UNITED STATES OF AMERICA
^  *  .
FOUNDED 1836
WASHINGTON, D. C.
Bl9574 
 
 
E.SSAY
\
EPIDEMICS
OF
THE WINTERS OF 1813 AND 1814,

                   IN

   TALBOT # qUEEN-JUVWE'S COUNTIES


                 IN  THE


          STATE OF  MARYLAND.




                  —  L/
          BY ENNALLS MARTIN, M. B.
     PRACTITIONIK OF MEDICINE IN EASTON, MARTI.AXD.
  I do not contend for my own opinion, but for reason, or what carries the appearance
,f if.                                    Staliger.








               BALTIMORE :

  PRIXIT.D BY JOSEPH ROBINSON, 96, MARKET-STREET.


                   1815. 
 
DEDICATION.
            TO NOAH  WEBSTER, Esq.

 Author ofa" Brief History of Epidemical and Pestilential
                    Diseases,1" Sfc. Sfc.

Sir,
    Believing  as I do, that you have contributed more than
any other man in ancient, or modern times, to develope the
origin, and cause of epidemical disease, I should be greatly want-
ing in due respect, and indeed gratitude, if I did not endeavour
to make suitable acknowledgments for the great advantage I
have  derived from your inestimable " history of epidemical,
and pestilential diseases;" as it must be perceived by all those,
who may take the trouble of reading this piece, that I am much
indebted to you even for the principles on which the following
essay are attempted to be established.
   In the memorable year of 1783,1 commenced the practice of
medicine in this place, with a full share of theory upon medical
subjects, while  at the same  time I was not a little  tinctured
with all the wild and ridiculous notions about contagion  and
infection ;  of course, like all other  young men, puffed up with
themselves, I felt a constant predisposition to  make  all the
facts, which were daily, as well as yearly coming to my notice,
bend  to the theories, which I had adopted, for I really believed
the "principles, and doctrines" of Dr. Cullen, the medical ty-
rant of the  day, as infallible, and as true as  " holy writ."
   When the mind takes a certain direction even in the method
of  curing diseases, and it so happens, and happen it may under
the most absurd practice, that success  attends for a " time, 
IV
 and for a season or  seasons," an established routine, a physi-
 cian of some understanding may forget to reason on causes and
 effects, and even when he does exercise his reasoning faculties,
 he may err in his judgment, because he has not taken the same
 steps you have done  in tracing causes to their proper source.
   Whether I have reasoned correctly, by making theory bend
 to facts, others  will  take the  liberty of judging, however im-
 properly and unfairly ;  being  rivetted  to system,  and conse-
 quently indisposed to believe facts, and principles  founded on
 those facts, as I was, until fatal effects from erroneous practice,
 forced me to relinquish an erroneous system.  Notwithstand-
 ing I had read your history of " epidemical diseases," I might,
 like too many others, have continued to  ridicule you as vision-
 ary, if the  truth had not been  forced upon  me by sad experi-
 ence.
  Contagion and infection, which have  been too generally
 confounded, and made synonymous, have been conjured up in
 all ages, and in every  country, by the learned and unlearned,
 the wise and the foolish, and  made the stalking horse of all
 malignant diseases;  somuch so, that they are sung as lullabies
 to reason, and held  forth as childish bug bears to fear.   If I
 am to be believed  when I  assert with  confidence, what hun-
 dreds and thousands could  have testified to, that the  range of
 the epidemic of 1813, was as accurately  defined  as to limits,
 as an island by the sea, how is it possible, that contagion should
go thus far and  no farther, while a constant intercourse was
 kept up with the adjacent country.
  Though we have to lament the loss of many valuable lives in
 this quarter, for the want of better knowledge, it  must never-
 theless  afford not a little  gratification to you to learn, that a   -
 recent epidemic, has thu6 made its appearance in unquestiona-
 ble shape, winch must contribute to  fix more  completely the
 principles, which you have laboured  with so much ability and
 learning to inculcate; and when I make the declaration, you
 must attribute it to the proper  motive, that it would be the
 means of saving thousands of lives, yearly, if every physician
 in this and every other country, was laid under a moral obliga- 
V
tion to read once every year your " history of epidemical and
pestilential diseases."
  That you may live to hear more of your  usefulness, if it
should please the wise disposer of all human  events, to afflict
the inhabitants of any other quarter of this world, is the sincere
wish of,
          Sir, your candid friend,
                  and devoted humble servant,
                                ENNALLS MARTIN.

Easton, Maryland, January 21,1815. 
 
PREFACE.
   It may be considered rather an unhappy circumstance at-
tendant on the science of medicine, that its practice should be
commenced, and continued under impressions of the correct-
ness of certain theoretic principles, more especially so, if the
physician  should  be so presumptuous as to suppose, his doc-
trines are  capable of standing the test of experience.  The
mind thus  predisposed is  prepared  to  make facts bend  to
theory, instead of founding theory  on facts.  In other words,
under such preconceived notions, the judgment is too  liable to
be perverted by false reasoning from incorrect principles. Cor-
rect practice will ever depend  on a great variety of circum-
stances, but on nothing more than a knowledge of the " consti-
tution" of the atmosphere, which unfortunately can never be
sufficiently understood, until it has discovered its  morbid
effects on the human body in the production of disease. Hence
to establish a system of medical  practice upon the experience
of a course of years, might before the expiration of another
year, be attended with very fatal issue.
  The occurrence of an epidemic  disease in this  town and
county (Talbot, Maryland,) in the winter and spring of 1813,
has proved beyond all controversy, that established systems of
practice, which had apparently stood the test of time immemo-
rial, have been dangerous in the hands of the unwary, and that
being at constant variance  with epidemics, they may become a
double scourge at such a period.   Folly  and wickedness have
destroyed thousands of human beings, but system and emperi-
cism have done more; they have  multiplied the instruments of 
Vll
 death, and destruction ten fold.  Whether the following essay
 will have any tendency to correct some of the errors, which are
 incident to human weakness, in the preservation  of life, the
 author will not be so vain as even to express a hope, much less
 an opinion,  being too sensible of his own  imperfections, and
 liability to err j but  thus much  he will venture to proclaim  to
 the world, that the epidemic of 1813, has freed his mind  from
 the shackles of system.   Having  made  the  attempt to prevent
 or lessen  the  evils, to  which he believes every quarter of this
 globe may become liable, he has some consolation, that, per-
 haps, he may be the humble means, of putting the practitioner
 of medicine on his guard against the hasty  use  of remedies,
 which though they have frequently done much good, they may
 under a change of circumstances, even when the symptoms  of
 a disease are apparently the same, do much harm.  He trusts,
 it will not be deemed presumptuous to use the language of the
 preat Sydenham, when he says, " though the same variety does
 " not happen in all distempers, yet I hope to make  it  plainly
 " appear in the following sheets, that  there are several, which,
 " notwithstanding their being treated of by authors under the
" same name, without any distinction of kind, are extremely
" different," as to their cause, and the effects of that cause on
the human body. 
                          THE

             EPIDEMIC  OF  1813,

In Talbot and Queen Anne's County, in the State of Maryland.
 BEING fully persuaded, that it is altogether impossible for a
 physician, who undertakes to write the history of a disease of
 any kind, but more especially that of an epidemical disease, to
 be instructive and useful, unless he  candidly relate the errors,
 as well as the  correctness of his judgment in its treatment,
 I shall commence  the  account of  the epidemic  of  1813, by
 setting down a few of the first cases, with a faithful account of
 their treatment.
  It is generally admitted, that the whole of the Eastern-shore
 of Maryland, of which Talbot, and Queen Anne's counties make
 a part, is sickly, being addicted every autumn to intermittent
 and remittent fevers; but it was a fact beyond all contradiction,
 that the autumnal months of 1812, were uncommonly healthy.
 During all November, and the greater part of December, there
 was scarcely any thing like disease in Talbot! This great bane
 to human happiness seemed to be bushed to rest.   The whole
 district of country appeared to feel  a state of security,  and
 tranquillity,  so much  so, that if there had not  been a few
 chronic cases of disease; it would  have  been forgotten,  that
 physicians were necessary appendages to society!  It was in
 our attendance  on one of these distressing cases, about the 20th
 of December, that  Dr. Tristram Thomas, and myself fell  into
conversation on the subject of the unusual  healthiness of the
preceding season, and particularly that of the present and last 
10
month, when we were both of one  opinion, that we had never
known a more healthy time.
  On the 24th of December 1812,1 was called to visit Hannah
Martin about 27 years old. late in the evening, eight miles from
Easton. in a southerly direction, who being  the mistress of a
large family, after more than usual exercise on the preceding
day  had gone to betl early, and was taken about 12 o'clock at
ni«ht with a violent ague, which was succeeded as was believed
by as violent a fever with all the common symptoms of pleurisy.
A neighbouring physician  was  called in before day, who con-
sidered the case a plain one, and bled her  largely, to  the quan-
tity of more than a pint.   When I saw  her after night, she
wa  comotose; her face flushed; skin dry and hot ;*  tongue
moist, and  to appearance  as well as in perfect health; pulse
feeble, complained when roused, of nothing except a violent
pain in the head; but upon being interrogated,  and desired  to
make a full inspiration, she said, she  felt  a  pain about the
sternum, and some stricture across the thorax,  as well as a de-
gree of heaviness and fullness there.  At  first  view there was
an appearance of something singular in this case, though I con-
fess I did not from habit, take time to consider it as any thing
new, or extraordinary.   I  commenced the treatment upon the
symptoms, but never thought of deviating  from  the usual mode
in such cases.  As the pulse was such as not to indicate the use
of the lancet, and other symptoms did not seem to call for it, it
was not used at all; but nauseating  doses of vir. antimon. &c.
&c.  were  used freely.  Blisters were  not  spared; and as it
seemed  to be soon indicated, a decoction of bark  with serpentan.
virg. was administered liberally, together  with a sparing use of
wine and toddy. The chamber contrary to my desire, was kept
warm, which, I have not the least doubt,  was a most fortunate
circumstance, as may appear before long.  Her bowels  were
moved with difficulty throughout the whole course of  her ill-
ness, another lucky  circumstance.   She never expectorated
freely, and yet she recovered unexpectedly, though slowly.
* The feet were not attended to. 
11
  On the 25th, I visited  William Brown, a black-smith in
Easton, of very intemperate habits, about  30 years old.   He
had been ill a day or two.   His pulse was full, but neither very
hard, nor frequent; his face was much flushed, and he complain-
ed greatly of his head, and of nothing else until interrogated,
as in the  case of  Hannah Martin, when he said, he had a pain
in his side, &c.  He was rather comotose, but rambled in his
sleep.   His expectoration was inconsiderable, and had nothing
unusual in its  appearance.  Under a consideration of all these
symptoms, I did not hesitate long about taking away hlood'from
the arm, but contrary to  expectation, before I had drawn off half
the quantity at first intended, the pulse sunk, and I found my-
self  under the necessity of stopping  short of eight ounces.
Though I saw him two and  three times daily, I did not venture
on bleeding him  the  next day, but thought myself justified
from the  symptoms,  to venture on a second  bleeding on the
27th, but with the same result.   In the evening of this same
day, he was very delirious ;  stole  out of the house, and wan-
dered on the commons  some time  before  he could be found.
On the 28th I  bled him again, whicli he bore much better.  On
the 30th  he  was bled,  but never  with those pleasing effects,
which I have so often experienced  in former years, and on  for-
mer occasions.  He was blistered on his sides, back and head,
and went through the usual  routine of antimonials, &c. which
are so common in cases of pneumonia in ordinary seasons.  But
after depleting to some extent, and finding my patient sinking,
I reflected on the stimulating habits of the man and did  not
hesitate long, before I saw the necessity of altering my course,
and of supporting sinking nature by a free use of diffusible  sti-
mulus, which,  perhaps,' were  the principle  means of rescuing
him from the jaws of death, though  it might have contributed
to have  confirmed him in old and bad habits.
  On the  29th I was  called on to visit John Burgess, 54 years
of age, intemperate, and  much addicted to the gout, living three
miles from Easton in an easterly direction.   He had been bled
in the morning by a young physician  rather freely;  perhaps,
in a  high fever, but when I saw him, his pulse was hardly per- 
12
  ceptible.   Himself and his wife  thought  he had been taken
  the night  before with  the cholic, but that  could  not have
  been so; for from their own statement, he was taken with an
  ague some time in the  night, and  had been  chilly, and cold
  from that time.  I  thought it advisable to do nothing more
  than give him forty or fifty drops of laudanum, and direct hot
  bricks to be applied to  his feet, and something warm to his
  stomach, where he complained of  some pain; and left him not
  to see him again, unless sent for.  I understood he was visited
  the next day, or day after by some other physician, but too late
  to arrest the hand of death.  The 7th of January 1813,1 was
  called on by one of his neighbours t© visit Thomas Custallo,
 eight miles from Easton, directly north, but found him  dead.
  I understood be had  been  sick only three or four days, with a
 pleurisy, and that he had been bled more than once. No doubt,
 this was a case of the epidemic.
   On the 14th, I saw a small boy, son of the late John Burgess*
 His face  was much  flushed, his fever was  high, and he com-
 plained very much of his head; and a little of his side when
 desired to make a full inspiration.   I  bled  him, and gave him
 some  antiinonial medicine, and though the pulse  sunk, while
 the blood was flowing, he soon recovered without any further
 medical aid.
   On  the 15th, I visited John  Higgins in Easton.  He was
 taken the night before, with an ague succeeded by a fever, pain
 in his head, side, and all the ordinary symptoms  of  pleurisy,
 and yet he repeatedly expressed an opinion, that though  he
 had been addicted to the  pleurisy almost every winter or
 spring, yet nis feelings were different   from  any thing  which
 he had experienced before.  I did  not bleed him immediately,
 but determined to wait for  the  bleeding point, and then was
 disappointed as to the happy result, for  his  pulse evidently
 sunk before I had taken as much blood,  as the occasion seemed
 to require.   For two successive days I  bled him, and went on
 with nauseating doses, blisters and anodynes at bed-time, not
thinkingvense sectio indicated a<ain, before the 20th, when he
expressed relief, before the arm was untied. On the 7th day from 
13
 the first attack, he complained of a pain in his ankle, which was
 succeeded by severe inflammation, when all the symptoms of
 pleurisy gradually went off, and his whole attention was direct-
 ed to his ankle.   The inflammation  terminated  in resolution.
   On the  16th, Robert Huzza came  across the street from his
 house about 10 o'clock at night, requesting me to see his wife.
 She  had  been taken the night before with symptoms, which
 were beginning to be familiar to several families,  though  not as
 yet alarming.   Mr.----was called in because he could bleed,
 and  give calomel and jalop.   She was bled in  the morning.
 and  took calomel and jalop, which operated violently. She
 ceased to exist long before the beginning of another day.—
   About  this  time the alarm  began to spread,  not more  on
 account of the death of liobert Huzza's wife, than from several
 other sudden  deaths in Easton, and its vicinity.  Bleeders
 were called in as soon as a patient was taken ill: more parti-
 cularly  as the disease assumed  scarcely any other type, than
 that of pleurisy ;  and as the lancet had been proved on former
 occasion  and  seasons, it was expected it would  retain its vir-
 tues, but  alas!  all things are uncertain in  this world, and
 nothing more precarious than a remedy, which is administered
 without caution,  and without judgment.  This  is proved un-
 fortunately on ordinary occasions, but the history of epidemics
 ought to be a lesson  to physicians, who ought to use the lancet
 with fear and trembling, whenever the seasons usher in  a dis-
 ease of any type whatever.  Though this  epidemic fever had
 been stalking  along in formidable disguise,  it had  until now
 been productive of but few deaths, and I can assert without a
 fear  of contradiction, that the numbers would  have been much
 fewer, if  the lancet had not been " wielded by  chance," and
 not by the steady hand of judgment.   When I was called to a
 patient about this time, I was too often mortified  to find, that
 any  judgment, which I had acquired  from experience, was
rendered  useless by an  indiscriminate  use of the lancet,  or
a dose of calomel and jalop, which continued to be the first and
last resort, notwithstanding deaths were multiplied every day, 
14
  and few recovered,  who  were  attacked  violently.   I will
  candidly confess, that though I  was staggered in my un-
  bounded confidence in the lancet, yet like  all others wedded
  to  system, I continued to use it in almost  every case, which
  seemed to indicate it, but with caution, and due reflection,
  aiming like Dr. Rush to hit " the  bleeding point" both as to
  time, and quantity.   Like others I plunged along through all
  January, and a great part, of Febuary, before I could be induced
  to consider this  unrelenting disease as an epidemic sui gene-
  ris, differing in  its origin,  and effects on the human system
  from every other disease, which had appeared before  in this
 part of the country, but not unlike a disease, which had recent-
 ly made its appearance in several of the New Eno-land states
 exciting alarms, and proving in too many instances malignant
 and mortal.
   When this Epidemic commenced its career  in December
 1812, it was in the type of Pneumonia, and  continued so with
 very little variation, (if my observation was  correct, and I am
 confirmed in it by the testimony of the most  experienced phy-
 sicians  in  Easton)  through  all January, down to the 20th of
 Febuary, when for the  first time, and in the first case in that
 neck of land,  I was called to visit William Blake, over  Miles
 River Ferry, who had been taken the night before with an ague,
 succeeded by a fever, and sore-throat.   It was then snowing,
 and  blowing most dreadfully, which with the risk of crossing
 the ferry deterred me  from visiting him until the next day,
 when I fonnd him in a smart fever, and labouring under all the'
 other common symptoms of synanche tonsillaris.  I was told
 he had got a neighbour to bleed him the preceding evening, and
 thought himself relieved by it.  I repeated the same remedy
 and directed a dose of salts to be given in divided doses, pro-
 mising to see him the  next  day, when I  was mortified and
disappointed to find him much worse !  His  tongue was now
 so much swelled  as to  be protruded out of his mouth.  Yet I
did not despair of affording him speedy relief having seen se-
veral such cases, as I conceived, happily terminated by topical
bleeding.  In this however, I was greatly disappointed.   Upon 
15
 examining the part affected under the tongue, I could see none
 of those numerous veins, which had been so visible, and so rea-
 dily opened on former occasions.   They were entirely obsun-
 ed by an effusion of serum under the sneideiion membrane. Yet
 I was confident of relieving him, if, perchance, I could divide
 a vein, and therefore boldly plunged the lancet in, and through
 the membrane, and serum, but to little purpose, as scarcely any
 blood flowed from the several punctures!  The pulse being full,
 though not hard, and topical bleeding having failed, I ventured
 on taking blood from the arm, omitting none of the usual reme-
 dies at the same time, which I thought could relieve him except
 a blister ot his throat, which was improperly, though I have not
 the least doubt in vain, reserved for the next day,  but  alas!
 I had the mortification of seeing him no more.  There is not
 the least question with me, that the "effusion of serum," which
 was  so visible in his mouth, had in a very short space of time
 extended to his lungs,  and thus suddenly,  in all  probability,
 closed the avenues of life!  This was an instructive case, which
 raised reflections, and considerations, which  heretofore had not
 been pressed  upon my mind.  I began to view the subject of
 the "prevailing complaint" with new light under  whatever
 shape it might appear, and to reflect, that there was something
 new, and extraordinary in the several cases which had come
 under my notice, as well those, which had terminated in reco-
 very, as those, which had been fatal in their issue.  The lungs
 had most generally been the seat of the disease, and "effusion"
 had invariably been its termination.   From hence I concluded,
 there was something in the air, or something deficient in its
 qualities, which had been and still was the cause of the disease,
 and that that  cause  was singular in its effects, or at least they
 were such as had not, except in a few sporadic cases ever came
 under my notice before. In truth, that, though I had succeeded
 in most cases, (where there had not been  any interference of
 others,) merely by close attention to the symptoms: neverthe-
 less I had heretofore  incorrect ideas of the nature, and treat-
 ment of the disease ;  and that, though it had assumed the lead-
ing and characteristic symptoms of the various types of pneu- 
16
  rnonia, which had, as I conceived, been familiar to me for near-
  ly thirty years; yet I had been mistaken in the exact, and cor-
  rect mode of treating the epidemic under this type.   The obser-
  vations I had made upon the cold stage of the fever more espe-
  cially as to its duration, had begun early to give a new direction
  to  my reflections, and to cause the necessity of adopting the
  method of cure to the nature of symptoms, which has been a con-
  stant rule in my practice from its earliest date, as may be per-
  ceived in the treatment of those cases, which had ushered in this
  extraordinary epidemic at a time, when the most knowing had not
  expected any thingbeyond the usual routine of annual complaints.
   Though the symptoms of the epidemic have been in a great
  measure delineated  in  the history of the  several  preceding
  cases, which, as was just observed, had  ushered in the disease ;
  it will nevertheless for the sake of order be necessary to give
 as accurate a description of it as possible, and to endeavour to
 distinguish it from other diseases, notwithstanding it was ac-
 customed to assume the form of all other diseases to  which the
 human body has been subjected, which is nothing more than
 saying that every " type of disease partook of the nature of the
 epidemic," because the remote cause of all was the same.   Rut
 inasmuch as  it cannot be expected under these circumstances,
 that  any disease to which  we are liable can be described ;  it
 will be deemed proper to select the type of disease, which was
 the most common, and at the same time  the most fatal; there-
 fore  I shall  content  myself with describing the epidemical
 pneumonia, considering  all others  of  minor  consideration,
 except synanche.
  It does not appear from any observations, which I was capa-
 ble of making, that there were any premonitory signs, or s, mp-
 toms, which  indicated an approaching attack of this disease.
 Patients were seized  at all times of the dav, but more general-
 ly,  as in  ordinary pleurisy, sleeping in bed, while  the  least
 insensible to external  stimuli, and in a state of the most  fatal
 security !  As in all other fevers it commenced with an a-ue,
seldom  violent, but of protracted duration; and th:»u-jh the
patient might soon cease complaining of sensations of cold, the 
17
•xternal surface of the body had in the most dangerous cases a
cold feel, and in almost all  while the other parts  might be
warm to the touch, and the face flushed, the extremities, more
especially the feet, would have an icy feel, if some warm appli-
cations had not been made to them.   Indeed in the most ad-
vanced stage, it would most  generally seem as if the patient
was insensible to the  cold, complaining at  the  same  time of
great internal heat.  If he were asked, if his feet were cold, the
answer, nine times out of ten> would be in the negative. If hot
applications were made to the feet and removed, they would
soon become cold again.  In fact it was difficult to determine,
whether the cold stage in the most violent cases,  was even
completely succeeded by the hot stage, until  symptoms of re-
covery were actually apparent.
  The face was flushed from  the very beginning, though most
other parts of the body were cold ; and the head in every type
of the disease, was most violently complained of, if the patient
complained of any thing, insomuch so, that the epidemic very
early in the season, got the name of the " head complaint;" for
though he might have a pain in the side, it was rarely  he com-
plained of it, unless interrogated concerning it.
  If  a cough and common cold, had not been hanging upon
him before the formation of the disease, it was sure to come on
very shortly afterwards, when he would sometimes complain of
pain in the  thorax, though  very  seldom, unless  questioned on
the occasion, and requested to make a full inspiration.
  The respiration was, generally speaking, free and easy, from
the commencement of attack, unless, as was  too  often the
case, the  economy of nature was disturbed by some improper
interference, which might, and did  in  many instances bring
on an "effusion of serum" in the lungs, before a determination
could be  made to the skin, when it became quick and labori-
ous, and a sure presage of a fatal termination.
  Expectoration of mucus from  the lungs was among the first
symptoms  of their  affection, and was  rarely copious, except
when it was bloody, which was  an unfavourable sign, though
not a fatal one, as in the case of quick respiration.
                             3 
18
   The pulse was frequently full, even when the cold had not
 been completely succeeded by the hot stage, and was some-
 times feeble, when the external surface  was rather warm.  It
 could never be said to be hard, and very seldom quick.  Very
 frequently, if other symptoms  were not attended to, it might
 be said to be a healthy one from  the feel.   In  fact, when the
 epidemic began to be better understood, it ceased with me to
 be a sure guide in the treatment of topical affections of the
 lungs, and every other  type of disease; though it had  beea
 almost unerring in its indications in hundreds and thousands
 of cases  before this  period : For when it would seem to indi-
 cate in some cases, from its fulness, the loss of 24 oz. of blood,
 it would begin to intermit before three ounces were taken
 away,  and not unfrequently  cease to beat before five were
 abstracted.
  The blood never flowed freely, and was invariably of a dark
 livid colour, and yet had very much the appearance of pleuritic
blood in former times, which had been considered as a test of
violent "inflammation."   I  have known it stand for hours,
without separating into crassamentun and serum, fully demon-
strating to my view of the subject, that it had not acquired in
its passage through the  lungs, a sufficient  proportion  of that
vital principle from the atmosphere, which could make it active
and properly vital.
  The skin in some violent cases would  be cold, but in others
scorching hot, while the feet and hands, as has been before ob-
served would be cold.  At other times, it would feel soft and
cool, while the patient  would complain of  great eternal
heat   It would feel warm, while covered by bed clothes, but
upon the leas exposure, it would become cool; and put on the
appearance of goose flesh, ^en the surrounding atmosphere
was rather of moderate temperature.
  The stomach was rarely disordered at  any stage of the dis-
ease, bu  on some occasions, and in some instates, it became
exremely irritable when  considerable quantities of bile, and
tough mucus  were ejected, which I never have  consider d a. 
19
 an indication of any thing unpromising^ though it might some-
 times have proved troublesome.
   The bowels were disposed in most cases to remain quiescent,
 unless disturbed by improper treatment; from whence as much
 mischief might, and too often did arise as from bleeding.  The
 one could be instantly restrained, the other was generally be-
 yond controul.
   The urine was in almost every case free, and often copious,
 but could not be considered as  in ordinary pleurisy, a favour-
 able sign.  In fact there was neither sign, nor symptom, from
 whence any thing favourable could  not be prognosticated ex-
 cept a warm moisture of the whole body, which  was seldom
 excited by nature, but very  readily by art at the earliest com-
 mencement of the disease, but with  great difficulty afterwards.
   In whatever type of disease this epidemic fever might have
 appeared, I think, I can assert without a fear of contradiction,
 that the above description  might be applied to it, with the ex-
 ception nevertheless of the symptoms peculiar to affections of
 the lungs, and adding at the same time, those which are pecu-
 liar to  the several parts or organs  of the body, when disor-
 dered ; so that it may be said of this epidemic, what Sydenham
 has said of the epidemics of his day, viz. that " all other dis-
 eases, partook of the nature of  the epidemics," for this plain
 and obvious reason, they all proceeded from the same

