;:k- ■V."1*' .ft* h P ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C MEDICAL INQUIRIES AND OBSERVATIONS. /* «; MEDICAL INQUIRIES AND OBSERVATIONS. <*' ^s By BENJAMIN RUSH, M. D. ^^ Professor of the Institutes of Medicine, and of ^ Clinical Practice in the University of Pennsylvania. Q V ^ ...<-r *2- VOLUME I. ^'T/ts*** Second American Edition. PHILADELPHIA: PRINTED BY THOMAS DOBSON, AT THE STONE-HOUSE, N° 41, SOUTH SECOND-STREET. M. DCC. XCIV. I ?ff To JOHN REDMAN, M. D. Prefident of the College of Phyflcians of Philadelphia, THIS SECOND AMERICAN EDITION of a SMALL VOLUME of Medical Inquiries & Observations is infcribed, As a Mark of RefpedT: for the Virtues and Talents, which adorn his venerable Age, By his affectionate and grateful former pupil, BENJAMIN RUSH. 14th June, 1794. \ CONTENTS. j Page. I. AN Inquiry into the natural hiflcry of medicine among the Indians of North America, and a comparative view of their difeafes and remedies with thofe of civilized nations, 9 II. An account of the climate of Pennfylvania, and its influence upon the human body, 79 III. An account of the bilious remitting fever, as it appeared in Philadelphia in thefum- mer and autumn of the year 1780, 123 IV. An account of the fcarlatina anginofa, as it appeared in Philadelphia, in the years 1783 and 1784, 141 V. Additional obfervations upon the fcarlatina anginofa, 151 VI. An inquiry into the caufe and cure of the cholera infantum^ i?g VII. Obfervations on the cynanche trachealis, 171 VIII. An account of the ejfecls of blifiers and bleeding in the cure of obflinate intermit- ting fevers, 179 IX. An account of the diforder occafioned by drinking cold water in warm weather and the method of curing it, 183 X. An account of the efficacy of common fait in the cure of hamoptyfis, j 8 9 viii CONTENTS. Page. XL Thoughts upon the caufe and cure of the pulmc?1.ary confumption, 195 XII. Obfervations upon worms in the ali- mentary canal, and upon anthelmintic me- dicines, 113 XIII. An account of the external ufe of arfenic in the cure of cancers, 231 XIV. Obfervations on the caufe and cure of the tetanus, 239 XV. Additional obfervations on the tetanus and hydrophobia, 251 XVI. The refult of obfervations made upon the difeafcs which occurred in the military hofpiia'is of the United States, during the late war, XVII. An account of the influence of the mi- litary and political events of the American revolution upon the human body, 263 XVIII. An inquiry into the relation of taflles and aliments to each other ; and into the influence of this relation upon health and pleafure, 279 XIX. Olfervations on the new mode of inocu- lation for the fmall-ptx, XX. Appendix containing—Obfervations on the duties of a phyfician, and.the methods of improving medicine. Accommodated to the pre/cut flate of' fociety and manners in the United States, „ T _ 255 291 A N INQUIRY INTO the NATURAL HISTORY OF MEDICINE AMONG THE INDIANS OF NORTH-AMERICA. AND A COMPARATIVE VIEW OF THEIR DISEASES AND REMEDIES WITH THOSE OF CIVILIZED NATIONS. Read before the American Philosophical Society, held at Philadelphia, on the 4th of February, 1774. Gentlemen*, I RISE with peculiar diffidence to addrefs you upon this occafion, when I refleft upon the entertainment you propofed to yourfdves from the eloquence of that learned member, Mr Charles Thompson, whom your fuffrages appointed to this honor after the delivery of the lafl: anniver- * This Inquiry was the fubjedr. of an Anniverfary Ora- tion. The flyle of an oration is therefore preferved in many parts of it. Vol. I. B fary 10 natural history or medicine fary oration. Unhappily for the interefls of liter- ature, his want of health has not permitted him to comply with your appointment. I beg there- fore that you would forget, for a while, the abili- ties neceffary to execute this talk with propriety, and liften with candor to the efforts of a mem- ber, whofe attachment to the fociety was the only qualification that entitled him to the honor of your choice. The fubjecl: I have chofen for this evening's entertainment, is " An inquiry into the natural " hiftory of medicine among the Indians in North '; America, and a comparative view of their dif- " eafes and remedies, with thofe of civilized na- " dons." You will readily anticipate the diffi- culty of doing juftice to this fubjecl:. How fliall we diftinguifh between the original difeafes of the Indians and thofe contra&ed from their inter- course with the Europeans ? By what arts fliall we perfuade them to difcover their remedies? And laftly, how fliall we come at the knowledge of facts in that cloud of errors, in which the cre- dulity of the Europeans, and the fuperftition of the Indians have involved both their difeafes and re- medies? Thefe difficulties ferve to increafe the importance of our fubjeft. If I fhould not be able ' AMONG THE INDIANS. H able to folve them, perhaps I may lead the way to more fuccefsful endeavours for that purpofe* I fliall firfl limit the tribes of Indians who are to be the objects of this inquiry, to thofe who in- habit that part of North-America which extends from the 30th to the 60th degree of latitude. When we exclude the EfcjuimaUx, who inhabit the fhores of Hudfon's bay, we fliall find a general refemblance in the colour, manners and flate of fociety, among all the tribes of Indians who inha- bit the extenfive tract of country above-men- tioned. Civilians have divided nations into favage, bar- barous, and civilized. The favage, live by fifhing and hunting. The barbarous, by paflurage or cattle; and the civilized by agriculture. Each of thefe is connected together in fuch a manner, that the whole appear to form different parts of a cir- cle. Even the manners of the mod: civilized na- tions partake of thofe of the favage. It would feem as if liberty and indolence were the higheft purfuits of man; and thefe are enjoyed in their greateft perfection by favages, or in the practice of cuftoms which refemble thofe of favages. B 2 The 12 NATURAL HISTORY OF MEDICINE The Indians of North-America partake chiefly of the manner of favages. In the earliefl accounts we have of them, we find them cultivating a fpot of ground. The maize is an original grain among them. The different diflies of it which are in ufe among the white people ftill retain Indian names. It will be unneceflfary to fliew that the Indians live in a flate of fociety adapted to all the exigen- cies of their mode of life. Thofe who look for the fimplicity and perfection of the flate of nature, rauft feek it in fyftems, as abfurd in philofophy, as they are delightful in poetry. Before we attempt to afcertain the number or hiflory of the difeafes of the Indians, it will be neceflary to inquire into thofe cufloms among them which we know influence difeafes. For this purpofe I fliall, Firfl, mention a few facts which relate to the birth and treatment of their children. Secondly, I fliall fpeak of their diet. Thirdly, Of the cufloms which are peculiar to the fexes, And, Fourthly, AMONG THE INDIAN S. 13 Fourthly, Of thofe cufloms which are common to them both*. I. Of the birth and treatment of their children. Much of the future health of the body depends upon its original flamina. A child born of healthy parents always brings into the world a fyflem formed by nature to refill the caufes of difeafes. The treatment of children among the Indians, tends to fecure this hereditary firmnefs of confli- tution. Their firfl food is their mother's milk. To harden them againft the action of heat and cold (the natural enemies of health and life among the Indians) they lire plunged every day in cold water. In order to facilitate their being moved from place to place, and at the fame time to pre- * Many of the fads contained In ^he Natural Hiiiory of Medicine among the Indians in this Inquiry, are taken from La Hontan and Charlevoix's hiRories of Canada ; but the moll mateiial of them are taken from perfons who had lived, or travelled among the Indians. The author acknow- ledges himfelf indebted in a particular manner to Mr Ed- ward Hand, furgeon in the 18 th regiment, afterwards brigadier.general in the army cf the United States, who, during feveral years' refidence at Fort Pitt, directed his in- quiries into their'cuftoms, difeafes, and remedies, with a ;Uocefs tl:~t docs equal honour to his ingenuity and diligence. B3 ferve 14 NATURAL HISTORY OF MEDICINE fcrvt their fliape they are tied to a board, where they lie on their backs for fix, ten, or eighteen months. A child generallly fucks its mother till it is two years old, and fometimes longer. It is eafy to conceive how much vigour their bodies muft acquire from this fimple, but wholefome nou- rifhment. The appetite we fometimes obferve in children for flefli is altogether artificial. The pe- culiar irritability of the fyflem in infancy, forbids flimulating aliment of all kinds. Nature never calls for animal food till fhe has provided the child with thofe teeth which are neceflary to divide it. I fliall not undertake to determine how far the wholefome quality of the mother's milk is increafed by her refufing ijie embraces of her hufband, du- ring the time of giving fuck. II. The diet of the Indians is of a mixed nature, being partly animal and partly vegetable; their animals are wild, and therefore eafy of digeflion. As the Indians are naturally more difpofed to the indolent employment of fifhing than hunting in fummer, fo we find them living more upon fifh than land animals, in that feafon of the year.__ Their vegetables confifl of roots and fruits, mild in themfelves or capable of being made fo by the a&ion of fire. Although the interior parts of our continent abound with fait fprings, yet I cannot find AMONG THE INDIANS. 1$ find that the Indians ufed fait in their diet, till they were inflructed to do fo by the Europeans. Thq fmall quantity of fixed alkali contained in the afhes on which they roafled their meat, could not add much to its flimulating quality. They preferve their meat from putrefaction, by cutting it into fmall pieces, and expofing it in fummer to the fun, and in winter to the frofl. In the one cafe its moifture is diflipated, and in the other fo frozen, that it cannot undergo the putrefactive procefs. In drefling their meat, they are careful to preferve its juices. They generally prefer it in the form of foups. Hence we find, that among them the ufe of the fpoon preceded that of the knife and fork. They take the fame pains to preferve the juice of their meat when they roafl it, by turning it often. The efficacy of this animal juice in dif- folving meat in the flomach, has not been equalled by any of thofe fauces or liquors which modern luxury has mixed with it for that purpofe. The Indians have no fet time for eating, but obey the gentle appetites of nature as often as they are called by them. After whole days fpent in the chafe or in war, they often commit thofe exceffes in eating, to which long abflinence can- not fail of prompting them. It is common to fee jhem fpend three or four hours in fatisfying their B 4 hunger.. l6 NATURAL HISTORY OF MEDICINE hunger. This is occafioned not more by the quantity they eat, than by the pains they take in maflicating it. They carefully avoid drinking water in their marches, from an opinion that it leflcns their ability to bear fatigue. III. We now come to fpeak of thofe cufloms which are peculiar to the fexes. And, firfl, of thofe which belong to the women. They are doomed by their hufbands to fuch domeflic labour as gives a firmnefs to their bodies, bordering upon the mafculine. Thtir menfes feldom begin to flow before they are eighteen or twenty years of age, and generally ceafe before they are forty. They have them in fmTl quantities, but at regular in- tervals. They feldom marry till they are about twenty. rIhe conltitution has now acquired a vigour, which enables it the better to fupport the convulfions of child-bearing. This cuflom like- wife guards againft a premature old age. Doctor Bancroft afcribes the haggard looks—the loofe hanging breafls—and the prominent bellies of the Indian women at Guiana, entirely to their bear- ing children too early*. Where marriages are unfruitful (which is feldom the cafe) a feparation is obtained by means of an eafy divorce; fo that * Natural Hiftory of Guiana. they AMONG THE^INDIANS.- I"/ they are unacquainted with the difquietudes which fometimes arife from barrennefs. During preg- nancy, the women are exempted from the more laborious parts of their duty : hence mifcarriages rarely happen among them. Nature is their only midwife. Their labours are fhort, and accompa- nied with little pain. Each woman is delivered in a private cabbin, without fo much as one of her own fex to attend her. After wafliing herfelf in cold water, flie returns in a few days to her ufual employments; fo that flie knows nothing of thofe accidents which proceed from the carelefT- nefs or ill management of midwives; or thofe weaknefles which arife from a month's confine- ment in a warm room. It is remarkable that there is hardly a period in the interval between the erup- tion and the ceafing of the menfes, in which they are not pregnant or giving fuck. This is the mofl natural ft.ite of the conflitution during that in- terval ; and hence we often find it connected with the beft flate of health, in the women of civilized nations. The cuftoms peculiar to the Indian men, con- fifl chiefly in thofe employments which are necef- fary to preferve animal life, and to defend their nation. Thefe employments are hunting and war, each of which is conducted in a manner that tends to z8 NATURAL H/IST0RY OF MEDICINE to call forth every fibre into exercife, and to en- fure them the poffefBon of the utmofl pofliblc health. In times of plenty and peace, we fee them fometimes rifing from their beloved indolence, and fhaking off its influence by the falutary exercifes of dancing and fwimming. The Indian men fel- dom marry before they are thirty years of age: They no doubt derive confiderable vigour from this cuftom 5 for while they are fecured by it from the enervating effects of the premature dalliance of love, they may enfure more certain fruitfulnefs to their wives, and entail more certain health upon their children. Tacitus defcribes the fame cuflom among the Germans, and attributes to it the fame good effects. " Sera juvenum venus, eoque in- " exhaufta pubertas; nee virgines feflinantur; " eadem juventa, fimilis proceritas, pares vali- " dique mifcentur; ac robora parentum liberi " referunt*. Among the Indian men, it is deemed a mark of Jieroifm to bear the mofl exquifite pain without * Csefar, in his hiftory of the Gallic war, gives the fame account of the ancient Germans. His words are " Qui " diutiffimi impuberes permanferunt, maximam inter fuos " ferunt laudem: hoc ali ftaturam, ali vires, nervafque con- ** firmari putant." Lib. vi. xxi. complain. AMONG THE INDIANS. 19 complaining ; upon this account they early inure themfelves to burning part of their bodies with fire, or cutting them with fharp inftruments. No young man can be admitted to the honours of man- hood or war, who has not acquitted himfelf well in thcfe trials of patience and fortitude. It is eafy to conceive how much this contributes to give a tone to the nervous fyftem, which renders it lefs fub- ject to the occafional caufes of difeafes. IV. We come now to fpeak of thofe cufloms which are common to both fexes : Thefe are painting, and the ufe of the cold bath. The practice of anointing the body with oil is common to the favages of all countries j in warm climates it is faid to promote longevity, by checking ex- ceflive perfpiration. The Indians generally ufe bear's greafe mixed with a clay, which bears the greatefl refemblance to the colour of their Ikins. This pigment ferves to leflen the fenfibility of the extremities of the nerves; it moreover fortifies them againft the action of thofe exhalations, which we fliall mention hereafter, as a confiderable fource of their difeafes. The cold bath likewife forti- fies the body, and renders it lefs fubject to thofe difeafes which arife from the extremes and vicifli- tudes of heat and cold. We fhall fpeak hereafter of the Indian manner of ufing it. It 20 NATURAL HISTORY OF MEDICINE It is a practice among the Indians never to drink before dinner, when they work or travel. Experience teaches, that filling the ftomach with cold water in the forenoon, weakens the appetite, and makes the fyftem more fenfible of heat and fatigue. The flate of fociety among the Indians excludes the influence of mofl of thofe paflions which dis- order the body. The turbulent effects of anger are concealed in deep and lafling refentments. Envy and ambition are excluded by their equality of power and property. Nor is it neceffary that the perfections of the whole fex fhould be afcribed to one, to induce them to marry. " The weak- " nefs of love (fays Dr Adam Smith) which " is fo much indulged in ages of humanity and " politenefs, is regarded among favages as the " mod unpardonable effeminacy. A young man " would think himfelf difgraced for ever, if he ei fhewed the leafl preference of one woman above " another, or did not exprefs the mofl complete ts indifference, both about the time when, and " the perfon to whom, he was to be married*." Thus are they exempted from thofe violent or Jafting difeafes, which accompany the fevcral * Theory of Moral Sentiments. AMONG THE INDIANS. 2T ftages offuch paflions in both fexes among civi- lized nations. It is remarkable that there are no deformed In- dians. Some have fufpected from this circum- ftance, that they put their deformed children to death ; but nature here acts the part of an unna- tural mother. The feverity of the Indian man- ners deftroy them *. From a review of the cufloms of the Indians, we need not be furprifed at the ftatelinefs, regula- rity of features, and dignity of afpect by whch they are characterifed. Where we obferve thefe among ourfelves, there is always a prefumption of their being accompanied with health, and a ftrong conftitution. The circulation of the blood is more languid in the Indians than in perfons who are in the conflant exercife of the habits of civi- lifed life. Out of eight Indian men whofe pulfes I once examined at the wrifts, I did not meet with one in whom the artery beat more than fixty- four flrokes in a minute. * Since the intercourfe of the white people with the Indi- ans, we find fome of them deformed in their limbs. This de- formity, upon inquiry, appears to be produced by thofe acci- dents, quarrels, &c. which have been introduced among them by fpirituous liquors. The 22 NATURAL HISTORY OF MfiDlCINfi The marks of old age appear more early among Indian, than among civilized nations. Having fmifhed our inquiry into the phyfical cuftoms of the Indians, we fhall now proceed to inquire into their difeafes. A celebrated profeflbr of anatomy has afTerted, that we could not tell by reafoning a priori, that the body was mortal, fo intimately woven with its texture are the principles of life. Lord Bacon declares, that the only caufe of death which is na- tural to man, is that from old age ; and complains of the imperfection of phyfic, in not being able to guard the principle of life, until the whole of the oil that feeds it is confumed. We cannot ad- mit of this propofition of our noble philofopher. In the inventory of the grave in every country, we find more of the fpoils of youth and manhood than of age. This muft be attributed to moral as well as phyfical caufes. We need only recollect the cuftom among the Indians, of fleeping in the open air in a variable climate—the alternate action of heat and cold upon their bodies, to which the warmth of their cabins expofes them—their long marches—their exceffive exercife—-their intemperance in eating, to AMONG THE INDIANS. 23 to which their long falling, and their public feafts naturally prompt them; and, laflly, the vicinity of their habitations to the banks cf rivers, in or- der to difcover the empire of difeafes among them in every ftage of their lives. They have in vain attempted to elude the general laws of mortality, while their mode of life fubjedts them to thefe re- mote, but certain caufes of difeafes. From what we know of the action of thefe potentias nocentes upon the human body, it will hardly be neceflary to appeal to facts to determine that fevers conftitute the only difeafes among the Indians. Thefe fevers are occafioned by the fenfible and infenfible qualities of the air. Thofe which are produced by cold, are of the inflamma- tory kind, fuch as pleurifies, peripneumonies, and rheumatifms. Thofe which are produced by the infenfible qualities of the air, or by putrid exhala- tions, are intermitting, remitting, and inflamma- tory, according as the exhalations are conbined with more or lefs heat or cold. The dysentery (which is an Indian difeafe) comes under the clafs of fevers. It appears to be the febris introverfa of Dr Sydenham. The Indians are fubject to animal and vege- table poisons. The effects of thefe upon the body, 24 NATURAL HISTORY OF MZDICINE body, are in fome degree analogous to the exhala- tions we have mentioned. When they do not bring on fudden death, they produce, according to their malignity, either an inflammatory or pu- trid fever. The small pox and the venereal disease were communicated to the Indians in North- America by the Europeans. Nor can I find that they were ever fubject to the scurvy. Whether this was obviated by their method of preferving their flefli, or by their mixing it at all times with vegetables, I fliall not undertake to determine. Dr Maclurg afcribes to frefli meat an antiftptic quality *. The peculiar cuftoms and manners of life among the Indians, feem to have exempted them from thefe, as well as all other difeafes of the fluids. The leprofy, elephantiafis, fcurvy, and venereal difeafe, appear to be different modifica- tions of the fame primary diforder. The fame caufes produce them in every age and country. They are diverfified like plants by climate and nourifhment. They all fprung originally from a moift atmofphere and unwholefome diet; hence we read of their prevailing fo much in the middle centuries, when the principal parts of Europe * Experiments on the Bile, andjR.efhS.ior.s on the Biliary Secretion. 4 were AMONG THE INDIANS. 2$ were overflowed with water, and the inhabitants lived entirely on fifh, and a few unwholefome vegetables. The abolition of the feudal fyftem in Europe, by introducing freedom, introduced at the fame time agriculture ; which by multiply- ing the fruits of the earth, leffened the confump- tion of animal food, and thus put a flop to thefe diforders. The elephantiafis is almoft unknown in Europe. The leprofy is confined chiefly to the low countries of Africa. The plica polonica once fo common in Poland, is to be found only in books of medicine. The fmall pox is no longer a fatal diforder, when the body is prepared for its reception by a vegetable regimen. Even the plague itfelf is lofing its fling. It is hardly dreaded at this time in Turkey ; and its very exiftence is preferved there by the doctrine of fatalifm, which prevails among the inhabitants of that country. It may ferve as a new and powerful motive againft political flavery to obferve, that it is connected with thofe difeafes which moft deform and debate the human body. It may likewife ferve to en- hance the bleflings of liberty, to trace its effects, in eradicating fuch loathfome and definitive diforders *. * Muratori, in his Antiquities of Italy in the middle ages, •lefcribes the greateft part of Europe as overflowed with water. Vol. I C The iS NATURAL HISTORY OF MEDICINE I have heard of two or three cafes of the gout among the Indians, but it was only among thofe who had learned the ufe of rum from the white The writings of the hiftorians of thofe ages are full of the phy- fical and political miferies which prevailed during thofe cen- turies. The whole of the difeafes we have mentioned, raged at one time in all the countries of Europe. In the ninth century there were 19,000 hofpitals for lepers only, in Chrifl- endom. Lewis VIII. king of France, in the year 1227, be- queathed legacies to 2000 leprous hofpitals in his own king- dom. The fame diet, and the fame dampnefs of foil and air, produced the fame effetfs in South-America. The venereal difeafe probably made its appearance at the fame time in South America and Naples. Precis de l'hiftoire phyfique des terns, par M. Raymond. The leprofy and fcurvy ftill pre- vail in the northern parts of Europe, where the manner of living, among the inhabitants, ftill bears fome refemblance to that which-prevailed in the middle centuries. Pontopiddan's natural kiftory of Norway. Between the years ioo6andi68o, we read of theplague being epidemic fifty-two times dirough- out all Europe. The fituation of Europe is well known du- ing the fourteenth century : every country was in arms; agri- culture was neglected ; nourifhment of all kinds was fcanty and unwholefome; no wonder, therefore, that we read of the plague being fourteen times epidemic in Europe during that period. In proportion as the nations of Europe have become civilized, and cultivated the earth, together with the arts of peace, this diforder has gradually mitigated. It prevailed only fix times in the fixteenth, and five times in the feventeenth centuries. It made its laft general appearance in the year 163o. It has occasionally vifited feveral cities in Europe with- in AMONG THE INDIANS. 2J people. A queftion naturally occurs here, and that is, why does not the gout appear more fre- quently among that clafs of people, who confume the greateft (quantity of rum among ourfelves ? To this I anfwer, that the effects of this liquor upon thofe enfeebled people, are too fudden and violent, to admit of their being thrown upon the extremities ; as we know them to be among the Indians. They appear only in vifceral obflructi- ons, and a complicated train of chronic difeafes. Thus putrid miafmata are fometimes too flrong to bring on a lever, but produce inftant debility and death. The gout is feldom heard of in Ruflia, Denmark, or Poland. Is this occafioned by the vigour of conftitution peculiar to the inhabitants of in die laft century, but has raged with much lefs violence than formerly. It is highly probable its very exiftence would be deftroyed, could the inhabitants of Turkey (where it is at all times endemic) be prevailed upon to ufe the fame precau- tions to prevent its fpreading, which have been found fuccefs- ful in other parts of Europe. The Britifh, and other foreign- ers, who refide at Conftantinbple, efcape the plague more by avoiding all intercourfe with perfons, houfes, clothes, &c. in- fected with the diforder, than by any peculiarities in their diet or manners. That the ufe of wine alone does not preferve them from the infection, we learn from the hiftory of the Ar- menians, who drink large quantities of wine ; and yet, from their belief in the doftrine of fatalifm, perifli in the fame pro- portion as the Turks. C 2 thofe 28 NATURAL HISTORY OF MEDICINE thofe northern countries ? or is it caufed by their exceffive ufe of fpirituous liquors, which produce the fame chronic complaints among them, which we faid were common among the lower clafs of people in this country ? The fimilarity of their difeafes makes the lafl of thefe fuppofitions the moft probable. The effects of wine, like tyranny in a well formed government, are felt firft in the extremities ; while fpirits, like a bold invader, feize at once upon the vitals of the conftitu- tion. » After much inquiry, I have not been able to find a fingle inftance of madness, melancholy, or fatuity among the Indians; nor can I find any accounts of difeafes from worms among them. Worms are common to moft animals; they pro- duce difeafes only in weak, or increafe them in flrong conftitutions*. Hence they have no place in the nofological fyftems of phyfic. Nor does dentition appear to be a diforder among the Indians. The facility with which the healthy * Indian chidlfen are not exempted from worms. It is common with the Indians, when a fever in their children is afcribed by the white people to worms, (from their being difcharged occafionally in their ftools) to fay, « the fever " make* the worms come, and not the worms the fever." children AMONG THE INDIANS. 29 children of healthy parents cut their teeth among civilized nations, gives us reafon to conclude that the Indian children never fuffer from this quarter. The Indians appear moreover to be ftrangers to difeafes and pains in the teeth. The employments of the Indians fubjedt them to many accidents; hence we fometimes read of wounds, fractures, and luxations among them. Having thus pointed out the natural difeafes of the Indians, and fhewn what diforders are foreign to them, we may venture to conclude, that fe- vers, old age, casualities and war, are the only natural outlets of human life. War is no- thing but a diftemper; it is founded in the imper- fection of political bodies, juft as fevers are found- ed on the weaknefs of the animal body.