &c. may be constantly used at discretion.
In this grade of fever, the bath should be used eve-
ry morning, but not often with an intention to pro-
duce a profuse sweat. A very gentle perspiration is
all that is necessary. The same may be repeated at
night as often as it is agreeable to the patient.
In remittent and continued fevers, it sometimes
happens that determinations take place, threatening
injury to some of the vital organs. If this should
happen, and continue after using the bath a few
times, a large blister should be drawn, for the rea-
sons heretofore stated.
Typhus fever is the most distinct exhibition of
disease, consequent upon a predisposition with ex-
hausted power. In this form of fever, debility so
prevails, and the abandonment of the surface is so
complete, that the skin is almost left without a sup-
ply of blood. The eye-lids of the patient are not suf-
ficiently expanded to cover the eyes—the skin ap-
pears to cleave fast to the bones of the sternum or
breast, and the surface generally, is dry and husky.
The narrow limits to which the feeble excitement is
reduced, are scarcely sufficient to expend the slow
production of vital power, and determinatious upon
the muscles, evinced in nervous twitchings, or wild
mental effort, in form of a delirium, are employed by
84
the syster»> to maintain an equilibrium. The heat
whick is collected and retained on the surface, is ac-
counted for in a preceding part of this work.
This grade of disease, may have for its remote
cause, the pernicious gasses exhaled in a cellar or
prison—or some region of atmosphere more expanded,
sometimes limited to a family or neighborhood—some-
times spread over an extensive section of country.—
It may also be produced by loss of sleep? by exces-
sive indulgence, by unwholesome or insufficient diet,
&c. &c.
The predisposition is attended by unaccountable
debility, great propensity to sleep, giddiness of the
head, an unusual inclination to be near the fire. As
the case progresses, some pain is felt in the back part
of the head and neck, aching in the loins and limbs,
&c. &c. which gradually increase, till the disease is
completely formed.
When practicable, the remote cause ought to be
avoided—when this cannot be done, the patient should
avoid fatigue. Sometimes rest and" composure for a
sufficient length of time, will be completely to correct
the predisposition. But a moderate use of the bath
every morning and evening, would contribute much
towards the certainty of the effect.
After the fever is formed, first administer a mode-
rate bath, then an emetic, followed by a gentle ca-
thartic. Afterwards a daily repetition of the ba(h
85
when necessary." fen occasional w petition of a suit-
able cathartic, cordial drinks, as panada, chicken
broth, wine and water, and to quench thirst, a little
of the spirit of nitre, as before advised. In this and
in every grade of fever, where depletion is not neces-
sary, a large blister drawn on the region of the sto-
mach frequently contdbutes to hasten recovery.
-.__.___r-.-^j| •;',;• mgrrw— -—
Having thus given, a general view of disease—to-
gether with some instructions, for the formation of a
proper intention, in attempting its cure ; having said
a few things, respecting the mode of operation, of
some articles of medicine,*and specified a simple me-
thod of applying them, in the cure of fever ; I shall
now drop some desultory remarks, and come to a
conclusion.
* That artificial heat is an important agent, in the cure of fe-
ver with proftration, might be proved by induction, from the
writings of Dr. Ruth. See his lecture upor animal life —
*' Heat," fays he, " is an uniform and active ftimulus, in promo-
ting life. It is derived in certain feafons and countries, in part
from the fun, but it£ principal fource is from the lungs, in which
it appears to be gererated by the decompolition of pure air, and
from whence it is conveyed by means of the circulation to eve-
ry part of the body." But if the whole fyftem is proftrated,
the column of heat decompofed in the lungs, muft be lefs than
natural. In confequence of the feebleness of the excitement, it
cannot be properly conveyed to the remote points of the fyftem.
It muft, therefore, neceffarily follow, that an external applicati-
on of an appropriate portion, will aiford the meft natural aid in
this fituation. In proof of this, it is always agieeable to the
patient.
$6
Yellow fever, is a high grade of morbid excite-
ment, consequent upon some poisonous agent, sudden-
ly produced, and acting upon persons with good stock
of vital power. After the necessary depletion, the
hot bath has been found beneficial, and I would ex-
pect great advantages from it, if administered upon
the principles which I recommend.
Gout and Rheumatism, are the result of morbid
determinations upon the joints, or muscles, or fascia,
or sheaths of the muscles, or tendons. The bath with
or without depletion, according to the state of ex-
citement, will always afford relief. It should be us-
ed so far and repeated so often, as may be necessary,
to receive and maintain, a determination of excite-
ment, upon the surface.