                    REMOTE CAUSE.

 But this great man seems to think an " investigation of remote
 causes" of no importance, and little short of a "loss of labour,"
 inasmuch as " they are undiscoverable."
   Before we proceed, it may be of consequence to describe the
 extent of  country, which this epidemic occupied, and  know,
whether there was not an invisible power, which seemed to say,
"thus far shalt  thou go, and no farther," when the reflecting
and candid reader, will have an opportunity of judging for him-
self, and of determining, after he has heard the whole matter,
whether there may be any use in tracing causes, and the effects 
20
 ©f those causes on the human body.  Certainly at this sera of
 philosophical  enquiry, when a disease is prevailing, and it is
 obviously  the  effects of a peculiar  cause, while  those effects
 are of a very extraordinary and  singular nature, it cannot be
 deemed presumptuous, nor  unphilosophical to attempt an in-
 vestigation of that cause; more especially when it is considered,
 that too many are in the constant habit of referring the cause nf
 all epidemical diseases to contagion, which at one dash cuts up
 all further enquiry, to the no small injury of medical sciencef
 and the cause of humanity.
   While the epidemic of 1813 has been seen springing up insi-
 diously in every direction of my small circle of practice, it was
 at the same moment bursting forth throughout  all Talbot and
 Queen  Anne's Counties, scarcely  touching  on  the banks of
 Choptank on the  Dorchester side, doing no injury beyond the
 village of Cambridge, in a manner altogether desultory.   Per-
 haps, it did not  reach the opposite banks of the Tuckahoe,
 which  divides  Caroline  from Talbot county;  then  skirting
 along in zigzag direction the whole line, which separates the
 first named county from Queen Anne's, it probably stretched
 across to the head of  Chester river, which is known to have
 cut it  oft* from Kent county,  and from the Western shore by
 the Chesapeake bay.  These were the limits of this mortal
 epidemic ; and I  defy contradiction, while the mourning rela-
 tives of its numerous victims  live in this devoted district, for
 beyond them there is scarcely one, who can be found to say, as
 here, I have lost a father, mother, brother, sister, son, daughter,
 or some one or more relatives.
   That the remote cause of this epidemic was in the atmos-
phere, there can be no question; but why it should commence,
 and rage in the small  section of country, and not spread into
 those parts contiguous  to it, where the same causes apparently
 existed, so far as they could depend upon heat, cold, moisture,
 and every other  sensible  quality of the air, is a phenomenon
 both singular and  extraordinary, and not very readily account-
 ed for; more especially in this  quarter of the country, where
 epidemic fevers in the autumnal seasons, are as familiar as the 
21
ieasons, which revolve around! These can be traced to certain
sources, such as putrid effluvia, and marsh miasmata, but not so
with this epidemic, which unexpectedly and insidiously com-
menced in the month of December from no visible source, and
progressed with accumulated malignity throughout the remain-
ing winter months, and all the  spring months with very little
if any  abatement; and at a time, as has been just observed,
when our neighbours were enjoying more  than usual health;
a circumstance  truly astonishing, and  a phenomenon, which
seems to bid defiance to  investigation; nevertheless the re-
search is a laudable  and  useful one, and such as I conceive
ought to be attempted.
   Should I, like the learned, and the elaborate Noah Webster,
Esq. descend in imagination into the bowels of the earth, and
suppose noxious vapours, invisibly ascending from its dark and
impenetrable caverns by the convulsions  of earthquakes, I may
be involved in mysterious speculations, and in the  prejudiced
opinions of some great men, very far from the correct road in
search of the truth.
   The  epidemic commenced its career in cold, dry weather,
and still  continued a steady undeviating course through cold
and dry, wet and  snowy weather; and at a time when the
changes of the weather, were the same  throughout the whole
Eastern Shore of Maryland, and yet its dominion was confined
to its certain, and well marked limits, which have been  well
and accurately  ascertained!   Had  the  habits  of  the people
been different, as to modes of living, or could it be shown, that
this afflicted country  was exposed to any visible source of dis-
ease, many difficulties would vanish, though  I might be unable
to account for the peculiar, nature of the disease, and its sin-
gular effects on the human body.
  The epidemic being confined only to the country above speci-
fied, it at once becomes a reasonable supposition,  that there
was something in the atmosphere of that particular section,
which did not exist in the parts contiguous; otherwise some-
thing could not have originated from nothing, nor could effects
have been produced  without an adequate cause.   It thence 
22
ceases to be a supposition, but a fact, that the cause was in the
air of the above limits, and actually confined to those regions
only;  all idle notions of contagion to the contrary  notwith-
standing.   But, if the  cause  was in  the  atmosphere as above
stated ! why was it not in the country  contiguous ?  and  why
was it not extended throughout the whole of the Eastern Shore
of Maryland, where the whole face of the country is very much
the same, with some trifling variation ? The temperature of the
air is at all times nearly the same.   There was probably, no
difference as to dry, moist or frosty weather; and there is very
little  difference in  the habits of the people.  From all these
considerations, there must have been something originated in,
and arising from the earth in this particular region, which in
some  way  vitiated  the  qualities of  the atmospheric  air, and
made it unfriendly to human  life, and the peculiar cause of
this singular disease.
  Hippocrates  has  laid it down as an established  fact, "  that
" when any disease  spreads generally, it is evident, that the
" mode of living is not the cause, but what we imbibe in breath-
"ing,  which  clearly retains   some  morbific quality."   Dr.
Sydenham alio, though he has expressed himself with indiffer-
ence as to the " remote  cause" of epidemics in his preface to
his very valuable, and important  history of these  destructive
diseases, says, "there are various  general  constitutions of
" years, that owe their  origin neither to  heat, cold, dryness,
" nor moisture; but rather depend upon a certain secret, and
" inexplicable alteration in the bowels of the earth,  whence the
" air becomes  impregnated with such kinds of effluvia as  sub-
" ject the human body to particular distempers, so long as  that
"kind of constitution prevails, which after a certain course of
" years declines, and gives  way to another.   Each of these
" general  constitutions  is attended, with its own  proper and
" peculiar kind of fever, which never appears in any other, and
«therefore," as he emphatically expresses it, " I call this kind
" of fever stationary."   Such most explicitly was the epidemic
in this particular quarter. 
23
  Again " it must be observed," says this illustrious character,
"that  whenever  any constitution produces various species of
" epidemics, all these species differ in  kind from those which
" have the same name, but are produced in another constitution.
" But  how many peculiar species soever arise in one, and the
" same constitution, they all agree in being produced  by one
" common general cause, viz. some peculiar state of the air ; and
"consequently how  much soever  they may  differ from one
" another in appearance, and specific nature, yet the constitu-
" tion common to all of them, works upon the subject-matter
" of each, and moulds it to such a state and condition, that the
" principal  symptoms  (provided they  have no  regard  to the
" particular manner of  evacuating) are alike in all.  Hence,"
continues this acute observer, " we may see how various and
" subtile a method, nature uses in  producing diseases, which
 " no one has  hitherto traced in proportion to the dignity of
"the  subject," and  that though epidemic distempers, espe-
cially fevers, depend upon the secret  constitution  of the air,
 yet" those persons labour unprofitably, who deduce the causes
 " of different  fevers, from the morbific matter gradually col-
 " lected in  the body," &c.
   Dr. Rush in his note on the above paragraphs observes, that
<* the  existence of a morbid constitution of the air, and depend-
 " ing  upon matter of some kind has been admitted ever since
 " the days of Hippocrates.   Our inability to discover  its pre-
 " sence,is no more a proof of its not existing, than our ignorance
 " of the  precise nature of fire, furnishes an argument  against
 "the  existence of light or heat, which are connected with it."*
    Vanswieten  in  his commentaries on  Boarhaave  states,
 " that the cause of epidemics is to be sought for in the air.  But
 " to ascertain what that is in the air,  which does the mischief,
 " is a matter of very great difficulty."  Dr. Boarhaave himself
 declares, that though "the weather, climate, season of the year,
 " soil, the sea, lakes, marshes, rivers, vapours, exhalations, and
 " meteors do induce such a charge in  the air as to render it
* Vide Sydenham, page 8. 
24
 " capable of creating various diseases, not depending on the
 " natural constitution of the air, or its properties, or qualities,
 " but on the nature, and efficacy of a mixed substance."   And
 therefore says his commentator, "although the qualities of the
 " air are by no means to be neglected by a physician, when he
 "is considering diseases, yet they do not seem sufficient to give
 " us an insight into the original cause of epidemic diseases."
   Marsh  miasmata, and putrid exhalations produce diseases
 every autumnal  season  in this unhealthy region, but it cannot
 be supposed, that an epidemic in the winter season could have
 been influenced by such causes, because they could not have
 existed here more than in the parts contiguous.    Vansweiten
 observes nearly to the same effect, and that " although it can-
 " not be denied that putrid  exhalations are noxious, and pro-
 " duce  disorders,  yet it is no way certain, that  all epidemic
 " diseases are produced by putridity."
  From all these high authorities, as well as the subject now
 before us, it seems plain, and obvious, that many epidemics do
 arise from " hidden causes," which the great Boarhaave  asserts,
 are " inexplicable and that those causes are not always from pu-
 trid exhalations, but from the " earth" independent of " putridi-
 ty."  If from the earth and not from putridityjit surely will not
 be considered unphilosophical to attempt some investigation of
 a subject so curious, and important to the health of man, more
 especially as  this epidemic  has been confined to  so  small a
 portion of the earth as herein specified.
  From the earliest ages earthquakes  have been  supposed to
have had great influence in the generation of epidemics by ex-
tricating something from the  earth, which vitiates the atmos-
 pheric air, so as to render it unfriendly to animal life.  " Sen-
" eca asserts, that pestilential  diseases  usually  follow great
" earthquakes.   He supposes the air enclosed in the earth to
" become vitiated, either by stagnation, or through the defect of
" internal fires, ab internorum ignium vitio.  He thinks,  this
" air when forced into the atmosphere, renders it impure, and
" unwholesome, generating new kinds of diseases."
  It would be tedious to cite all the  authorities,  with which 
25
 history abounds, to show that it has been a general  opinion
 among the learned of all ages, and  countries, that earthquakes
 have been the means of evolving something from the " bowels of
 the earth," which has vitiated the air, in some way or other, so
 as to be  productive of diseases of various  descriptions.   The
 learned Noah Webster has investigated the subject more fully,
 and satisfactorily than any other writer of the present, or former
 times.  He deserves great credit for his deep and elaborate en-
 quiries,  which must carry conviction to the understanding of
 every man, who will take the trouble of going through his useful
 history of "epidemic, and pestilential diseases."  In truth, I
 might say, with a reverend and very sensible  friend of mine,
 who commenced  reading this important work at my request,
 but  with great prejudice on  his mind, " conviction  will be
forced upon him *."  Being persuaded, that his reasoning is
 more powerful than any  thing  which could fall from my pen
 on the causes of epidemics, I shall take  the liberty of extract-
 ing a few paragraphs, and consider  them in a chain of my own
 reasoning in cause, and effect.
   "It will not,"  says this  illustrious character, "escape  the
 " notice of the most inattentive reader of the foregoing history,
 " that all  the violent, and general plagues have been  preceded,
 " with remarkable phenomena in the physical world, as comets,
 " earthquakes; explosions of volcanoes, and others of a subor-t
 " dinate kind.
  " We are to admit, with great  caution  the influence of the
 " planets, in producing the calamitous diseases, which at peri-
 " ods afflict mankind.   It is an influence very uncertain, and
 " undesirable.  It is not indeed unphilosophical to suppose, the
 " several immense orbs, that compose the solar system, to have
" an influence on each other by means of the great laws of at-
" traction, and repulsion.   The contrary supposition would be
" most unphilosopical.  But it might be very difficult to ascer-
■ • tain precisely what that iufluence  is, because it might not be