—Provi- dence in thefe difeafes feems to act like a mild le- giflature which mitigates the feverity of death, by inflicting it in a manner the leaft painful upon the whole to the patient and the furvivors. Let us now inquire into the remedies of the Indians. Thefe, like their difeafes, are fimple, C 3 and 30 NATURAL HISTORY OF MEDICINE and few in number. Among the firft of them wc fliall mention the powers of nature. Fevers, we faid formerly, conftituted the chief of the dif- eafes among the Indians; they are likewife, in the hands of nature, the principal inftruments to re- move the evils which threaten her diffolution; but the event of thefe efforts of nature, no doubt, foon convinced the Indians of the danger of truft- ing her in all cafes; and hence in tlie earlieft ac- counts we have of their manners, we read of per- fons who were intrufted with the office of phy- flcians. It will be difficult to find out the exact order in which the Indian remedies were fuggefted by na- ture or difcovered by art; nor will it be eafy to arrange them in proper order. I fhall however attempt it, by reducing them to natural and artificial. To the clafs of natural remedies belongs the Indian practice of abftracting from their pa- tients all kinds of flimulating aliment. The com- pliance of the Indians with the dictates of nature, in the early ftage of a diforder, no doubt, pre- vents in many cafes their being obliged to ufe any other remedy. They follow nature ftill clofer, in allowing AMONG THE INDIANS. 3 I allowing their patients to drink plentifully of cold water; tnis being the only liquor a patient calls for in the fever. Sweating is likewife a natural remedy. It was probably fuggefted by obferving fevers to be ter- minated by it. I fliall not inquire how far thefe fweats are effential to the crifis of a fever. The Indian mode of procuring this evacuation is as follows: the patient is confined in a clofe tent, or wigwam, over a hole in the earth, in which a red hot ftone is placed; a quantity of water is thrown upon this ftone, which inftantly involves the pa- tient in a cloud of vapour and fweat; in this Actu- ation he rufhes out, and plunges himfelf into a ri- ver ; from whence he retires to his bed. If the remedy has been ufed with fuccefs, he rifes from his bed in fcur and twenty hours, perfectly re- covered from his indifpofition. This remedy is ufed not only to cure fevers, but remove that un- eafinefs which arifes from fatigue of body. A third natural remedy among the Indians, is purging. The fruits of the earth, the flefli of birds, and other animals feeding upon particular vegetables, and above all the fpontaneous efforts of nature, early led the Indians to perceive the neceflity and advantages of this evacuation. C 4 Vomits 32 NATURAL HISTORY OF MEDICINE Vomits conftitute their fourth natural remedy. They were probably, like the former, fuggefted by nature, and accident. The ipecacuanha is one of the many roots they employ for this purpofe. The artificial remedies made ufe of by the Indians, are bleeding, caustics, and astrin- gent medicines. They confine bleeding entirely to the part affected. To know that opening a vein in the arm, or foot, would relieve a pain in the head or fide, fuppofes fome knowledge of the animal economy, and therefore marks an advanced period in the hiftory of medicine. Sharp ftones and thorns are the inftruments they ufe to procure a difcharge of blood. We have an account of the Indians ufmg fome- thing like a potential caustic, in obftinate pains. It confifts of a piece of rotten wood called punk, which they place upon the part affected, and afterwards fet it on fire; the fire gradually confumes the wood, and its aflies burn a hole in the flefh. The undue efforts of nature, in thofe fevers which are conne&ed with a diarrhoea, or dyfen- tcry, AMONG THE INDIANS. 33 tery, together with thofe hemorrhagies to which their mode of life expofed them, neceffarily led them to an early difcovery of fome astringent vegetables. I am uncertain whether the In- dians rely upon aftrin^ent, or any other vegeta- bles, for the cure of the intermitting fever. This difeafe anions them probably requires no other remedies than the cold barh, or cold air. Its greater obflinacy, as well as frequency among ourfelves, muft be fought for in the greater fee- blenefs of our conftitutions ; and in that change which our country has undergone, from meadows, mill-dams and the cutting down of woods; where- by morbid exhalations have been multiplied, and their paffage rendered more free, through every part of country. This is a fhort account of the remedies of the Indians. If they are Ample, they are, like their eloquence, full of ftrength ; if they are few in number, they are accommodated, as their lan- guages are to their ideas, to the whole of their difeafes. We faid, formerly, that the Indians were fub- ject to accidents, fuch as wounds, fractures, and the like. In thefe cafes, nature performs the of- fice 34 natural history of medicine fice of a furgeon. We may judge of her qualifi- cations for this office, by obferving the marks of wounds and fractures, which are fometimes dif- covered on wild animals. But further, what is the practice of our modern furgeons in thefe cafes ? Is it not to lay afide plafters and ointments, and truft the whole to nature? Thofe ulcers which re- quire the afliftance of mercury, bark, and a par- ticular regimen are unknown to the Indians. The hemorrages which fometimes follow their wounds, are reftrained by plunging them- felves into cold water, and thereby producing a conftriction upon the bleeding veffels. Their practice of attempting to recover drown- ed people, is irrational and unfuccefsful. It con- fifts in fufpending the patient by the heels, in or- der that the water may flow from his mouth. This practice is founded on a belief that the pa- tient dies from fwallowing an exceffive quantity of water. But modern obfervation teaches us \hat drowned people die from another caufe. This difcovery has fuggefted a method of cure, directly oppofite to that in ufe among the Indians ; and has fhewn us that the practice of fufpending by the heels is hurtful, I do AMONG THE INDIANS. $$ I do not find that the Indians ever fuffer in their limbs from the action of cold upon them. Their mokafons*, by allowing their feet to move freely, and thereby promoting the circulation of the blood, defend their lower extremities in the day- time, and their practice of fleeping with their feet near a fire, defends them from the morbid effects of cold at night. In thofe cafes where the motion of their feet in their mokafons is not fufficient to keep them warm, they break the ice, and reftore their warmth by expofing them for a fhort time to the flimulus of cold water f. We have heard much of their fpecific antidotes to the venereal disease. In the accounts of thefe antivenereal medicines, fome abatement mould be made for that love of the marvellous, and of novelty, which are apt to creep into the writings of travellers and phyflcians. How many medicines which were once thought infallible in this diforder, are now rejected from the materia medica! I have found upon enquiry that the In- * Indian fhoes. f It was remarked in Canada, in the winter of the year 1759, during the war before laft, that none of thofe foldiers who wore mokafons were froft-bitten, while few of thofe efcaped that were much expofed to the cold who wore fhoes. dians 36 NATURAL HISTORY OF MEDICINE dians always aflift their medicines in this difeafe, by a regimen which promotes perfpiration. Should we allow that mercury acts as a fpecific in deftroy- iiig thi> difordi r, it does not follow thit it is proof againft the efficacy of medicines which act more mechanically upon the body *. There cannot be a ftronger mark of the imper- fect flare of knowledge in medicine among the In- dians, than their method of treating the small- pox. We are told that they plunge themfelves in cold water in the beginning of the diforder, and that it generally proves fatal to them. Travellers fpeak in high terms of the Indian antidotls to poisons. We mull remember, that many things have been thought poifonous, which later experience hath proved to poffefs no unwholefome quality. Moreover, the uncertainty and variety in the operation of poifons, renders it extremely difficult to fix the certainty of the anti- * I cannot help fufpefting the antivenereal qualities of the lobelia, ceanothus and ranunculus, fpoken of by Mr Kalm, in the memoirs of the Swedifh academy. Mr Hand infermed me, that the Indians rely chiefly upon a plentiful ufe of the decoctions of the pine-trees, againft the venereal difeafe. He added moreover, that he had often known this difeafe prove fatal to them. 4 dotes AMONG THE INDIANS. 37 dotes to them. How many fpecifics have derived their credit for preventing the hydrophobia, from perfons being wounded by animals, who were not in a fituation to produce that diforder! If we may judge of all the Indian antidotes to poifons, by thofe which have fallen into our hands, we have little reafon to afcribe much to them in any cafes whatever. I have heard of their performing feveral re- markable cures upon stiff join rs, by an infufion of certain herbs in water. The mixture of feveral herbs together in this infufion calls in queftion the fpecific efficacy of each of them. I cannot help attributing the whole fuccefs of this remedy to the great heat of the water in which the herbs were boiled, and to its being applied for a long time to the part affected. Wc find the fame medicine to vary frequently in its fuccefs, according to its ftrength, or to the continuance of its application. De Haen attributes the good effects of electricity, entirely to its being ufed for feveral months. I have met with one cafe upon record of their aiding nature in parturition. Captain Carver gives us an account of an Indian woman in a diffi- cult labour, being fuddenly delivered in confe- quence of a general convulfion induced upon her fyftem, 38 NATURAL HISTORY OF MEDICINE fyftern, by flopping, for a fhort time, her mouth and nofe, fo as to obftruct her breathing. We are fometimes amufed with accounts of In- dian remedies for the dropsy, epilepsy, colic, gravel and gout. If, with all the advantages which modern phyflcians derive from their know- ledge in ANATOMY, CHEMISTRY, BOTANY and philosophy ; if, with the benefit of difcoveries communicated from abroad, as well as handed down from our anceftors, by more certain me- thods than tradition, we are ftill ignorant of cer-* tain remedies for thefe difeafes; what can we ex- pect from the Indians, who are not only deprived of thefe advantages, but want our chief motive, the fenfe of the pain and danger of thofe diforders to prompt them to feek for fuch remedies to re- lieve them? There cannot be a ftronger proof of their ignorance of proper remedies for new or difficult difeafes, than their having recourfe to en- chantment. But to be more particular; I have taken pains to inquire into the fuccefs of fome of thefe Indian fpecifics, and have never heard of one well attefted cafe of their efficacy. I believe they derive all their credit from our being igno- rant of their compofition. The influence of fe- crecy is well known in eftablifliing the credit of a medicine. The fal feignette was an infallible medicine AMONG THE INDIANS. 39 medicine for the intermitting fever, while the ma- nufactory of it was confined to an apothecary at Rochelle ; but it loft its virtues as foon as it was found to be compofed of the 'acid of tartar and the foflil alkali. Dr Ward's famous pill and drop ceafed to do wonders in fcrophulous cafes as foon as he bequeathed to the world his receipts for making them. I forefee an objection to what has been faid corf* cerning the remedies of the Indians, drawn from that knowledge which experience gives to a mind intent upon one fubjedt. We have heard much of the perfection of their fenfes of feeing and hear- ing. An Indian, we are told, will difcover not only a particular tribe of Indians by their foot- fteps, but the diftance of time in which they were made. In thofe branches of knowledge which relate to hunting and war, the Indians have ac- quired a degree of perfection that has not been equalled by civilized nations. But we muft re- member, that medicine among them does not en- joy the like advantages with the arts of war and hunting, of being the chief object of their atten- tion. The phyfician and the warrior are united in one character; to render him as able in the for- mer as he is in the latter profeflion, would require an 40 NATURAL HISTORY OF MEDICINE" an entire abflraction from every other employ- ment, and a familiarity with external objects, which are incompatible with the wandering life of favages. Thus have we finifhed our inquiry into the dif- eafes and remedies of the Indians in North-Ame- rica. We come now to inquire into the difeafes and remedies of civilized nations. Nations differ in their degrees of civilization. We fliall felect one for the fubject of our enquiries which is moft familiar to us; I mean the Britifh nation. Here we behold fubordination and claffes of mankind eftablifhed by government, commerce, manufactures, and certain cuftoms common to moft of the civilized nations of Europe. We lhall trace the origin of their difeafes through their cuftoms in the fame manner as we did thofe of the Indians. I. It will be fufficient to name the degrees of heat, the improper aliment, the tight dreffes, and the premature ftudies children are espofed to, in order to fhew the ample fcope for difeafes, which is added to the original defect of flamina they de- rive from their anceftors. II. AMONG THE INDIANS. 41 II. Civilization rifes in its demands upon the health of women. Their fafhions; their drefs and diet; their eager purfuits and ardent enjoyment of pleafure; their indolence and undue evacuations in pregnancy; their cordials, hot regimen and neglect or ufe of art, in child-birth, are all fo many inlets to difeafes. Humanity would fain be filent, while philofo- phy calls upon us to mention the effects of inte- refted marriages, and of difappointments in love, increafed by that concealment which the tyranny of cuftom has impofed upon the fex*. Each of thefe exaggerates the natural, and increafes the number of artificial difeafes among women. III. The difeafes introduced by civilization ex- tend thcmfelves through every clafs and profeinon * " Married women are more healthy and long-lived « than fingle women. The regifters, examined by Mr Mu- « ret, confirm this obfervation; and fhow particularly, that « of equal numbers of fingle and married women between «« fifteen and twenty-five years of age, more-of the former « died than of the latter, in the proportion of two to one: " the confequence, therefore, of following nature muft be « favourable to health among the female fex." Supple- ment to Price's Obfervations on Reverfionary .Payments. P- 357- Vol. I. D amonS 4- NATURAL HISTORY OF MEDICINE among men. How fatal are the effects of idlenefs and intemperance among the rich, and of hard la- bour and penury among the poor 1 What pallid looks are contracted by the votaries of fcience from hanging over the " fickly taper!" How many difeafes are entailed upon manufacturers by the materials in which they work, and the pofture of their bodies! What monkifh difeafes do we obferve from monkifh continence and monkifh vices! We pafs over the increafe of accidents from building, failing, riding, and the like. War, as if too flow in deftroying the human fpecies, calls in a train of difeafes peculiar to civilized na- tions. What havock have the corruption and monopoly of provifions, a damp foil, and an un- wholefome fky, made, in a few days, in an army! The atehicvements of Britifh valour at the Ha- vannah, in the laft war, were obtained at the ex- pence of 9,000, men, 7,000 of whom perifhed with the Weft India fever*. Even our modern * The modern writers upon the difeafes of armies, won- der that the Greek and Roman phyficians have left us nothing upon that fubjeft. But may not'mojl of the dif- eafes of armies, be produced by the different manner in which wars are carried on by the modern nations ? The difcoveries in geography, by extending the field of w;:.r, expofe fcldiers to many difeafes from long voyages, and a fadden change of climate; which were unknown to the arrnie. AMONG THE INDIANS. 43 difcoveries in geography, by extending the empire of commerce, have likewife extended the empire of difeafes. What defolation have the Eaft and Weft Indies made of Britifh fubjedts! It has been found upon a nice calculation, that only ten of an hundred Europeans, live above feven years after they arrive in the ifland of Jamaica. IV. It would take up too much of our time to point out all the cuftoms both phyfical and moral, which influence difeafes among both fexes. The former have engendered the feeds of difeafes in the human body itfelf: hence the origin of ca- tarrhs, jail and miliary fevers, with a long train of contagious diforders, which compofe fo great a part of our books of medicine. The latter like- wife have a large fliare in producing difeafes. I am not one of thofe modern philofophers, who derive the vices of mankind from the influence of civilization ; but I am fafe in afftrting, that their number and malignity increafe with the refine- ments of polifhed life. To prove this, we need only furvey a fcene too familiar to affect us: it is armies of former ages. Moreover, the form of the wea- pons, and the variety in the military exercifes of the Gre- cian and Roman armies, gave a vigour to the conftitution, which can never be acquired by the ufe of mufkets and artillery. D 2 a bed- 44 NATURAL HISTORY OF MFDICINE a bedlam; which injuftice, inhumanity, avarice, pride., vanity, and ambition, have filled with in- habitants. Thus have we briefly pointed out the cuftofn.s which influence the difeafes of civilized nations. It remains now that we take notice of their dif- eafes. Without naming the many new fevers, fluxes, hemorrhages, fwelluigs from water, wind, flefli, fat, pus and blood; foulness on the fkin from cancers, leprofy, yawes, poxes, and itch; and laftly, the gout, the hyfteria, and the hypo- condriaiis, in all their variety of known and un- known fhapes; I fhall fum .up all that is neceflary upon this fubject, J)y adding, that the number of difeafes which belong to civilized nations, accord- ing to Doctor CuUen's ttofology, amounts to 1387; the fingle clafs of nervous difeafes form 612 of this number. before we proceed to fpeak of the remedies of civilized nations, we (hall examine into the abi- lities of nature iii curing their difeafes. We found her active and fuccefsful in curing the dif- eafes of the Indians. Is her ftrength, wifdom, or benignity, equal to the increafc of thofe dangers which threaten her diffolution among civilized na- tions? In order to anfwer this queftion, it will be ' AMONG THE INDIANS. 4$ be tteCefTafy to explain the meaning of the term nature. fey* nature, in the prefent cafe, I uriderftaud nothing but phyfical neceffity. This at once ex- cludes every thing like intelligence from her ope- rations : thefe are all performed in obedience to the fame laws which govern vegetation in plants and the infeftine motions of foflils. They are as tfu'Iy mechanical as the laws of gravitation, elec- tricity or magnetifm. A fhip when laid on her broadfide by a wave, or a fudden blaft of wind, rifes by the Ample laws of her mechanifm; but fuppofe this fhip to be attacked by fire, or a wa- ter-fpout, We are not to call in queftion the fkiil of the fhip-builder, if flie be confumed by the one, or funk by the other. In like manner, the Author of nature hath furnilhed the body with powers to preferve itfelf front its natural enemies; but wh?n it is attacked by thofe civil foes which are bred by the peculiar cuftoms of civilization, it refem- bies a company of Indians, armed with bows and arrows, againft the complicated and deadly ma- chinery of fire-arms. To place this fubjeft iri a pro- per light, we fliall deliver a hiftory of the opera- tions of nature in a few of the difeafes of civilized nations. D 3 I. There 46 NATURAL history of medicine I. There are cafes in which nature is ftill fuc- cefsful in curing difeafes. In fevers flie ftill deprives us of our appetite for animal food, and imparts to us a defire for cool air and cold water. In hemorrhages fhe produces a faintnefs, which occafions a coagulum in the open veflels ; fo that the further paffage of blood through them is ob- ftructed. In wounds of the flefli and bones flie difcharges foreign matter by exciting an inflammation, and fupplies the wafle of both with new flefh and bone. II. There are cafes where the efforts of nature are too feeble to do fervice, as in putrid and ner- vous fevers. III. There are cafes where the efforts of nature are over proportioned to the ftrength of the dif- eafe, as in the cholera morbus and dyfenterv. IV. There are cafes where nature is idle, as in the atonic ftages of the gout, the cancer, the epi- lepfy, among the ineians. 47 epfy, the mania, the venereal difeafe, the apo- plexy, and the tetanus*. V. There are cafes in which nature does mif- chief. She waftes herfelf with an unneceffary fever, in a dropfy and confumption. She throws a plethora upon the brain and lungs in the apo- plexy and peripneumonia notha. She ends a pleurify and peripneumony in a vomica, or em- pyema. She creates an unnatural appetite for • food in the hypochondriac diforder. And laflly, flie drives the melancholy patient to folitude, where, by brooding over the fubject of his in- fanity, he increafes his difeafe, We are accuftomed to hear of the falutary kind- nefs of nature in alarming us with pain, to prompt us to feek for a remedy. But, VI. There are cafes in which flie refufes to fend this harbinger of the evils which threaten her, as in the aneurifm, fcirrhus, and ftone in the bladder. VII. There are cafes where the pain is no: proportioned to the danger, as in the tetanus, confumption, and dropfy of the head. And, * Hoffman de hypothefium medicarum damno, feci. xv. D4, VIII. 48 NATURAL HISTORY OF MEDICINE VIII. There are cafes where the pain is over- proportioned to the danger, as in the paronychia and tooth-ach. This is a fhort account of the operations of na- ture, in the difeafes of civilized nations. A lu- natic might as well plead againft: the fequeftration of his eftate, becaufe he once enjoyed the full ex- ercife of his reafon, or becaufe he ftill had lucid intervals, as nature be exempted from the charges we have brought againft her. But this fubjecl: will receive ftrength from corr- fidering the remedies of civilized nations. AH the products of the vegetable, foflil, and animal kingdoms, tortured by heat and mixture into an almofl infinite variety of forms; bleeding, cup- ping, artificial drains by fetons, iffueg, and blifiers; exercife, active and paflive; voyages and journies; baths, warm and cold; waters faline, aerial and mineral; food by weight and meafure ; the royal touch; enchantment; miracles ; in a word, the combined difcoveries of natural hiftory and philo- fophy, united into a fyftem of materia medica, all fhow, that although phyficians are in fpeculation the fervants, yet in practice they are the mailers of nature. The whole of their remedies feem con- trived on purpofe to aroufe? aflift, reftrain, and controul her operations, There * AMONG THE INDIANS. 49 There are fome truths like certain liquorsf, which require flrong heads to bear them. I feel myfelf protected from the prejudices of vulgar minds, when I reflect that I am delivering thefe fentiments in a fociety of philofophers. Let us now take a comparative view of the difeafes and remedies of the Indians with thofe of civilized nations. We fliall begin with their difeafes. In our account of the difeafes of the Indians we beheld death executing his commiflion, it is true; but then his dart was hid in a mantle, under which he concealed his fliape. But among civilized na* tions we behold him multiplying his weapons in proportion to the number of organs and functions in the body •, and pointing each of them in fuch a manner, as to render his meffengers more terrible than himfelf. We faid formerly that fevers conftituted the chief difeafes of the Indians. According to Doc- tor Sydenham's computation, above 66,000 out of 100,000 died of fevers in London about 100 years ago ; but fevers now conftitute but a little more than one-tenth part of the difeafes of that city. Out of 21,780 perfons who died in London * between 50 NATUilAL HISTORY OF MEDICINE between December 1770 and December 1771, only 2273 died of fimple fevers. 1 have more than once heard Doctor Huck complain, that he could find no marks of epidemic fevers in London as defcribed by Dr Sydenham. London has un- dergone a revolution in its manners and cuftoms fince Doctor Sydenham's time. New difeafes, the offspring of luxury, have fupplanted fevers ; and the few that are left, are fo complicated with other difeafes that their connection can no longer be difcovered with an epidemic coriftitution of the year. The pleurify and peripneumony thofe in- flammatory fevers of ftrong conftitutions, are now loft in catarrhs, or colds; which inftead of chal- lenging the powers of nature or art to a fair combat, infenfibly undermine the conftitution, and bring on an incurable confumption. Out of 22,434 who died in London between De- cember 1769, and the fame month in 1770, 4594 perifhed with that Britifh diforder. Our countryman, Doctor Maclurg, has ventured to foretel that the gout will be loft in a few years, in a train of hypocondriac, hyfteric and bilious diforders. In like manner, may we not look for a feafon when fevers, the natural difeafes oft he hu- man body, will be loft in an inundation of artificial difeafes, brought on by the modifli practices of civilization ? It AMONG THE INDIANS. 51 Ir may not be improper to compare the prog- nosis of the Indians, in difeafes, with that of civilized nations, before we take a comparative view of their remedies. The Indians are faid to be fuccefsful in pre- dicting the events of difeafes. While difeafes are fimple, the marks which diftinguifli them, or cha- racterize their feveral flages, are generally uni- form and obvious to the moft indifferent obferver. Thefe marks afford fo much certainty, that the In- dians fometimes kill their phyficians for a falfe prognofis, charging the death of the patient to their careleflhefs, or ignorance. They eflimate the danger of their patients by the degrees of appetite ; while an Indian is able to eat, he is looked upon as free from danger. But when we confider the number and variety in the figns of difeafes, among civilized nations, together with the fliortnefs of life, the fallacy of memory, and the uncertainty of obfervation, where fliall we find a phyfician willing to riik his reputation, much lefs his life, upon the prediction of the event of our acute difeafes ? We can derive no advantage from the fimple fign, by which the Indians eflimate the danger of their patients ; for we daily fee a want of appetite for food in difeafes which are at- tended with no danger ; and we fometimes obferve an 52 NATURAL HISTORY 07 MEDICINE an unufual degree of this appetite to precede the agonies of death. I honour the name of Hip- pocrates: But forgive me ye votaries of anti- quity, if I attempt to pluck a lew grey hairs from his venerable head. I was once an idolater at his altar, nor did I turn apoftate from his worfhip, till I was taught, that not a tenth part of his prog- nostics correfponded with modern experience, or obfervation. The pulfe *, urine, and fweats, from which the principle figns of life and death have been taken, are fo variable'" in moft of the acute difeafes of civilized nations, that the wifeft phy- ficians have in fome meafure excluded the prog- nofis from being a part of their profeffiofl. I am here infenfibly led to make an apology for the inftability of the theories and practice of phyfic. The theory of phyfic is founded upon the laws of the animal economy. Thefe (unlike * Doflor Cullen ufed to inform his pupils, that after forty years experience, he could find no relation between his own obfervations on the pulfe, and thofe made by Dodor Solano. The climate and cuftoms of the people in Spain being fo diffe- rent from the climate and cuftoms of the prefent inhabitants of Britain, may account for the diverfity of their obfervations. Doctor Heberden's remarks upon die pulfe, in the fecond vo- lume of the Medical Tranfactions, are calculated to fhow how little the iflue of difeafes can be learned from it. the ? AMONG THE INDIANS. 