Measles, is a fever of the skin. If it be slow in
coming to a crisis, a bath or two brings it forward.
If it be followed by much debilty, inducing an intro-
version of excitement, similar repetitions made morn-
ing and evening, will maintain the excitement in a
state of balance, till the tone of the system is recover-
ed, and all danger is avoided. The bath in this case,
should never be continued longer than is necessary,
to produce a pleasant degree of moisture-
87
Bowel complaints are instances of introverted
morbid excitement. In these it is all important to se-
cure a return to the surface. The bath will aid in
accomplishing this intention.
Colics, may be the effect of inflammatory action,
or of spasm. In either case, the bath will afford re-
lief. In the one, aided by blood-letting, it diffuses
excitement and lessens the force of the determinati-
on—In the other, it extinguishes the accumulation of
vital power, upon which the spasm or cramp depends.
Art can accomplish no more than three great and
leading intentions. One is to diminish or put down
excessive action. Another is to extinguish any ex-
cess of vital power. The third is to support the system
in any case of debility. A fourth might be added, as
the result of a combination or modification of these,
which is, to correct any morbid determination by se-
curing an equalization of excitement. The great
utility of this powerful agent, must therefore be evi-
dent. And every physician must see, that it will ad-
mit of more universal application than blood-letting
or any other individual remedy.
Varying its degree and duration, according to the
demands of the intention, it will be useful in colds,
catarrhs, croups, asthmas, pleurisies, &c. In cramps,
spasms, colics, cholera-morbus, &c. In nervous
head-ache, and all nervous affections. In habitual
paleness or sallowncss of complexion. In female
ss
complaints of a certain description. In scrofulous
and other glandular and ulcerous affections. In ex-
cessive fatness, and in old age. In £mt, rheumatism
and fever, &c. &c.
In a word, if an excess or diminution of vital pow-
er ; If an increase or deficiency of action, with or
without a morbid determination of excitability or ex-
citement, must be present, in every possible mode of
disease 5 It necessarily follows, that disease itself is
a unit. And, therefore, that there must be in nature,
some great and universal agent, which may be so
modified, as to meet every case. Heat may be so
used. The pain of heat on the surface can safely
extinguish vital power, and thus indirectly diminish
the force of excitement. And in an agreeable tem-
perature, it is an universal cordial. Finally, it can
be made to have an universally diffusive tendency,
and thus correct any morbid determination.
I shall conclude with some additional instructions
for the use of the bath.
In making the application, the bath should most
commonly be placed at the feet j a suitable frame
should be made, to support the bed eloathes, so as to
give the gas a convenient passage all around the body
of the patient. And a sheet of paper should defend
the bed eloathes from being scorched by the heat,
which is considerable at the mouth of the pipe. The
choice of the cup,' and the quantity of the spirit,
should be proportioned, as nearly as may be, to the
89
intended duration and temperature of the bath. In
robust patients, it is commonly safest, to take some
blood, before the commencement of the process. In
any and every case, if it be continued in an intense
degree, and for a sufficient length of time, some throb*
ing of the head will certainly be produced. In deli-
cate cases, it ought not to be pushed up to this pitch.
But the fire should be occasionally extinguished, and
afterwards lighted up, as it may be found agreeable
to the patient.
When the bath is to be a long time continued, as
in cases of feeble and very old persons, the smallest
cup ought to be used. And in most instances it ought
to be repeated once every sixth hour, sometimes once
every third hour.
Sometimes it may be beneficial, to move the ap-
paratus from the feet to the side of the patient, and
so on alternately, as the judgment of the practitioner
will quickly discover.
It is scarcely necessary to observe, that the bow-
els should be regulated by the use of proper medi-
cines, as often as there is need.
It may sometimes happen, in a case of pain in the
breast or bowels, for which the bath may be deemed
proper, that it may produce partial sweating and
temporary ease—but in a little time, all appearances
of perspiration will disappear, and the pain suddenly
increase. This circumstance may be considered as
a certain indication of the necessity of blood-letting $
M
90
which will be found more effectual after the bath than
it would have been prior to its application.
In eases of long standing debility, it sometimes
happens that the bath is scarcely put into operation,
before the patient feds distressing sickness, threaten-
ing danger of fainting. When this happens, let the
fire be extinguished, and give the patient a glass of
wine and water, and when sufficiently refreshed, re-
kindle the bath. After a day or two it will be dis-
covered, that more intcuse heat and greater duration
of its application, will be borne with less anxiety.—
By well timed repetitions of this course, vigor will be
regained by the system and health recovered.