               * The Rev. Mr. Joseph Jackson.
                             4 
26
 " possible to separate its effects from those which are produced
 " by other causes.
   " The ancients went much too far in ascribing: events on this
 " earth to planetary influence.  They ascribed not only natu-
 " ral, but moral effects to that influence, and by their extrava-
 " gant system of judicial astrology, brought into contempt the
 " study of the influence of heavenly bodies.
   " We are not however to discard all considerations of such
 " an influence.  We are naturally led to suppose, that all parts
 " of our 6ystem are connected by principles of attraction, and
 " that a certain order and equilibrium are necessary to keep all
 " parts in due harmony.   It is very obvious, that the moon has
 " a most natural influence in regulating the seasons, and changes
 " of weather on this globe, especially the weekly, and monthly
 " vicissitudes.  The  more distant bodies may  have a similar
 " effect, though less  obvious."  Then quoting  the authorities
 of Claudian, Aristotle, and Pliny, of the ancients,  he  comes
 down to more  modern times, and establishes it beyond all possi-
 ble contradiction, that comets have their influence in producing
 effects on the terrestrial globe,  particularly by earthquakes,
 whicli become the means of evolving something from the earth,
 which vitiates the air, and is the cause of epidemics.
  " It has sometimes happened," he adds, " that in those con-
 " vulsions of the earth, a vapour has been extricated, which has
 "producedimmediate disease,"and further,"the idea that new,
 " and unknown species of diseases follow earthquakes," and " if
 «well founded, leads us to suspect, that  the  changes  in the
 " character of diseases  are attributable to the various action of
 " the electrical fluid."  But whether the change in the charac-
 ter of disease proceeds from electricity,  carbon, or any other
 subtle matter evolved from the earth, I  hope to make it appear,
 that a change must be made first in the air itself, before disease
can be produced, unless when it acts instantaneously  by its
dehtenous effects;  and it is to be presumed, that can rarely,
if ever, happen in the times of epidemical and pestilential dis-
eases;  for if that was really the  case, every person around
would  become a victim to its effects;  and in fact that some 
27
 change must also be produced by this same remote cause in the
 animal functions before it can generate the disease.
   Atmospheric air is not an elementary body as the ancients
 have supposed, but a compound, as the moderns have proved;
 of course, it must be susceptible of changes.   It is more than
 probable, like all other  compounds, it does, upon the applica-
 tion of some other body, or bodies, undergo some kind of decom-
 position, but  how this  is effected in  the great laboratory of
 nature, may forever be hid from human investigation.  Be this
 as it may, it is, nevertheless,  well  understood, that there is a
 vital principle in atmostpheric air, which is absolutely neces-
 sary to human life.  Deprive it of this vital, and  component
 part, and it instantly ceases to support life; so also, if it is by
 any means diminished in quantity, the vital functions begin to
 languish in their energy, and in a little time are unable to sup-
 port  life without the aid of some artificial stimuli.  On  the
 other hand, it is a fair presumption,  that this vital principle
 may  by some  other cause  be encreased, and act with too much
 force as a stimulus.   In  either case the doctrine, which sup-
 poses animal heat to arise from a decomposition of oxygen  air
 in the blood, is greatly strengthened ; as the effect in  either
 will be in proportion to the generating cause, that is, if there is
 too little of the vital principle, cseteris paribus, there will be a
 deficiency of animal heat generated ;  and so on the other hand,
 if there is an  even  proportion of oxygen in the air, the human
 body every  day runs the risk of being stimulated into extraor-
 dinary action.  Fortunately in either situation, there is a prin-
 ciple in the animal economy, which gives it a  capability of
 accommodating itself to these charges in the  " constitution of
 the air," and  here it is, that some, however violent the cause
 of the epidemic, or pestilential disease, escape the power of its
 influence.
   Whilst all  the organs  of the body remain sound, and their
various functions harmonize together, the human body may for
a great length of time resist the remote cause of the most invet-
erate disease,  unless some one function should be disordered
from some contingent circumstances, or as the old writers used 
28
   to express it, by an abuse of some one of the non-naturals.   Now
   as the lungs are the  immediate organ,  through which  animal
   heat  is generated, they become  more  liable  than any other
   organ of the body to be the primary seat of disease, and hence
   it was in  1813, that the  lungs were more  generally affected
   than any other part of the body.
    From all these circumstances, and  considerations, I am led
  to believe, that though I may not have  gone into an investiga-
  tion of the subject fully, and  completely, nor have altogether
  explained it  satisfactorily, the remote cause of this epidemic
  was something arising from  the  earth in consequence of some
  great convulsion in the bowels of the earth,* which took place

    * In the autumn of 1811 a comet appeared, and continued to be visible
 until the January folio wing.  On the 12th day of February 1812 a few
 minutes after nine o'clock, a shock of an earthquake was felt  in  this
 town, Easton, and  generally  throughout  the  whole epidemic district.
 Many persons staggered, and were ready  to fall down ;  others were
 made sick at the stomach ;   and  some puked, who had just ate their
 breakfasts.   Several were  alarmed by the  weights of clocks striking
 violently  against the  sides  of their  cases.   The same  shock  was
 distinctly felt on the  third, or fourth day after the first.
   Perhaps, it wll be explained,and satisfactory reasons assigned, why
 the effects of this earthquake did not at  once break out, but were
 deferred to the next winter, ten months afterward.
   Though the earthquake did not continue, there can be no  sort of
 doubt, that its effects were frequently perceptible, particularly,  during
 the rage of  the epidemic twelve months  after.   It  was repeatedly
 observed to me in the  winter of 1813, that a disagreeable smell was
 every now and then to be perceived, not unlike gun powder.  One gen-
 tleman observed to me, that at two several times, when he had crossed
 Mdes river, immediately on his landing on the  opposite shore, he smelt
 something Lke  bilge-water.   Another was impressed with the idea,
 that the smell and smoke of gun powder had been wafted by a souther!
 ly breze from the British fleet which, was laymg sixty,  or a hundred
 miles  clown  the Chesapeake bay;  because he did not  take  tune to
 reflect, and attempt to amount for this extraordinary phenomenon in
 some other way.   It is true, these circumstances were not noticed by
 every body, neither was the earthquake.   I  was in Easton  at the time,
 and not sensible of the  first, or any other of the  shocks.   Probably I
might have been walking the street at the time, and might have been 
29
 eight, or  nine months previously to its commencement, which
 something must have altered, or decomposed the atmospheric
 air, and thus deprived it of a portion of its " vital principle,"
 by which  means effects were produced on the human body,
 which constituted a disease sui generis, differing from diseases
 of the same type, which had been familiar to physicians, time
 immemorial, in this part of the world: and as the remedies were
 different, that is, instead of the  depleting,  and antiphlogistic
 plan, an opposite one was  discovered to be exclusively  benefi-
 cial, I conclude, the cause  was not positive, but negative in its
 effect, because the  air was  partly deprived of its  "vital
 principle," and of course acted negatively.   But inasmuch as
 the remote cause did not act instantaneously from its  being a
 negative, and not a positive, there must  have been, as there is
 generally in an opposite  state of the atmosphere.

      PREDISPOSING, AND EXCITING CAUSES.

   That the human system  from its very nature, and  constitu-
 tion is constantly varying in the  regularity of its functions, by

 as inattentive to that as I was afterwards to the vapours, and sulphuri-
 ous  smells.   It  is true, that I have at all seasons  of the  year  been
 assaded by disagreeable smells, but I never stopped to enquire into
 the cause of them, so regardless have I been of evciy thing, which did
 not strike my senses more forcibly !
   The  Rev. Matthew Wilson in his  letter on an epidemic, which pre-
 vailed on Indian river in Sussex county,  Delaware, in 1775,  which will
 be noticed in its proper place, observes, " the causes of this  malady
 •*are not easy to be determined.  Permit me to offer some conjectures.
 " So dry, and warm a winter has not been known in the memory of the
 "living."  (Though in the very nesjt paragraph he makes the  thermo-
 meter vary 30 degrees in a very few hours.")   " The  air has generally
 " been  full of a dry smoky  vapour.  It  is to be wished philosophers
 "would investigate this  phenomenon.  To raise such smoke from fire,
 " would reqmre almost  a general conflagration, all JEtna could not do
 it."  See Noah Webster on the year 1775 with regard to the general
convulsions of the earth, Jkc. who amidst his great researches,  had not
an opportunity of seeing this valuable paper on the epidemic of Indian
 river. 
30
 which the harmony of the whole may be disordered,  must be
 sensibly felt at times by every man, but more especially when
 he has been guilty of the slightest indiscretion in eating, drink-
 ing, or exposure of any kind ; all which tend to predispose the
 body to various disorders.   But when a number of persons, at
 the same period of time, are similarly disordered, though their
 observations in the non-naturals may  have been very differ-
 ent, it  at once becomes a reasonable enquiry, whence does
 all this proceed ? There must be something common to all
 which disposes so many to be similarly affected, while others
 again are not at all, or but slightly disordered.   This, as stated
 above, is called the remote cause of disease.  Could this cause
 possibly be removed, its effects would cease!  But while this
 exists, it must gradually undermine the health of all such as are
 exposed to it, and gradually predispose the system to be affect-!
 ed by such causes as are very properly called exciting causes ;
 among these more particularly must be considered cold, which
 being a negative, must be also taken in the same point of view
 as the remote cause of the epidemic, and consequently as a  pre-
 disposing cause also.*  But  inasmuch as the degrees of cold
 were the same at all times in the neighbourhood of the epidem-
 ic district, it could only  be considered as an adjunct  predis-
 posing cause which could have had no effect without the aid of
 the remote cause, and of course acted only conjointly with  that
 cause in disordering  the system, on some one of its functions
 which was most generally that of respiration.
  It has  been observed in the preceding pages, or it ought to
 have been so observed, that persons were taken with symptoms.
 of the epidemic most generally  immediately upon any sudden
 transition to colder weather; of course, cold might be consider-
 ed, and  most certainly was  an exciting as well as the most
 general predisposing cause went to the remote cause, as above
 laid down, while intemperance, fear, and some other passions
 of the mind, joined with extreme abstinence, acted partially as