53 the laws, of the mind, or tfcc common laws of matter) do not appear at once, but are gradually brought to light by the phaenomena of difeafes.." The fuccefs of nature in curing the fimple difeafes of Saxony, laid the foundation • for the anima medica of Doctor Stahl. The endemics of Holland * led Doctor Boerhaave to feek for the caufes of all difeafes in the fluids. And the uni- verfal prevalence of the difeafe of the nerves, in Great-Britain, led Doctor Cullen to difcover their peculiar laws, and to found a fyftem upon them; a fyftem, which will probably laft till fome new difeafes are let loofe upon the human fpecies, which fliall unfold other laws of the animal ceconomy. It is in confequence of this fluctuation in the principles and practice of phyfic, being fo necef- farily connected with the changes in the cuftoms * " The fcurvy is very frequent in Holland ; and draws it- origin partly from their ftrong food, fea-fifh, and fmoaked flefli, and partly from their denfe and moift air, together with their bad water." Hoffman on Endemical Diftempers. " We are now in North-Holland ; and I have never feen, among fo few people, fo many infe&ed with the leprofy as here. They fay the reafon is, becaufe they eat fo much fifli." Howell's Familiar Letters. of 54 NATURAL HISTORY OF MEDICINE of civilized nations,*hat old and yciing phytician3 fo often difigree in their opinions and practices. And it is by attending to the conftant changes in thefe cufloms of civilized nations, that thofe phy- ficians have generally become the moft eminent, who havt fooneft emancipated themfelves from the tyranny of the fchocls of phyfic ; and having occa- fionally accommodated their principles and practice to the changes in difeafes *. This variety in difjafes, which is produced by the changes in the cuftom:* of civilized nations, will enable us to account for many of the contradictions which are to be found in authors of equal candour and abilities, who have written upon the materia medica. * We may learn from thefe obfervations, the great impro- priety of thofj Egyptians laws which ob'ige phyficians to adopt, in all cafes, the prefcriptions which had been collected, and approved of, by the phyficians oi former ap;es. Every change in the cuPioms of civilized nations, produces a change in their difeafes, which cal'sfor a change in their remedies. What havoc would plentiful bleeding, purging, and fmall beer, formerly ufed with fo much fuccefs by Dr Sydenham in the cure of fevers, now make upon the enfeebled citizens of London ! The fevers of the fame, and of more fouthern lati- titudes, ftill admit of fuch antiphlogiftic remedies. In the room of thefe, baik, wine, and other cordial medicines, are prefcribed in London in almoft every kind of fever. In AMONG THE INDIANS. • 55 In forming a comparative view of the remedies of the Indians, with thofe of civilized nations, we fliall remark, that the want of fuccefs in a me- dicine is occafloned by one of the following caufes. Firft, our ignorance of the diforder. Secondly, an ignorance of a fuitable remedy. Thirdly, a want of efficacy in the remedy. Confidering the violence of the difeafes of the Indians, it is probable their want of fuccefs is al- ways occafloned by a want of efficacy in their me- dicines. But the cafe is very different among the civilized nations. Diffections daily convince us of our ignorance of the feats of difeafes, and caufe us to blufh at our prefcriptions. What cer- tain or equal remedies have we found for the gout, the epilepfy, apoplexy, palfy, dropfy of the brain, icancer and confumption ? How often are we dif- appointed in our expectation from the moft certain and powerful of our remedies, by the negligence or obftinacy of our patients! What mifchief have we done under the belief of falfe facts (if I may be allowed the expreflion) and falfe theories! We have affifted in multiplying difeafes.—We have dene more—we have increafed their mortality. But 56 NATURAL HISTORY OF MEDICINJ? X I fhall not paufe to beg pardon of the faculty, for Acknowledging in this public manner the weaknefles of our profefEon. I am purfuing truth, and while I can keep my eye fixed upon my guide, I am indif- ferent whither I am led, provided fhe is my leader. But further, the Indian fubmits to his difeafe, without one fearful emotion from his doubtfulnefs of its event; and at laft meets his fate without an anxious wifh for futurity ; except it is of being admitted to an " equal Iky," where " His faithful dog fhall bear him company." But among civilized nations, the influence of a falfe religion in good, and of a true religion in bad men, has converted even the fear of death into a difeafe. It is this original diflemper of the imagi- nation which renders the plague moft fatal, upon his firft appearance in a country. Under all thefe difadvantages in the ftate of me- dicine, among civilized nations, do more in pro- portion die of the difeafes peculiar to them, than of fevers, cafualties and old age, among the In- dians ? If we take our account from the city of London, we fhall find this to be the cafe. Near a twentieth part of its inhabitants perifh one year 2 with AMONG THE INDIANS; $y with another. Nor does the natural increafe of inhabitants fupply this yearly wafte. If we judge from the bills of mortality, the city of London contains fewer inhabitants, by feveral thoufands, than it did forty years ago. It appears from this fact, and many others of a like nature, which might be adduced, that although the difficulty of fupporting children, together with fome peculiar cuftoms of the Indians, which we mentioned, limit their number, yet they multiply fafter, and die in a fmaller proportion than civilized nations, under the circumftances we have defcribed. The Indians, we are told, were numerous in this coun- try before the Europeans fettled among them; Travellers agree likewife in defcribing numbers of both fexes who exhibited all the marks of extreme old age. It is remarkable that age feldom impairs the faculties of their minds* The mortality peculiar to thofe Indian tribes who have mingled with the white people, muft be afcribed to the extenfive mifchief of fpirituous liquors. When thefe have not acted, they have fuffered from having accommodated themfelves too fuddenly to the European diet, drefs, and manners. It does not become us to pry too much into fu- turity ; but if we may judge from the fate of the original natives of Hifpaniola, Jamaica, and the E provinces NATURAL HISTORY OF MEDICINE provinces on the continent, we may venture to foretell, that, in proportion as the white people multiply, the Indians will diminifli ; fo that in a few centuries they will probably be entirely extir- pated *. It may be faid, that health among the Indians, like infenfibility to cold and hunger, is propor- tioned to their need of it; and that the lefs degrees, or entire want of health, are no interruption to the ordinary bufinefs of civilized life. To obviate this fuppofition, we fliall firft attend to the effects of a fingle diftemper in thofe people who are the principle wheels in the machine of civil fociety. Juftice has flopt its current, victo- ries, have been loft, wars have been prolonged, and * Even the influence of christian principles has not been able to put a flop to the mortality introduced among the In- dians, by their intercourfe with the Europeans. Dr Cotton Mather, in a letter to Sir William Afhurft, printed, in Bolton in the year 1705, fays " That about five years before, there were about thirty Indian congregations in the fouthern parts of the province of Maflachufetts-Bay." The fame author, in his hiftory of New-England, fays, \" That in the iflands of Nantucket and Martha's Vineyard, there were 3000 adult In- dians, 1600 of whom profefTed the Chriltian religion." At prefent there is but one Indian congregation in the whole M ■uTachufletts province. It AMONG THE INDIANS. 59 embaflies delayed, by the principle actors in thefe departments of government being fudddenly laid up by a fit of the gout. How many offences are daily committed againft the rules of good breeding, by the tedious hiftories of our diforders, which com- pofe fo great a part of modern converfation ! What fums of money have been lavifhed in foreign coun- tries in purfuit of health* ! Families have been ruined by the unavoidable expences of medicines and watering-places. In a word, the fwarms of beggars which infeft fo many of the European countries, urge their petitions for charity chiefly by arguments derived from real or counterfeit difeafes, which render them incapable of fupport- in themfelvesf. But may not civilization, while it abates the violence of natural difeafes, increafe the lenity of It may ferve to extend our knowledge of difeafes, to re- mark, that epidemics were often obferved to prevail among the Indians in Nantucket, without affeding the white people. * It is faid, there are feldom lefs than 20,000 Britifh fub- jecls in France and Italy ; one half of whom refide or travel in thofe countries upon the account of their health. f Templeman computes, that Scotland contains 1,500,000 inhabitants ; 100,000 of whom, according to Mr Fletcher, are fupported at the public expence. The proportion of poor people is much greater in England, Ireland, France, and Italy. E 2 thofe 6o NATURAL HISTORY OF MEDICINE thofe that are artificial, in the fame manner that iff leffens the ftrength of natural vices by multiplying them ? To anfwer this queftion, it will only be ne- ceflary to afk another : Who fhould exchange the heat, thirft and uneafinefs of a fever, for one fit of the cholic or ftone ? The hiftory of the number, combination and fafhions af the remedies we have given, may ferve to humble the pride of philofophy j and to con- vince us that with all the advantages of the whole circle of fciences, we are ftill ignorant of antidotes to many of the difeafes of civilized nations. We fometimes footh our ignorance by reproaching our idlenefs in not inveftigating the remedies peculiar to this country. We are taught to believe that every herb that grows in our woods is poflefled of fome medicinal virtue, and that heaven would be wanting in benignity if our country did not pro- duce remedies for all the different difeafes of its inhabitants. It would be arrogating too much to fuppofe that man was the only creature in our world for whom vegetables grow. The beafts, birds and infects, derive their fuftcnance either dire&ly or indirectly from them ; while many of them were probably intended from their variety in figure, foliage and colour, only to ferve as orna- ments for our globe. It would feem flrange that the AMONG THE INDIANS. 61 the Author of nature fhould furnifh every fpot of ground with medicines adapted to the difeafes of its inhabitants, and at the fame time deny it the more neceflary articles of food and cloathing. I know n©t whether heaven has provided every country with antidotes even to the natural difeafes of its inhabitants. The intermitting fever is com- mon in almoft every corner of the globe ; but a fovereign remedy for it has been difcovered only in South-America. The combination of bitter and aftringent fubftances, which ferve as a fucceda- neum to the Peruvian bark, is as much a prepara- tion of art, as calomel or tartar emetic. Societies fland in need of each other as much as individuals: and the goodnefs of the Deity remains unimpeach- ed when we fuppofe, that he intended medicines to ferve (with other articles) to promote that know- edge, humanity, and politenefs among the inhabi- tants of the earth, which have been fo juftly attri- buted to commerce. We have no difcoveries in the materia medica to hope for from the Indians in North-America It would be a reproach to our fchools of phyfic, if modern phyficians were not more fuccefsful than the Indians, even in the treatment of their own difeafes, E3 Do 62 NATURAL HISTORY OF MEDICINE Do the bleffings of civilization compenfate for the facrifice we make of natural health, as well as of natural liberty ? This queftion muft be anfwered under fome limitations. When natural liberty is given up for laws which enflave inftead of protect- ing us, we are immenfe lofers by the exchange. Thus, if we arm the whole elements againft our health, and render every pore in the body an avenue for a difeafe, we pay too high a price for the bleffings of civilization. In governments which have departed entirely from their fimplicity, partial evils are to be cured by nothing but an entire renovation of their con- ftitution. Let the world bear with the profeflions of law, phyfic, and divinity ; and let the lawyer, phyfician and divine yet learn to bear with each other. They are all neceflary, in the prefent flate of fociety. In like manner, let the women of fafhion forget the delicacy of her fex, and fubmit to be delivered by a man-midwife*. Let her fnatch her offspring from her breaft, and fend it to repair * In the enervated age of Athens, a law was pafTed which confined the practice of midwifery only to the men. It was, however, repealed, upon a woman's dying in childbirth, ra- ther than be delivered by a man-midwife. It appears from the bills of mortality in London and Dublin, that about one in feventy of thofe women die in childbirth who are in the hands AMONG THE INDIANS. 6% the weaknefs of its (lamina, with the milk of a ruddy cottager*. Letartfupply the place of nature in the preparation and digeftion of all our aliment. Let our fine ladies keep up their colour with car- mine, and their fpirits with ratifia; and let our fine gentlemen defend themfelves from the excefles of heat and cold, with lavender and hartfhorn. Thefe cuftoms have become neceffary in the cor- rupt ftages of fcciety. We muft imitate, in thefe hands of midwives ; but from the accounts of the lying-in hofpitals in thofe cities which are under the care of man-mid- wives, only one in an hundred and forty perifhes in childbirth. * There has been much common-place declamation againft the cuftom among the great, of not fuckling their children. Nurfes were common in Rome, in the declenfian of the em- pire : hence we find Cornelia commended as a rare exam- ple of maternal virtue, as much for fuckling her fons, as for teaching them eloquence. That nurfes were common in Egypt, is probable from the contract which Pharaoh's daughter made with the unknown mother of Mofes, to allow her wages for fuckling her own child. The fame degrees of civilization require the fame cuftoms. A woman whofe times for eating, fleeping, &c. are conftantly interrupted by the calls of enervating pleafures, muft always afford milk of an unwholefome nature. It may truly be faid of a child doomed to live on this aliment, that as foon as it receives its -------" breath, It fucks in " the lurking principles of death." E 4 cafes, 6"4 NATURAL HISTORY OF MEDICINE cafes, the practice of thofe phyficians who confult the appetite only, in difeafes which do not admit of a remedy. The flate of a country in point of population, temperance, and induftry, is fo connected with its difeafes, that a tolerable idea may be formed of it, by looking over its bills of mortality. Hospitals, with all their boafted advantages, exhibit at the fame time monuments of the charity and depravity of a people *. The Opulence of phyficians, and the divifions of their offices, into thofe of furgery, * " Aurengezebe, emperor of Perfia, being afked Why he did not build hofpitals ? faid, I will make my empire fo rich, that fherejhall le no need of hofpitals. He ought to have faid, I will begin by rendering my fubje&s rich, and then I will build hofpitals. " At Rome, the hofpitals place every one at his eafe, ex.. cept thofe who labour, thofe who are induftrious, thofe who have lands, and thofe who are engaged in trade. " I have obferved, that wealthy nations have need of hof- pitals, becaufe fortune fubje&s them to a thoufand accidents ; but it is plain, that tranfient afliftances are better than perpe- tual foundations. The evil is momentary; it is neceffary, therefore, that the fuccour fhould be of the fame nature, and that it be applied to particular accidents." Spirit of Laws, b. xx'ai ch. 29. h AMONG THE INDIANS. 6$ pharmacy and midwifery, are likewife proofs of the declining flate of a country. In the infancy of the Roman empire, the prieft performed the office of a phyfician; fo fimple were the prin- ciples and practice of phyfic. It was only in the declenfion of the empire that phyficians vied with the emperors of Rome in magnificence and fplendor* I am forry to add in this place, that the number of patients in the hospital, and incurables in the It was referved for the prefent gener ation to fubftitute in the room of public hofpitals private dispensaries for the re* lief of the fick. Philofophy and chriftianity alike coHcur in deriving praife and benefit from thefe excellent inftitutions. They exhibit fomething like an application of the mechanical powers to the purpofes of benevolence ; for in what other cha- ritable inftitutions do we perceive fo great a quantity of diftrefs relieved by fo fmall an expence ? * The firft regular practitioners of phyfic in Rome, were women and flaves. The profeffion was confined to them above fix hundred years. The Romans during this period lived chiefly upon vegetables, particularly upon pulse; and hence they were called, by their neighbours pultifagi. They were likewife early inured to the healthy employments of war and hufoandry. Their difeafes, of courfe, were too few and fimple to render the cure of them an objecl of a libe- ral profeffion. When their difeafes became more numerous and complU 66 NATURAL HISTORY OF MEDICINE almshouse of this city, (how that we are treading in the enervated fteps of our fellow fubjects in Britain. Our bills of mortality likewi fe fhow the encroachments of Britiih difeafes upon us. The nervous fever has become fo familiar to u$, that we look upon it as a natural difeafe. Dr Syden- ham, fo faithful in his hiftory of fevers, takes no notice of it. Dr Cadwallader informed me, that it made its firft appearance in this city about five and twenty years ago. It will be impoflible to name the consumption without recalling to our minds the memory of fome friend or relation, who has periflied within thefe few years by that dif- order. Its rapid progrefs among us has been un- juftly attributed to the growing refemblance of our climate to that of Great-Britain. The hys- teric and hypochondriac disorders, once1 peculiar to the chambers of the great, are now to be found in our kitchens and workfhops. All complicated, their inveftigation and cure required the aids of philofophy. The profefEon from this time became liberal; and maintained a rank with the other profeffions which are founded upon the imperfection and depravity of human in- ftitutions. Phyficians are as necefiary in the advanced ftages of fociety as furgeons, although their office is lefs ancient and- certain. There are many artificial difeafes, in which they give certain relief; and even where their art fails, their prefcriptions are dill neccfTary, in order to fmooth the avenues of death. thefe AMONG THE INDIANS. 67 thefe difeafes have been produced by our having deferted the fimple diet, and manners, of our anceftors. The bleffings of literature, commerce, and re- ligion were not originally purchafed at the expence of health. The complete enjoyment of health is as compatible with civilization, as the enjoyment of civil liberty. We read of countries, rich in every thing that can form national happinefs and national grandeur, the difeafes of which are nearly as few and fimple as thofe of the Indians. We hear of no difeafes among the Jews, while they were under their democratical form of govern- ment, except fuch as were inflicted by a fupcrna- tural power*. We fhould be tempted to doubt the the accounts given of the populoufnefs of that people, did we not fee the practice of their fim- ple cuftoms producing nearly the fame populouf- nefs in Egypt, Rome, and other countries of anti- quity. The Empire of China, it is faid contains more inhabitants than the whole of Europe. The political inftitutions of that country have exempted * The principal employments of the Jews, like thofe of the Romans in their fimple ages, confifted in war and huf- bandry. Their diet was plain, confuting chiefly of vegetables. Their only remedies were plafters and ointments; which were calculated for thofe difeafes which are produced by accidents. 68 natural history of medicine its inhabitants from a large fhare of tjie difeafes of other civilized nations. The inhabitants of Swif- ferland, Denmark, Norway* and Sweden, enjoy the chief advantages of civilization without having furrendered for them the bleffings of natural health. accidents. In proportion as they receded from their fimple cuftems, we find artificial difeafes prevail among them. The leprofy made its appearance in their journey through the wildernefs. King Afa's pains in his feet, were probably brought on by a fit of the gout. Saul and Nebuchad- nezzar were afflicted with a melancholy. In the time of our Saviour, we find an account of all thofe difeafes in Judea, which mark the declenfipn of a people; fuch as, the palfy, epilepfy, mania, blindnefs, hemorrhagia uterina, &c. It is unneceffary to fuppofe, that they were let loofe at this junc- ture, on purpofe to give our Saviour an opportunity of making them the chief fubjecl: of his miracles. They had been produced from natural caufes, by the gradual depravity of their manners. It is remarkable, that our Saviour chofe thofe artificial difeafes for the fubjeft of his miracles, in pre- ference to natural difeafes. The efforts of nature, and the operation of medicines, are too flow and uncertain in thefe cafes to detract in the leaft from the validity of the miracle. He cured Peter's mother-in-law, it is true, of a fever; but to fhew that the cure was miraculous, the facred hiftorian adds, (contrary to what is common after a fever) "that fhe arofe immediately and miniftered unto them." * In the city of Bergen, which confifts of 30,000 inhabi- tants, there is but one phyfic iari; wTho is fupported at the cxpence of the public. Pontoppidan's Nat. Hift. of Norway. But AMONG THE INDIANS. 6g But it is unneceflary to appeal to ancient or re- mote nations to prove, that health is not incom- patible with civilization. The inabitants of many parts of New England, particularly the province of Connecticut, are ftrangers to artificial difeafes. Some of you may remember the time, and our fathers have told thofe of us who do not, when the difeafes of Pennsylvania were as few and as fimple as thofe of the Indians. The food of the inhabitants was then fimple; their only drink was water ; their appetites were reftrained by labour ; religion excluded the influence of fickning paf- fions ; private hofpitality fupplied the want of a public hofpital; nature was their only nurfe, tem- perance their principal phyfician. But I muft not dwell upon this retrofpect of primaeval manners; and I am too ftrongly imprefled with a hope of a revival of fuch happy days, to pronounce them the golden age of our province. Our efteem for the cuftoms of our favage neighbours will be leflened, when we add, that civilization does not preclude the honours of old age. The proportion of old people is much greater among civilized, than among lavage na- tions. It would be eafy to decide this afler- tion in our favour, by appealing to facts in the natural hiftories of Britain, Norway, Sweden, North- JO NATURAL HISTORY OF MEDICINE North-America*, and feveral of the Weft-India Iflands. The laws of decency and nature, are not ne- ceflarily abolifhed by the cuftoms of civilized na- tions. In many of thefe, we read of women among whom nature alone ftill performs the office of a midwife f, and who feel the obligations of fuck- * It has been urged againft the ftate of longevity in America, that the Europeans, who fettle among us, ge- nerally arrive to a greater age than the Americans. This is not occafloned fo much by a peculiar firmnefs in their ftamina, as by an increafe of vigour, which the conftitu- lion acquires by a change of climate. A Frenchman (ce- teris paribus) outlives an Englifhman in England. An Hollander prolongs his life by removing to the Cape of Good Hope. A Portuguefe gains fifteen or twenty years by removing to Brazil. And there are good reafons to believe, that a North-American would derive the fame ad- vantages, in point of health and longevity, by removing to Europe, which an European derives from coming to this country. From a calculation made by an ingenious foreigner, it appears, that a greater proportion of old-people are to be found in Connecticut, than in any colony in North-Ameri- ca. This colony contains 180,000 inhabitants. They have no public hofpitals or poor-houfes; nor is a beggar to be feen among them. There cannot be more ftriking proofs than thefe fadts of the fimplicity of their manners. f Parturition, in the fimple ages of all countries, is per- formed by nature. The Ifraelitifh women were delivered even AMONG THE INDIANS. Jt ling their children, to be equally binding with the common obligations of morality. Civilization does not render us lefs fit for the neceflary hardfliips of war. We read of armies of civilized nations, who have endured degrees of cold, hunger and fatigue, which have not been exceeded by the favages of any country*. Civilization does not always multiply the ave- nues of death. It appears from the bills of mor- tality, of many countries, that fewer in proportion die among civilized, than among favage nations. even without the help of the Egyptian midwives. We read of but two women who died in child-birth in the whole hiftory of the Jews. Dr Bancroft fays, that child-bearing is attended with fo little pain in Guiana, that the women feem to be exempted from the curfe inflifted upon Eve. Thefe eafy births are not confined to warm climates. They are equally fafe and eafy in Norway and Iceland, according to Pont'oppidan and Anderfon's hiftories of thofe countries. * Civilized nations have, in the end, always conquered favages as much by their ability to bear hardfhips, as by their fuperior military fkill. Soldiers are not to be chofen indifcriminately. The greateft generals have looked upon found conftitutions to be as effential to foldiers, as bravery or military difcipline. Count Saxe refufed foldiers born and bred in large cities; and fought for fuch only as were bred ia mountainous countries.. The King of Pruifia calls young foldier; Ji NATURAL HISTORY OF MEDICINfi Even the charms of beauty are heightened by civilization. We read of ftatelinefs, proportion, and fine teeth* and complexions in both fexes, forming the principal outlines of national cha- racters. The danger'of many difeafes, is not propor- tioned to their violence, but to their duration. America has advanced but a few paces in luxury and effeminacy. There is yet ftrength enough in her vitals to give life to thofe parts which are foldiers only to the dangers and honours of the field in his elegant poem, Sur l'Art de la Guerre, chant, i. Old fol- diers generally lofe the advantages of their vete/anifm, by their habits of idlenefs and debauchery. An able general, and experienced officers, will always fupply the defects of age in young foldiers. * Bad teeth are obferved chiefly in middle latitudes, which are fubjetf to alternate heats and colds. The inha-" bitants of Norway and Ruffia are as remarkable for their fine teeth as the inhabitants of Africa. We obferve fine teeth to be univerfal likewife among the inhabitants of France, who live in a variable climate. Thefe have been afcribed to their protecting their heads from the action of the night air by means of woollen night-caps, and to the extraordinary attention to the teeth of their children. Thefe precautions fecure geod teeth ; and are abfolujely neceflary in all variable climates where people do net adopt all the euftoms of the favage life. i decayed AMONG THE INDIANS. 