In some instances, when the bath is administered
to patients, inclined to be feverish, without previous
Hood-letting, and especially, when the bath has been
pushed a little too far, an uncomfortable restlessness
is felt. This circumstance, as well as ahead-aehe,"or
any other pain, will commonly indicate the necessity
of blood-letting. Also a proper dose, of some agree-
able pill, should be taken immediately, or some suit-
able cathartic, the following morning.
In ail cases, considerable regard should be paid to
the feelings of the patient. The operation should ne-
ver be continued after it becomes disagreeable, ex-
cepting those cases, in which the intention is, to pro-
duce a profuse perspiration. After having acquired
a proper understanding of the principles laid down
in this work, experience will quickly teach every
other necessary precaution.
THE UNITED STATES OF AMERICA:
To all to whom these Letters Patent shall come.
WHEREAS, Samuel K. Jennings, a citizen of
the United States, hath alledged, that he hath invent-
ed a new aud useful improvement, being .4 Portable
Warm and Hot Bath ; which improvement he states,
has not been known or used before his application -?
hath made oath that he does verily believe that he is
the true inventor or discoverer of the said improve-
ment ; hath paid into the Treasury of the United
States, Thirty Dollars, delivered a receipt for the
same, and presented a petition to the Secretary of
State, signifying a desire of obtaining an exclusive
property in the said improvement, and praying that
a patent may be granted for the purpose :—'these are
therefore to grant, according to law, lo the said Sam-
uel K. Jennings, his heirs, administrators or assigns,
for the term of fourteen years, from the twenty-first
day of January, one thousand eight hundred and four*
teen, the full and exclusive right and liberty of mak-
ing, using, and vending to others to be used, the said
improvement; a description whereof is given in the
words of the said Samuel K. Jennings himself, in the
schedule hereto annexed, and is made a part of these
presents.
In testimony whereof, I have caused these letters
to be made patent, and the seal of the United States
to be hereunto affixed. -
Given under my hand at the city of
W^ff^y^ Washington, this twenty-first day of Ja-
|^ U. S. Ji nuary, in the year of our Lord, one
JT seal. ^ thousand eight hundred and fourteen,
y^-J^Jl^A and of the Independence of the United
States, of America, the thirty-eighth,
By the President,
JAMES MADISON,
City or Washington—To wit:
J do heirly certify, that the foregoing Letters Pa-
tent were delivered to me on the twenty first day of
January, in the year of our Lord, one thousand eight
hundred and fourteen, to be examined ; that I have
examined thesame, andfind them conformable to law ;
and I do hereby return the same lo the Secretary of
State, within fifteen days from the doM aforesaid, to
wit: on this twenty-fiast day of January, in the
year aforesaid.
WILLIAM P1NKNEY,
Attorney General of the United States*.
The schedule referred to in these Letters Patent,
and making part of the same, containing a descripti-
on in the words of the said Samuel K. Jennings him-
self, of his Portable Warm and Hot Bath—
Is an apparatus, which is to be used as a stove and
pipe, to convey the heated gas arising from burning
ardent spirit, to the body of the patient sitting in a
chair, or lying on a bed, couch, sofa or cot, and co-
vered sufficiently, so as to retain the heat, agreeably
to the intended temperature of the hath.
It may be made of tin, sheet-iron, copper or lead,
or wood. A cup of suitable diameter, containing a
proper quantity of warmed ardent spirit is placed in
the stove, the pipe of which is introduced under the
bed eloathes or covering of the patient, the spirit is
then to be set on fire. The gas ascends as smoke
in a chimney, and is conveyed to its destination by
ikb stove.
SAMUEL K. JENNINGS,
Witnesses,
Reuben Peery,
Jko. F. Lamb,
E R R A T A,
Page 30, 3d line of the note, for " maintaining,"
read, " in maintaining.9'
Page 38,2d line of last clause, for « when," read
" where.1"
Page 42, 10th line, for " missentery" read <« me-
sentery."—7 tb. line from bottom, for " this vital pow-
er," read '< vital power."
Page 48, 6th line, for <•'an induced" read " con-
s^dcra6Ie.,,
Page 52, 7th line, for « pernicious," read « most
beneficial."
Page 54, 8th line from bottom, for " actions/' read
" action."
Page 61,10th line, for " tti*/' read <« f/te."
Page 63, lowest line, for " /fee blood," read " blood.'3
Page 67,13thline,for "performaned9' read ' — ■ on gout, rheumatism and
measles, 86
-------— on bowel complaints, colics, 87
Some particular directions in using the bath, 88
Med- Hist.
Wz:
J 5f5>