  * This will be more fully explained, and perhaps better understood,
when the rationale of the cure of the epidemic is gone into. 
31
predisposing causes,  and very frequently in conjunction with,
cold as powerful exciting causes.
   This view of the subject is confirmed by a number of circum-
stances, and facts.  1st, Strangers coming among us, in no one
instance, were affected by the epidemic.   2nd, All those, who
were careful in avoiding the exciting causes,  which were cold,
fear, and other passions of the  mind, intemperance, and too-
great abstemiousness, with very few exceptions  escaped the,
disease,  or were only slightly disordered by it.  3d, There
were many amongst us, as at all periods of the reign of epidem-
ics who were so fortunately constituted as to resist the power of
conjoint causes,  inasmuch as no change had  been induced du-
ring that period ; thus demonstrating, that the transition from
health to disease  is always gradual,  until the predisposition is
formed, by which means the body becomes susceptible of mor-
bid impressions;  or in other words a morbid  excitability must
be generated before  a morbid excitement can  be produced.
Cold, and all the other exciting causes, above mentioned, have
at various  times  predisposed the body to numberless diseases,
but the epidemic having exhibited itself in a character peculiar
to itself, from the negative qualities of the remote  cause, it fol-
lows of consequence, that the  remote cause  was the principal
predisposing cause, while cold, and the other causes, just stated,
were the actual exciting causes in producing this  epidemic,
which assumed a character depending entirely on the nature
of the remote cause.   Hence a fair conclusion may be deduced,
that all febrile diseases  originate  from,  and  depend on these
causes, the remote, as a sine qua non, predisposing, and exciting
causes, and that the remote, and exciting do generally act on
the system in such a way as to become the predisposing causes.
   The principles thus attempted to be established will appear
in still greater force by reflecting maturely  on the rise, pro-
gress, and termination of this epidemic ot 1813, and by learning
at the same time, that it recurred again wiith all its character-
istic symptoms, and phenomena, as soon as the cool frosty wea-
ther set in  early in the month of  November of the same year,
demonstrating that cold as an exciting  cause was absolutely 
32
 necessary to create thig peculiar disease, and that had not the
 vital principle in the air been deficient, the  effects of cold, and
 of the other exciting causes would have been different, exhibit-
 ing at  the  same time  nothing  peculiar, or unusual in its rise,
 progress, or termination, more than what had  been familiar to
 the people, and more especially so to any  experienced physi-
 cian in this quarter.
  As corroborative of  the  sentiments just expressed, Van-
 sweeten  in his commentaries on Boarhoave very aptly  quotes
 the following sentence from Galen, viz. "In our bodies, as it
 " were purposed for disease, some external adventitious circum-
 " stance kindles a fever, which would not of  itself generate a
 " violent  disease <§"c. yet from  the disposition of the body,
 " every one of these i; rendered, not the cause of the disease, but
 " the occasion, those  causes  have been called  the TITotpxseiv.
" Whence" says this learned commentator, " errors committed
" in point of diet may indeed predispose the body to be affected
" more easily, and more severely by any occasional, or exciting
 " cause, but without that, will never alone occasion an epidem-
 " ical disease.  If for instance, a person should get very drunk
 " at a season of the year, when no quartan  agues  made their
 " appearance, he would not get a quartan ague, but at another
" season, when quartans were epidemic, he would be attacked
 " by that  distemper even from a much less error in diet.  Where-
 " fore," he continues,  " Galen has  laid down  the following
" observation : It is always necessary to remember, throughout
 '■ this whui> discourse, that no cause can affect without a pre-
 t; disposition of boot;  otherwise all who are exposed to the
 '" ray*  of a summer  sun would be seized with fevers as well as
 " all those who use too much exercise, are passional, or griev-
 " ed.   .Moreover all would fall sick, du ring the dog-daus,^or die
 "of the plague.  In the mean  while, no pestilence has ever
" been  so violent as to kill all:  for many, thou-h constantly
" exposed to the contagious effluvia have escaped being infect-
ed;  in whom therefore their did not exist a predisposition
" to receive the infection.   Persons  who  have once  had the
<• small pox, have undergone such a change, that they are very 
33
 ' seldom capable of receiving the variolous infection a second
" time.
  " We may therefore conclude,  that this  exciting, or pro-
" catarctic cause is not to be sought in the abuse, or defect of
" the  six non-naturals;  but that it is far less obvious, so that
" the most experienced physicians have  often acknowledged,
" they were wholly ignorant with respect to this Intent  cause
" of epidemics,  which only shows  itself  by  its effects on the
" human body, while its specific genius is unknown.
  Thus much for absolute  causes, without which mankind
would live in health almost uninterrupted, and have their days
prolonged  to years, perhaps,  equal to those of the antidelu-
vians, before this globe had undergone changes, which are every
where visible, from one general deluge, and the great convulsions
from earthquakes, &c. which  are continually going on  in its
bowels from the  centre to the surface, which we inhabit. These
causes are yearly, and daily showing their effects on the bo-
dies of men, while the grand occasional cause, generally called
the remote cause, is too often hid from  human investigation.
 But I would fain hope, Dr. Sydenham to the contrary notwith-
standing, that my " labour will not be in vain, though  I may
" attempt to deduce the rationale" of the epldemic/rom the
effects of  the cause, while I am well assured  in my own  mind,
that much light  may be thrown upon the method of cu -e by a
proper and correct consideration of the "re-r,Ae ccuse."
  But physicians  have  been in the  practice -of considering
another cause,  which,  as being supposed " nearest to the dis-
ease" has been denominated the

                  PROXIMATE  CAUSE.

The reason why  the  subject has been taken in this point of
view, I confess,  has never appeared altogether satisfactory to
my understanding, yet  it must be admitted,  that inasmuch as
every disease must originate from a cause in the  body itself,
or remote from the body, there may be some correct foundation
for this  practice, when it is  considered, that there is a vastly
                             5 
34
 wide difference between a  cause acting on inanimate matter,
 and acting on a living body : in the one, if the cause is removed
 the effects will cease,  in  the other, though the  cause  shall
 be removed, the effects will not cease, because motions are ex-
 cited by the cause, which do not afterwards depend on the ap-
 plication of the same cause.   Hence, doubtless, has originated
 the idea, as well as the practice among both ancients, and mo-
 derns of searching for something in the  system, which is the
 cause of the continuance  of  disease, and  more especially of
 febrile disease, called the proximate cause, as being " nearest
 the disease itself."
   I feel myself indisposed to controversy, therefore I shall not
 touch upon the opinions, nor theories of others on the subject of
 general fever, but shall venture directly upon the rationale of the
 epidemic, and leave it to the unprejudiced reader to determine,
 whether hints may be dropt in the course of discussion, which
 may have a tendency to throw light upon a subject abstruse
 and elusive.  It will  be enough, and I trust  satisfactory, if I
 explain to those,  who are capable of understanding, in  what
 manner the remote cause of the epidemic of 1813, produced its
 effects on the bodies of men with their continuance, and  more
 especially so, if the explanation will lead, as I am persuaded
 it will, to the rationale of the prevention and cure.
  The remote cause has been stated  to be  a  negative in its
 effects on the human  body, arising from a " deficiency of pure
 vital air," or oxygen in the atmosphere.  This being a fact, it
 follows as a reasonable and philosophical deduction, that the
principles of life, which depend on " air's pure essence,"  were
necessarily weakened;  of  course,  the system became  more
liable to disorder.  But inasmuch as animal heat depends on
 this same principle, it [the system] was  rendered more liable
to be acted upon negatively by cold and other predisposing and
exciting  causes; thus decidedly placing the  epidemic in the
train ofxause and  effect, making at  the same time the cause
altogether, and the effects in some measure negative.  Assum-
ing then as data, that  " animal heat  is produced by a decompo-
 sition of oxygen air in the blood," and that the lungs, being 
35
indisposed to perform their functions, from a morbid change,
induced  by the predisposing  causes  constantly acting  upon
them, they must, as a necessary consequence, transmit less
air, and that of deficient quantity and quality, to the blood in
its passage through the lungs : of course less heat will be gene-
rated by decomposition, while at the same time from the above
causes, the whole system will be more susceptible of the effects
of cold, so much so, that if artificial heat is not supplied, a
" torpor" must be produced upon the whole irritativ e and sen-
sitive  faculties, and  thus  the  cold  stage of fevers must com-
mence.  Now this happened at all times of the day, and under
all  circumstances  during  the dominion of the epidemic, but
more especially in  consequence of sudden changes from  heat
to cold, and  after much exercise, or any improper exposure,
or when all the animal faculties were sunk in the arms of sleep
and insensibility,  all  which  concurring with  the negative
powers so often mentioned, produced a more complete torpor,
and thus formed the cold stage of the epidemic fever, which
became more violent, and protracted according to the proper,
or improper treatment from the beginning of the disease.  The
disorder being thus formed with the commencement of the cold
stage,  the difficulty arises, which Dr. Cullen says," has eluded
the research of physicians," but  as  just observed, I shall not
attempt any thing beyond that of the epidemic.
  It is laid down as a principle by  the  same great man, and
daily  experience would seem to  confirm it, that " there is a
" general law of the animal economy, whereby it happens, that
" powers which have a tendency to hurt and destroy the sys-
" tern, often  excite such motions as  are suited to obviate the
" effects of the noxious power.   This is the vis medicatrix
" naturce, so famous in  the schools of physic; and it seems
" probable, that many of the motions excited in fever are the
" effects of that power."  That  there is a principle in the liv-
ing body, not unlike the one here  alluded to, there can be no
sort of question.  It is the excitability of Dr. Brown, and in-
herent in the system, " varying at different times in the same
body," and as I now believe in different seasons, and " consti- 
36
 lotions of the air."  T trust there will be a proper and compre-
 hensive understanding of this part of the subject, as I conceive
 much depends upon it in the application of remedies, as I hope
 to make  appear in due  time, not only in the epidemic but in
 ordinary diseases, but more especially in febrile diseases.  But
 to the  point.   Every person who exposes himself to the effects
 of cold, experiences the power of this principle more or less ;
 for instance, in washing the hands and  face, a torpor in some
 degree is produced in those parts, which as Dr. Cullen perhaps
 incorrectly, expresses himself with regard to cold, " becomes
 an indirect stimulus," or as I would venture  to say, when the
 principle of irritability  is suspended  for a  time by cold as a
 negative power, the parts become more excitable according to
 that law of Dr. Cullen or principle of excitability of Dr. Brown,
 and a greater action takes place in consequence of the state
 of exhaustion or suspension, though no other stimulus shall be
 applied, than what arises from the  common circulating fluid9
 the blood, and the natural diffusion of heat by that fluid.   The
 same  principles applied in the cold stage of fever; the same
 results will follow; the  system will endeavour to relieve itself
 by the same established principles.  But in ordinary fever, the
 excitement has always been in proportion to  the excitability ;
 the cold stage being violent, the fever which has succeeded,
 has been generally proportionately so, so much so, that the life
 of the  patient could alone be saved by restraining the violence
 of excitement by abstracting a portion  of the vital fluid.  In
 the multiplied cases of the epidemic, every thing appeared to
 be reversed, for there appeared  strong presumptive evidence,
 that there was a deficiency of oxygen air in the atmosphere, to
join the " vital fluid," and thus to generate heat by decomposi-
 tion, while at the same time there  seemed to be a predisposed
 indisposition in the lungs to perform their function, as well as
 a want of excitability throughout the whole system ; of course
 after the cold stage had  commenced, the system generally had
 acquired an inaptitude, or an incapacity to assist in generating
 heat, and thus to keep up the ordinary circle of actions: hence
 it was, that a coldness of the extremities became a character- 
37
istic symptom of the disease, and  was disposed to continue
throughout its whole course, unless artificial heat was applied
to them.  All this was corroborated from an attention to the
established symptoms of the disease, as already described; for
if blood was drawn from the arm, it flowed sluggishly, and of
a dark livid colour,  indicating according to my view of the sub-
ject a want of its accustomed and necessary vitality, wliile the
pulse frequently began to intermit before three ounces of blood
was taken away, and ceased to beat before five could be drawn
off, thus demonstrating to the  most common understanding,
that the system  was for the above reasons, at the same time
deprived in great degree of its proper excitability, aud as a ne-
cessary consequence, that the  excitement would  be irregulai:
and languid.  But before this period, when the "pure vital air"
was in due proportion in the atmosphere, and the lungs not
indisposed to perform their function, the blood was in the gene-
rality of cases of pneumonia, accustomed to flow with rapidity,
and of a florid colour, indicating no deficiency of " air's pure
essence to dispart heat," which was  one of the most common
symptoms attendant on fever; and  further fainting was rarely
attended with any  pernicious consequences, as it seemed as if
this vital principle  in the air was disposed to rush into the cir-
culation by the lungs to save the  sinking patient, changing the
blood almost instantly from a dark to a florid colour, while the
patient would as instantaneously revive.  In fact the change
in the colour of the blood,  used to be among common bleeders
a sure criterion as they supposed, to  ascertain when a sufficient
quantity was taken  away.   Alas! in the epidemic this prac-
tice was death, and vast numbers fell victims under this mis-
taken treatment as  well as every other, which diminished the
natural powers of the system.
   From this view of the  subject, I trust it will  appear clear,
and obvious to all those who will give themselves time to re-
flect, that the epidemic of  1813  was the effect of a cause, as a
sine qua non, which was negativet and that 
38
                    THE PREVENTION
 Was more in the power of the inhabitants of the section of
 country heretofore specified, than the  ordinary diseases, to
 which they had been usually  addicted ; but alas!  physicians,
 and mankind generally can never learn the truth but from fatal
 experience, which  unhappily is too often perverted  by false
 reasoning.
   It is a common, though very  correct observation as applied
 to mankind, that when  the mind is predisposed to receive cer-
 tain impressions, the slightest exciting cause will produce cer-
 tain effects ; just so with regard to the body, when it is already
 predisposed to disease by certain causes continually acting up-
 on it, the slightest exciting cause  will produce  a disease in
 conformity to the nature of the remote  cause.
   Cold has  been stated to be the principal exciting cause; of
 course if this could have been guarded against, very few would
 have  been seized with this singular disease.   Hence it was,
 that those, who  were most exposed to cold without the means
 or precaution, of guarding against its effects, were too often
 the victims of the epidemic.  Hence also it was, the poorer class
 of people were the greatest sufferers, while the rich, or those
 who  were  well  clothed, and  little exposed,  were  seldom
 taken  down.   All  the  predisposing and  exciting  causes
 being negatives, or such as were calculated to diminish the ani-
 mal powers in generating heat, the principle, and indeed the
 only means  of  prevention consisted in  aiding and assisting
 the natural  powers by artificial means.  These were  warm
 clothing, keeping the feet warm and dry, avoiding exposure to
 cold, and sudden transitions from heat to cold;  and lastly free
 but temperate living, more especially  a moderate use  of wine
or ardent spirits ! All these may be considered  as equally use-
ful, and necessary  to guard against common colds, as well as
every species of inflammatory  disease, excepting  the use of
 wine, or ardent spirit of every  kind, for the reasons just as-
signed.   In  both cases,  that is, of the epidemic and ordinary
diseases, it is supposed  that a torpor takes  place ; but in the
 one the excitability is diminished, in the  other it is encreased, 
39
so much so as to require the means of diminishing the  excite-
ment of the system.   But why do I pretend to enter into par-
ticulars!  If I am correct in the principles  which I have at-
tempted to establish, the method, or means of prevention must
be clear, and strikingly obvious  to  every reasonable and  un-
prejudiced understanding, if  experience had not proved the
great advantage in attending to the above plan, while it must
be equally obvious, that the

                          CURE

 Must be founded upon the same principles.
   There is nothing, in which  mankind is so materially inte-
 rested as in the preservationof health, and the cure of disease.
 It is to be lamented, that there have not been, and it  is pro-
 bable, there never will be any fixed  principles, by which phy-
 sicians  can be governed in the treatment of fever, which in the
 character of an epidemic,often becomes the greatestof scourges.
 It will be  presumption in me to suppose, that  the  view  I
 have taken of the subject of the  epidemic of 1813, can lead to
 any certain indications of cure in all fevers.  It will be enough
 if the indications become plain,  in the cure of this peculiar
 fever, which as has been observed, most generally assumed the
 type of pneumonia, though every  other  type  partook of the
 same nature, and was of the  same character, as to their ef-
 fects.
   Diseases of the  lungs have, by writers, been considered of
 that nature, as almost invariably to require, as early as possi-
 ble an abstraction of a portition of that fluid, the blood, which
 is constantly circulating through them, as well as through every
 other part of the system.   Most unfortunately for the people of
 this quarter, these notions prevailed not only amongst physi-
 cians, but the people themselves.
   It is already seen, that I commenced the treatment of some of
 the  first cases, which came under my notice, according to esta-
 blished practice.  I am ready to admit, that the success, which
 attended this early practice, was accidental,  as I was really 
40
  ignorant of the nature of the disease, or rather of its character.
  I have now learnt, what every  other physician ought to learn,
  that the correct mode of treating disease, but more especially
  febrile disease, consists in two things, or rather circumstances,
  viz. a knowledge  of the constitution of  the atmosphere,  and
  the excitability of the system consequent, or depending on that
  "constitution" at  the time of its prevalence.
    From the earliest commencement of the epidemic, it was
  very obvious, that  though the pulse seemed to indicate, together
  with other apparent symptoms, a loss of a considerable portion
  of blood, these symptoms were deceptive.  I have endeavoured
 to prove, that this circumstance originated from a deficiency in
 the vital principle of the air ; but how was it possible to ascer-
 tain  this fact?  Not  from any sensible qualities  in the  air,
 though every thing seemed to combine to strengthen that opi-
 nion, as I  think, must be evident, while  it was  equally clear,
 that the blood did  not  act equally on the  excitability;*  for

   * I could  wish the word excitability to be well understood, as on this
 knowledge  greatly depends, according to the principles of this essay,
 the correct method of curing not only the epidemic, but as I conceive,
 all febrile diseases.   It is a phrase first introduced by the celebrated
 Dr. John Brown, who  deservedly has made a great noise in the world;
 but unfortunately he had seen too  little of medical practice  to have
 given him all those correct ideas, which he would have adopted, if he
 had had sufficient opportunities of seeing the effects of fever in all its
 variety and types.   Further, he did  not live long enough to have had
 an opportunity of reflecting on the present pneumatic doctrines.  Never-
 theless I do not know that a better idea can be given of this important
 term, than the following in his own language.
  "We know not what excitability is,  or in what manner it is affected
 " by the exciting powers.   But, whatever it be, either a certain quan-
 tity, or a certain energy of it, is assigned to  every  being upon  the
 " commencement of its living state.  The quantity, or energy, is differ-
 " ent in different animals, and in the same animal at different times   It
"is partly owing to the uncertain  nature of the subject, partly to the
  poverty of common language, and likewise to the novelty of this doc-
 trine, that the process of the excitability  being abundant, encreased,
^ ^ccumul^d, superfluous;  or weak, not well enough sustained,  not
  well enough exercised, or deficient in  energy, w^ enough ofttimulu* 
41
for though the face was flushed, and  the pain in the head was
the constant subject of complaint, the whole surface  seemed
constringed, looking like goose  flesh, and  sometimes cold.
together with the extremities always; from whence it would
seem as if the excitability was greater, the  nearer its source,
the brain.  But the  lungs also  have a surface, which is more
immediately exposed to  the  atmospheric air, and therefore
were more liable to be immediately  acted upon,  and to suffer
by this general torpor during the cold stage of fever; of course
they were  the principal seat of the disease, having partly
lost their excitability from the  effects of all the predisposing,
and exciting causes; and thence it was, that  death was always
at the door, because the powers within, and  without were un-
able to perform the  necessary functions by generating heat
sufficient to keep  the body alive.
   A physician of the least reflection would certainly, never
think of abstracting blood, which is considered the  grand sti-
mulant of the living body, during the cold stage of fever,conse-
 quently, if the system was in that state throughout the course
of this  disease, practice of that kind  could  never be  deemeu
proper,  and correct.   This must be strikingly obvious, if th?
subject is taken in a proper point of  view.   During the cold
stage of fever, the whole  surface of the body  including more
especially that of the lungs is supposed to be in a state of torpor,
or inaction,  while at the same time the circulation in the larger
blood  vessels is considered as going on irregularly, but with
rapidity; consequently  by the mere propelling powers of the
heart, and arteries, the blood, or  its finer component part, tl.o
 serum,  would be more  liable to be forced into passages,  ar.-.l
 cavities, from whence it might not so readily be extricated 1. v