73 decayed. She fcay recall her fleps. For this purpofe, I. Let our children be educated in a manner more agreeable to nature. II. Let the common people (who conftitute the wealth and ftrength of our country) be preferved from the effects of fpirituous liquors. Had I a double portion of all that eloquence which has been employed in defcribing the political evils that lately threatened our country, it would be too lit- tle to fet forth the numerous and complicated phy- fical'and moral evils which thefe liquors have intro- duced among us. To encounter this hydra requires an arm accuftomed like that of Hercules to van- quifh monfters. Sir William Temple tells us, that in Spain no man can be admitted as an evi- dence in a court, who has once been convicted of drunkennefs. I do not call for fo fevere a law in this country. Let us firft try the force of fevere manners. Lycurgus governed more by thefe, than by his laws. " Boni mores non bonae leges," according to Tacitus, were the bulwarks of virtue among the ancient Germans. III. I defpair of being able to call the votaries of Bacchus from their bottle, and fhall therefore Vol. I. F leave 74 NATURAL HISTORY CF MEDICINE leave them to be roufed by the more eloquent twinges of the gout. IV. Let us be cautious what kind of manufac- tures we admit among us. The rickets made their firft appearance in the manufacturing towns in England. Dr Fothergill informed me, that he had often obferved, when a pupil, that the great- eft part of the chronic patients in the London Hofpital were Spittal-field weavers. I would not be underftood, from thefe facts, to difcourage thofe manufacturers which employ women and children: thefe fuffer few inconveniences from a fedentary life: nor do I mean to offer the leaft reftraint to thofe manufactories among men, which admit of free air, and the exercife of all their limbs. Perhaps a pure air and the abftraction of fpirituous liquors might render fedentary employ- ments lefs unhealthy in America, even among men, than in the populous towns of Great-Britain. The population of a country is not to be accora- plifhed by rewards and punifhments. And it is happy for America, that the univerfal prevalence of the proteftant religion, the checks lately given to negro flavery, the general unwillingnefs among us to acknowledge the ufurpations of primogeni- ture, the univerfal practice of inoculation for the fmalU AMONG THE INDIANS. 75 fmall-pox, and the abfence of the plague, render the interpofition of government for that purpofe unneceflary. Thefe advantages can only be fecured to our country by agriculture. This is the true bafis of national health, riches and populoufnefs. Na- tions, like individuals, never rife higher than when they are ignorant whither they are tending. It is impoflible to tell from hiftory, what will be the effects of agriculture, induftry, temperance5 and commerce, urged on by the competition of colonies, united in the fame general purfuits, in a country, which for extent, variety of foil, climate, and number of navigable rivers, has never been equalled in any quarter of the globe. America is the theatre where human nature will probably receive her laft and principal literary, moral and political honours. But 1 recall myfelf from the ages of futurity. The province of Pennfylvania has already fhewn to her fifter colonies, the influence of agriculture and commerce upon the number and happinefs of a people. It is fcarcely an hundred years fince our illuftrious legiflator, with an handful of men, landed upon thefe fhores. Although the perfection of out government, the heahhinefs of our climate, F 2 and j6 NATURAL HISTORY OF MEDICINE and the fertility of our foil, feemed to enfure a rapid fettlement of the province; yet it would have required a prefcience bordering upon divine, to have foretold, that in fuch a fliort fpace of time, the province would contain above 300,000 inhabitants; and that near 30,000 of this number fhould compofe a city, which fhould be the third, if not the fecond in commerce in the Britifli em- pire. The purfuits of literature require leifure gnd a total recefs from clearing forefts, planting, building, and all the common toils of fettling a new country: but before thefe arduous works were accomplilhed, the sciences, ever fond of the company of liberty and induftry, chofe this fpot for the feat of their empire in this new world. Our college, fo catholic in its foundation, and extenfive in its objects, already fees her fons exe- cuting offices in the higheft departments of foci- ety. I have now the honour of fpeaking in the prefence of a moft refpectable number of philofo- phers, phyficians, aftronomers, botanifts, patriots, and legislators; many of whom have already feized the prizes of honour, which their anceftors had allotted to a much later pofterity. Our firft offer- ing had fcarely found its way into the temple of fame, when the oldeft focieties in Europe turned their eyes upon us, expecting with impatience to fee the mighty fabric of fcience, which like a well fc>uijt AMONG THE INDIANS. Jf built arch, can only reft upon the whole of its materials, completely finiflied from the treafures of this unexplored quarter of the globe* It reflects equal honour upon our fociety and the honourable aflembly of our province, to ac- knowledge, that we have always found the latter willing to encourage by their patronage, and re- ward by their liberality, all our fchemes for pro- moting ufeful knowledge. What may we not ex- pect from this harmony between the fciences and government! Methinks I fee canals cut, rivers once impaflible rendered navigable, bridges erect* ted, and roads improved, to facilitate the expor- tation of grain. I fee the banks of our rivers vying in fruitfulnefs with the banks of the rivef of Egypt. I behold our farmers, nobles; oiif merchants princes. But I forbear—-Imagination cannot fwell with the fubject. I beg leave to conclude, by deriving art argu- ment from our connection with the legiflature, to remind my auditors of the duty they owe to the fociety. Patriotifm and literature are here con- nected together; and a man cannot neglect the one without being deftitute of the other. Nature and our anceftors have completed their works among us; and have left us nothing to do, but to enlarge and perpetuate our own happinefs. ( 79 3 A N ACCOUNT Of THH CLIMATE of PENNSYLVANIA; AND ITS INFLUENCE UPON THE HUMAN BODY. IN order to render the obfervations upon the epidemic difeafes which compofe a part of this volume more ufeful, it will be neceflary to prefix to them a fhort account of the climate of Pennfyl- vania, and of its influence upon the human body. This account may perhaps ferve further, to lead to future difcoveries, and more ex;enfive obferva- tions, upon this fubject. The ftate of Pennfylvania lies between 39° 43' 25", and 420 north latitude, including, of courfe, 20 16' 35//, equal to 157 miles from its fouthern F4 to 80 ACCOUNT OF THE CLIMATE to its northern boundary. The weftern extremity of the ftate is in the longitude of 50 23' 4o//, and the eaftern, is that of 27' from the meridian of Philadelphia, comprehending in a due weft courfe 311 miles, exclufive of the territory lately pur- chafed by Pennfylvania from the United States, of which as yet no accurate furveys have been obtain- ed. The ftate is bounded on the fouth by part of the ftate of Delaware, by the whole ftate of Maryland, and by Virginia to her weftern extremity. The laft named ftate, the terrritory lately ceded to Con- necticut, and Lake Erie, (part of which is included in Pennfylvania) form the weftern and north-weft- ern boundaries of the ftate. ' Part of New-York and the territory lately ceded to Pennfylvania, with a part of Lake Erie, compofe the northern, and another part of New-York, with a large extent of New-Jerfey (feparated from Pennfylvania by the river Delaware) compofe the eaftern boundaries of the ftate. The lands which form thefe boun- daries (except a part of the ftates of Delaware, Maryland, and New-Jerfey) are in a ftate of na- ture. A large tract of the weftern and north-eaft- ern parts of Pennfylvania are nearly in the fame uncultivated fituation. The ftate of Pennfylvania is interfered and di- versified with numerous rivers, and mountains. To defcribc OF PENNSYLVANIA. 81 defcribe, or even to name them all, would far exceed the limits I have propofed to this account of our climate. It will be fufficient only to remark, that one of thefe rivers, viz. the Sufquehannah, begins at the northern boundary of the ftate, twelve miles from the river Delaware, and winding feve- ral hundred miles through a variegated country, enters the ftate of Maryland on the Southern line, fifty eight miles weftward of Philadelphia ; that each of thefe rivers is fupplied by numerous ftreams of various fizes; that tides flow in parts of two of them, viz. in the Delaware and Schuylkill; that the reft rife and fall alternately in wet and dry weather ; and that they defcend with great rapi- dity, over prominent beds of rocks in many place?, until they empty themfelves into the bays of Dela- ware and Chefapeak on the eaft, and into the Ohio on the weftern part of the ftate. The mountains form a confiderable part of the Mate of Pennfylvania. Many of them appear to be referved as perpetual marks of the original empire of nature in this country. The Allegany, which croffes the flate about two hundred miles from Philadelphia, in a north inclining to eaft courfe, is the moft confiderable and extenfive of thefe mountains. It is called by the Indians the back- bone of the continent. Its heighth in different places 82 ACCOUNT OF THE CLIMATE places is fuppofed to be about 1300 feet from the adjacent plains. The foil of Pennfylvania is diverfified by its vi- cinity to mountains and rivers. The vallies and bottoms confift of a black mould, which extends from a foot to four feet in depth. But in general a deep clay forms the furface of the earth. Im- menfe beds or limeftone lie beneath this clay in many parts of the ftate. This account of the foil of Pennfylvania is confined wholly to the lands on the eaft fide of the Allegany mountain. The foil on the weft fide of this mountain fhall be defcribed in another place. The city of Philadelphia lies in the latitude of 39° 57'i m longitude 750 8' from Greenwich, and fifty five miles weft from the Atlantic ocean. It is fituated about four miles due north from the conflux of the rivers Delaware and Schuylkill. The buildings which confift chiefly of brick, ex* tend nearly three miles north and fouth along the Delaware, and above half a mile due weft towards the Schuylkill, to which river the limits of the city extend ; the whole of which include a diftance of two miles from the Delaware. The land near the rivers, between the city and the conflux of the rivers, * OF PENNSYLVANIA. S^ rivers, is in general low, moift and fubject to be overflowed. The greateft part of it is meadow ground. The land to the northward and weft- ward, in the vicinity of the city, is high, and in general well cultivated. Before the year 1778 the ground between the prefent improvements of the city, and the river Schuylkill, was covered with woods. Thefe together with large tracts of wood to the northward of the city, were cut down during the winter the Britifh army had poflef- fion of Philadelphia. I fhall hereafter mention the influence which the cutting down of thefe woods, and the fubfequent cultivation of the grounds in the neighbourhood of the city, have had upon the health of its inhabitants. The mean height of the ground on which the city flands, is about forty feet above the river De- laware. One of the longeft and moft populous ftreets in the city, rifes only a few feet above the river. The air at the north is much purer than at the fouth end of the city; hence the lamps exhibit a fainter flame in its fouthern than its northern parts. The tide of the Delaware feldom riles more than fix feet. It flows four miles in an hour. The width of the river near the city is about a mile. The 84 ACCOUNT OF THE climate The city with the adjoining diftricts of South* wark and the Northern Liberties contain between 40 and 50,000 inhabitants. From the accounts which have been handed down to us by our anceftors, there is reafon to believe that the climate of Pennfylvania has under- gone a material change. Thunder and lightning are lefs frequent, and the cold of our winters and heat of our fummers are lefs uniform, than they were forty or fifty years ago. Nor is this all. The fprings are much colder, and the autumns more temperate than formerly, infomuch that cat- tle are not houfed fo foon by one month as they were in former years. Within the laft eight years, there have been fome exceptions to part of thefe obfervations. The winter of the year 1779, 80, was uniformly and uncommonly cold. The river Delaware was frozen near three months during this winter, and public roads for waggons and fleighs connected the city of Philadelphia in many places with the Jerfey fhore. The thicknefs of the ice in the river near the city, was from fixteen to nineteen inches, and the depth of the froft in the ground was from four to five feet, according to the expofure of the ground and the quality of the foil. This extraordinary depth of the froft in the earth, compared with its depth in more nor- thern OF PENNSYLVANIA. »5 them and colder countries, is occafloned by the long delay of fnow, which leaves the earth without a covering during the laft autumnal and the firft winter months. Many plants were deftroyed by the intenfenefs of the cold during this wrinter. The cars of horned cattle and the feet of hogs expofed to the air, were froft-bitten; fquirrels periflied in their holes, and patridges were often found dead in the neighbourhood of farm houfes. The mer- cury in January ftood for feveral hours at 52 be- low o, in Farcnheit's thermometer ; and during the whole of this month, (except on one day) it never rofe in the city of Philadelphia fo high as to the freezing point. The cold in the winter of the year 1783,4, was as intenfe but not fo fleady, as it Was in the winter that has been defcribed. It differed from it mate- rially in one particular, viz. there was a thaw in the month of January which opened all our rivers for a few days, The fummer which fucceeded the winter of 1779, 80, was uniformly warm. The mercury in the thermometer, during this fummer, ftood on one day (the 15th of Auguft) at 950, and fluctuated between 93° and 80? for many weeks. The thermometer, in every reference that has been, or fhall 86 ACCOUNT OF THE CLIMATE fhall be made to it, ftood in the fhade in the open air. I know it has been faid by many old people, that the winters in Pennfylvania arc lefs cold, and the fummers lefs warm, than they were forty or fifty years ago. The want of thermometrical ob- fervations before and during thofe years, renders it difficult to decide this queftion. Perhaps the diffe- rence of clothing and fenfation between youth and old age, in winter and fummer, may have laid the foundation of this opinion. I fufpect the mean temperature of the air in Pennfylvania has not altered, but that the principal change in our climate confifts in the heat and cold being lefs confined than formerly to their natural feafons. I adopt the opinion of Doctor Williamfon * re- fpecting the diminution of the cold in the fouthern,, being occafioned by the cultivation of the northern parts of Europe ; but no fuch cultivation has taken place in the countries which lie to the north-weft of Pennfylvania, nor do the partial and imperfect improvements which have been made in the north- weft parts of the ftate, appear to be fufficient to leflen the cold, even in the city of Philadelphia. I have been able to collect no facts, which difpofe * American Philofophical Tranfa&ions, vol. I. OF PENNSYLVANIA. 87 me to believe that the winters were colder before the year 1740, than they have been fince. In the memorable winter of 1739, 4°> tne Delaware Was croffed on the ice in fleighs on the 5th of March, old flyle, and did not open till the 13th of the fame month. The ground was covered during this winter with a deep fnow, and the rays of the fun were conftantly obfcured by a mill, which hung in the upper regions of the air. In the winter of 1779, 80, the river was navigable on the 4th of March ; the depth of the fnow was moderate, and the gloominefs of the cold was fometime fufpended for a few days by a cheerful fun. From thefe facts it is probable the winter of 1739, 40, was colder than the winter of 1779, 80. Having premifed thefe general remarks, I pro- ceed to obferve, that there are feldom more than twenty or thirty days in fummmer or winter in Pennfylvania in which the mercury rifes above 8o° in the former, or fails below 300 in the latter feafon. Some old people have remarked that the number of extremely cold and warm days in fuc- ceffive fummers and winters, bears an exact pro- portion to each other. This was ftrictly true in the years 1787 and 1788. The 85 ACCOUNT OF THE CLIMATE. The warmeft part of the day in fummer is at tWo, in ordinary, and at three o'clock in the after- noon in extremely warm weather. From thefe hours the heat gradually diminifhes till the enfuing morning. The cooleft part of the four and twenty hours is at the break of day. There are feldom more than three or four nights in a fummer in tvhich the heat of the air is nearly the fame as in the preceding day. After the warmeft days, the evenings are generally agreeable, and often delightful. The higher the mercury rifes in the daytime, the lower it falls the fucceeding night. The mercury at 8o° generally falls to 68°, while it defcends, when at 6o° only to $6°. This difpro- portion between the temperature of the day and night, in fummer is always greateft in the month of Auguft. The dews at this time are heavy in pro- portion to the coolnefs of the evening. They are fometimes fo confiderable as to wet the clothes; and there are inftances in which marfh-meadows, and even creeks, which have been dry during the fum- mer, have been fupplied with their ufual water3 from no other fource than the dews which have fall- en in this month, or in the firft weeks of September. There is another circumftance connected with the one juft mentioned, which contributes very much to mitigate the heat ot fummer, and that is, i it OF PENNSYLVANIA. 89 it feldom continues more than two or three days without being fucceeded with fhowers of rain, ac- companied fometimes by thunder and lightning, and afterwards by a north-weft wind, which pro- duces a coolnefs in the air that is highly invigo- rating and agreeable. The warmeft weather is generally in the month of July. But intenfely warm days are often felt in May, June, Auguft and September. In the annexed table of the weather for the year 1787, there is an exception to the firft of thefe remarks. It fhews that the mean heat of Auguft was greater by a few degrees than that of July. The tranfitions from heat to cold are often very fudden, and fometimes to very diftant degrees. After a day in which the mercury has ftood at 86° and even 900, it fometimes falls in the courfe of a fingle night to the 65th, and even to the 60th degree, infomuch that fires have been found neceffary the enfuing morning, efpecially if the change in the temperature of the air has been accompanied by rain and a fouth-eaft wind. In a fummer month in the year 1775, the mercury was obferved to fall 200 in an hour and an half. There are few fummers in which fires are not agreeable during fome parts of them. My inge- Vol. I. G nious 90 ACCOUNT OF THE CLIMATE nious friend Mr. David Rittenhoufe, whofe talent for accurate obfervation extends alike to all fub- jects, informed me, that he had never paffed a fummer, during his refidence in the country, with- out difcovering froft in every month of the year, except July. The weather is equally variable in Pennfylvania during the greateft part of the winter. The mer- cury fell from 37° to 4I0 below o, in four and twenty hours, between the fourth and fifth of February 1788. In this feafon nature feems to play at crofs purpofes. Heavy falls of fnow are often fucceeded in a few days by a general thaw, which frequently in a fliort time leaves no vcftige of the fnow. The rivers Delaware, Schuylkill and Sufquehannah have fometimes been frozen (fo as to bear horfes and carriages of all kinds) and thawed fo as to be paflable in boats, two or three times in the courfe of the fame winter. The ice is formed for the moft part in a gradual manner, and feldom till the water has been previoufly chil- led by a fall of fnow. Sometimes its production is more fudden. On the night of the 31ft of De- cember 1764, the Delaware was completely frozen over between ten o'clock at night and eight the next morning, fo as to bear the weight of a man. An unufual vapour like a fog was feen to rife from OF PENNSYLVANIA. - 91 from the water, in its paflage from a fluid to a fo- lid ftate. This account of the variablenefs of the weather in winter, does not apply to every part of Penn- fylvania. There is a line about the 41 ° of the ftate, beyond which the winters are fleady and regular, infomuch that the earth there is feldom without a covering of fnow during the three win- ter months. In this line the climate of Pennfyl- vania forms a union with the climate of the eaftern and northern flates. The time in which froft and ice begin to fhew themfelves in the neighbourhood of Philadelphia, is generally about the latter end of October or the beginning of November. But the intenfe cold feldom fets in till about the 20th cr 25th of De- cember ; hence the common faying, " as the day lengthens the cold ftrengthens." The coldeft weather is commonly in January. The navigation of the river Delaware, after being frozen, is fel- dom practicable for large veflels, before the firft week in March. As in fummer there are often days in which fires are agreeable, fo there are fometimes days in winter in which they are difagreeable. Vegetation G 2 has 92 ACCOUNT OF THE CLIMATE has been obferved tn all the winter months. Gar- lic was tafted inbutter in January 1781. The leaves of the willow, the blofloms of the peach tree, and the flowers of the dandelion and the crocus, were all feen in February 1779 ; and I well recollect, about thirty-two years ago, to have feen an apple- orchard in full bloom, and fmall apples on many of the trees, in the month of December. A cold day in winter is often fucceeded by a moderate evening. The coldeft part of the four and twenty hours is generally at the break of day. In the moft intenfe cold which has been re- corded in Philadelphia, within the laft twenty years, the mercury ftood at 50 below o. But it appears from the accounts publifhed by Meflieurs Mafon and Dixon, in the 58th volume of the Tranfactions of the Royal Society of London, that the'mercury ftood at 220 below o on the 2d of January 1767, at Brandy wine, about thirty miles to the weftward of Philadelphia. They inform us, that on the firft of the fame month the mer- cury ftood at 200, and on the day before at 70 below o. 1 have to lament that I am not able to procure any record of the temperature of the air in the fame year in Philadelphia. From the va- riety in the height and quality of the foil, and from 1 OF PENNSYLVANIA. % 93 ' from the difference in the currents of winds and the quantity of rain and fnow which fall in differ- ent parts of the ftate, it is very probable this ex- ceffive cold may not have extended thirty miles from the place where it was firft perceived. The greateft degree of heat upon record in Philadelphia, is 950. The ftandard temperature of the air in the city of Philadelphia is 52^°, which is the temperature of our deepeft wells, as alfo the mean heat of our common fpring water. The fpring in Pennfylvania is generally lefs pleafant than in many other countries. In March the weather is ftormy, variable and cold. In April, and fometimes in the beginning of May, it is moift, and accompanied by a degree of cold which has been called rawnefs, and which from its difagreeable effects upon the temper has been called thefirocco of this country. From the vari- able nature of the weather in the fpring, vegeta- tion advances very differently in different years. The colder the fpring, the more favourable it proves to the fruits of the earth. The hopes of the farmer from his fruit-trees in a warm fpring ?re often h! ifted by a froft in April and May. A G 3 fall 94 (f ACCOUNT OF THE CLIMATE fall of fnow is remembered with regret by many of them on the night between the third and fourth of May in the year 1774. The colder the win- -.;-J ter, the greater delay we obferve in the return of the enfuing fpring. Sometimes the weather during the fpring months is cloudy and damp, attended occafionally with a gentle fall of rain refembling the fpray from a cataract cf water. A day of this fpecies of wea- ther is called, from its refemblance to a damp day in Great-Britain, " an Englifh day." This damp weather feldom continues more than three or four days. The month of May 1786, will long ■' be remembered, for having furniflied a very un- common inftance of the abfence of the fun for four- teen days, and of conftant damp or rainy weather. The month of June is the only month in the year which refcmbles a fpring month in the fouth- ern countries of Europe. The weather is then generally temperate, the fky is ferene, and the ver- dure of the country is univerfal and delightful. The autumn is the moft agreeable feafon in the year in Pennfylvania. The cool evenings, and mornings, which generally begin about the firfl week in September, are fuccee;Ld by a moderate tempera- OF PENNSYLVANIA. g^ 95 temperature of the air during the day. ^!is fpe- cies of weather continues with an increafe of cold fcarcely perceptible, till the middle of October, when the autumn is clofed by rain, which fome- times falls in fuch quantities as to produce de- finitive frefhes in the rivers and creeks, and fometimes defcends in gentle fhowers, which con- tinue with occafional interruptions by a few fair days, for two or three weeks. Thefe rains are the harbingers of the winter; and the Indians have long ago taught the inhabitants of Pennfyl- vania, that the degrees of cold during the winter, are in proportion to the quantity of rain which falls during the autumn*. From this account of the temperature of the air in Pennfylvania, it is evident that there are feldom * I cannot help agreeing with Mr Kirwan, in one of his remarks upon the fcience of meteorology in the preface to his eftimate of the temperature of different latitudes. " This " fcience (fays he) if brought to perfection would enable " us at lead to forefee thofe changes in the weather which we " could not prevent. Great as is the diftance between fuch " knowledge, and our own prefent attainments, we have no " reafon to think it above the level of the powers of the " human mind. The motions of the planets muft have ap- " peared as perplexed and intricate to thofe who firft con- " templated them j yet by perfevering induflry, they are now " known to the utrnoft precifion. The prefent is (as the " great Leibnitz e.xprefTes it) in every cafe pregnane with G 4 " the $6 ^ ACCOUNT OF THE CLIMATE more than four months in which the weather is agreeable without a fire. In winter the winds generally come from the north-weft mfair, and from the north-eaft in wet weather. The north-weft winds are uncommonly dry as well as cold. It is in confequence of the violent action of thefe winds that trees have uni- formly a thicker and more compact bark on their northern than on their fouthern expofures. Even brick houfes are affected by the force and drynefs of thefe north-weft winds: hence it is much more difficult to demolifh the northern than the fouth- ern walls of an old brick houfe. This fact was communicated to me by an eminent bricklayer in the city of Philadelphia. The winds in fair weather in the fpring, and in warm weather in the fummer, blow from the fouth-weft and from weft-north-weft. The raw air before mentioned comes from the north-eaft. The fouth-weft winds likewife ufually bring with them thofe fhowers of rain in the fpring and fum- " the future, and the connexion muft be found1 by long and " attentive observation/' The influence' which the perfe&ion of this fcience muft have upon health, agriculture, navigation and commerce, is too obvious to be mentioned. mcr OF PENNSYLVANIA. ^^^' 97 mer which refrefh the earth. The^^Breover moderate the heat of the weather, provided they are fueceeded by a north-weft wincu * Now and then fhowers of rain come from the weft-north- weft. There is a common fact connected with the ac- count of the ufual winds in Pennfylvania, which it may not be improper to mention in this place. While the clouds are feen flying from the fouth- weft, the feud, as it is called, or a light vapour, is feen at the fame time flying below the clouds from the north-eaft. The moifture of the air is much greater than formerly, occafloned probably by the exhalations which in former years fell in the form of fnow, now defcending in the form of rain. The depth of the fnow is fometimes between two and three feet, but in general feldom exceeds between fix and nine inches. Hail frequently defcends with fnow in winter. Once in four or five years large and heavy fhowers of hail fall in the fpring and fummer. They generally run in narrow veins (as they are called) of thirty or forty miles in length, and two or three miles in breadth. The heavieft fliower of hail that is 98 —ACCOUNT OF THE CLIMATE is rcmewWered m Philadelphia, did not extend in breadth more than half a mile north and fouth. Some of'the flones weighed half an ounce. The windows of many houfe's were broken by them. This fliower fell in May 1783. From hidden changes in the air, rain and fnow often fall together, forming what is commonly called fleet. In the uncultivated parts of the ftate, the fnow, fometimes lies on the ground till the firft week in April. The backwardnefs of the fpring has been afcribed to the paflage of the air over the undif- folved beds of fnow and ice which ufually remain, after the winter months are paft, on the north-weft grounds and waters of the ftate, and of the adja- cent country. The diffolution of the ice and fnow in the fpring is fometimes fo fudden as to fwell the creeks and rivers in every part of the ftate to fuch a degree, as not only to lay wafle the hopes of the huf- bandman from the produce of his lands, but in fome inftances to fweep his barns, flables, and even his dwelling houfe into their currents*. The * The following account of the thaw of the river Sufque- hannih, in the fpring of 1784, was publiihed by the author in the Columbian Magazine for November 1786. It may ferve to OF PENNSYLVANIA. ^ 99 wind during a general 'thaw, comes Trom the fouth-weft or fouth-eaft. to illuftrate a fatt related formerly in the Hiftory of the win- ters in Pennfylvania, as well as to exhibit an extraordinary inftance of the deftruftive effects of a fudden thaw. "The winter of 1783-4, was uncommonly cold, info- much that the mercury in Farenheit's thermometer ftood fe- veral times at 5 degrees below o. The fnows were frequent; and, in many places, from two to three feet deep, during the greateft part of the winter. All the rivers in Pennfylvania were frozen, fo as to bear waggons and fleds with immenfe weights. In the month of January a thaw came on fuddenly, which opened our rivers fo as to fet the ice a-driving, to ufe the phrafe of the country. In the ceurfe of ©ne night, during the thaw, the wind fhifted fuddenly to the north-weft, and the weather became intenfely cold. The ice which had floated the day before, was fuddenly obftrucled ; and in the river Sufquehannah, the obftru&ions were formed in thofe places where the water was moft (hallow, or where it had been accuftomed to fall. This river is feveral hundred miles in length, and from half a mile to a mile and an half in breadth, and winds through a hilly, and in many places a fertile and highly cultivated country. It has as yet a moft difficult com- munication with our bays and the fea, occafloned by the num. ber and height of the falls which occur near the mouth of the river. The ice in many places, efpecially where there were falls, formed a kind of dam, of a moft ftupendous height. About the middle of March our weather moderated, and a thaw became general. The effects of it were remarkable in all our rivers; but in none fo much as in the river I have mentioned. I fliall therefore endeavour in a few words to de- fcribe them. Unfortunately the dams of ice did not give way all too ' ACCOUNT OF THE CLIMATE The air; when dry in Pennfylvania, has a pecu- liar elafticity, which renders the heat and cold lefs infupportable than the fame degrees of both are in moifter countries. It is in thofe cafes only when fummer fhowers are not fucceeded by north- weft winds, that the heat of the air becomes op- preflive and diftrefling, from being combined with moifture. all at once, nor thofe which lay neareft to the mouth of the river, firft. While the upper dams were fet a-float by the warm weather, the lower one^, which were the largeft, and in which, of courfe, the ice was moft impacted, remained fixed. In confequence of this, the river rofe in a few hours, in many places, above 30 feet; rolling upon its furface large lumps of ice from 10 to 40 cubic feet in fize. The effefrs of this fudden inundation were terrible. Whole farms were laid under water. Barns—ftables—horTes—cattle—fences—mills of every kind, and in one inftance, a large ftone houfe, 40 by 30 feet, were carried down the ftream. Large trees were torn up by the roots—feveral fmall iflands covered with woods, were fwept away, and not a veftigeof them was left behind. On the barns which preferved their fhape, in fome inftances, for many miles were to be feen living fowls; and, in one dwelling, a candle was feen to burn for fome time, after it was fwept from its foundation. Where the fhore was level, the lumps of ice, and the ruins of houfes and farms, were thrown a quarter of a mile from the ordinary height of the river. In fome inftances, farms were ruined by the mould being fwept from them by the cakes of ice, or by depofitions of fand; while others were enriched by large depof.il. ns of mud. The damage, upon the whole, done to the ftate of Pennfylvania OF PENNSYLVANIA. IOI From tradition, as well as living obfervation, it is evident, that the waters in many of the creeks in Pennfylvania have diminifhed confiderably with- in the laft fifty years. Hence many mills, erected upon large and deep ftreams of water, now fland idle in dry weather; and many creeks, once navi- gable in large boats, are now impaflable even in canoes. This diminution of the waters has been afcribed to the application of a part of them to the purpofe of making meadows. The mean elevation of the barometer in Phila- delphia, is about 30 inches. The variations in the barometer are very inconfiderable in the great- eft changes of the weather, which occur in the city of Philadelphia. During the violent and de- finitive florm which blew from the fouth-weft on the 1 ith of November 1788, it fuddenly fell from 30 to 29-^* Mr. Rittenhoufe informs me, that long and faithful obfervations have fatisfied him, Pennfylvania by this frefh, was very great. In moft places it happened in the day time, or the confequences muft have been fatal to n»any thoufands. " I know of but one ufe that can be derived from record- ing the hiftory of thir; inundation. In cafe of fimilar ob- ftructions of rivers, from caufes fuch as have been defcribed, the terrible effects of their being fet in motion by means of a general thaw may in part be obviated, by removing fuch things out of the courfe of the water and ice as are within our 102 ACCOUNT OF THE CLIMATE f that the alterations in the height of the mercury in the barometer do not precede but alwdysfuccecd changes in the weather. It falls with the fouth and fouth-weft, and rifes with the north and north- weft winds. The quantity of water which falls in rain and fnow, one year with another, amounts to from 24 to 36 inches. But to complete the account of ' variable qualities in the climate, it will be necef- fary to add, that our fummers and autumns are fometimes marked by a deficiency, and fometimes by an exceffive quantity of rain. The fummer and autumn of 1782 were uncommonly dry. Near two months elapfed without a fingle fhower of rain. There were only two fhowers in the whole months of September and October. In confe- quence of this dry weather, there was no fecond crop of hay. The Indian corn failed of its in- creafe in many places, and was cut down for food for cattle. Trees newly planted, died. The paf- ture fields not only loft their verdure, but threw up fmall clouds of duft when agitated by the feet of men, or beafts. Cattle in fome inftances were driven many miles to be watered, every morning our power; particularly cattl?, hay, grain, fences, and farm- ing utenflls of all kinds." and OF PENNSYLVANIA. *°3 and evening*. The earth became fo inflammable in fome places, as to burn above a foot below its furface. A complete confumption of the turf by an accidental fire kindled in the adjoining ftate of ' New-Jerfey, fpread terror and diftrefs through a large tract of country. Springs of water and large creeks were dried up in many parts of the ftate. Rocks appeared in the river Schuylkill which had never been obferved before, by the oldeft perfons then alive. On one of them were cut the figures 1701. The atmofphere, during part of this dry weather, was often filled, efpeci- ally in the mornings, with a thin miftf, which while it deceived with the expectation of rain, ferved the valuable purpofe of abating the heat of the fun. I am forry that I am not able to fur- nifh the mean heat of each of the fummer months. My notes of the weather enable me to add no- thing further upon this fubject, than that the fummer was " uncommonly cool.'' * It was remaiked during this dry weather, that the fheep were uncommonly fat, and their flefli well tafted, while all the other domeftic animals languiflied from the want of grafs and-water. f A fimilar mift was obferved in France by Dr Franklin, in the fummer of 17 8 2. The winter which fucceeded it was uncommonly cold in France, as well as in Pennfylvania. 2 The 104 ACCOUNT OF THE CLIMATE The fummer of the year 1788 afforded a re- markable inftance of excefs in the quantity of rain which fometimes falls in Pennfylvania. Thirteen days are marked with rain in July in the records of the weather kept at Spring-Mill. There fell on the 18th and 19th of Auguft feven inches of rain in the city of Philadelphia. The wheat fuf- fered greatly by the conftant rains of July in the eaftern and middle parts of the ftate. So unpro- ductive a harveft in grain, from wet weather, had not been known, it is faid, in the courfe of the kft 70 years. The heat of the air during thefe fum- mer months was very moderate. Its mean tem- perature at Spring-Mill was 67,8 in June, 74,7 in July, and only 70,6 in Auguft. It is fome confolation to a citizen of Pennfyl- vania, in recording facts which feem to militate againft our climate, to reflect that the difference of the weather in different parts of the ftate at the fame feafon, is happily accommodated to pro- mote an increafe of the fame objects of agricul- ture; and hence a deficiency of crops has never been known in any one year throughout the whole ftate. The aurora borealis and meteors are feen occa- fionally in Pennfylvania. In the prefent imper- fect flate of our knowledge of their influence upon the human body, it will be foreign to the defign OF PENNSYLVANIA. Ioj defign of this hiftory of our climate to defcribe them. Storms and hurricanes are not unknown in Pennfylvania. They occur once in four or five years, but they are moft frequent and deftructive in the autumn. They are generally accompanied by rain. Trees are torn up by the roots, and the rivers and creeks are fometimes fwelled fo fud- denly as to do confiderable damage to the adjoin- ing farms. The wind, during thefe ftorms, gene- rally blows from the fouth-eaft and fouth-weft^ In the ftorms which occurred in September 1769* and in the fame month of the year 1785, the Wind veered round contrary to its ufual courfe, and blew from the north. After what has been faid, the character of the climate of Pennfylvania may be fummed up in a few words. There are no two fucceffive years alike. Even the fame fucceffive feafons and months differ from each other every year. Per- haps there is but one fleady trait in the character of our climate, and that is, it is uniformly variable. To furnifh the reader with a fuccinct view of the weather in Pennfylvania, that includes all the articles that have been mentioned, I fhall here * Vol. I. H fubjoin lo6 ACCOUNT OP THE CLIMATI fubjoin a table containing the refult of meteoro- logical obfervations made near the river Schuyl- kill, for one year, in the neighbourhood of Phila- delphia, by an ingenious French gentleman*, who divides his tirrie between rural employments and ufeful philofophical purfuits. This table is ex- tracted from the Columbian magazine for February 17 8 &. The height of Spriftg-Mill above the city of Philadelphia, is fuppofed to be about jo feet * Mr. Legeaux. VI £ 1 EO KOLUtflCAL UiJMiKV ATlONb, made ;u si ring-Mii.t . , < i>ts m\W of fh ilddeii'tua. 1-euilt ot the lear 1 ii i^\ 2 1 HERMOMETER. B A ROME- 1 ►« \r--j r\ i S.-^ WATER ■" ' ______________________________■*■ TER. 1 - * 0 0 i 0 0 c o 2: H of Farenheit, de Reaumur^ mean height. 3 < 5 t "1^ 3'S-3, ^ 3* 0 n "3 ot and RAIH SNOW. WEATHER. B mean degree degres moyens 0 n (T m n d. TV 0 D- To" 0 in. pts. TV 0 •^ 4 in. pts. -rff , - January 35 t .* 4 29 9 9 Vatiable ftill i 7 * > IO 10 Fair, ftill, cold, and fnow. February 33 8 8 29 9 9 NE 3 3 2 3 7 3 Fair, overcaft. March 45 1 5 3 29 9 7 W 6 3 2 4 2 Fair, windy." April 54 3 9 9 29 9 6 Still, sw 3 2 1 X 1 2 *3 Fair, and very dry. Jime J«iy 6t 2 *3 29 9 2 Still, wsw I 14 6 2 4 11 4 Foggy, cold, and wet. 70 7 17 » 29 8 2 WNW 9 1 1 10 4 Very fair and growing weather. 72 2 r7 9 29 9 10 WWSWvari. 1 5 2 } 1 11 Fair, and overcaft. Auguft Septembei 74 5 •64 7 18 9 U 5 29 10 6 29 10 4 W WNW 11 * 4 1 1 I 5 2 2 7 3 Very fair, and cloudy. 8 Fair weather. Oftober Novembei 5i 1 45 1 « S 5 * 29 11 9 29 11 1 WNW variab. Still, variable. , I I 4 1 2 7 6 10 Foggy, fair, and dry weather. 10 Very fair. |Verr fjir, and vervtfrv. December 34 9 29 7 7 WNW 1 I 9 10 Feb greateft D. of cold. 10 Feb. D. du plus gr. froid. 8 Mar. greateft elevation. H 5 12 0 30 10 TEMPERATURE 3 July» greateft 3 July plus G. 2 Febr. leaft ^ D. of heat. D. de chaud. j elevation. OF RESl) 96 1 28 5 29 WNW 4 73 r7 12 9 32 8 M- THE YEAR 1787. Very fair, dry, abundant in Variation. Variation. Variation. 91 1 40 5 1 10 every thing, andiieaithy. Temperature. Temnpratiirp Mean elevat. I08 ACCOUNT OF THE CLIMAT2 It is worthy of notice, how near the mean heat Of the year, and of the month of April, in two fucceffive years, are to each other in the fame place. The mean heat of April 1787 was 54°3, that of April 1788 was S2°2- By the table of the mean heat of each month in the year, it ap. pears that the mean heat of 1787 was 53°5 at Spring-Mill. The following accounts of the climates of Pekin and Madrid, which lie within a few minutes of the fame latitude as Philadelphia, may ferve to fhew how much climates are alterecl by local and relative circumftances. The account of the tem- perature of the air at Pekin will ferve further to fhew, that with all the advantages of the higheft degrees of cultivation which have taken place in China, the winters are colder, and the fummers warmer there than in Pennfylvania, principally from a caufe which will probably operate upon the winters of Pennfylvania for many centuries to come, viz. the vicinity of an uncultivated north- well country. " Pekin, lat. 39°54', long, ii6°2^' W. " By five years obfervations its annual mean temperature was found to be 55°5'. 4 January ■ Of PENNSYLVANIA. I09 January -February -March - - 2Q°,75 32 - 48 July - -Auguft September - 84* 63 April -May June - 59 - 72 83,75 Oftober - -November December 5* 41 27 " The temperature of the Atlantic under this parallel is 62, but the ftandard of this part of the globe is the North Pacific, which is here 4 or 5 degrees colder than the Atlantic. The Yellow Sea is the neareft to Pekin, being about 200 miles diftant from it; but it is itfelf cooled by the moun- tainous country of Corea, which interpofes be- tween it and the ocean, for a confiderable part of its extent. Befides, all the northern parts of China (in which Pekin lies) muft be cooled by the vicinity of the mountains of Chinefe Tartary, among which the cold is faid to be exceffive. " The greateft cold ufually experienced during this period, was 50, the greateft heat, 98° : on the 25th of July 1773, the heat arofe to 1080 and 1 io°; a N. E. or N. WJwind produces the greateft cold, a S. or S. W. or S. E. the greateft Jieat*." * " 6 Mem. Scav. Etrang. p. 528." H3 " Madrid^ HO ACCOUNT OF THE CLIMATE " Madrid, lat. 400 25' long. 3? 20' E. " The ufual heat in fummer is [faid to be from 75 to 850 ; even at night it feldom falls below 700 ; the mean height of the barometer is 27,9$, It feems to be about J900 feet above the level of tbefea*." The above accounts are extracted from Mr, jCirwan's ufeful and elaborate eftimate of the tern* perature of different latitudes. The hiftory which has been given of the cfi- .mate of Pennfylvania, is confined chiefly to the country on the eaft fide of the Allegany moun- tain. On the weft fide of this mountain, the cli- mate differs materially from that of the foutfo eaftern parts of the ftate in the temperature of the air, in the effe&s of the winds upon the weather, and in the quantity of rain and fnow, which falls every year. The winter feldom breaks up on the mountains before the 25th of March. A fall of fnow was once perceived upon it, which meafured an inch and an half on the nth day of June, The trees which grow upon it are fmall, and Indian corn is with * " Mem. Par. J777, p. 146." difficulty OF PENNSYLVANIA. in difficulty brought to maturity even at the foot of the eaft fide of it. The fouth-weft winds on the weft fide of the mountain are accompanied by cold and rain. The foil is rich, confifting of near a foot in many places^ of black mould. The roads in this country are muddy in win- ter, but feldom dufty in fummer. The arrange- ment of ftrata of the earth on the weft fide, differs materially from their arrangement on the eaft fide the mountain. "The country, (fays " Mr. Rittenhoufe in a letter to a friend in Phi- " ladelphia*) when viewed from the weftern " ridge of the Allegany appears to be one vaft, " extended plain. All the various ftrata of " ftone fecm to lie undifturbed in the fituation " in which they were firft formed, and the lay- " ers of ftone, fand, clay, and coal, are nearly ** horizontal." The temperature of the air on the weft is fel- dom fo hot, or fo cold, as on the eaft fide of the mountain. By comparing the ftate of a thermo- meter examined by Dr. Bedford at Pittfburg, 284 miles from Philadelphia, it appears that the weather was not fo cold by twelve degrees in * Columbian Magazine for October 1786. H4 that tit ACCOUNT OF THE CLIMATE that town, as it was in Philadelphia, on the 5th of February 1788. To fhew the difference between the weather at Spring-Mill and m Pittfburg, I fiiall here fob- join an account of it, in both places, the firft taken by Mr. Legeaux, and the other by Doftor Bedford, 3 ftJETEOROLOGICAL OBSERVATIONS, nude at. SPRING-MILL, 13 Miles NNW of Philadelphia. Month of -ipnl, i /lX. p THERMOMETER. 1 r-D AYS-, WATER. ■ a A BAROMETER. PC 0 a > e 2.2. r ™ '"■ " -i- .*, ►*, tr of de 3 5 s 1 1 r. S.' ^ * 2. of RAIN n g Farenheity Reaumur, mean height — > a' a. and snow, WEATHER. o mean degree degres moyens a ►1 ■1 r^ I D. T'r O D. -r?r O in. pts. T*0- p .in. pts. ^ 58 I it 6 39 10 5 W Overcaft, fair. 3 46 9 6 9 30 I Calm. Overcaft and wiudj. 3 40 3 3 7 30 3 Changeable. I 1 15 Overcaft, rainy. 4 5i 3 8 6 29 11 7 s\v Overcaft. 5 51 I 8 S 30, ? E Overcaft, fair, 6 55 7 , 10 5 29 11 7 Calm. I 1 3 Overcaft, rainy. 7 5i 3 8 6 30 a NE 1 * 7 Overcaft, rainy. 8 4* I 4 5 29 11 E I 1 4 Raiiy 9 63 J 14 29 8 W Overcaft, windy. IO 46 7 6 5 29 10 W Fair. n 53 8 9 7 3° * W Very fair. 12 44 5 J 5 29 10 Calm. I I II Overcaft, rainy. 13 60 5 ia 7 «9 10 3 SW Very fair. 14 50 a 8 1 39 9 E I I 14 Fair, overcaft, rainy, 15 58 1 11 6 39 9 7 SW I 1 1 * 13 loggy, rainy. M ETEOROLOGII ^ALOBSERVA TIONS, made at PITTSBURG, 384 Miles Weft of Philadelphia. Month of April, 1788. i 46 SW I Oloudy. a 4» X NEbN i Jlear. J 43 SE I l 1 Cloudy, 4 64 Calm. j Clear. 5 80 SE b S I I ! Cloudy. 3 5* SW I Cloudy. 7 48 NEb N Cloudy. 8 66 SEbS I I Cloudy. 9 56 , NW b N Cloudy. IO 60 SW Cloudy, with wind. n 6a Calm . Clear. 12 67 SW Cloudy, with wind. 13 6* Calm. Clear. * . . • ,, "-.l * ' 114 ACCOUNT OF THE CLIMATE From a review of all the facts which havebeea mentioned, it appears that the climate of Pennfyl- vania is a compound of moft of the climates in the world. Here we have the moifture of Britain in the fpring? the heat of Africa in fummer, the temperature of Italy in June, the fky of Egypt in the autumn, the cold and fnows of Norway and the ice of Holland in the winter, the tempefts (in a certain degree) of the Weft-Indies in every fea- fon, and the variable winds and weather of Great- Britain in every month of the year. From this hiftory of theiclimate of Pennfylva- nia, it is eafy to afcertain what degrees of health, and what difeafes prevail in the ftate. As we have the climates, fo we have the health, anu the acute difeafes, of all the countries that have been mentioned. Without attempting to enumerate the difeafes, I fliall only add a few words upon the time and manner in which they are produced. I. It appears from the teftimonies of many aged perfons, that pleurifies and inflammatory dif- orders of all kinds, are lefs frequent now than they were forty or fifty- years ago. II. It is a well known fact, that intermitting and bilious fevers have increafed in Pennfylvania in proportion OF ?S*fN«YLVANLA. 115 proportion as the country has been cleared ef its wood, in many parts of the ftate. III. It is equally certain that thefe fevers have leflened, or difappeared, in proportion as the country has been cultivated. IV. Heavy rains and frefhes in the fpring feldom produce fevers, unlefs they are fucceeded by un- feafonably warm weather. V. Heavy rains or froft, in the autumn, alike check the progrefs of bilious fevers in Pennfyl- vania. VI. The fame ftate of the atmofphere, whether cold or warm, moift or dry, continued for a long time without any material changes, i* always. healthy. Acute and inflammatory fevers were in vain looked for in the cola* winter of 1779-80, The dry fummer of 1782, and the wet fummer of 1788, were likewife uncommonly healthy in the city of Philadelphia. Thefe facts extend only to thofe difeafes which depend upon the fenfible qua- lities of the air. Difeafes from miafmata and con- tagion, are lefs influenced by the uniformity of the weather. The autumn of 1780 was very fickly in Philadelphia, from the peculiar lituation of the grounds Il6 ACCOUNT OF THE CLIMATE grounds in the neighbourhood of the city, while the country was uncommonly healthy. The dry fummer and autumn of 1782 were uncommonly fickly in the country, from the cxtenfive fources of morbid exhalations which were left by the di- minution of the waters in the creeks and rivers. The city of Philadelphia owed its peculiar healthi- nefs during thefe two feafons, to its being nearly forrounded by tide water. VII. Difeafes are often generated in one feafon and produced in another. Hence we frequently obferve fevers of different kinds to follow every fpecies of the weather that was mentioned in the laft obfervation, VIII. The fevers which accompany, or follow a warm fummer, are bilious and remitting. In pro- portion as the cool weather advances, they put on the type of Doctor CuUen's typhus mitior. After a very cold winter, I have twice feen pleurifies in the fpring, accompanied by the fymptoms of the bilious fever. In one of thofe epidemics, the pulfe, on the fifth day, in feveral cafes, became irregular, and flopped after every third or fourth flroke. This complication of typhus with pneumonia, is not peculiar to Pennfylvania. I have been in- formed that fevers of even a putrid kind frequently fucceed OF PENNSYLVANIA. 117 Succeed long and cold winters in Ruffra and Swe- den. They have been afcribed, by a Ruffian phy- fician, to extreme cold producing the fame fedativc effects as extreme heat, upon the human body. IX. The exceffive heat in Pennfylvania has fome- times proved fatal to perfons who have been much expofed to it. Its morbid effects difcover them- felves by a difficulty of breathing, a general lan- gour, and in fome inftances, by a numbnefs and an immobility of the extremities. The exceffive cold in Pennfylvania has more frequently proved fatal, but it has been chiefly to thofe perfons who have fought a defence from it, by large draughts of fpirituous liquors. Its operation in bringing on fleepinefs previous to death, is.well known. On the 5th of February 1782, many people were af- fected by the cold. It produced a violent pain in the head; and in one inftance, a ficknefs at the ftomach, and a vomiting appeared to be the con- fequence of it. I have frequently obferved that a greater number of old people die, during the con- tinuance of extreme cold, and warm weather, than in the fame number oi days, in moderate weather. X. May and June are ufually the healthieft months in the year. XI. The 1*8 ACCOUNT Of THE CLIMATE XI. The influence of th« winds upon health, depends very much upon the nature of the coun* try over which they pafs. Winds which pafs over mill-dams and marines in Auguft and September, generally carry with them the feeds of fevers. XII. The country in the neighbourhood of Phi- ladelphia is much more fickly than the central part* of the city, after the 20th of Auguft. XIII. The night-air is always unwholefome from the 20th of Auguft, efpecially during the paffivc ftate of the fyftem in fleep. The frequent and fud- den changes of the air from heat to cold, (exclu- five of its fenfible qualities) render it unfafe at any time to fleep with open windows. XIV. Philadelphia became unufually fickly after the year 1778, during the late war, in confe- rence of the meadows being overflowed to the fouthward of the city, and of the cutting down of the trees by the Britifh army, which formerly fhel- tered the city from the exhalations of the grounds to the north and north-weft. From the repairs of the banks of the meadows, which exclude tides and freflies; from the cultivation of the grounds to the weftward of the city, which were formerly covered with filth, or with ftagnating waters; and laftly, from OF PENNSYLVANIA. - 119 from the more regular cleaning of the ftreets, and the enclofure of a large and offenfive dock which croffed two of the principal ftreets near the centre of the city, Philadelphia, from having been for- merly the moft fickly, has become one of the heal- ihieft cities in the United States. XV. Valetudinarians always enjoy the moft health in Pennfylvania in the fummer and winter months. The fpring, in a particular manner, is very unfavourable to them. I fhall conclude the account of the influence of the climate of Pennfylvania upon the human body, with the following obfervations. 1. The fenfations of heat and cold are influenced fo much by outward circumftances, that we often miftake the degrees of them, by neglecting to ufe fuch conveniences as are calculated to obviate the effects of their excefs. A native of Jamaica often complains lefs of the heat, and a native of Canada ©f the cold, in their refpective countries, than they do under certain circumftances in Pennfylva- nia. Even a Pennfylvanian frequently complains lefs of the heat in Jamaica, and of the cold in Ca- nada, than in his native ftate. The reafon of this 1 h 120 ACCOUNT OF THE CLIMATE is plain. In countries where heat and cold arc intenfe and regular, the inhabitants guard them* felves by accommodating their houfes and dreffes to each of them. The inftability and fhort dura- tion of exceffive heat and cold in Pennfylvania, have unfortunately led its inhabitants, in many in- ftances, to neglect adopting cuftoms, which are ufed in hot and cold countries to guard againft them. Where houfes are built with a fouthern, . \ or fouth-weftern front expofure, and where other accommodations to the climate are obferved in their conftruction, the difagreeable exceffes of heat and cold are rendered much lefs perceptible in Pennfylvania. Perhaps the application of the principles of Philofophy and tafte to the conftruc- tion of our houfes within the laft thirty or forty years, may be another reafon why fome old people have fuppofed that the degrees of heat and cold are lefs in Pennfylvania than they were in former years. i. The number, height, and vegetable produc- tions of the mountains in Pennfylvania, afford a favourable prognofis of the future healthinefs of the ftate. Exclufive of the beneficial effects of thefe mountains in producing falutary winds, and gentle rains, they will ferve as a perpetual and in- exhauftibk OF PENNSYLVANIA. 121 Cxhauftiblc ftore-houfe of that pure fpecies of air, which has of late been proved to conftitute the vital part of common air. 3. The variable nature of the climate of Penn- fylvania does not render it neceffarily unhealthy. Doctor Huxham has taught us, that the healthieft feafons in Great-Britain have often been accompa- nied by the moft variable weather. His words upon this fubject convey a reafon for the fact. " When the conftitutions of the year are frequent- " ly changing, fo that by the contrafl a fort of " equilibrium is kept up, and health with it; and " that efpecialiy if perfons are careful to guard si themfelves well againft thefe fudden changes*.'