" has not been applied."   Again in  the next paragraph.  " There is
"always some excitability,  however  small, while  life remains, and ti.o
" action  of the exciting powers is never wanting in one degree,  o;
" another, the conclusion from that fact  is, that they are all endow.d
" with more, or less of stimulant  powers, and that this must be either
"excessive in due proportion, or deficient."
                               6 
42
 the returning veins, and the common absorbents, which are also
 in a torpid state.  Thus it would seem, as if the lungs in a mor-
 bid, and inactive state, from the various predisposing, and ex-
 citing causes constanly acting upon them, are more apt to be
 disordered;  and hence the serum once stagnating under the
 sneiderian membrane was not to be moved by any powers of
 of nature, or art. This, I believe, was the only fatal termination
 the epidemic, whether in the type of pneumonia, or synanche;
 and as daily experience had heretofore taught, before this  epi-
 demic period, was the most common  termination of ordinary
 pneumonia, though  evidently from very different causes.  In
 the one, the excitability generally, but more especially in the
 lungs must have been " deficient in energy" from " enough of
 stimulus not applied;"  in the other,  it was " too abundant,"
while the stimidus of the blood was in " due proportion /" and
hence it was, that the indications of cure were directly oppo-
site because during the reign of the epidemic in its own domaint
the causes were constantly negative, consequently their effects
 were as  constantly so.   In the  one, the torpor on the lungs,
and  whole surface of the body  was constant  throughout  the
 course of the disease; in the other, the torpor was momentary
 in the generality of cases, which, agreeably to the principles laid
 down in  the proximate cause, while the excitability was abun-
dant, indirectly became the cause of excessive excitement, and
hence the same termination by effusion might take place from
 causes directly opposite.  But it is presumed,  the excitability
before this period was not always the same  in all cases, at the
 accession of the cold stage of fever, in pneumonia; it might be
 deficient in energy, at that juncture, merely from the effects of
 the predisposing, and exciting causes,  which consisted in cold
 principally; and thus effects might, and no doubt have taken
 place in a great variety of cases, similar to the  uniform cases
 of the epidemic, making the sporadic cases, which have  some
times excited the astonishment of physicians, when they have
found the effects of the  lancet  fatal and at a time when they
 have expected to have performed a wonderful cure. 
43
   If these principles and observations  are  correct, can there
be a  physician,  who  would venture to  wield  the  lancet,
without  a  pause ?   But it may be conceived,  that,  though
the  main  point may,  and ought to  be  given  up,  the  old
routine consisting of pukes, and purges ought not to be aban-
doned.   It is highly incumbent  on a physician, before he ad-
ministers a medicine of any kind to take  into consideration
the indications,  upon which that  medicine is about to be pre-
scribed.  If a puke is thought to be proper  for the  cure of this
epidemic pneumonia;  the question ought to be ;  why does it
seem to be indicated ?  Can the operation  of an  emetic have
any  salutary effect on a disease, while the cold  stage is pre-
dominant ?  Yes, it may, by a sudden operation,  determine to
the surface !  I grant, if this effect could always be relied  on,
it would be a very happy one;  for it would at once go to the
very root of the disease.  It would restore action to an inactive
surface, and the disease would  be at once cured.  As to  the
idle notions of  cleansing the prima via, and  throwing up  the
bile from the stomach, the whole matter  is so absurd, that I
think it altogether a waste of time to say a word upon the sub-
ject, if I have been so  fortunate as to have made  any  impres-
sion  on the reflecting  mind in this whole  discussion.   If  the
above effect of an emetic could always be relied on, I would at
once accede to the propriety of the indication;  but unfortunate-
ly this never can be depended on.   It almost always nauseates
the stomach for some time before it pukes.  If so, it weakens
the  energies of the system;  and during this effect,  it must
encrease the whole torpor on the surface ; and hence the use of
nauseating doses of medicine in  old pneumonia, when  there is
excessive excitement, and directly the reverse in this  disease.
While it nauseates, it nine times out of ten  operates on  the
bowels as a purge.  If so, the enquiry must be, whether a purge
 can have any good effect in tliis epidemic disease, and what
are its indications.  In the cold stage of fever, all the humours
of the body are necessarily disposed to retire from the surface,
because  the  capillaries are torpid, or inactive; of course  any
action on the bowels must encrease the  action  of their exha- 
44
 lents, and  cause a greater determination of the  humours  to
 those parts, while all the other functions of the body would be
 more liable to be diminished, and more especially that of the
 lungs, the primary organ in the animal economy in generating
 animal heat, which, it has been seen was  peculiarly defective
 from the negative qualities of the remote cause.   Further, the
 encreased action of the exhalents necessarily diminishes  that
 of the absorbents, and not unfrequently  invents their peristal-
 tic motion, as may be seen explained by some physioligists.
 This effect alone would be sufficient to sink all the powers of
 life.  But if a purge has this effect on the exhalents, and absor-
 bents in the intestines; is it not a reasonable presumption,  that
 a similar effect might take place  in the lungs, and thus more
 certainly produce an effusion of serum on them, which  at first
 view must be the commencement of death ? I am confident, I
 have seen this effect take place from one evacuation from the
 bowels.   To the action on the bowels, let it be remembered, is
 necessarily superadded, among the lower class of people, more
 especially, exposure to the air, which most certainly would
 check perspiration, and again produce the recurrence of a cold
 chill, if it had in some measure gone  off.
  From all these considerations, and reflections, it must appear
 as clear as the light, that emetics never ought to be relied on
 as to their ultimate effects, and that  cathartics must  in  a
 general way be much more pernicious, than the lancet.  In the
 hands of a judicious, and cautious physician, the effects of the
 lancet may probably, be restrained, because, he can say, " thus
 " far shalt thou go, and no farther,"  but not so in the adminis-
 tration of a purge: when this  medicine begins to operate, no
 human foresight can  determine,  to what extent it will go.  In
 fact the depleting system, which had heretofore been altogether
 in fashion  among the people as well as physicians from its
known good effects in pleurisy, and  peripneumonv, was disco-
vered never to have any beneficial effects, and too often brought
on a fatal termination ;  for the plainest reasons in the world,
which ought forever to be  impressed on the  minds of physi-
cians.  In ordinary pneumonia, there has generally been, with 
45
some sporadic exceptions,  a high state of excitability in the
system, as well as in the lungs from whence they were capable
of high excitement, and though a state of exhaustion " might be
produced, the excitability was only encreased thereby, and
the excitement consequently so agreeably to " certain laws of
the animal economy;" but in  the epidemic  pneumonia, the
whole system, and more especially the skin and sneiderian mem-
brane were in a peculiar state of torpor,  having partially lost
their excitability, so that the lungs  seemed to have lost their
function from the first accession of the cold stage; and thus the
blood, which did not receive from the atmosphere through them
enough of " air's pure essence," by which " heat" could be " dis-
parted" to the whole system, and by this  means excite the ex-
citability to relieve a sinking system from  the  cold stage of
fever, which never went entirely off, but with a  return of inci-
pient health.
   It being understood, as I trust it is, by all intelligent physi-
cians, that the cause of the epidemic disease was a negative,
tlie indications  were  plainly positive; and  inasmuch as the
system had, by those negative causes, lost the power of gene-
rating heat, the indications were to restore it by artificial
means.   In truth, the remedies were " simple and plain ,• for
such are the ways and laws of nature."
   After  a great waste of  life, from a few days before the  first
of January, to a late  period in February, I am candid to ac-
knowledge, that though some were disposed to say, that I had
been  more fortunate than my brethren of the  faculty, I was
vacillating in practice, and not unfrequently preferred the sim-
plicity of nature to the former, and active remedies;  for I can
say with truth, that no physician ever carried depletion by the
lancet to a greater extent, than I have done, not excepting Dr.
Rush himself; for I do really believe, like him, if I had been
among the first attacked,  I should  have fallen a victim to a re-
medy, which I had seen  so powerfully beneficial in  pleurisy,
&c.
   From  these reflections, it may  readily be  conceived that I
gave up the lancet with  great  reluctance, believing  like Dr. 
46
 Hosach of New York, that the epidemic pleurisy was a modifi-
 cation of the " head pleurisy."   I would  advise those who set
 out to teach others, to be certain that they themselves do not
 require teaching.   I recollect a great many such kind souls on
 the other side of the  Atlantic, who published instructions to
 the citizens of Philadelphia, &c.  purely for their  good, and
 nothing  else, when they ought  to have sought for instruction
 themselves.*


  * These transatlantick doctors remind me of the account given of two
great physicians of high sounding names in the city of Pavia, who it
would seem, did not volunteer their advice, as Dr. Hoggarth of Bath,
in England, as well as a host of other mighty Doctors in France, &e. to
the unlearned Doctors of the United States of America,  all of  whom
know as little about the epidemics of America, as Dr. Hosach did of that
prevailing in, and about Albany.   For the amusement, and instruction
of the reader, T cannot refrain from transcribing it from Vansweiten's
commentaries or Boarhoave's aphorisms.
  " In a publick oration which Ramazzini delivered in the college of
" Pavia, to demonstrate, that that theory had no right to privacy in physic
" before practice, but that both these parts of medicine  ought to be strictly
" enjoined, he relates, that in theyear 1576, signs of a pestilence by no means
" to be contemned, made their appearance at Venice, and when the fears
" of the people increased from the frequent deaths, and as usual great
" differences arose among the physicians about the nature of the disorder,
" some affirming it to be pestilential disease, others denying it; by a decree
" of the  senate, Jerome Mercurialis, and Jerome Capivicca, (what
" high sounding names in physic!)  were sent for.  These famous men
" accordingly set out  for Venice with  a splendid ritinue,  nor did they
" meet a less flattering reception.  Upon their arrival they instituted
« a  Severe inquiry with  respect  to the disorder, gave the physi-
" cians on both  sides an  impartial  hearing, and afterwards  in  the
" college  of  physicians, in presence of  the  Doge,  solemnly  deli-
vered  their  opinion,  that the  epidemic  disease  which  raged,
" was not pestilential, and  openly declared that  they -would  cure the
" disease by  a method, and  regimen  that they  should lay  down.   Thia
« declaration was received with  the utmost pleasure, and  the city
« forgot all its fears: but when they ceased carrymgaway the infected,
« to distant places, with their usual carefulness, in a few days this fatal
" disease, declared uninfects by judges of such vast authority,  began 
47
   The correct practice in treating this epidemic disease, which
 was almost  invariably in the form of pneumonia, was  simply
 this.   As soon as a patient was seized with chill or ague, it was
 absolutely necessary to have him put in a warm bed, after giv-
 ing him forty or fifty drops  of  laudanum; to apply hot bricks
 to his feet, and if occasion  seemed  to  require it to his sides,
 knees and back ; to dose him freely with hot teas of any kind,
 every fifteen or twenty minutes, and if the chill did not seem
 to give way, a little spirit was necessary to be added.   It was
 no uncommon thing, if this treatment was commenced instan-
 taneously and properly persisted in, that a patient who seemed
 to be threatened with death in a few hours, was perfectly re-
 lieved in as many;  and all  done by  restoring heat to  the sur-
 face of the  body, and by sympathy to the  lungs, which were
 enabled to renew their functions by this simple method.
   But it is to be lamented, that  few were so fortunate as to be
 put under this treatment in such good time.  For though it had
 been sounded from the overflowings of benevolence, that bleed-
 ing  and purging were  injurious; physicians and the people
 themselves would persist in  destruction;  so that after the cor-
 rect treatment was generally understood, there were some that
 would go on as they had been taught, that is  to " kill by rule,
 and cure by chance."
   It was nothing unusual during the whole winter and spring,
 when  patients had not been thus treated, but were left to them-
selves for some days, that  though they at first complained of
cold for a few hours, they would say, they did not feel at all
 so; which might be  readily believed from the appearance of
the countenance, which was always flushed.  As to complaints

 " to spread among the populace with greater security, so that in the
" space of a year almost 100,000 were carried off.   However this pesti-
" lential disease behaved very politely to its judges ; for it spared them, so
" that they returned back to Pavia safe and sound, though they lost great
" part of their retinue.   Their method of cure proving injurious, the pro-
" feasors -were dismissed.  If such great men fall into so pernicious an
" error, how cautious ought physicians to be, when  they are consulted
" about epidemic disorders." 
48
generally they had none except in the head; and though they
were incessantly coughing, and sometimes spitting freely, it was
rarely they complained of any pain in the chest, unless interro-
gated !  The pulse was generally full, and almost always indi-
cated the use of the lancet, if other circumstances  were not
attended to, such as the coldness of the feet and hands, which
showed clearly that the hot had not yet completely succeeded
the cold stage  of  the  fever.   Even under all these, the most
alarming of symptoms, there  was little apprehension, but that
the patient might be perfectly relieved, though not so speedily
by the same mode of treatment.   Though the face was flushed;
the head constantly complained of; and great stricture and full-
ness in the thorax, yet this same hot treatment relieved all these
distressing symptoms with  more  certainty, than the depleting
system used to relieve similar symptoms, when it was actually
indicated in the old pleurisy and peripneumony.   It is true that a
perspiration was not so readily excited in this stage of the dis-
ease, but the cure was almost as certain.  Butif blood was drawn
or a purge was given, all was doubt and difficulty, until it could
be ascertained, that an effusion had not taken place.  If it had
taken place, it was quickly discovered by a quick respiration,
when even hope  vanished.    This soon became with me the
only symptom to  be apprehended;  so  much so, that  when I
was called on to visit a patient and got into his room, I placed
myself in a situation to view the sta! e of his respiration, and
looked steadfastly  first  at  his chest, and then at  his counte-
nance, feeling  his  pulse at the same time.  If his respiration
was easy, I directed with confidence, that every thing which
has just  been  advised, should be applied with  unremitting
diligence, and that he should not by any means be permitted
to get out  of bed; and that  every  thing  should be avoided,
which could disturb his bowels, even for a week.   If 1 was not
successful,  1 am confident  it has  been, because these direc-
tions have not been complied with.  Indeed it so happened,
that if a patient was  not put immediately upon  this plan in
the course of a few days, it was a difficult matter to keep him
still.   He would insist on it  that he was  not cold, though hit 
49
feet were  like ice to the feel, but on the contrary, that he was
burning with heat internally! In pulmonic complaints, this was a
circumstance altogether new and extraordinary to me, but had
been familiar in autumnal seasons, when intermittent and re-
mittent fevers prevail here, as invariably as the seasons revolve
around.  During that  season,  when patients are taken with
either  type of fever;  I have seen so many  fatal cases  from
cholera, that I have for many years  made it a practice to caution
them and their friends  against the results, which may probably
take place  in the cold stage.  If the bowels are put in motion
by nature or art, at that  particular  juncture, there is always
some risk  of an afflux of humours to those parts, which are
not so easily restrained;  and when left to nature, soon put
a period to life.  In this situation when the whole body is exter-
nally cold, the patient complains of intolerable heat  internally,
clearly demonstrating  that he is labouring  under the effects of
the cold stage of fever.  Just so in our epidemic, if the bowels
were once disturbed, the consequence were always alarming,
because the disease was made up of  but one stage, which was
the cold stage.  In truth, this symptom which was seldom na-
tural but unhappily too often artificial, was vastly more injuri-
ous in the one case than the other  ; it  weakened the system,
disturbed the healthy action of the lungs as heretofore stated
and diminished, or rather obstructed the powers of  the animal
economy in generating animal heat.   Under all these circum-
stances and reflections, is it possible that a physician can ever
think, without seeing the absurdity of bleeding, puking or purg-
ing ?  Well may it be said of such persons, " they  have eyes,
and see not, understanding and perceive not."
  But notwithstanding what has been so earnestly  inculcated
as to the pernicious, and fatal effects of depleting by the lancet
or by the bowels, it is  not to be supposed, that these  violet
remedies destroyed all, who came under such  treatment.  II
this had been so, a vast many more would have fallen victim  .
than really did, to this terrible scourge.  It is only wished ;  ;
be understood, that in  such  cases,  which survived this unnatu-
ral  treatment, they would have recovered with much great t
                            7 
5(5
facility, if they had in tender mercy, been left to the care of
friends and nature.
   Those who have ever given themselves the trouble to read
the various histories of epidemics, and pestilence in different
parts of this globe, must know, that "no pestilence has ever been
so violent as to kill all;"  that all are not taken down with the
disease, which is  daily thinning the  ranks of human life; and
that of the great numbers which are seized with it, a great pro-
portion are but slightly affected: in  fact that there are grades
of the same disease.  This  being actually the  case, the pre-
sumption is, that the violent operation of a medicine of this kind,
so much to be avoided, may not always have the  effects, which
have been here attempted to be portrayed, but on the contrary, it
may at times have a very salutary effect. But sure I am, that the
abstraction of blood, while the  epidemic was raging, could never
have been useful,  though as in the cases described at the com-
mencement of the disease, it did not prove fatal, when taken
with caution.  Pounds of salts, pounds of calomel and jalop,
&c. were used throughout the season, and yet human life was
spared in some cases, which seemed rather desperate; but does
this prove that purges were not pernicious ?  I trust not, while I
can vouch for the fatal effects; if the  reasoning on this subject
has made no impression on the reader.  I have been told often
and often, of the wonderful effects of'" evacuating freely," but
I am constrained to say, that out of the numbers of such cases,
which have fallen under my notice after purging rostrums have
been persisted in, I can say candidly, that four-fifths have fallen
victims to folly, and a want of accurate observation, while of
the other fifth, whicli have survived such stupidity, I am confi-
dent, they would  have been  perfectly recovered by the  only
safe treatment in a few days, or perhaps hours ;  whereas by a
contrary system of ignorance of the animal economy, they have
languished for  weeks; frequently to the great   credit of  the
skilful Doctor, who ought to have been ashamed of  himself.
These reflections remind me  of my attendance on a negro boy
of the Rev. Dr. Keene, one of the best of  men, and of great 
51
ecclesiastical learning, some four or five years ago, in the au-
tumnal season.  I proposed giving him either a puke or a purge,
I really forget which, and was very  earnest in directing that
it should be given at  such a period, before the next paroxysm,
that it might have time to complete its operation.  Why, said
the good old man, are you so solicitous about that matter ?  I
endeavoured to explain, by telling him  of the probable danger,
if it should be operating, when the cold stage or ague came on.
Holding up his hands with  amazement, he exclaimed with a
smile ! Is it possible ? Why, I have given blue stone as a puke
for forty or more years, and have always given it in such way,
that it might operate, as  the  ague was about coming on ; and
this practice has been attended with invariable success ! I think
I asked him, if he had never known a patient to be taken with
a cholera morbus, after  the  second, third, fourth, or fifth pa-
roxism of an intermittent, which had  sometimes proved  fatal.
I am rather confident, his answer was in the affirmative, though
he seemed equally confident, that the blue stone had never done
any harm!!
   It  is a circumstance frequently  of deep regret,  that men
however well  informed  upon  general topics, will have their
own notions about the good effects of certain remedies for parti-
cular diseases, though they have never taken one requisite step
to be  correctly  informed upon  subjects, in which life itself is
materially  concerned; but  for a physician not to  reflect on
cause and effect, as they regard the various motions of the hu-
man  body, when they are about prescribing for a disease of
an alarming nature,  it actually becomes criminal.   It is the
duty of  a physician to reason with himself,  and to ascertain
the state of probabilities as to the ultimate effects of the me-
dicine, which he is about to direct.   If he thinks an emetic is
really indicated, and that it will probably have a happy effect
as such ; he ought to reflect, that this same medicine may not
have  any such  effect, and that even if it should operate as an
emetic, it may  also act as a cathartic, and thus defeat  his whole
intention. I trust it is clearly shown, that both emetics and car-
tliarticsare hazardous remedies, if administered during the cold 
                            52