* Perhaps no climate or country is unhealthy, where men acquire from experience, or tradition, the arts of accommodating themfelves to it. The hif- tory of all the nations in the world, whether favage, barbarous, or civilized, previoufiy to a mixture of their manners by an intercourfe with ftrangers, feems to favour this opinion. The climate of Chi- na appears, in many particulars, to refemble that of Pennfylvania. The Chinefe wear loofe gar- ments of different lengths, and increafe or diminifh the number of them, according to the frequent * Obfervations on the Air and Epidemic Difeafes, vol. I. p. 5. Vol. I. I and 122 ACCOUNT OF THE CLIMATE and fudden changes of their weather; hence they have very few acute difeafes amongft them. Thofe inhabitants of Pennfylvania who have acquired the arts of conforming to the changes and extremes of our weather in drefs, diet, and manners, efcape moft of thofe acute difeafes which are occafloned by the fenfible qualities of the air; and faithful in- quiries and obfervations have proved, that they attain to as great ages as the fame number of peo- ple in any part of the world. AN [ I23 3 A N ACCOUNT OF THE Bilious Remitting Fever, AS IT APPEARED IN PHILADELPAIA IN THE SUM. MBR AND AUTUMN OF THE YEAR 1780. BEFORE I proceed to defcribe this fever, it will be neceffary to give a fhort account of the weather, and of the difeafes which preceded it. The fpring of 1780 was dry and cool. A ca- tarrh appeared among children between one year and feven years of age. It was accompanied by a defluxion from the eyes and nofe, and by a cough and dyfpncea, refembling, in fome inftances, the cynanche trachealis, and in others a peripneumony. In fome cafes it was complicated with the fymp- I 2 toms 124 ACCOUNT OF THE toms of a bilious remitting, and intermitting fever. The exacerbations of this fever were always at- tended by dyfpncca and cough. A few patients expectorated blood. Some had fwellings behind * their ears, and others were affected with fmall ul- cers m the threat. I met with only one cafe of this fever in which the pulfe indicated bleeding. The reft yielded in a few days to emetics, blifiers, and the bark, aflifted by the ufual more fimple •■ remedies in fuch diforders. An intermittent prevailed among adults in the month of May. July and Auguft: were uncommonly warm. The mercury ftood on the 6th of Auguft at 944.°, on the 15th of the fame month at 950, and for feveral days afterwards at 900. Many labouring people perifhed during this month by the heat, and by drinking, not only cold water, but cold liquors of feveral kinds, while they were under the violent impreffions of the heat. 'Ihe vomiting and purging prevailed univerfally, during thefe two warm months, among the chil- dren, and vi h uncommon degrees of mortality. "Children from one year to eight and nine years old were likewife very generally affected by blotches and BILIOUS REMITTING FEVEa. 125 and little boils, efpecially in their faces. An erup- tion en the fkin, called by the common people the prickly heat, was very common at this time among perfons of all ages. The winds during thefe months blew chiefly from the fouth, and fouth- weft. Of courfe they paffed over the land which lies between the city, and the conflux of the ri- vers Delaware and Schuylkill, the peculiar fitua- tion of which, at that time, has been already de- fcribed. The dock, and the ftreets of Philadelphia, fup- plied the winds at this feafon, likewife, with a por- . tion of their unwholefome exhalations*. The remitting fever made its firft appearance in July and Auguft, but its fymptoms were fo mild, and its extent fo confined, that it excited no ap- prehenfions of its fubfequent more general preva- lence throughout the city. On the 19th of Auguft the air became fuddenly very cool. Many hundred people in the city com- plained, the next day, of different degrees of in- difpofition, from a fenfe of laffitude, to a fever of * The mufchetoes wer-j uncommonly numerous during the autumn. A certain fign (fays Dr. Lind) of an unwhole- fome atmofpliere. I 3 the 126 ACCOUNT OF THE the remitting type. This was the fignal of the epidemic. The weather continued cool during the remaining part of the month, and during the whole month of September. From the expofure of the diftrict of Southwark (which is often diftin- guifhed by the name of the Hill) to the fouth-weft winds, the fever made its firft appearance in that appendage of the city. Scarcely a family, and in many families fcarcely a member of them, efcaped it. From the Hill it gradually travelled along the Second-ftreet from the Delaware, improperly call- ed Front-ftreet. For a while it was confined to this ftreet only, after it entered the city, and hence. it was called by fome people the Frontflreet fever. It gradually fpread through other parts of the city, but with .very different degrees of violence. It prevailed but little in the Northern Liberties. It was fcarcely known beyond Fourth-ftreet from the Delaware. Intemperance in eating or drinking, riding in the fun or rain, watching, fatigue, or even a fright, but more frequently cold, all ferved to excite the feeds of this fever into action, where- ever they exifted. All ages and both fexes were affected by this fever. Seven of the practitioners of phyfic were confined by it nearly at the fame time. The city, during the prevalence of the fever, was filled with an BILIOUS REMITTING FEVER. 127 an unufual number of ftrangers, many of whom, particularly of the Friends (whofe yearly meeting was held in the month of September) were affected by it. No other febrile difeafe was obferved du- ring this time in the city. This fever generally came on with rigor, but feldom with a regular chilly fit, and often without any fenfation of cold. In fome perfons it was in- troduced by a flight fore throat, and in others, by a hoarfenefs which was miftaken for a common cold. A giddinefs in the head was the forerunner of the difeafe in fome people. This giddinefs at- tacked fo fuddenly, as to produce, in feveral in- ftances, a faintnefs, and even fymptoms of apo- plexy. It was remarkable that all thofe perfons who were affected in this violent manner, recover- ed in two or three days. I met with one inftance of this fever attacking with coma, and another with convulfions, and with many inftances in which it was introduced by a delirium. The pains which accompanied this fever were exquifitely fevere in the head, back, and limbs. The pains in the head were fometimes in the back parts of it, and at other times they occupied only 14 the 128 ACCOUNT OF THE the eyeballs. In fome people, the pains were fo acute in their backs and hips, that they could not lie in bed. In others, the pains affected the neck and arms, fo as to produce in one inftance a diffi- culty of moving the fingers of the right hand. They all complained more or lefs of a forenefs in the feats of thefe pains, particularly.when they oc- cupied the head and eyeballs. A few complained of their flefli being fore to the touch, in every part of the body. From thefe circumftances, the dif- eafe was fometimes believed to be a rheumatifm; but its more general name among all claffes of people was, the Break-bone fever, I met with one cafe of pain in the back, and another of an acute ear-ach, both of which re- turned periodically every night, and without any fever. A naufea univerfally, and in fome inftances a vomitting, accompanied by a difagreeable tafte in the mouth, attended this fever. The bowels were, in moft cafes, regular, except where the difeafe fell with its whole force upon them, producing a fymptomatic dyfentery*. * A fymptomatic dyfentery frequently accompanies the autumnal fevers in Pennfylvania. In the hilly parts of the ftate, it has been remarked that it prevails chiefly on the high grounds; BILIOUS REMITTING FEVER. I 29 The tongue was generally moift, and tinctured of a yellow colour. The urine was high coloured, and in its ufual quantity in fevers. The fkin was generally moift, efpecially where the difeafe terminated on the third or fourth day. The pulfe was quick and full, but never hard, in a fingle patient that came under my care, till the 28th of September. It was remarkable, that little, and in fome in- ftances, no thirft attended this fever. A fcreatus, or conftant hawking and {pitting, attended in many cafes through the whole difeafe, and was a favourable fymptom. There were generally remiflions in this fever every morning, and fometimes in the evening. The exacerbations were more fevere every other day, and two exacerbations were often obferved in one day. grounds; while the remitting or intermitting fevers prevail in the neighbourhood below them. A rafh *3° ACCOUNT OF THE A rafli often appeared on the third and fourth days, which proved favourable. This rafh was accompanied in fome cafes by a burning in the palms of the hands and foles of the feet. Many people at this time, who were not confined to their beds, and fome, who had no fever, had an efflore- • fcence on their ikins. In feveral perfons the force of the difeafe feem- ed to fall upon the face, producing fwellings under the jaw and in the ears, which in fome inftances terminated in abfceffes. When the fever did not terminate on the third or fourth day, it frequently ran on to the eleventh, fourteenth, and even twentieth days, affuming in its progrefs, according to its duration, the ufual fymptoms of the typhus gravior, or mitior, of Doctor Cullen. In fome cafes, the difcharge of a few fpoons-full of blood from the nofe accompanied a folution of the fever on the third or fourth day; while in others, a profufe haemorrhage from the nofe, mouth, and bowels, on the tenth and ele- venth days, preceded a fatal iffue of the difeafe. Several cafes came under my care, in which the fever was fucceeded by a jaundice. The BILIOUS REMITTING FEVER. 131 The difeafe terminated in fome cafes without fweating, or a fediment in the urine; nor did I find fuch patients more difpofed to relapfe than others, provided they took a fufficient quantity of the bark. About the beginning of October the weather became cool, accompanied by rain and an eafterly wind. This cool and wet weather continued for four days. The mercury in the thermometer fell to 6o°, and fires became agreeable. From this time the fever evidently declined, or was accom- panied by inflammatory fymptoms. On the 16th of October, I met with a cafe of inflammatory an- gina ; and on the next day I vifited a patient who had a complication of the bilious fever with a pleu- rify, and whofe blood difcovered ftrong marks of the prefence of the inflammatory diathefis. His ftools were of a green and black color. On the third day of his diforder the rafh appeared on his fkin, and on the fourth, in confequence of a fe- cond bleeding, his fever terminated with the com- mon fymptoms of a crifis. During the latter end of October, and the firft weeks in November, the mercury in the Ther- mometer fluctuated between 500 and 6o°. Pleu- rifies 132 ACCOUNT OF Til/. rifies and inflammatory difeafes of all kinds now made their appearance. They were more nu- merous and more acute, than in this ftage of the autumn, in former years. I met with one. cafe of pleurify in November, which did not yield to lefs than four plentiful bleedings. I fliall now add a fliort account of the metho» » I purfued in the treatment of this fever. I generally began by giving a gentle vomit of tartar emetic. This medicine, if given while the fever was in its forming ftate, frequently produced an immediate cure; and if given after its forma- ! tion, on the firfl day, feldom failed of producing a crifis on the third or fourth day. The vomit always difcharged more or lefs bile. If a naufea, or an ineffectual attempt to vomit continued after'" ^M the exhibition of the tartar emetic, I gave a fe- cond dofe of it with the happieft effects. If the vomit failed of opening the bowels, I gave gentle dofes of falts and cream of tartar*, * I have always .found that cream cf tartar renders the purging neutral falts lefs difagreeable to the tafte and fto- mach ; but accident has lately taught me, that the juice of two limes or of one lemon, with about half an ounce of loaf iugar added to fix drachms cf Glauber or Epfc n fait, ia BILIOUS REMITTING FEVER. I •»-* or of the butter-nut pill*, fo as to procure two or three plentiful ftools. The matter difcharged from the bowels was of a highly bilious nature. It was fometimes fo acrid as to excoriate the rec- tum, and fo offenfive, as to occafion, in fome cafes, ficknefs and fa'intnefs both in the patients and in their attendants. In every inftance the patients found relief by thefe evacuations, efpecially from the pains in the head and limbs. In thofe cafes, where the prejudices of the patients againft an emetic, or where an advanced ftate of pregnancy, or an habitual predifpofition to hcematemefis occurred, I difcharged the bile entirely by means of the lenient purges that have been mentioned. In this practice I had the ex- ample of Doctor Cleghorn, who prefcribed purges with great fuccefs in a fever of the fame fpecies in Minorca, with that which has been defcribedf. Doctor Lining prefcribed purges with equal fuc- cefs in an autumnal pleurify in South Carolina, in half a pint of boiling water, form a mixture that is nearly as pleafant as ftrong beverage. * This pill is made from an extrail of a ftrong decoction •f the inner bark of the white walnut-tree. '' f The tertiana interpofita remifllone tantum, of LV. Culler. which 134 ACCOUNT OF THE which I take to be a fpecies of a bilious remit- tent, accompanied by an inflammatory affection of the breaft. After evacuating the contents of the ftomach and bowels, I gave fmall dofes of tartar emetic, mixed with Glauber's fait. This medicine excited a general perfpiration. It likewife kept the bowels gently open, by which means the bile was dif- charged as faft as it was accumulated. I conftantly recommended to my patients, in this ftage of the diforder, to lie in bed. This favoured the eruption of the rafh, and the folution of the difeafe by perfpiration. Perfons who ftruggled againft the fever by fitting up, or who attempted to fhake it off by labour or exercife, either funk under it, or had a flow recovery. A clergyman of a refpectable character from the country, who was attacked by the difeafe in the city, returned home, from a defire of being attended by his own family, and died in a few days afterwards. This is only one, of many cafes, in which 1 have obferved travelling, even in the eaficft carriages, to prove fatal in fevers after they were formed, or after the firft fymptoms had fhewn themfelves. The quickeft and moft effec- tual BILIOUS REMITTING FEVER. 135 tual way of conquering a fever, in moft cafes, is, by an early fubmifuon to it. The drinks I recommended to my patients were fage and baum teas, apple* and tamarind water, weak punch, lemonade, and wine whey. I found obvious advantages in many cafes, from the ufe of pediluvia, every night. In every cafe, I found the patients refrefhed and relieved by frequent changes of their linen. On the third or fourth day, in the forenoon, the pains in the head and back generally abated, with a fweat which was diffufed over the whole body. The pulfe at this time remained quick and weak. This was, however, no objection to the ufe of the bark, a few dofes of which immediately abated its quicknefs, and prevented a return of the fever. If the fever continued beyond the third or fourth day without an intermiflion, I always had recourfe * That apple-water is moft agreeable which is made by pouring boiling water upon flices ot raw apples. It is more lively than that which is made by pouring the wa- ter on roafted apples. 1 to I$6 ACCOUNT OF THE v- to blifters. Thofe which were applied to the neck, and behind the ears produced the moft immediate good effects. They feldom failed of producing an intermiffion in the fever, the day after they were applied. Where delirium or coma attended, I applied the blifter to the neck on the firfl day of the diforder. A worthy family in this city will always afcribe the life of a promifmg boy of ten years old, to the early application of a blifter to the neck, in this fever. Where the fever did not yield to blifters, and affumed the fymptoms of typhus gravior or mitior, I gave the medicines ufually exhibited in both the fpecies of that fever. I took notice in the hiftory of this fever, that it was fometimes accompanied by the fymptoms of a dyfentery. Where this diforder appeared, I prefcribed lenient purges and opiates. Where thefe failed of fuccefs, I gave the bark in the in- termiffions of the pain in the bowels, and applied blifters to the wrifts. The good effects of thefe i remedies led me to conclude, that the dyfentery was the febris inrroverfa of Dr. Sydenham. I am happy in having an opportunity, in this place, of bearing a teftimony jn favour of the ufe- 2 fiilnefs BILIOUS REMITTING FEVER. 137 fulnefs of opium in this diforder, after the necef* jary evacuations had been made. I yielded, in prefcribing it at firft, 10 the earned folicitations of my patients for fomething to give them relief from their infupportable pains, particularly when they were featcd^in the ^ye-balls and head. Its falutary effects in procuring fweat, and a remiffion of the fever, led me to prefcribe it afterwards in almoft every cafe and always with the happieft effects. Thofe phyficians enj y but little pleafure in pradtifing phyfic, who know not how much of the pain and anguifh of fevers, of a certain kind, may be leffcned by the judicious ufe of opium. In treating of the remedies ufed in this diforder, I have taken no notice of blood-letting. Out of feveral hundred patients whom I vifited in this fever, I did not meet with a fingle cafe, before the 27th of September, in which the ftate of the pulfe indicated this evacuation. It is true, the pulfe was full, but never hard. I acknowledge that I was called to feveral patients who had been bled without the advice of a phyfician, who recovered afterwards on the ufual days of the folution of the fever. This only can be afcribed to that dif- pofition which Doctor Cleghorn attributes to fevers, to preferve their types under every variety K of 1^5 ACCOUNT OF THE of treatment, as well as conftitution. But I am bound to declare further, that I heard of feveral cafes in which bleeding was followed by a fatal termination of the difeafe. In this fever relapfes were very frequent, from expofure to the rain, fun, or night air, and from an excefs in eating or drinking. The convalefcence from this difeafe was marked by a number of extraordinary fymptoms, which rendered patients the fubjedts of medical attention for many days after the pulfe became perfectly regular, and after the crifis of the difeafe. A bitter tafte in the mouth, accompanied by a yellow colour on the tongue continued for near a week. Moft of thofe who recovered complained of naufea and a total want of appetite. A faintnefs, efpecially upon fitting up in bed, or in a chair,, followed this fever. A weaknefs in the knees was univerfal. I met with two patients, who were moft fenfible of this weaknefs in the right knee. An inflammation in one eye, and in fome inftances in both eyes, occurred in feveral patients after their recovery. But BILIOUS REMITTING FEVER. I39 But the moft remarkable fymptom of the con- valescence from this fever, was an uncomman de- jection of the fpirits. I attended two young ladies who fhed tears while they vented their complaints of their ficknefs and weaknefs. One of them very aptly propofed to me to change the name of the diforder, and to call it in its prefent ftage, inftead of the Break-bone, the Break-heart fever. To remove thefe fymptoms, I gave the tincture of bark and elixir of vitriol in frequent dofes. I likewife recommended the plentiful ufe of ripe fruits; but I faw the beft effects from temperate meals of oyfters, and a liberal ufe of porter. To thefe was added, gentle exercife in the open air, which gradually completed the cure. [ Ui ] ■ AN ACCOUNT pr t trs Scarlatina Anginofa* AS IT APPEARED IN PHILADELPHIA, IN THE YEARS 1783 ahd 1784. THE beginning of the month of July was unufually cool; infomuch that the mercury in Farenheit's thermometer ftood at 61 ° in the day time, and fires were very comfortable, efpecially in the evening. In the laft week but one, of this month, the weather fuddenly became fo warm, that the mercury rofe to 94^0, at which it re- mained for three days. As this heat was accom- panied by no breeze from any quarter, the fenfe of it was extremely diftreffing to many people. Upwards of twenty perfons died in the courfe of thefe three days, from the excefs of the heat, and from 142 ACCOUNT OF THE from drinking cold water. Three old people died fuddenly within this fpace of time. This ex- treme heat was fucceeded by cool weather, the mercury having fallen to 6o°, and the month clofed with producing a few intermitting and re- mitting fevers, together with fevcral cafes of in- flammatory angina. The weather in the month of Auguft was ex- tremely variable. The mercury, after ftanding for feveral days at 920, fuddenly fell fo low, as not only to render fires neceffary, but in many places to produce froft. Every genus of fever made its appearance in this month. The fynocha was fo acute, in feveral cafes, as to require from three to four bleedings. The remitting fever was accompanied by an un- common degree of naufea and faintnefs. Several people died, after a few days illnefs, of the typhul gravior, of Dr. Cullen. The intermittents had nothing peculiar in them, either as to their fymp- toms or method of cure. Towards the clofe of the month, the fcarlatina anginofa made its appearance, chiefly among chil- dren. The SCARLATINA ANGIN0SA. I43 The month of September was cool and dry, and the fcarlatina anginofa became epidemic among adults as well as young people. In moft of the patients who were affected by it, it came on with a chillnefs and a fickncfs at the ftomach, or a vo- mitting ; which laft was fo invariably prefent, that it was with me a pathognomonic fign of the dif- eafe. The matter difcharged from the ftomach Was always bile. The fwelling of the throat was, in fome inftances fo great, ;as to produce a diffi- culty of fpeaking, fwallowing, and breathing. In a few inftances, the fpeech was accompanied by a fqueaking voice, refembling that which attends the cynanche trachealis. The ulcers on the ton- fils were deep, and covered with white, and in .omc inftances, with black Houghs. In feveral cafes there was a difcharge of a thick mucus from the nofe, from the beginning, but it oftner occur- red in the decline of the difeafe, which moft fre- quently happened on the fifth day. Sometimes the fubfiding of the fwelling of the throat was follow- ed by a fwelling behind the ears. An eruption on the fkin generally attended the fymptoms which have been defcribed. But this fymptom appeared with confiderable variety. In fome people it preceded, and in others followed the ulcers and fwelling of the throat. In fome, it K 4 appeared *44 ACCOUNT OP TMfi appeared only on the outfide of the throat and on the breaft ; in others, it appeared chiefly on the limbs. In a few it appeared on the fecond or third day of the diforder, and never returned after- wards. I faw two cafes of eruption without a fin- gle f/mptom of fore throat. The face of one of thofe patients was fwelled, as in the eryfipelas. In the other, a young girl of feven years old, there was only a flight rednefs on the fkin. She was feized with a vomiting, and died delirious in fifty- four hours. Soon after her death, a livid colour appeared on the outfide of her throat. The bowels, in this degree of the diforder, were in general regular. I can recollect but few cafes which were attended by a diarrhcea, The fever which accompanied the diforder was generally the typhus mitior of Doctor Cullen. In a few cafes it affumed the fymptoms of the typhus gravior. The difeafe frequently went off with a fwelling of the hands and feet. I faw one inftance in a gentlewom n, in whom this fwelling was abfent, Who complained of very acute pains in her limbs, refembling thofe of the rheumatifm. In SCARLATINA ANGIN0SA. I45 In two cafes which terminated fatally, there were large abfceffes; the one on the outfide, and the other on the infide of the throat. The firft of thefe cafes was accompanied by troublefome fores on the ends of the fingers. One of thefe patients lived twenty-eight, and the other above thirty days, and both appeared to die from the difcharge which followed the opening of their ab- fceffes. Between the degrees of the difeafe which I have defcribed, there were many intermediate degrees of indifpofition which belonged to this diforder. I faw in feveral cafes a difcharge from behind the ears, and from the nofe, with a flight erup- tion, and no fore throat. All thefe patients were able to fit up and walk about. I faw one inftance of a difcharge from the in- fide of one of the ears in a child, who had ulcers in his throat, and the fqueaking voice. In fome, a pain in the jaw, with fwellings be- hind the ears and a flight fever, conftituted the whole of the difeafe. In I4&* ACCOUNT OF TH2 In one cafe, the difeafe came on with a coma, and in feveral patients it went off with this fymp- tom. A few inftances occurred of adults, who walked about, and even tranfacted bufinefs until a few hours before they died. The intermitting fever, which made its appear- ance in Auguft, was not loft during the month of September. It continued to prevail, but with fe- veral peculiar fymptoms. In many perfons it was accompanied by an eruption on the fkin, and a fwel in^ of the hands and feet. In fome, it was attended by a fore throat and pains behind the ears. Indeed, fuch was the prevalence Of the con- tagion which produced the fcarlatina anginofa^ that many hundred people complained of fore throats without any other fymptom of indifpofi- tion. The flighteft occafional or exciting caufe, and particularly cold, feldom failed of producing the diforder. The month of October was much cooler than September, and the difeafe continued, but with lefs alarming fymptoms. In feveral adults, who were feized with it, the hardnefs of the pulfe indicated blood- SCARLATINA ANOTNOSA. T47 blood-letting. The blood, in one cafe, was co- vered with a buffy coat, but beneath its furface it was diffolved. In the month of November the difeafe affumed feveral inflammatory fymptoms, and was attended with much lefs danger than formerly. I vifited one patient whofe fymptoms were fo inflammatory as to require two bleedings. During the decline of the difeafe, many people complained of troublefome fores on the ends of their fingers. A number of children likewife had fore throats and fevers, with eruptions on their fkins, which refembled the chicken-pox. I am difpofed to fufpedt that this eruption was the effect of the contagion of the fcarlatina anginofa, as feveral inftances occurred of patients who had all the fymptoms of this dif- eafe, in whom an eruption of white blifters fuc- ceeded their recovery. This form of the difeafe has been called by Sauvage, the fcarlatina vari- olofa. I faw one cafe of fore throat, which was fuc- ceeded not only by fwellings in the abdomen and limbs, but by a catarrh, which brought on a fatal confumption. A confiderable fhock of an earthquake was felt on the 29th of this month, at ten o'clock at night, in I48 ACCOUNT OF THE in the city of Philadelphia; but no change was perceived in the difeafe, in confequence of it. In December, January, and February, the wea- ther was intenfely cold. There was a thaw for a few days in January, which broke the ice of the Delaware, but it was followed by cold fo exceffive as to clofe the river till the beginning of March. The mercury on the 28 and 29th of February, ftood below o in Fareinheit's thermometer. For a few weeks in the beginning of December the difeafe difappeared in the circle of my patients, but it broke out with great violence the latter end of that month, and in the January following. Some of the worft cafes that I met with, (three of which proved fatal) were in thofe two months. The difeafe difappeared in the fpring, but it fpread afterwards through the neighbouring ftates of New-Jerfey, Delaware and Maryland-. I fliall now add an account of the remedies which I adminiftercd in this diforder. . In every cafe that I was called to, I began the cure by giving a vomit joined with calomel. The vomit was either tartar emetic or ipecacuana, ac- cording to the prejudices, habits, or conftitutions of SCARLATINA ANGINOSA. I49 of my patients. A quantity of bile was generally difcharged by this medicine. Befides evacuating the contents of the ftomach, it cleanfed the throat' in its paffage downwards. To enfure this effect from the calomel, I always directed it to be given mixed with fyrup or fugar and water, fo as to diffufe it generally over every part of the throat. The calomel feldom failed to produce two or three ftools. In feveral cafes I was obliged, by the continuance of naufea, to repeat the emetics, and always with immediate and obvious advan- tage. I gave the calomel in moderate dofes in every ftage of the diforder. To reftrain its purga- tive effects, when neceffary, I added to it a fmall quantity of opium. During the whole courfe of the diforder, where the calomel failed of opening the bowels, I gave lenient purges, when a difpofition to coftivenefs required them. * The rbroat was kept clean by detergent gargles. In feveral inftances I faw evident advantages from adding a few grains of calomel to them. In cafes of great difficulty of fwallowing or breathing, the patients found relief from receiving the fteams of warm water mixed with a little vinegar, through a funnel into the throat. A per- X50 ACCOUNT OF THB A perfpiration kept up by gentle dofes of anti* monials, and diluting drinks, impregnated with wine, always gave relief. In every cafe which did not yield to the above remedies on the third day, I applied a blifter be- hind each ear, or one to the neck, and I think, always with good effects. I met with no cafes in which the bark appeared to be indicated as an antifeptic, except the three in which the difeafe proved fatal. Where the fore throat was blended with the intermitting fe- ver, the bark was given with advantage. But in common cafes it was unneceffary. Subfequent obfervations have led me to believe, with Doctor Withering, that it is fometimes hurtful in this diforder. This difeafe proved fatal in many parts of the country, upon its firft appearance ; but wherever the mode of treatment here delivered was adopt- ed, its mortality was foon checked. The calomel was ufed very generally in New-Jerfey and New- York. In the Delaware ftate, a phyfician of cha- racter made it a practice not only to give calomel, but to anoint the outfide of the throat with mer- curial ointment. ADDITIONAL C '5' J ADDITIONAL OBSERVATIONS V PON THE Scarlatina Anginofa. rT1HIS difeafe has prevailed in Philadelphia, at different feafons, ever fince the year 1783. It has blended itfelf occafionally with all our epidemics. Many cafes have come under my notice fince its firft appearance, in which dropfi- cal fwellings have fucceeded the fever. In fome inftances there appeared to be effufions of water not only in the limbs and abdomen, but in the ' thorax. They "yielded, in every cafe that I at- tended, to purges of calomel and jalap. Where thefe fwellings were neglected, they fometimes proved fatal. In the winter of 1786-7, the fcarlatina angi- nofa was blended with the cynanche parotidea, and in one inftance with a typhus mitior. rl he 1 laft 154 ADOITIOTAL OBSERVATIONS laft was in a young girl of nine years of age. She was feized with a vomiting of bile and an efflorefcence on her breaft, but difcovered no other fymptoms of the fcarlatina anginofa till the fix- teenth day of her fever, when a fwelling appear- ed on the outfide of her throat ; and after her re- covery, a pain and fwelling in one of her knees. In the month of July 1787, a number of peo- ple were affected by fudden fwellings of their lips and eyelids. Thefe fwellings generally came on in the night, were attended with little or no pain, and went off in two or three days. I met with only one cafe in which there was a different iffue to thefe fymptoms. Ic was in a patient in the Pennfylvania hofpital, in whom a fwelling in the lips ended in a fuppuration, which, notwithstand- ing the liberal ufe of bark and wine, proved fatal in the courfe of twelve days. In the months of June ancj July 1788, a num- ber of people were affected by fudden fwellings, not only of the lips, but of the cheeks and throat. At the fame time many perfons were affected by an inflammation of the eyes. The fwellings were attended with more pain than they were the year before, and fome of them required one or two purges UPON THE SCARLATINA ANGINOSA I55 pnrges to remove them; but in general they went without medicine, in two or three days. Is it proper to refer thefe complaints to the fame contagion which produces the fcarlatina anginofa ? The prevalence of the fcarlatina' anginofa at the fame time in this city j its difpofition to pro- duce fwellings in different parts of the body; and" the analogy of the intermitting fever, which often conceals itfelf under fymptoms that are foreign to its ufual type;" all feems to render this'con- jecture probable. .«In one of the cafes of an in- flammation of the eye, which came under my notice, the patient Was affected by a vomiting a few hours before the inflammation appeared, and complained of a ficknefs at his ftomach for two or three days afterwards. Now a vomiting and naufea appear to be pathognomonic fymptoms of the fcarlatina anginofa. In the autumn of 1788, the fcarlatina anginofa appeared with different degrees of' violence in many parts of the city. In two inftances it ap- peared with an obftinate diarrhoea; but it was in young fubjects, and not in adults, as defcribed by Doctor Withering. In both cafes, the difeafe Vol. I. L proved 15$ ADDITIONAL OBSERVATIONS proved fatal; the one on the third, the other on the fifth day. In the month cf December of the fame year, I faw one cafe in which a running from one of the ears and a deafnefs came on, on the fifth day immediately after the difcharge of mucus from the nofe had ceafed. This cafe terminated fa- vourably on the ninth day, but was fucceeded for feveral days afterwards by a troublefome cough. 1 fhall conclude this effay by the following remarks: i. Camphor has often been fufpended in a bag from the neck, as a prefervative againft this difeafe. Repeated Obfervations have taught me, that it poffeffes little or no efficacy for this purpofe. I have had reafon to entertain a more favourable opinion of the benefit of wafhing the hands and face with vinegar, and of rinfing the mouth and throat with vinegar and water every morning, as means of preventing this diforder. 2. Whenever I have been called to a patient where the fcarlatina appeared to be in a forming ftate, a vomit of ipecacuana or tartar emetic, mixed UPON THE SCARLATINA ANGINOSA. Iff mixed with a few grains of calomel, has never failed of completely checking the diforder, or of fo far mitigating its violence, as to difpofe it to a favourable iffue in a few days; and if thefe obfervations fhould ferve no other purpofe than to awaken the early attention of patients and phyficians to this fpeedy and effectual remedy, they will not have been recorded in vain. 3. When the contagion of this difeafe has been received into the bddy, a purge has prevented its being excited into action, or rendered the diforder mild, throughout a whole family. For this prac- tice I am indebted to fome obfervations on the Scarlatina, publifhed by Dr Sims in the firft vo- lume of the Medical Memoirs. L» ,..T' • '. I '59 ] A N Q U I R Y INTO THE USE AND CURE OF T HE Cholera Infantum. T> Y this name I mean to defignate a difeafe, called, in Philadelphia, the " vomiting and purging of children." From the regularity of its appearance in the fummer months, it is like- wife known by the name of " the difeafe of the feafon." It prevails in moft of the large towns in the United States. It is diftinguifhed in Charleftown in South Carolina, by the name of " the April and May diforder," from making its firft appearance in thofe two months. It feldom appears in Philadelphia till the middle of June, or the beginning of July, and generally continues till near the middle of September. Its frequency L 3 and I N CA l6o THE CAUSE AND CURE OF and danger are always in proportion to the heat of the weather. It affects children from the firft or fecond week after their birth, till they are two years old. It fometimes begins with a diarrhoea, which continues for feveral days without any other fymptom of indifpofition ; but it more frequently comes on with a violent vomiting and purging, and a high fever. The matter difcharged from the ftomach and bowels is generally yellow or green, but the ftools are fometimes flimy and bloody, without any tincture of bile. In fome inftances they are nearly as limpid as water. Worms are frequently difcharged in each kind of the ftools that has been defcribed. The children in this ftage of the diforder, appear to fuffer a good deal of pain. They draw up their feet, and are never eafy in one pofture. The pulfe is quick "and weak. The head is unufua'lly warm, while the extremities retain their natural -heat, or incline to be cold. THe fever is of the remitting kind, and difcovers evident exacerbations, efpecially in the evenings. The difeafe affects the head fb much, as in fome ih'ftartces to produce fynyptoms not only of dtliYium, but of mania^ infomucli that the children throw then- heads backwards and forwards, -and fometimes make attempts to fcratch, and to bite, their parents or nurfes, A fwelling frequently occurs in the abdomen, and in THE CHOLERA INFANTUM. 10T in the face and limbs. An intenfe thirft attends every ftage of the diforder. The eyes appear languid and hollow, and the children generally fleep with them half clofed. Such is the infen- fibility of the fyftem in fome inftances in this diforder, that flies have been feen to alight upon the eyes when open, without exciting a motion in the eyelids to remove them. Sometimes the vomiting continues without the purging, but more generally, the purging continues without the vomiting, through the wl}.^ courfe of the diforder. The ftools are frequently large, apd extremely foetid, but in fome inftances they are without fmell, and refemble drinks or alimenr. which has been taken into the body. The dif- eafe is fometimes fatal in a few days. I once faw it carry off a child in four and twenty hours. Its duration is varied by the feafon of the year, and by the changes in the temperature of the weather. A cool day frequently abates,its vio- lence, and difpofes it to a favourable termination. It often continues with occafional variations in its appearance, for fix weeks or two months. Where the difeafe has been of long continuance, the approach of death is gradual, and attended by a number of diftreffing fymptoms. An emacia- tion of the body to fuch a degree, as that the .bones come through the lkin, livid (pots, a fin- L 4 gultus, l6*2 THE CAUSE AND CURE OF gultus, covulfions,a-ftrongly marked hippocratic countenance,- and a fore mouth, generally pre- cede the fatal termination of this diforder. i Few children ever recover, after the laft fymptoms which have been mentioned make their appear- ance. ' t •■■■-) tut z 'This difeafe has been afcribed to feveral caufes; of each of which ;I fhall take notice in'order. '■' I. It has beerf' attributed to dentition. To refute 'this opinion, it will be neceffary to obferve, that it appears only in one feafon of the year. Den- tition, I acknowledge, fometimes aggravates the diforder; hence we find it is moft fevere in that period of life, when the greateft number of teeth make their appearance, which is generally about the 10th month. I think I have obferved more children to die of this diforder at that age, than at any other. II. Worms have likewife been fufpected of being the caufe of this difeafe. To this opinion, I object the-uncertainty of worms ever producing an idiopathic fever, and the improbability of their combinining in fuch a manner as to produce an annual epidemic difeafe of any kind. But fur- ther, we often fee the diforder in all its force, 4 before THE CHOLERA INFANTUM. 163 before thatage, in which worms ufually produce difeafes; we likewife often fee it refift the moft fpowerful anthelmintic medicines; and laftly, it appears from diffection,,. where jthe .difeafe has proved fatal, that not a fingle worm has been dif- eovered in the bowels. It is true, worms are in fome inftances difcharged in this diforder, but they are frequently difcharged in greater numbers in the hydrocephalus internus, and in the fmall- pox, and yet who will aflert either of thofe dif- eafes to be. produced by worms. ■ .•1 -.'J • • . III. The fummer fruits have been accufed of producing this diforder. To this opinion, I object, that the. difeafe is but little known in country places, where fihi)dren eat much more fruit than in cities. Asfar as-1 have,obferved, I am difpofed to believe that the moderate ufe of ripe fruits, rather tends to prevent, than to induce the difeafe. ^ From the difcharge of bile which generally introduces the difeafe, from the remiflions and exacerbations of the fever which accompanies it, and from its occurring nearly in the fame feafon with the cholera and remitting fever in adults, I am difpofed to confider it as a modification :of the fame difeafes. Its appearance earlier in the "feafon than the cholera and remitting fever in adults, 164 THE CAUSE AND CURS Of admits, muft be afcribed to the conftitutions of children being more predifpofed from weaknefs to be acted upon, by the remote caufes which produce thofe diforders. 1 fhall now mention the remedies which arc proper and ufeful in this diforder. I. The firft indication of cure is to evacuate the bile from the ftomach and bowels. This fliould be done by gentle dofes of ipecacuanha, or tartar emetic. The vomits fhould be repeated occafionally, if indicated, in every ftage of the diforder. The bowels fhould be opened by means of manna, eaftor oil, or magnefia. I have gene- rally found rhubarb improper for this purpofe, while tiie ftomach was in a very irritable ftate. In thofe cafes, where there is reafon to believe that the -offending contents of the prima? viae have been difcharged by nature, (which is often the cafe) -the emetics and purges fhould by no means be -given; but, inftead of them, recourse muft be had to II. Opiates. A few drops of liquid laudanum, combined in a teftaceous julep, with pepper-mint or cinnamon-water, feldom fail of compofing the ftomach and bowels. In fome inftances, this me- dicine THI CHOLERA INPANTUM. 165 dicine alone fubdues the difeafe in two or three days; but where it does not prove fo fuccefsful, it produces a remiffion of pain, and of other dif- treffing fymptoms, in every ftage of the diforder. IIL demulcent and diluting drinks have an Agreeable effect in this difeafe. Mint and mallow teas, er a tea made of blackberry roots infufcd in cold water, together with a decoction of the Shavings of* haftfhotti and gum arabic with cinna- feon, fhould all be given in their turns for this £urp6fe. fV. Olyfters made of flaxfced tea, or of mut- ton broth, or of ftarch diffolved m water, with a few drdps of liquid laudanum in them, give eafe, and produce other ufeful effects. V. Plafters of Venice treacle applied to the re- gion of the ftomach, and flannels dipped in infu- lions of bitter and romatic herbs in warm fpirits, or Madeira wine, and applied to the region of the abdomen, often afford confiderable relief. VI. As foon as the more violent fymptoms of the difeafe are compofed, tonic and cordial medi- cines fhould be given. The bark in decoction, or in fubftance, (where it can be retained in that form) 166 .;THE* CAUSE AND CU^RE OF fonn) mixed ^ith a little, nutmeg,/ often produce the moft falutary. effects. Port wine or .claret mixed with water are likewife proper in this ftage of the diforder. After tjie difeafe has qontinuejl for fome time, we often fee an appetite fuddenly awakened for articles;of diet of a ftimujating:na- ture. I have feen. many children recover from being gratified in an inclination to eat falted fifh,, or the different Junds; of falted meat. In-fpme in- ftances they; difcover an appetite for butter, and the richeft gravies of roafted meats, and eat thera with obvious relief to all their fymptoms. I once faw a child of fixteen months old, perfectly re- ftored, from the loweft ftage of this diforder/by eating large quantities of rancid Englifh checfe, and drinking two or three glaffes of Port wine every day. She would in no inftance eat bread with the cheefe, nor tafte the wine, if it was mix- ed with water. ■ We fometimes fee relief given by the ufe of the warm bath, in J cafes of obftinate pain. The bath is more i effectual, if warm wine is ufed, in- ftead of water. I have had but few opportunities of trying the effects of cold water applied to the body in this diforder; but from the benefit whjch attended its ufe THE CHOLERA INFANTUM. l6? tile in the cafes in which it was prefcribed, I am difpofed to believe that it would do great fervice, could we overcome the prejudices, which fubfift in the minds of parents againft it. 'After all that has been' faid in favour of the remedies that have been mentioned, I am forry to add, that I have very often feen them all admini- ftered without effect. My principal dependence, therefore, fof n\iny years, has been placed upon VII. Country air. Out of many hundred chil- dren whom I have fent into the country in every ftage of this diforder, I have loft only three ; two of whom, were fent, contrary to my advice, into that unhealthy part of the neighbourhood of Phi- ladelphia called the Neck, which lies between the city and the conflux of the rivers Delaware and Schuylkill. I have feen one cure performed by this remedy, after convulfions had taken place. To derive the utmoft benefit from the country air, children fhould be carried out on horfeback, or in a carriage, every day; and they fhould be ex- pofed to the open air as much as poflible in fait weather in the day time. Where the convenience of the conftant benefit of country air cannot be obtained, I have feen evident advantages from taking children out of the city once or twice a day. 168 THE GAU«« AN© CURB Of day. It is extremeiy agreeable to fee the little fuffercrs revive as foon as they efcapc from the city air, and infpire the pure air of tjie country. I fliall conclude this inquiry, by recommending the following methods of preventing this diforder, all of which have been found by experience to be ufefuL I. The daily ufe of the cold bath. 2. A faithful and attentive accommodation of the dreffes of children, to the ftate and changes of the air. 3. A moderate quantity of falted meat takefr occafionally in thofe months in which this difeaft wfually prevails. It is perhaps in part from the daily ufe of falted meat in diet that the children of country people efcape this diforder. 4. The ufe of found old wine in the fummer months. From a tea-fpoon-full, to half a wine glafs full, according to the age of the child, may be given every day. It is remarkable, that the children of perfons in eafy circumftances, whp fip occafionally with their parents the remains qf a glafs of wine after dinner, are much lefs fubject to THE CHOLERA INFANTUM. 169 to this diforder, than the children of poor people, who are without the benefit of that article of diet. 5. Cleanlinefs both with refpect to the fkin and cloathing of children. Perhaps the neglect of this direction may be another reafon why the children of the poor are moft fubject to this di£ order. 6. The removal of children into the country before the approach of warm weather. This ad- vice is peculiarly neceffary during the whole pe- riod of dentition. I have never known but one inftance of a child being affected by this diforder, who had been carried into the country in order to avoid it. f :1# • 1VS r >7i ] OBSERVATIONS ON THE Cynanche Trachealis\ I TAKE great pleafure in thus publicly ac- knowledging a miftake, which I committed in my letter to Doctor Millar, publifhed by him in London in the year 1770, in fuppofing that there was but one fpecies of this diforder, and that that was fpafmodic. I am now fatisfied, from repeated obfervations, that there is another fpecies, which I fhall take the liberty of calling the cynanche tra- chealis humida. I exclude, as a fpecies of this diforder, the cynanche trachealis maligna. Many of the fymp- toms of the cynanche trachealis occur in the ma- lignant fore throat, but they fhould by no means Vol. I. M confti- 172 OBSERVATIONS ON THE conftitutc the name of a fpecies of that difeafe. 1 have feen the fame fymptoms in the fcarlatina anginofa, and yet I never thought of ranking a cynanche trachealis fcarlatina among the fpecies of that diforder. I have likewife feen the cynan- che trachealis in the laft ftage of the fecondary fever of the fmall-pox, without fuppofing that it ought to derive a fpecific name from that difeafe. The fpecies of diarrhoea would be innumerable, if, every time it occured as a fymptom of other diforders, it was to receive a fpecific name, and to be confidered as an idiopathic diforder. The re^fons which I offered in my letter to Doctor Millar, for believing that the cynanche trachealis is frequently a fpafmodic diforder, con- tinue to operate upon me with as much force as ever. But a number of diffections related by dif- ferent authors, fatisfy me, that the cynanche tra- chealis humida is a diflinct fpecies from the fpaf- modic, and requires a different method of cure. The cynanche trachealis fpafmodica is known, 1. By coming on fuddenly, and that generally in the night. 2. By frequent and perfect intermijfions of the fymptoms for hours, and in fome inftances for days, CYNANCHE TRACHEALIS. 173 days, without the leaft fenfible difcharge from the trachea. And, 3. By yielding to antifpafmodic remedies, par- ticularly to the warm bath. If thefe facts had left any reafons to doubt of a fpafmodic fpecies of this diforder, I fhould have been confirmed in the opinion, by the diflection of a child in the year 1770, who died by it, in whom no marks were to be found of a membrane, or even of mucus in the trachea, The lungs and trachea appeared to be in a found ftate. The cynanche trachealis humida is known, 1. By coming on gradually, and that moft com- monly in the day time. 2. By its continuing or increafing for feveral days without any remarkable remiflion, or even abatement of the fymptoms. 3. By the difcharge of phlegm or mucus from the trachea, and the occafional appearance of it in the ftools. And, 4. By not yielding to antifpafmodic medicines. M2 On 174 OBSERVATIONS ON THE On the eighth of December 1790, I examined the lungs and trachea of a child (aged five years) who died of this fpecies of the cynanche trachealis. I found about two tea-fpoonfulls of mucus in the trachea. The bronchial veffels feemed to be full of the fame kind of liquid. There was no ap- pearance of a membrane in the trachea. Its an- terior part was a little inflamed. Blood drawn from this child during its illnefs, was fizy. My opinion of the caufe of the membrane which is formed in the trachea continues to be the fame as expreffed in my former publication*, with this * " The veffels of the trachea and bronchiae always " abound with a thin mucus, which is poured into them in " proportion as they are irritated by inflammation, or the " action of the external air. Children abound with a greater '■' quantity of mucus in thefe parts than adults ; and when " it is accumulated in the trachea or bronchias in a greater " quantity than ordinary, they are unable, upon the ac- " count of their weaknefs, to bring it up. It is eafy to " conceive in whr.t manner it is converted into a thin mem- " brane, afttr i:s more fluid parts are diffipated. We have " an analogy of this in the nofe. Were the pafTages of " this organ lefs in cur reach, it is probable a membrane " refembling that found in the trachea would be found in " it every four ^nd twrsty hours, efpecially when it was ** affected by a cold. We always find the phlegm accumu- *« lated in proportion to the time the diforder has conti- " nued. CVNANCHE TRACHEALIS. 175 difference, that I believe the membrane to be the effect of the humid fpecies only, and that it is not an accidental confequence of the fpafmodic, as I once fuppofed. The fymptoms of the fpafmodic fpecies are defcribed by Dr. Millar, in his obfer- vations on the afthma and hooping cough, in the following words : " Children (fays he) at play " were fometimes feized with it, but it generally " came on at night. A child who went to bed in " perfect health, waked an hour or two afterwards " in a fright, with his face much flufhed, or fome- " times of a. livid colour; incapable of defcribing " what he felt; breathing with much labour, and 89 ] AN ACCOUNT of the EFFICACY of COMMON SALT, IN THE CURE OF H2E MOPTT S I S. FROM the prefent eftabliflied opinions and practice refpecting the caufe and cure of hse- moptyfis, the laft medicine that would occur to a regular-bred phyfician for the cure of it, is com- mon salt ; and yet I have feen and he.ird of a great, number of cafes, in which it has been admi- niftered with fuccefs. The mode of giving it, is to pour down from a tea to a table-fpoonful of clean fine fait, as foon as poffible after the hsemorrhage begins from the lungs. This quantity generally ftops it; but the N 2 dofe ll)0 THE EFFICACY OF COMMON SALT dofe muft be repeated daily for three or four days, to prevent a return of the diforder. If the bleed- ing continues, the fait muft be continued till it is checked, but in larger dofes. I have heard of fe- veral inftances in which two table-fp6onsful were taken at one time for feveral days. It fometimes excites a ficknefs at the ftomach, and never fails to produce a burning fenfation in the throat in its paffage into the ftomach, and confiderably thirft afterwards. I have found this remedy to fucceed equally ;vell in hacmorrhagies, whether they were active or paflive, or whether they ocurred in young or in old people. I had prefcribed it for feveral years before I could fatisfy myfelf with a theory, to account for its extraordinary action upon the human body. My enquiries led me to attend more particularly to the following facts : t. Thofe perfons who have been early inftruct- ed in vocal mufic, and who ufe their vocal organs moderately through life, are feldom affected by an hemorrhage from the lungs. c. Law- IN THE CURE OF HAEMOPTYSIS. 191 2. JLawyerv players, public cryers, and city watchmen, all of whom exercife their lungs either by long or loud fpeaking, are lefs affected by this diforder, than perfons of other occupations. I acknowledge I cannot extend this obfervation to the public teachers of religion. I have known feveral inftances of their being aflected by hae- moptyfis ; but never but one in which the difor- der came on in the pulpit, and that was in a per- fon who had been recently cured of it. The cafes which I have feen, have generally been brought on by catarrhs. To this diforder, the practice of fome of our American preachers difpofes them in a peculiar manner; for it is very common with this clafs of them, to expofe themfelves to the cold or evening a;r immediately after taking, what a celebrated and eloquent preacher ufed to call a pulpit fweat. 3. This hemorrhage chiefly occurs in debili- tated habits, or in perfons afflicted by fuch a dif- pofition to confumption, as indicates a weak and k hited flate of the lun?s. 4. It generally occurs when the lungs are in r. paflivc flate; as in fitting, walking, and more N 3 frequently I92 THE EFFICACY OE COMMON SALT frequently in lying. Many of the cafes that I have known, have occurred during fleep in the middle of the night. From thefe facts, is it not probable that the common fait, by acting primarily and with great force upon the throat, extends its ftimulus to the bleeding vefftl, and by giving it a tone, checks the further effufion of blood ? I fhall only add to this conjecture the following obfervations; 1. I have never known the common fait per- form a cure, where the hemorrhage from the lungs has been a fymptom of a confumption. But even in this cafe it gives a certain temporary re- lief. 2. The exhibition of common fait in the has- moptyfis, fhould by no means fupercede the ufe of occafional bleeding when indicated by plethora, nor of that diet which the ftate of the pulfe, or of the ftomach, may require. 