stage of fever, and as the epidemic was made up altogether of
the cold stage, therefore emetics and carthartics, were hazard-
ous remedies, and oftener did much more harm, than they could
possibly have done good.
  Further, as sporadic cases of pneumonia, similar in their na-
ture and effects to this epidemic,  have frequently  occurred at
all times and seasons, the same reasoning with regard to their
treatment will apply, when such cases do again recur. To say
that I have guarded against the early use of carthartics in cases
of pleurisy, would  be only  acknowledging, that I have  taken
the  advice of some  of the most eminent medical writers, while
I must at the same time  acknowledge, that I did not understand
the  rationale of such cautious treatment; and  that I have had
cause to lament that I have given nauseating doses of emetic
medicine, which have operated as cathartics, and at other times
I have been importuned to give carthartic medicine, which in
both cases have hastened the patients out of the world.  Such
being the  effects  of these  important  remedies  in ordinary
times, in diseases of the  lungs  under  certain circumstances,
how much more were  they to be dreaded in our pneumonia
epidemic ?
  It must be recollected, that I conceived the case of William
Blake to throw much  light on the  subject of the epidemic,
though it appeared for  the first time in the type of synanche;
because there was an effusion of serum, under  the syneiderian
membrane  of the whole fauces.  My reason for thus express-
ing  myself was, that there  appeared a want of action m the
exhalents and absorbents of that  part, which finally extended
into the lungs, which is lined with a continuance of the same
membrane.  Under this impression I commenced  the use  of
stimulants, though  with much caution;  and  began with a me-
dicine which had become obsolete, until revived by Dr. Archer
of this state, in cases of  synanche trachealis.  I  had learnt from
some  experience, that  seneka snake root  was a considerable
stimulant upon the fauces, and  therefore  concluded that it
would have a double effect agreeably to  its character, in  excit-
ing action of the skin.   In many cases of affection of the throat 
53
 I found it a most useful remedy, as well as in affections of the
 lungs, until  it was discovered  that it would too often take a
 turn  upon the bowels, whicli unhappily defeated all its proper
 indications.  This  much I can  say for it, that in slight affec-
 tions of the throat, it is one of the best gagles I ever used, but
 must caution physicians against the use of it, when it is  sup-
 posed, that an operation on  the bowels will  have any bad ef-
 fect.
   All fhese observations and reflections, lead to this plain and
 obvious conclusion, that in prescribing for all fevers, particular
 attention ought at all times, to be paid to the stage of the fever,
 and  that every thing  which will  disturb the progress of it from
 the cold to the hot stage, must most probably be highly injuri-
 ous ;  of course, as it could never at any period of the epidemic
 fever, be well ascertained, when the cold had gone into the hot
 stage ; and that when that had actually taken place, a relapse
 was more  likely to happen than in any other disease, until re-
 covery had actually become complete.   Every caution became
 necessary, which could affect the negative state of the system,
 while every thing which could in any degree, aid and assist the
 animal  powers in emerging  from  a state of cold to a state of
 heat, became  altogether  important and  essential.  All these
 circumstances have made so deep an impression on my mind,
 that I never will make use of depletion in any way, unless that
 by the  skin,  can be  called  such, until I have ascertained the
fact,  whether the feet  are warm, and whether  the arm, when
 exposed to the air puts on the appearance of goose flesh.   For
 let it be remembered  that a coldness in the feet was a patho-
 gnomia circumstance peculiar to the epidemic of 1813, as  well
 as an apparent constriction on the skin ; both of which circum-
 stances may at times be attached to all fevers, and more espe-
 cially in fevers attendant on affections of the lungs.
   That epidemics of  a character similar to the one, which I
 have been endeavouring to pourtray, have fallen upon  different
parts of this world from the  earliest times, there can be little
question  while it is greatly to be  regretted, that  few if any, me-
dical  writers have been sufficiently accurate in their descrip- 
54
 tions, and method of treating it! Sydenham attempts to give
 gome account of the rise of a new fever,but not so distinctly as
 to induce a belief, that it partook altogether of  the nature and
 character of this epidemic of 1813.  He thinks, that a " change
 " of a constitution depends  principally  on some  secret and
 " hidden alteration, in the bowels of the earth, communicated
 "to the  whole atmosphere, or on some  influence of the pla-
 "nets;" from whence it is  presumed,  originated a kind  of
 " bastard peripneumony," which did not " bear repeated bleed-
 " ings," as in former times. The whole is wrapped in unmean-
 ing phrases, and leaves us very much in the dark, whether this
 epidemic peripneumony was  in any respect of the nature, or
 character of our epidemic pneumonia.  In his account of the
 "epidemic cough,pleurisy and peripneumonia of 1675," some
 doubts are raised about  the  propriety of bleeding, though he
 seems unwilling  to give up  his fondness for the lancet, and
 leaves us in doubt about the  real  character of his epidemic.
 But  Dr. Rush  in a note on this subject at one dash removes all
 difficulty in his own mind, by referring it to the character of
 what he, and others are pleased to  call a " bilious pleurisy  so
 " well known in the southern parts of the United States," and
 talks about its "grades" with as much confidence as if he really
 understood the subject;  and contrary to his own principles
 confuses the whole, with the high sounding words, " synochus
 fortis, synocha, synochus mitis, typhoid and typhus," observ-
 ing at the same time, that " more copious bleeding is necessary
 " in  the first, and second, than when the bilious fever or pleu-
 " risy exist separately."  Perhaps  I may  say a few words on
,this  mistaken idea about " bilious pleurisy."
   Vansweeten in his commentaries on Boarhaave's Aphorisms
 slightly glances over an  « epidemic pleurisy," that would not
 yield to the " usual method of cure, nor bear repeated plentiful
 " bleeding," but was happily cured by a free use of " emollient
 " decoctions, and large and frequent doses of  oleaginous me-
 " dicine."  It does not appear that he considered it a disease,
 which created any alarm, or that it proved by any  means of a
 fatal nature, while it was evidently altogether transitory.  Sy- 
55
denham is candid in his treatment of epidemic diseases, and
has given some excellent advice, when he says,  he "could
" scarce  ever  preserve  one or two of his  first patients from
" danger, till he had thoroughly investigated the nature of the
" disease, and then  he proceeded in a direct and safer way to
" the cure." Vansweeten also, is equally entitled to attention,
when lie makes the following observations, viz. " sometimes
" distempers offer, which although they are entitled epidemics,
" are  entirely  anamolous,  cannot be  restricted to any fixed
" form or type, and are  entirely irregular, both as  to their va-
" riety and dissimilarity of the symptoms, that the same dis-
" ease  in the  very  same constitution of the year, frequently
" appears in a various and  dissimilar  manner.  Whence,"  he
adds, " it were to be wished, that physicians who have an ex-
" tensive practice would meet  together, and  deliberate from
" their joint observations, on the nature of the incipient epide-
" mic disease;  and  publish the best, and most  certain method
" of cure, as well as such  as  had proved successful.  Thus,
" many mistakes would  be avoided, and if any error was comr
" mitted, it  might instantly be rectified."
   These great and illustrious characters, have  given excellent
advice in the above  short quotations, which may very correctly
and properly apply to all epidemics, but as  to the cure of this.
epidemic I can discover nothing, which amidst their various
remarks, can lead to a correct indication of cure.  Neverthe-
less I shall always consider myself, in some measure, bound to
give each of them due  attention wherever a disease occurs,
which  appears  in a suspicious  form, as they  contain almost
every thing  upon epidemics, during and before their day of
usefulness.
   It has  been reserved for our countryman, Noah Webster, to
have thrown more  light upon the subject of epidemics, than
any other man in ancient or modern times; and though not a
member of  the faculty, has said  more than  any other person
of our day, with all  the advantages of modern improvement, to 
56
 lead to correct notions of the causes of epidemics, and at the
 same time to the cure of them.
   I must take the liberty of advising every practising physi-
 cian to read his book on epidemical diseases with patience and
 attention, when perhaps he will be better prepared for such a
 scourge, as has afflicted this devoted section of the country for
 two years past.  He does not pretend to specify remedies, but
 as they  have been beneficial or injurious, agreeably to the au-
 thorities he has consulted, and these are so numerous, that it
 would be impossible  for  physicians to come at them in  any
 other way, situated as they generally are, whether in  town or
 country.  And yet  it is more than  probable, that he has not
 with all his elaborate  research, been able to come at one  half
 of the epidemics, which have devastated  many  particular sec-
 tions of our own country.  Even here  there is something like
 a tradition, such as he relates, as  " coming from  his father,"
 which  induces  me to believe, that this  particular part of the
 country, was afflicted with  an  epidemic pleurisy, &c. such as
 I have been treating of.   Independent  of what I have heard
from mv father also, who died in the year  1782, at the age of
 sixty-three, as well as some other persons, who are now living,
there  was for many years after I commenced the practice of
physic, in the memorable  year of 1783 ;  a common practice
 among the middling class of people, to give sweats in cases of
 pleurisy ! Though this might have been beneficial in some few
sporadic cases, as I endeavoured to  show in some of the pre-
 ceding pages,  I had generally to regret  the ill-judged us-e of
them.  Happy would it  have been for this quarter of our coun-
 try, if this once pernicious custom of piling bed clothes on a
 patient, applying any thing hot to his feet, and of plying him
 with hot toddy, hot teas, &c. had  been generally resorted to
during our epidemic.   Had this practice been regularly pur-
sued, I am confident nineteen-twentieths  of  the victims  to ig-
norance of the real nature of the disease, and the correct  mode
of treating it, would  have been spared ! !
  W e read in our miscellaneous works, more especially in the
Medical Repository of New-York, of " bilious pleurisy," which 
57
 required a different mode of treatment from ordinary pleurisy
 being particularly injured by bleeding;  but  whether this dis-
 ease, as described by Dr. Hugh Williamson of N. Carolina, and
 others, is  of the  nature and character of our epidemic, I shall
 not take  time to enquire, but really there is something so ab-
 surd in the idea of a bilious pleurisy, that I  am surprized any
 physician of common understanding would ever think of tole-
 rating it! Is it, because the  patient occasionally pukes bile ?
 Then every disease to which  the human body is subject, may
 be termed bilious ; for I can say with  truth, that this circum-
 stance may and  does take place in all cases whatever.  Is it,
 because the skin is frequently  tinged  with bile in pleurisy ?
 This I have  been witness to in  hundreds of cases, where the
 lancet was the only remedy, that could be relied on ; and when
 I have  taken  away day after day  pounds of blood, I have
 thougnt, that more might have been taken with advantage ! But
 then it is to be presumed, " the oxygen in the air was superabun-
 dant," and that  every thing  conspired to augment the excita-
 bility of  the system, so as to make it necessary to reduce the
 excitement, which was much  more likely to destroy life, than
 the negative state of the animal economy, during the reign of
 the epidemic of this section of the globe, arising from  a " defi-
 ciency of oxygen in the atmosphere."
  I may have been wandering from my  subject, but surely too
 much cannot be said, if  the  healing art can by any means  be
 improved, and I am sure, that a great deal  is yet to be learnt,
 and that  too by reflection, and a minute attention to every
 symptom and every circumstance, which may possibly arise in
 the treatment of every disease, and more especially of this
 epidemic  disease.
  Having dismissed the bilious pleurisy, I wish to call the
 attention of the faculty to the only epidemic, which seems  to
 correspond exactly with the one I am  treating of, and which
took place in this  peninsula in Sussex county, Delaware,  in
 1775.  It evidently originated  from local causes, which were
such as I have  endeavoured to prove.  The Rev. Matthew
Wilson, who practised medicine in Lewis, after telling us, that
                              8 
58
 it" raged chiefly during the three last weeks of February, and
 two first of March, most about Indian river, where the land
 is high and dry," but not at all on the other side of the river,
 where the ground  is low and moist, and that " so  dry and
 warm a winter has not been known in  the memory of the
 living;"  that " the air has generally been full of a dry smoky
 vapour, with many other remarks, which are highly pertinent
 to the case of  our  epidemic."  He seems to think, that " so
 great  was the variety," (in the symptoms I suppose,) that it
 was " not easy to describe it," and yet when he comes to the
 " remedies," which proved unsuccessful as welj as successful,
 he admits in plain  terms, that it was a pleurisy, though of a
 peculiar character.  As I think our subject will be elucidated
 thereby, I shall take the liberty of  transcribing a part of this
 important  letter to ---- of Philadelphia, as published in the
 Medical Repertory.
   " Remedies.  It would be more tedious than useful to relate
 " all the methods of  cure I tried, and the medicines and vari-
 " ous combinations of them to no purpose at all, for sometime.
 " At  first, it appeared by the account the messengers gave,
 " that it was a pleurisy.   I was then obliged to  go a journey,
 " and  could not attend;  but I sent  them the usual remedies
 " for that disease, ordering the usual evacuations.  They were
 "bled at intervals, blistered on the pain, had the best expecto-
 " rants, pectoral infusions, &c. but to no good purpose at all.
 " When I  came myself to see them, on weighing as well as I
 " could, all the circumstances,  I concluded it to be a peripneu-
 " monia typhoides, and had great expectations  from the class
 " of powerful antiseptics; but here I was as  much mistaken
 " On the whole I found salt petre and camphor mixed, useless
 " Camphor had no sensible effect, and salt petre seemed rather
 "injurious, except when blown  into the throat to cleanse it
" Opium increased the difficulty of breathing.  Volatile salts
« were insufficient.   I could not even promote perspiration by
 camphor, volatile*, and thebaic tincture together. I supposed
 worms ; and mild mercurials brought some away, but seemed
 to do no  other service.  Bark in large and repeated doses, 
59
" would check the gangrene; the acid elixir did small service;
" blisters to the pain seemed to increase the internal burning,*
"ovgangrene; bleedingt was certainly very pernicious; not
" one recovered, who was  bled in the arm: bleeding in the
" feet was little better if they bled freely.  The same  remark
" on bleeding, I since find was made by some in the pestilential
" fever  in London,  A.  D. 1665, when they  buried  9000 a
" week.
  " That which  is  said to be Heinsiers' anti-pestilential  re-
" medy, for  which he had a statue erected to him at Verona,
" was altogether  unsuccessful here.   Vomits,f at first seemed
" of service ; but I suspected they sometimes  induced a gan-
" grene in the stomach ; purgesf had the same tendency in the
" intestines ; the antimonial  essence as an alternative, would
" avail nothing, &c.  &c.
   " Distressed in mind in  this mortality, I gratefully ascribe
" to the Being of unerring wisdom and boundless compassion,
" the granting a clue to extricate us out of this perplexity.   It
 " is simple, indeed  and plain ; but  such are all the ways  and
 " laws of nature."
   " Reflecting on two  or three external mortifications, which
 " happened  about this time, I considered that this disease must
 " be the  same, only internal,*  and less accessible;  that some
 " very malignant peculiar acrimony,  must produce these ef-
" fects ; probably contracting  the nervous fibrils into spasms,
 " which gave the burning pain ;* and interrupting the nervous
 " and other  fluids, to the destruction of the part; whence the
 " paleness,  weakness, &c. I resolved  therefore to  try medi-
 " cines, which would blunt the acrid venom, remove the spasms,

  * Nothing  can  be more  characteristic of our epidemic, than this
 " internal burning," as well as every other descriptive part of this let-
ter, making due allowance for his ideas about "gangrene" &c.
  -J-1 would beg the  medical reader to attend to these fatal remedies,
viz. bleeding, vomits and purges .'  Can any thing be plainer, that they
 sometimes if not generally, brought on a diarrhxa, which could not be
 restrained as  in our epidemic, which in his opinion indicated a "gan-
 grene ?" 
60
 " raise the vital powers, warm and open the skin, and rouse the
 " languid nerves all at the same time.  By camphor gr. v. Bals.
 " Traumat ZS, Spt. Sal. Ammon. Th. The Bari au gut xxx
 « Deaset. Rad. Althfe ZS m. ft. hauster.
   " This was given to adults twice a day. A single dose would
 " sometimes relieve, when taken early in the first stage ; but
 " some required several doses.   The  camphor and  opium,
 " seemed necessary to ease the pain, remove dismal apprehen-
 " sions of mind, compose to rest and moisten the skin.   But
 " when the  disorder was advanced to the second  stage, even
 " when the sick were  very low, the following  rules I think,
 " always  succeeded, viz.
   " 1. By Rad. Valer. Sylv. 21, Serp. Virg. Camphor oa grs.
 " iv. Gum. Assafsetid. grs. 7 syrup con grs. st. Bol.  This may
 " be repeated two or three times a day, to promote  sweat and
 " urine, rouse the languid nerves, &c.
   " 2. To the pain we applied hot poultices of lays of ashes,
 " thickened with Indian meal, in a thin linen rag, which is ex-
 " cellent for pains, spasms and gangrenes.
   " 3. To correct acrimony, &c. &c.
   " 4. Their drink was a decoction of mallous roots, and catnep,
 " made into a hydromel, with honey and vinegar. Of this they
 " were obliged to drink a gill hot, every fifteen minutes, though
 " against  inclination."*
  This  last article  distinctly fulfils the indications of cure of
 the epidemic here,  while every thing else previously mention-
 ed must aid, and assist the system, become languid  from the
 effect of the negative powers of the remote cause, &c.  Another
 circumstance is  brought into view, though not mentioned un-
 der this article, and that is the probability of other directions,
 viz. that the patient  should be kept covered in bed, to aid and
assist the  "perspiration," which  seemed to  be the grand in-
tention of all the "remedies."   In fact  the  above treatment
was so nearly  similar to the correct one here, that it would be
unnecessary to detail any thing further on the subject; as the
.. Rep. for August, September and October, 1809. 
61
judgment of every physician must be  governed by times and
circumstances, as well as symptoms.  I am altogether disposed
to concur with this  able physician  and divine, that blisters
were not so much to be relied  on, as some kind of hot appli-
cations, at least at the  commencement of attack of the dis-
ease.
  It is greatly to be regretted that  physicians, generally have
not been more accurate in their observations, more  candid in
their enquiries, and  more  disposed to communicate their ob-
servations, especially when even  one  case of febrile disease,
has  put  on symptoms  which were any way  singular.  This
would lead to further investigation, and might be the means of
saving the lives of many.  It would appear the effect of acci-
dent more than  any thing else, that the above valuable com-
munication  was ever made, and full  as much so,  that it has
been rescued from oblivion !  On Indian river, even among the
best informed, the nature of  such a disease as above described
has long since been forgotten, though they may yet retain some
 vestige of remembrance, that there was a time, when " catnep
 tea" was considered a sovereign remedy for fevers and colds,
 by bringing on sweats, if they would keep themselves well co-
 vered with bed clothes, &c.  This and other circumstances
make it highly probable, that such  an  epidemic as described
has not unfrequently burst forth, laid waste a small, district of
country, and then given place to ordinary diseases.
   That a disease similar to  the  one I have  been  treating of,
has made considerable  inroads upon life for several winters
past in the New England states, there can be no sort of ques-
tion with ine; and yet most unfortunately there seems  to have
been great contrariety of opinion, as to the mode of treating it.
It would be unfair to pretend to decide  on a subject of this kind,
as  there  may have been many  little circumstances, attendant
on  the disease in different places, which might make the  indica-
tions very different from what they have been here.  But I must
be  candid, and confess  myself under some  obligation to the
benevolent  intentions of a Mr. Hayden of Connecticut, who
was some means of confirming me in a plan, which I had under 
62
the dispensation of an  overruling providence, begun to reason
correctly on before I had read his directions, &c.  In truth, it
was substantially the same as the Rev. Matthew Wilson's, and
such as I  have repeatedly declared to be the only correct me-
thod of cure.   But why do I talk about  correctness of treat-
ment, it was all to no purpose, if the disease was not arrested
at the threshold.  If an effusion of serum on the lungs had once
commenced, the powers of art were all in vain; in fact it was
synonymous with  death !  I am not altogether certain, that I
ever saw death approaching in any other  shape  or form, ex-
cept in the case of a young woman, who had been bled, purged,
blistered, &c. which terminated fatally in suppuration.  I have
been informed, that  some other cases terminated favourably
in the same way.  When external  inflammation took place, it
was invariably a favourable sign.
  But  alas ! the ravages which this simple, and altogether ma-
nageable disease made, were distressing to think of!  It com-
menced, it will be recollected late in December of  1812, and
continued  with short  interruptions, until some  time in June
1813, sweeping off in some instances,  almost every member of
large families !  It would be no difficult matter to state the loss
of three, four, five, six, and in some  instances, eight in one fa-
mily, in the short space of a few weeks.  Fatigue, distress of
mind, and exposure to  cold in nursing, were the principal ex-
citing  causes of this disease ; and  while too many were pos-
sessed of  their own notions  about pleurisy  and sore throat, it
was impossible to confine the sick, and keep them under proper
management;  because if  they  were  not immediately put to
bed, and a turn given  to the surface, they began to complain
of great internal  heat, and would sit  up in bed, or attempt to
walk, or sit in a chair, declaring that the heat inside was dis-
tressing beyond measure, while the whole surface was cold.  In
fact, it was absolutely necessary to  arrest the disease at the
very threshold, or life vanished like a shadow.
   Tell it  not in Gath ; publish it not  ----, here I will pause,
before the world can  know, that  in the  short space of  five
months 500 persons, at a very moderate computation perished 
63
in Talbot county in the state of Maryland, with a population
of something more than 15,000 souls ; and at a time when nine
out of ten might have been saved, by a more judicious and pro-
per treatment;—but not by physicians, for had every physician,
as it  were by inspiration or  intuition, perfectly  understood
the proper  mode of treating the epidemic  disease, the people
themselves would, with difficulty have been brought to submit
to such simple treatment, while they were wedded to the use
of the lancet, calomel and jalop! Well might it be said, if the
hot  regimen killed its hundreds; the  antiphlogistic system
killed its  thousands; therefore let us adopt the  old maxim,
Tempora mutantur, et mutamus cum illis !
   For a very short space of time, some few persons were idle
 enough to suppose, that while death was thinning the ranks of
 the white population,  the  black people were  exempted from
 this epidemic scourge ; but the pleasing delusion among that
 class of our fellow men soon vanished, and they had to learn,
 that the disease made no distinction of persons, but as they re-
 garded  themselves;  and  that the black population were the
 most numerous  victims, who from their  poverty, if free, or
 want of attention from their masters, if in slavery, were less
 guarded against the effects of all those causes, from whence
 the disease originated.   But it may not be improper to remark
 here, that my astonishment was  not  unfrequently excited,
 when I  saw so many persons, both black and  white, living in
 the most perfect health, while  they  were labouring under so
 many disadvantages from poverty and want; a proof that the
 animal economy is capable of resisting the " hurtful powers,"
 in a way that can hardly be accounted for, and equally striking,
 that this disease as well as all febrile diseases, are most gene-
 rally excited by sudden transitions from heat to cold, and vice
 versa.
    It has been observed in the course of this essay, that every
 type of disease, partook more or less of the nature of this epi-
 demic during its prevalence ; but the real  fact was, that there
 were few cases, very few  indeed,  that did not either run into
  the type of pneumonia or synanche, early in the cold stage, or 
64
 show a disposition to do so, unless where they were arrested
 by the correct, and only beneficial  treatment, for the plainest
 reason in the world, that  the  disease could  not  take place
 without  the predisposition  formed in the lungs, or that mem-
 brane so immediately connected with it.
   After  all that  has  been said upon this epidemical fever, it
 may appear to some rather singular, that I have not designated
 it by an appropriate name;  for it seems to  be a thing as much
 expected by the generality  of mankind, and indeed too much
 so by the mass of physicians, to distinguish a disease by a name
 as much so, as it is to designate one man  from another, by his
 proper name.   For the first two or three months, the epidemic
 got the vulgar appellation*of the "head complaint," as has
 been before remarked, because the head only was complained
 of, which I conceive to be far less appropriate than that of the
 "head  pleurisy," which pleased Dr. Hossack of New York  so
 much, when he undertook, (though it was  probably not without
an application) to instruct a you'ig physician of Albany, about
 the nature and treatment of  a disease, which, 1 will venture  to
 say, he was as ignorant of, as the man in  the moon, if it was of
the same character with our epidemic;  and  there is every rea-
son to suppose it was.  The term  " head  complaint,"  seemed
 completely to meet the ideas of the people, and to satisfy every
body as to name, for two or  three months, until it impercepti-
 bly got into the back ground, and  gradually acquired the  dig-
 nified, and more  scientific  title of typhus: fever, which by
 the bye, has become a sort  of plaything, among a certain de-
 scription of physicians and  other great men, while probably,
 they have no sort  of  definite idea affixed  to it!  My simple
 notion is, that it is a very appropriate term  if properly consi-
dered, and generally applied to our epidemic.  But very un-
luckily the term is applied to fevers, very essentially different
as to their  character,  cause and effect, both of high and low
 degree  or grade, for they are distinguished by nosologists into
 " typhus  mitior and typhus  gravior."  It  must be admitted,
that these terms have become very vague in  their signification,
 being used very much, as whim and  caprice may direct, and 
65
too often without any significant meaning whatever:. And yet^
I am of  opinion, it might be very appropriately applied to our
epidemic, as a generic  term.  The Greek substantive T«^»$
signifies  smoke, and  the Greek verb Tv<pa literally means to
burn without flame, which exactly corresponds with my theore-
tic doctrines, and principles of this extraordinary, and singular
epidemical fever, so that if  the term typhus could be applied
only to such a fever as I have been endeavouring to explain, it
would very properly and  generally  distinguish  it from  all
other fevers of a different character, when we should know at
once the nature of the fever from its name; and of course the
treatment  would be as  readily understood, for the term would
denote its cause, and the effects of that  cause, that is a defi-
ciency of that vital principle in the atmosphere, which produces
flame, consequently the animal  economy would be immediate-
ly considered as  deficient in its  powers, to generate heat.
This may be considered as something like speculation, which I
am very ready to admit, and therefore, unless a characteristic
distinction of this kind, could be generally agreed on among
physicians, it may be as well to let the whole  matter rest, as it
now stands, under a vague title and signification.   Neverthe-
less, I shall take the  same  liberty, which governed the great
Dr.  Sydenham, when he introduced  the term " intercurrent,"
and call it by that " term ivhich best pleases," therefore I must
beg  the reader to remember, that the epidemic of  1814, began
with the effects  of the winter's cold, and ended with the same,
which fairly entitles it to the simple appellation of the •' winter
epidemic," and places it in  a distinctive point of view, and in
contra-distinction to the pneumonia diseases,  which invariably
recur every winter  more  or less, but without such a remote
cause, as a sine qua non, which, I hope, I have clearly and sa-
tisfactorily proved to every candid mind, that will take time
to reflect impartially.
   I have been deeply impressed with the great importance of
the subject, which I have had under discussion, as nothing less
could have induced me to have undertaken it, while I have in
no small  degree, to regret the want of sufficient ability to de
                             9 
66
 it that justice, which it so eminently deserves.   I can say for
 myself, that the whole  matter has given a new direction to my
 reflections, on the treatment of fever generally, which I would
 fain hope, has been considerably elucidated, from the view
 which I have taken of the epidemic, as connected with it; and
 also that the idle and preposterous notion about infection and
 contagion, are not a little corrected.  Sure I am, if I am cor-
 rect in my sentiments, and principles of the epidemic, neither
 of them can have any share in the propagation of it, much less
 in generating it.  And  perhaps, such would  be the issue of all
 epidemics, if their causes could be accurately traced, and proper-
 ly ascertained.  But such are the wild and extravagant notions
 of the bulk of mankind,  and of too many physicians, that reason
 is indignantly spurned  at, when any thing clashes  with their
 pre-conceived  favorite  opinions;  and while their minds are
 pre-disposed to nothing, which  would  quiet their dreams of
 horror and devastation, the only pleasure they are capable of,
 is that of indulging in absurdity.
   Amidst all the controversies about infection and contagion,
 domestic and foreign origin, of " yellow  fever," or as I would
 say, epidemical fevers, which have swept off such multitudes
 of our fellow citizens in our  seaport towns, I have not been an
 indifferent spectator and observer, of what has been passing
 within my own knowledge and practice, for almost thirty-two
 years.   When I have heard or read a description, for instance,
 of the « yellow fever" in Philadelphia, I must have been indif-
 ferent, and blind indeed, had I not considered  and  reflected,
 how far  and in what manner this  disease corresponded or
 agreed with diseases, which had for years been familiar to me
 in the course of my practice ! If there was nothing essentially
 different in the symptoms of the "yellow fever," nor in the rise
 or declension of it into health or death, from the fevers here at
the same season of the year, (for autumnal fevers here are as
regular as the season,) surely it would be a fair, a reasonable
conclusion, that  the  diseases  were the   same, and that they
could differ only in degree.   And let me not be accused of ex-
aggeration, when I assert, that I have not unfrequently seen 
67
cases of autumnal fever  here, as  violent and as malignant as
the various cases of " yellow fever" in Philadelphia, though not
as uniformly so.  If the  fevers  here, and the fevers in Phila-
delphia, prevailing in the same season, were both similar in
their effects, they must have originated from similar causes; and
of course substantially the same  ; but our autumnal fevers are
domestic in their origin, therefore the " yellow fever" in Phila-
delphia must have been so too.   If Dr. Rush was correct in his
ideas about the  high degree of excitement in  the generality of
the cases of" yellow fever," there must in all probability  have
been something  singular  in the " constitution" of the air of Phi-
ladelphia, which encreased the excitability of the system, and
thus rendered the depleting system, under proper restrictions
and considerations, of the cold stage of fever, absolutely neces-
sary,  and the only mean of saving life,  but here where no
such " constitution" of the air  prevailed, the cases requiring
depletion by  the lancet, could have been considered only spo-
radic.  But the course of the epidemic here,  of the winter of
 1813, has been considered as a  negative in its effects on the
human body, because there was a deficiency of "pure Vital air"
in  the atmosphere, which is essentially necessary to life, and
the generation of animal heat, therefore the idea of even infec-
tion, much less that of contagion must fall;  and the epidemical
disease be considered as  standing alone, differing from all other
epidemics, not originating from  similar causes. 
 
THE
       EPIDEMIC  OF  1814,

Of Talbot County, Sfc. in the State of Maryland.
 THOUGH  it has been stated in the foregoing part of this
Essay, that the  epidemic of 1813, finished its course in the
month of June of the same year, with the effects of the cold of
the preceding winter, certain facts and circumstances, make
it more  than  probable, that the remote  cause of that disease,
still continued in the atmosphere  throughout the summer, and
fall, and only wanted the  return of cold to put it again into
action ;  and to have similar effects, in the production of a simi-
lar disease, which was clearly evinced, as soon as the cold and
frosty weather had again  set in, and  continued a sufficient
length of time to predispose  the system  conjointly with that
cause, to a disease of a similar character; while it must appear
to be  something amounting almost to a demonstration, of what
was only suspected before, that the earthquake of February the
12th 1812, was the  cause of the  one and the other, that is of
the epidemics of 1813 and 1814; at the same time  proving
what  I have attempted to explain, that though the remote cause
was a sine  qua non, it nevertheless could not  have had those
effects,  which were exhibited in the disease, without  other
conjoint causes ; which must altogether have acted  as predis-
posing  causes, and the cold principally as an exciting cause ;
confirming also what has been intimated, that the transition
from  health to disease is not so sudden, as some  have  sup- 
n
posed, and fully explaining the celebrated Dr. Brown's idea
of predisposition ; and finally, placing the whole matter beyond
all sort of contradiction, that our scientific countrymap Noah
Webster, has been  correct in  his principles and theory, with
regard to the origin of " epidemical and pestilential diseases,"
and that his work is above all praise.
  The autumnal epidemic which harrasses this region, as regu-
larly as the season  itself comes round, and is ascertained to
originate from  known causes  as  has  before been  remarked,
commenced somewhat earlier than usual, owing to the great
rains  and hot weather.  In July there were several cases of
cholera infantum, and intermitting and remitting fevers, were
beginning to rise, attended  with all their accustomed  variety
of symptoms.  These continued through their appropriate sea-
son, and  seemed to give way to the epidemical pneumonia in
November, which had commenced its career in December, in
the previous year ; though it was clearly obvious, that the cause
of the one had ceased, and that of the other had become active
with the  cold.
  As a proof that the  cause of  the  epidemic had not  ceased,
but actually existed, I will just notice two cases which occurred
in the month of  August, exhibiting most decidedly all the pa-
thognomic symptoms of previous epidemic  pneumonia.  The
first was  a case of a poor old woman of seventy, whom I saw
only once; the other was an old man, nearly if not  more than
eighty years of age, whom I saw several times  in passing.  It
can throw no sort of light upon the subject before us, to enter
minutely into these two cases, and the only two which I knew
or heard of, in this county from  the middle  of June, to the
middle of August.   Suffice  it to say, that I was not satisfied
with the treatment of either of them, though it is altogether
probable from their advanced age, neither could have been pre-
served by any  means  whatever, as old people are very apt to
go off  in the cold stage of fever ;  and I was disposed to think
an effusion of serum on the lungs had taken place in both cases
very  early in  the disease: of course  remedies  were useless 
71
from that time*   So much for a continuation of the  remote
cause.
   Early in November therefore, when the  cool  weather had
previously co-operated with the remote cause, so as to predis-
pose the system to be acted upon by the exciting causes, as has
been  attempted to be explained in1 this  essay, the epidemic
again commenced  in  earnest, and displayed itself at once in
all that array and character, which it had only done in a gra-
dual  manner from the last of December 1812, to the first of
February following; and at a time too, which was  altogether
different as to the state of the weather, in December 1812; for
it must be recollected, that all December of that year, was dry
and cold; the earth was frozen, and continued so throughout
the greater part of the following month, the  roads being  quite
dusty;  whereas now the epidemic commenced, when the earth
was wet from repeated rains, and occasionally snowy weather,
freezing at night, and thawing in the  day; clearly proving,
that the state of the weather had nothing to do with the pro-
duction of this disease, but as regarded cold.
   As soon as it was  ascertained, that the epidemic typhus had
again burst forth; it was proposed as a proper and necessary
step, that the physicians in Easton,  should  have a meeting to
consult on the proper  mode of treating a disease, which had
made such havoc in  the winter, and spring before.  This was
effected without difficulty with the exception of one gentleman
of the faculty, who did not choose  to be better informed!  It
was expected after all  the disasters of the former  season, that
there could be or rather ought  to he, but one opinion on this
occasion; nevertheless it so happened as it always happens,
that doctors will disagree. After some discussion it was finally
agreed, that a uniform mode of treatment should be pursued,
and that I alone  should publish in the two news-papers of this
place what should as I conceived, have been subscribed by all
those concerned  in the consultation.   Had this been done, it
would have carried more weight, not  only among the  people
themselves in the epidemic quarter, but it might have had a
better effect every Avhere else, as there was some  probability, 
n
 it might spread into the adjacent country;  and in that event
 physicians  who had  been in successful  practice heretofore,
 would reluctantly relinquish all  at  once their systematic  rou-
 tine.  The  consequence was, that my efforts to render service
 to my fellow creatures, were laughed at by some, and thought
 of  little importance by others! Unfortunately, Dr.  Rush had
 inculcated what medical writers had done  before without re-
 flecting, or perhaps not knowing that the human system is not
 always the same under certain " constitutions" of the air ;  and
 inasmuch as the patients had a "pain in the side,"  generally
 it was no easy matter to satisfy such unthinking  mortals as
 we  too generally are, that the lancet  would lose its virtues; or
 that a purge could  be  equally fatal in a disease,  consisting of
 the  cold stage only of fever.
  I will  not pretend to say, that the epidemic " typhus"  was
 every where so indiscriminate in the second season of its rage^
 but certain I am, that in some particular quarters of this coun-
 ty, (Talbot,) it was more violent,  than I had seen it in the pre-
 ceding year ; and yet where the hot regimen  was persisted in,
 from  the first to  the last, and no interference of venesection
 or purging, or nauseating doses were quacked upon the pati-
 ent, he never  failed  to do well.  But  notwithstanding  the
 fatality of such remedies in too many instances,  I am confident
 scarcely  fifty persons in the whole county, fell victims to this
 disease, which had  immolated five hundred in the same space
 of time, of the preceding year, viz. from the first of January to
 the  middle of June.
  But this  winter it burst the barriers, by which it seemed to
have been surrounded the preceding year.   It as it were pass-
 ed, almost harmlessly through Cambridge in Dorchester coun-
ty, where it had  done  some mischief twelve months before,
and suddenly made an  irruption  into the country  adjacent,
 which had escaped its ravages heretofore.   It burst  forth in a
section of that county,  called black-water, from a river of that
name, sweeping with the " besom  of destruction," a great pro-
portion of its population, leaving scarcely one-third of the men
behind ! I was in that quarter of the  county, about the middle 
                            73

of March, rather after its fury had subsided, and conversed
with one of the survivers, who told me with a tone of sadness,
that " the people had all  died up," meaning thereby, as I dis-
covered  afterward from  his  conversation, that the men more
especially had suffered, and that almost all had died, who were
attacked by this typhus fever ! It continued its course through
Black-Water, passed along  by Transquakin, with nearly the
same fatal effects ; crossed suddenly over  Nanticoke river; or
rather as I should have said  in every instance, a subtile some-
thing had evolved from  the earth months before, which had
now been put into action by the cold weather in due course of
time according to the principles and doctrines, which I have
been endeavouring  to impress upon the reader  throughout
this  whole  essay;   principles and  doctrines,  which if well
understood, may save in future the lives  of thousands of un-
thinking mortals, of which mankind  are made up.  Its effects
as just observed, began in Somerset on Nanticoke, in a neck of
land made by  that  river and a creek, the name of which I do
not recollect, where it did more mischief in a very short space
of time, than had ever before do*ne, with the  sad effects of the
lancet,  and  calomel and jalop,  Alas !  How often are  the
greatest blessings perverted, and  made the cruel instruments
of death, through blindness and ignorance  ?
  I have it from several  sources, that out of fifty-six men, who
were alive,  when this calamitous  scourge came upon them,
scarcely one  was left to sooth the grief of the women and chil-
dren, towards  whom it is said, it showed a tender mercy in
almost every instance ! !  Why it made this distinction can be
accounted for  in no other  way, than by  supposing that men
were more exposed  to the  vicissitudes of the weather, which
was the exciting cause of the disease!
  That this  great fatality might have been obviated by bettef
treatment, or the evil greatly diminished, by having  left the
whole  to nature, I  have  no  sort of question, while I have as
little doubt,  that  my silly  publication  was  regarded, just
about as much as the  passing wind.  Advice from higher sources
Upon many other occasions, is too often disregarded and some*
                              10 
74
times laughed at, until evils thicken upon us, and are with dif-
 ficulty, or perhaps never remedied.  To be candid, I ought to
 be cautious, how I take upon myself the office of a censor in
 such  matters, especially when 1 recollect, that I have felt no
 small spirit of indignation, when attempts  have been made to
 reclaim me from error, generally giving up with reluctance,
 principles and practices, which  I thought infallible, perhaps
 because they were inculcated by the high authority of a Cullen,
 a Rush, and a long list of medical  worthies.  " It is human to
 err," but  no small indication of an  improved understanding
to renounce  errors, which have had some appearance of endan-
gering life in cases of difficulty, and at the same time rather
novel in their appearance.   I am ready to confess, that before
I became  somewhat,  enlightened by  a  little practical  know-
ledge, I have been rather indisposed to believe all, that I have
heard, and read of the " spotted fever," in the  New England
states;  and  not a little disposed to  treat the accounts of it
with no small indifference, feeling at the  same  time inclined
to be a little incredulous as to the correct mode  of treating it,
more especially when I understood, that the lancet was  a dan-
gerous remedy in the winter and  spring months,  having consi-
dered it more entitled to infallibility, than any  other remedy
at such seasons, and in such a climate as that of New England,
if used judiciously ; of course, I thought  myself justifiable in
calling in question the judgment and skill, of the faculty in
that quarter! But now I have learnt to think very differently
of the whole matter, and  though' I am persuaded, that  the
"spotted fever" was of the same nature and character, of our
epidemic typhus, yet perhaps, it  has not been so well under-
stood, as it is at this time among our gentlemen of the faculty.
To be plain, I cannot be  induced to believe, that  the term
" spotted," could be properly applied to such a fever as our epi-
demic, or the one in New England.  The  spots from whence
it has derived its  name, could have  been nothing more, than
What are very commonly seen in dead bodies, or such as are
frequently seen on patients, during the cold stage of fever,
 when that stage has heen excessively violent; in fact such as 
75
I have seen hundreds of times, just before a patient has gone
off the stage of life in the cholera morbus, and many other com-
plaints ;  and not the petechise, which have characterized some
fevers.
   How much longer this epidemic, which has now become less
formidable here, because it is better understood, will continue
to revisit this quarter is altogether  impossible to determine or
foresee.   Two winters have passed  away, which have been
most  cruelly  marked  by its footsteps; while it is becoming
every  day, (January 21st, 1815,) a most consoling reflection to
think, that the noxious cause is gradually  subsiding, though it
is somewhat painful to observe, the very few cases of pneumo-
nia or pleurisies, which have occurred  since the cold weather
has  set in, are yet characterized with too many of  the symp-
toms of the epidemic typhus ; while at the same time, it is dis-
tressing  beyond measure, to hear from different parts of the
state, that some suspicions have arisen, that the same noxious
cause  has  burst forth in those  quarters, and generated a dis-
ease equally fatal in too many instances, with our epidemic in
1813 ; and thus for a while blasted our hopes of all'{kings re-
turning to their accustomed  order, and nature supporting a just
equilibrium among her elements.   But why do  I repine at the
order of Almighty Providence; "he tempers the winds to the
shorn lamb,7' and while in this instance of his dispensation, we
are murmuring, he has perhaps, made it less difficult to guard
against a negative, than we have formerly been able to breast
the positive power of the elements.  When the latter power
prevailed in our  atmosphere, it enabled disease to come npon
us like, what I once  heard Dr. Rush call a tornado, which art
too seldom was able to withstand with all the powers of anti-
phlogistics, and  the lancet which was wielded in vain ; but in
the former, the genial warmth  of  fire could always be drawn
forth by  art, to revive the sinking  faculties of  nature, which
were for  a while  unable  to accommodate  themselves to the
"deficiency of the vital principle in the air," which the con-
vulsions of nature in the bowels of the earth had deranged. 
76
   I am fully aware of the  embarrassing  situation, which phy-*
 sicians are beginning to feel themselves under  in  many parts
 of this and the other states, with regard to the treatment of
 pneumonia, &c. at this particular juncture of time, more espe-
 cially when  they have heard of, or seen  patients  sink  under
 the depleting system.   I may  therefore, be permitted  to ob-
 serve what they must all know, that common colds  or catarrhs,
 have always  been cured much  more readily, by putting a pa-
 tient to bed, and promoting perspiration by a plenteous use of
 dilutants, as they are called, than by any other method what-
 ever.  If  this method should fail in curing pleurisies, they will
 have some consolation, that they have done no harm, and that
 it is far preferable and less  wounding to a tender  conscience,
 that the patient should die in the hands of nature, than by their
 ofliciousness.  But  I trust every one, who  has any knowlege
 of the animal economy,  will fully comprehend and  soon learn
 the difference between excitability, and  a want of it  in  the
 system of the human body, and treat his patient  judiciously
 under all  circumstances ; therefore  when he is  called to a pa-
 tient at a time, when he has discovered that the cold stage of
fever is r*jon him, let him be cautious how he proceeds!  Let
 him feel the feet and regard the pulse less; and though the face
 may be flushed, if they are cold, he must go directly to work
 to restore heat to the system ! Let him inculcate wherever he
 goes, if any  such complaint is beginning  to rise, that a patient
 cannot begin too soon, after a chill or ague has commenced, to
 restore that heat to the system, which nature with all her pow-
 ers seems  unable to do.
   My practice has been for almost two years1, and still is when
 I am called to a patient who had a chill,  and the usual symp-
 toms of fever coming upon  him, to give him without much en-
 quiry, fifty drops of laudanum, and order him to bed, (if he is
 not already in it) to be covered up warm ;  to have hot bricks
 applied to his feet, which even at this period are always cold,
 while he may perhaps, be complaining of great internal heat;
 and  then order some kind of tea, always preferring Virginia
 snake root to any other, which he is directed to take from half 
77
a gill to a gill  every fifteen or twenty minutes, as hot as he
can drink it, until he gets into a perspiration, and then to dimi-
nish the dose a little; at bed-time or sometime sooner, the
laudanum, is again repeated,  and the tea to be continued as
much as possible  through  the night; and again to commence
regularly in the morning.   If the coldness in the feet or some-
times in the body, is not inclined to go off in some short time,
a spoonful or  two of  ardent spirits, to be put in sometimes
every dose.  If the disease  has been on the patient for some
days, it is sometimes  difficult to  raise a perspiration, but  if he
is just taken however violently, and an effusion of serum on
the lungs has not come on, (which by the bye sometimes takes
place almost instantaneously with the ague,) there is not the
least fear, but that a breathing sweat will come on, which  must
be kept up as above  directed day after  day, until the patient
is relieved  from the  cold stage, when the fever directly goes
off, and the patient is well!!
   It has been usual  besides the above simple way, to give bo-
losus of camphor and volatile salts, and to alternate them with
the  tea, something after the manner  of the Rev. Matthew Wil-
son.
   As  to  encouraging expectoration, I have on the contrary
always endeavoured  to  check  it, which has always  afforded
great  relief to the patient;  the heaviness and fullness of the
thorax or chest, being always relieved by it, which is altoge-
ther contrary to what I had formerly experienced, in ordinary
times.
   As to blisters, to the pained  part in the side, I never have
been fond of their use, • though I never failed to apply them, if
the patient was not relieved by the constant application of hot
salt, or hot any thing to his side,  in two or three  days.  Indeed
one  objection to blisters must be obvious, if the principles  of
this  essay are admitted, viz. the  surface of the body, is thereby
necessarily exposed to the cool air, during the time of applying
them,  which no doubt, has sometimes  aggravated the cold
stage, or brought it on a second  time, making  what has very
properly at times been called a relapse. 
78
   This method of treating a formidable disease, may appear
* simple indeed," but as the Rev. Matthew Wilson, has observ-
ed on a similar occasion, " nature is simple in all  her way."
Though I cannot say what this reverend gentleman has assert-
ed, that " he never lost a patient after he providentially  fell
upon this plan," this much I can say with as much truth, that
if it was begun upon in proper time, and properly persisted in,
that not one patient in twenty died ; which perhaps, is saying
more than could ever have been  said  of the depleting system,
when it was actually  indicated  in former  times.   If  others
should be  as fortunate, by the use of this method of treatment,
in a disease of a similar nature and character, my object is ac-
complished ; but  let the glory be to the great disposer of all
Human events!
FINIS. 
      J.  ROBINSON, PRINTER,
    No. 96, MARKET STREET, BALTIMORE,
         DOES EVERY DESCRIPTION OF
Book, Pamphlet and Job Printing, in the best
         and most correct manner. 
 
Med, Mist.

  170
M3t;c 

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