3. I have given the common fait in one cafe with fuccefs, in an haemorrhage from the ftomach, accompanied by a vomiting; and have heard of feveral IN THE CURE OF HEMOPTYSIS. I93 feveral cafes in which it has been fuppofed to have checked a difcharge of blood from the nofe and uterus, but I can fay nothing further in its favour in thefe laft haemorrhages, from my own expe- rience. It may perhaps ferve to leffen the prejudices of phyficians againft adopting improvements in medicine, that are not recommended by the au- thority of colleges or univerfities, to add, that we are indebted to an old woman, for the difcovery of the efficacy of common fait in the cure of h»« moptyfis. N 4 FREE I m J FREE THOUGHTS VTOV THI CAUSE and CURE O* THI Pulmonary Confumption. TH E ancient Jews ufed to fay that a man does aot fulfil his duties in life, who paffes through \t9 without building a boufe, planting a tree, and leaving a child behind him. A phyfi- cian, in like manner, fhould confider his obliga- tions to his prpfeflioa and fociety as undifcharged, who has pot attempted to jeffen the number of incurable difeafes. This is my apology for pre- fuming to make the confumption the fubject of a medical inqury. Perhaps I may fuggeft an idea, or fact, that may awaken the ideas and facts which now He ufelefs in the memories or common-place books of other phyficians; or I may direct their atten- tion 196 THOUGHTS ON THE CONSUMPTION. tion to fome ufeful experiments upon this fiib- jea. I fiiall begin my obfervations upon the con- fumption, by remarking, 1. that it is unknown among the Indians in North-America. 2. It is fcarcely known by thofe citizens of the United States, who live in the firfl ftage of ci- vilized life, and who have lately obtained the title of the firfl fettlers. The principal occupations of the Indian confift in war, fifhing, and hunting. Thofe of the firft fettler, are fifhing, hunting, and the laborious employments of fubduing the earth, cutting down forefts, building a houfe and barn, and diftant excurfions in all kinds of weather, to mills and courts, all of which tend to excite and preferve in the fyftem, fomething like the Indian vigour of conftitution. 3. It is lefs common in country places than in cities, and increafes in both, with intempe- rance and fedentary modes of life. 4. Ship THOUGHTS ON THE CONSUMPTION. 197 -4. Ship and houfe carpenters, fmiths, and all thofe artificers whofc bufinefs requires great ex- ertions of ftrength in the open air in all feafons of the year, are lefs fubject to this diforder, than men who work under cover, and at occupations which do not require the conftant action of their limbs. * 5. Women who fit more than men, and whofe work is connected with lefs exertion, are moft fubject to the confumption. From thefe facts it would feetu, that the moft probable method of curing the confumption, is to revive in the conftitution, by means of exer- cife or labour, that vigour which belongs to the Indians, or to mankind in their firft ftage of civi- lization. The efficacy of thefe means of curing confump- tion will appear, when we inquire into the relative merit of the feveral remedies which have been ufed by phyficians in this diforder. I fliall not produce among thefe remedies the numerous receipts for fyrups, boluffes, electuaries, deco«5lions,.infufions, pills, medicated waters, pow- ders, draughts, mixtures, and diet-drinks, v»hich have 198 THOUGHTS ON THE CONSUMPTION. have fo long and fo fteadily been ufed in this difeafe; nor fhall I mention as a remedy, the beft accommodated diet, fubmitted to with the moft patient felf-denial, for not one of them all withi out the aid of exercife has ever, I believe, cure4 a fingle confumption. 1. Sea-voyages have cured confumptions; bin it has been only when they have been fo long, or fo frequent, as to fubftitute the long continu* ance of gentle, to violent degrees of exercife of a fhorter duration, or where they have been accom- panied by fome degree of the labour and care of navigating the fhip. 2. A change of climate has often been prefcribed for the cure of confumptions, but I do not recollect an inftance of its having fucceeded, except when it has been accompanied by exer- cife, as in travelling, or by fome active laborious purfuit. Doctor Gordon of Madeira, afcribes the ineffi* cacy of the air of Madeira in the confumption, in part to the difficulty patients find of ufing exercife in carriages, or even on horfeback, from the bad- nefs of the roads in that ifland. 3. Jour- thoughts on the Consumption. 199 3. Journies have often performed cures in th* confumption, but it has been chiefly when they have been long, and accompanied by difficulties which have fouled and invigorated the powers of the mind and body,, 4. Vomits and nauseating medicines have been much celebrated for the cure of confump- tions. Thefe, by procuring a temporary determina- tion to the furface of the body, fo far leffen the pain and cough as fo enable patients to ufe pro- fitable exercife. Where this has not accompani- ed or fucceeded the exhibition of vomits, I be- lieve they have feldom afforded any permanent re<» lief. 5. Blood-lelting has often relieved con- fumptions ; but it has been only by removing the troublefome fymptoms of inflammatory diathefis, and thereby enabling the patients to ufe exercife, or labour, with advantage. 6. Vegetable bitters and fome of the sti- mulating gums have in fome inftances afforded relief in confumptions; but they have done fo Only in thofe cafes Where there was great debility, accompanied by a total abfence of inflammatory diathefis. They have moft probably acted by their so© thoughts on the consumption". their tonic qualities as fubftitutes for labour and exercife. 7. A plentiful and regular perspira- tion excited by means of a flannel fhirt worn next to the fkin, or by means of a ftove-room, or by a warm climate, has in many inftances prslonged life in confumptive habits; but all thefe remedies have acted as palliatives only, and thereby have enabled the confumptive patients to enjoy the more beneficial effects of exercife. 8. blisters, setons, and issues, by deter- mining the perfpirable matter from the lungs to the furface of the body, leffen pain and cough, and thereby prepare the fyftem for the more falu- tary effects of exercife. 9. The effects of swinging upon the pulfe and refpiration, leave us no room to doubt of its being a tonic remedy, and therefore a fafe and agreeable fubftitute for exercife. From all thefe facts it is evident that the reme- dies for confumptions muft be fought for in thofe exercifes and employments which give the greateft vigour to the confiitution. And here I am happy in being able to produce feveral facts which de- monftrate thoughts oh the consumption. 20X Sionftrate the fafety and certainty of this method of cure. ' During the late war, I faw three inftances of perfons in confirmed confumptions who were per- fectly cured by the hardfhips of a military life. They had been'my patients previoufiy to their entering into the army. Befides thefe, I have heard of four well attefted cafes of fimilar reco- veries from nearly the fame remedies. One of thefe was the fon of a farmer in New-Jerfey, who was fent to fea as the laft refource for a confump- tion. Soon after he left the American fhore, he was taken by a Britifh cruifer, and compelled to fhare in all the duties and hardfhips of a common failor. After ferving in this capacity for twenty- two months, he made his efcape, and landed at Bofton, from whence he travelled on foot to his father's houfe, (nearly four hundred miles) where he arrived in perfect health. Doctor Way of Wilmington informed me, that a certain Abner Cloud, who was reduced fo low by a pulmonary confumption as to be beyond all relief from medicine, was fo much relieved by fleeping in the open air, and by the ufual toils of building a hut and improving a farm in the un- fettled parts of a new country in Pennfylvania, that *02 THOUGHTS ON THE dOKfllTWPf fOtf« that he thought him in a fair way of a petfdtT: re. covery. Doctor Latimer Of* Wilmington had beeft long affiicTed with a cough and ari Otieafidrial hafimof*. tyfis. He entered into the American army as a furgeon, and ferved in that capacity till near the end of the war; during which time he was per- fectly free from all pulmonic complaints. The fnittirig of blood returned foon after he fettled in private practice. To remedy this complaint, he" had recourfe to a low diet, but finding it ineffec- tual, he partook liberally of the ufual diet of heal* thy men, and he now (as he lately informed me) enjoys a good fhare of health. It would be very eafy to ad I many other cafes, in which labour, the employments of agriculture, and a life of hardfhip by fea and land, have pre- vented, relieved, or cured, not only the confump- tion, but pulmonary difeafes of all kinds. To the cafes that have been mentioned, I mall add only one more, which was lately communi- cated to me by the venerable Doctor Franklin, whofe converfation at all times conveys inftruction, and not lefs in medicine than upon other fubjects. In travelling, many years ago, through New- i England, THOUGHTS ON THE CONSUMPTION. 203 England, the Doctor overtook the poft-rider; and i after fome inquiries into the hiftory of his Ufe, he informed him that he was bred a fhoemaker; that his confinement, and other circumftances, had brought on a confumption, for which he was or- dered by a phyfician to ride on horfeback. Find- ing this mode of exercife too expenfive, he made intereft, upon the death of an old poft-rider, to fucceed to his appointment, in which he perfectly recovered his health in two years. After this he returned to his old trade, upon which his con- fumption returned. He again mounted his horfe, and rode poft in all feafons and weathers, between New-York and Connecticut river, (about1 140 miles) in which employment he continued up- wards of thirty years, in perfect health. Thefe facts, I hope, are fufficient to eftablifh the advantages of reftoring the original vigour of the conftitution, in £very attempt to effect a radi- cal cure of confumption. But how fhall thefe remedies be applied in the time of peace, or in a coumry where the want of woods, and brooks without bridges, forbid the attainment of the laborious pleafures of the Indian mode of hunting ; or where the univerfal extent of civilization does not admit of our advifing the Vol. I. O toils 2C4 THOUGHTS ON THE CONSUMPTION. toils of a new fettlement, and improvements upon bare creation ? Und^r thefe circumftances, I con- ceive fubftitutes may be obtained for each of them, nearly of equal efficacy, and attainable with much lefs trouble. i. Doctor Sydenham pronounced riding on horfe-back, to be as certain a cure for confump- tions as bark is for an intermitting fever. I have no more doubt of the truth of this affertion, than I have that inflammatory fevers are now lefs fre- quent in London than they were in the time of Doctor Sydenham. If riding on horfeback in con- fumptions has ceafed to be a remedy in Britain, the fault is in the patient, and not in the remedy. " It is a fign that the ftomach requires milk, " (fays Doctor Cadogan) when it cannot bear it." In like manner, the "inability of the patient to bear this manly and wholefome exercife, ferves only to demonftrate the neceflity and advantages of it. I fufpect the fame objections to this exercife which,have been made in Britain, will not occur in the United States of America ; for the Ameri- cans, with refpect to the fymptoms and degrees of epidemic and chronic difeafes appear to be nearly in the fame ftate that the inhabitants of England were in the feventeenth century. I can eafily conceive the vigour of the human conftitu- tion THOUGHTS ON THE CONSUMPTION. 20j tion to have been fuch in Doctor Sydenham's timej as that a defluxion or ulcer in the lungs fhould have had no more effect in increafing the action of the arterial fyftem, than a moderate inflamma- tion of the eyes ha9 at prefent in exciting an in- flammatory fever in a good conftitution; hence the fafety and advantage formerly of riding on horfeback in pulmonic complaints. We find, in proportion to the decline of the vigour of the body, that many occafional caufes produce fever and inflammation, which would not have done it an hundred years ago. 2. The laborious employments of agriculture, if fteadily purfued, and accompanied at the fame time by the fimple, but wholefome diet of a farm- houfe, and a hard bed, would probably afford a good fubftitute for the toils of a favage or military life. 3. Such occupations or profeflions as require conftant labour or exercife in the open air in all kinds of weather, may eafily be chofen for a young man who, either from hereditary predifpo- fition, or an accidental affection of the lungs, is in danger of falling into a confumption. In this we fhould imitate the advice given by fome wife men, always to prefer thofe profeflions for our fons O 2 which 206 THOUGHTS ON THE CONSUMPTION. which are the leaft favourable to the corrupt in- clinations of their hearts. For example, where an undue paffion for money, or a crafty difpofi- tion difcover themfelves in early life, we are di- rected to oppofe them by the lefs profitable and more difmterefted profeflions of divinity, or phy- fic, rather than cherifh them by trade, or the practice of the law*. 4. There is a cafe recorded by Dr. Smollet, of the efficacy of the cold bath in a confumption; And I have heard of its having been ufed with fuccefs in the cafe of a negro man in one of the Weft-India Iflands. To render this remedy ufe- ful, or even fafe, it will be neceffary to join it with labour, or to ufe it in degrees that fhall pre- vent the alternation of the fyftem with vigour and debility; for I take the cure of confumption to * It is very common for parents to prefer fedentary occupations for fuch of their children who are of delicate conftitutions, and the more atfive occupations for thofe of them who are robuft. The reverfi of this pra&ice fhould be f jllowed. The weakly children fhould be trained to the laborious, and the robuft to the fedentary occupations. From a negleft of this pra&ice, many hundred apprentices to taylors, fhoemakers, conveyancers, watchmakers, filver- fmiths, mantua-makers, &c. &c. perifh every year by con- fumptions. depend THOUGHTS ON THE CONSUMPTION. 2©7 depend upon the fimple action of tonic, wi-hout the leaft mixture of debilitating powers. Indeed, I conceive it to be eafier to palliate the fymp- toms, and prolong life, by the ufe of powers which are fimply debilitating, than by a mixture of both of them. This is not a folitary fact in the human body. We often fee a ftiff neck and fpafms, brought on by a perfon's being expof:d, at the fame time, to a ftream of air from a door or a window, and to the heat of a warm room, where neither would have been injurious if it had acted fingly upon the fyftem. There are many extremes in phyfic, as in other things, which meet in a point. There is an inflammatory dia- thefis connected with debility, as certainly as with an excefs of tone in the arterial fyftem. And I think I have feen greater degrees of this inflam- matory diathefis in the male inhabitants of cities, than of the country, and more in women than in men. I have moreover feen the moft acute in- flammatory difeafes where the fyftem twd been previoufiy debilitated by a long continuance of warm weather, or of an obftinate intermitting fe- ver, and in too many inftances by the ufe of fpiri- tuous liquors. It is the prefence of this ipecies of inflammatory diathefis which renders confumptions fo much more difficult to cure than formerly? Is it this which often renders riding on horfeback fo O 3 ineffectual, 208 THOUGHTS ON THE CONSUMPTION. ineffectual, or fo injurious in this diforder? 1 fuf- pect it is; and it is to be lamented that it often requires fo much time, or fuch remedies to re- move this fpecies of inflammatory diathefis, as to reduce the patient too low to make ufe of thofe remedies afterwards which would effect a radical cure. If it were poffible to graduate the tone of the fyftem by means of a fcale, I would add, that to cure confumptions, the fyftem fhould be raifed to the higheft degree of this fcale. Nothing fhort of an equilibrium of tone, or a free and vigorous ac- tion of every mufcle and vifcus in the body, will fully come up to a radical cure for confumptions. * In regulating the diet of confumptive patients, I conceive it to be as neceffary to feel the pulfe, as it is in determining when and in what quan- tity to draw blood. Where inflammatory diathe- fis prevails, a vegetable diet is certainly proper; but where the patient has efcaped, or paffed this ftage of the diforder, I believe a vegetable diet alone to be injurious; and am fure a moderate quantity of animal food may be taken with advan- tage. In both cafes, the diet fhould confift, as much as poffible, of one kind of aliment. The THOUGHTS ON THE CONSUMPTION. 20C. The prefence or abfence of this inflammatory diathefis, furnifhes the indications for adminifter- ing or refraining from the ufe of th? bark and balfamic medicines. With all the teftimonies of their having done mifchief," many of which I could produce, I have known feveral cafes in which they have been given with obvious advantage; but it was only when there was a total abfence of inflam- matory diathefis. Perhaps the remedies I have recommended, and the opinions 1 have delivered, may derive fome fnpport from attending to the analogy of ulcers on the legs, and in other parts of the body. The firft of thefe occur chiefly in habits debilitated by fpirituous liquors, and the laft frequently in habits debilitated by the fcrophula. In curin? thefe diforders, it is in vain to depend upon inter- nal or external medicines. The whole fyftem muft be ftrengthened, or we do nothing; and this is to be effected only by exercife and a generous diet. In relating the facts that are contained in this effay, I wifti I could have avoided reafoning upon them; efpecially as I am confident of the certainty of the facts, and fomewhat doubtful of the truth of my reafonings. O 4 1 fliall 2IO THOUGHTS ON THE CONSUMPTION. I fhall. only add, that if the cure of confump- tions-fhould at laft be'effected by remedies in every refpect the oppofites of thofe palliatives which are now fafhioriable and univerfal, no more will happen than what we have already feen in the tetanus, the fmall-pox, and the management of fractured limbs. Should this be the cafe, we fhall not be fur- prifed to hear of phyficians, inftead of preferibing any one, or all of the medicines formerly enume- rated for confumptions, ordering their patients to exchange the amufements, or indolence of a city, for the toils of a country life; of their advifing farmers to exchange their plentiful tables, and comfortable fire-fides, for the fcanty Lur folid fub- fiftence, and midnight expofure of the herdfman; or of their recommending, not fo much the exer- cife of a pafiive fea-voyage, as the aclive labours and dangers of a common failor. Nor fhould it furprife us, after what we have feen, to hear pa- tients relate the pleafant adventures of their ex- curfions or labours, in queft of their recovery from this diforder, any more than it does now to fee a ftrong or well fhaped limb that has been broken; or to hear a man talk of his ftudies, or pleafures, during the time of his being inoculated and at- tended for the fmall-pox. I will THOUGHTS ON THE CONSUMPTION. 2U I will not venture to affert, that there does not exift a medicine which fhall fupply, at leaft in fome degree, the place of the labour or exercrfes, whofe ufefulnefs in confumptions has been efta- blifhed by the facts that have been mentioned. Many inftances of the analogous effects of medi- cines, and.of exercife upon the human body, for- bid the fuppofition. I fhall only add, that if there does exift in nature fuch a medicine, I am difpofed to believe it will be found in the clafs of tonics. If this fhould be the cafe, I conceive its ftrength, or its dofe, muft far exceed the prefent ftate of our knowledge or practice, wit'h refpect to the efficacy or dofe of tonic medicines. I except the diforder, which arifes from recent abfceffes in the lungs, from the general obferva- tion which has been made, refpedting the ineffi- cacy of the remedies that were formerly enume- rated for the cure of confumptions without labour or exercife. Thefe abfceffes, often occur without being preceded by general debility, or accompa- nied by a confumptive diathefis, and are frequently cured by nature, or by very fimple medicines. I 2I3 ] OBSERVATIONS UPON WORMS IN THE ALIMENTARY CANAL. AND UPON ANTHELMINTIC MEDICINES. ITH great diffidence I venture to lay be- fore the public my opinions upon worms: nor fhould I have prefumed to do it, had I not entertained a hope of thereby exciting further in- quiries upon this fubject. When we confider how univerfally worms are found in all young animals, and how frequently they exift in the human body, without producing difeafe of any kind, it is natural to conclude, that they ferve fome ufeful and neceffary purpofes in the animal ceconomy. Do they confume the fu- perfluous w 214 OBSERVATIONS UPON WORMS perfluous aliment which all young animals are dif- pofed to take before they have been taught, by ex- perience or reafon, the bad confequences which arife from it? It is no objection to this opinion, that worms are unknown in the human body in fome countries. The laws of nature are diverfi- fied, and often fufpended under peculiar circum- ftances in many cafes, where the departure from uniformity is ftill more unaccountable, than in the prefent inftance. Do worms produce difeafes from an excefs in their number, and an error in their place in the fame manner that blood, bile and air produce difeafes from an error in their place, or from excefs in their quantities ? Before thefe quef- tions are decided, I fliall mention a few facts which have been the refult of my own obfervations upon this fubject. < i. In many inftances I have feen worms dif- charged in the fmall-pox and meafles, from chil- dren who were in perfect health previoufiy to their being attacked by thofe diforders, and who never before difcovered a fingle fymptom of worms. I fhall fay nothing here of the fwarms of worms which are difcharged in fevers of all kinds, until I attempt to prove that an idiopathic fever is never produced by worms. 2. Nine AND ANTHELMINTIC MEDICINES. 2If 2. Nine out often of the cafes which I have feen of worms, have been in children of the groffi- eft habits and moft vigorous conftitutions*. This is more efpecially the cafe where the worms are diflodged by the fmall-pox and mealies. 3. In weakly children, I have often known the . moft powerful anthelmintics given without bring- ing away a fingle worm. If thefe medicines have afforded any relief, it has been by their tonic qua- lity. From this fact, is it not probable—The conjecture I am afraid is too bold—but I will rifk it. Is it not probable, I fay, that children are fometimes difordered from the want of worms ? Perhaps the tonic medicines which have been men- tioned, render the bowels a more quiet and com- fortable afylum for them, and thereby provide the fyftem with the means of obviating the effects of * Since the above obfervations upon worms were com- mitted to paper, I have met with the following fadts, in a letter from Dotfor Capelle of Wilmington, which has been read in the College of Phyficians of Philadelphia. In the livers of fixteen, out of eighteen rats which he differed, he imformed me that he found a number of the taenia worms. The rats were fat, and appeared in other refpecls to have been in perfect health. The two rats in which he found no worms, he fays, " were very lean, and their livers fmaller " in proportion than the others," crapulas, 2l6 OBSERVATIONS UPON WORMS crapulas, to which all children are difpofed. It is in this way that nature, in many inftances, cures evil by evil. I confine the falutary office of worms only to that fpecies of them which is known by the name of the round worm, and which occurs moft frequently in children. Is there any fuch difeafe as an idiopathic worm- fever ? The Indians in this country fay there is not, and afcribe the difcharge of worms to a fever, and not a fever to the worms*. By adopting this opinion, I am aware that I contradict the obfervations of many eminent and refpectable phyficians. Doctor Huxham defcribes an epidemic pleurify, in the month of March in the year 1740, which he fuppofes was produced by his patients feeding upon fome corn that had been injured by the rain the Auguft beforef. He likewife mentions that a number of people, and thefe too of the elderly fort j, were afflicted at one time with worms in the month of April in the year 1743. * See the Inquiry into the Difeafes of the Indians, p. 24. f Vol. II. »f his Epidemics, p. 5 6. J P. 136. Lieutaude AND ANTHELMINTIC MEDICINES. 217 Lieutaude gives an account of an epidemic worm-fever from Velchius, an Italian phyfician * ; and Sauvages defcribes, from Vandermonde, an epidemic dyfentery from worms, which yielded finally only to worm medicines -f-. Sir John Prin- gle, and Doctor Monro, likewife frequently men- tion worms as accompanying the dyfentery and re- mitting fever, and recommend the ufe of calomel as an antidote to them. I grant that worms appear more frequently in fome epidemic difeafes than in others, and oftener in fome years than in others. But may not the fame heat, moifture and diet, which produced the difeafes, have produced the worms ? And may not their difcharge from the bowels have been occa- floned in thofe epidemics, as in the fmall-pox and meafles, by the increafed heat of the body; by the want of nourifhment; or by an anthelmintic quality being accidentally combined with fome of the medicines that are ufually given in fevers ? In anfwer to this, we are told that we often fee the crifis of a fever brought on by the difcharge of worms from the bowels by means of a purge, * Vol. I. p. 76. f Vol. II. p. 329. or 2l8 OBSERVATIONS UPON WORMS or by an anthelmintic medicine. Whenever this is the cafe, I believe it is occafioned by offending bile being diflodged by means of the purge at ihe fame time with the worms, or by the anthelmintic medicine (if not a purge) having been given on, or near one of the ufual critical days of the fever. What makes the latter fuppofition probable is, that worms are feldom fufpected in the beginning of fevers, and anthelmintic medicines feldom given, till every other remedy has failed of fuccefs ; and this generally happens a^out the .ufual time in which fevers terminate in life or death. It is very remarkable, that fince the difcovery and defcription of the hydrocephalus internus, we hear and read much lefs than formerly of worm- fevers. I fufpect that diforder of the brain hag laid the foundation for the principal part of the cafes of worm-fevers which are upon record in books of medicine. I grant that worms fometimes increafe the danger frdm fevers, and often confound the diagnofis and prognofis of them, by a number of new and analogous fymptoms. But here we fee nothing more than that complication of fymp- toms which often occurs in difeafes of a very dif- ferent and oppofite nature. How often are we puzzled by hyfterie and hypocondriac fymptoms 4 in AND ANTHELMINTIC MEDICINES. 2ig in a fever; and yet what phyfician ever thought of an hyfteric or an hypocondriac fever* ? Having rejected worms as the caufe of fevers, I proceed to remark, that the difeafes moft com- monly produced by them, belong to the clafs of neuroses. And here I might add, that there is fcarcely a difeafe, or a fymptom of a difeafe, be- longing to this clafs, which is not produced by worms. It would be only publifhing extracts from books, to defcribe them. The chronic and nervous difeafes of children, which are fo numerous and frequently fatal, are, I believe, moft commonly occafioned by worms. There is no great danger, therefore, of doing mif- chief by prefcribing anthelmintic medicines in all our firft attempts to cure the chronic and nervous difeafes. I have taken great pains to find out, whether the prefence of the different fpecies of worms might not be difcovered by certain peculiar fymptoms; * I have been much gratified by finding myfelf fupported in the above theory of worm-fevers, by the late Dr. William Hunter, and by Dr. Butter in his excellent treatife upon the infantile remitting ferer. Vol. I. P but 220 OBSERVATIONS UPON W0RM3 but all to no purpofe. I once attended a girl of twelve years of age in a fever, who difcharged four yards of a taenia, and who was fo far from having difcovered any peculiar fymptom of this fpecies of worms, that fhe had never complained of any other indifpofition, than now and then a flight pain in the ftomach, which ofren occurs in young girls from a fedentary life, or from errors in their diet. I beg leave to add further, that there is not a fymptom which has been faid to in- dicate the prefence of worms of any kind, as the caufe of a difeafe, that has not deceived me; and none oftner than the one that has been fo much depended upon, viz. the picking of the nofe. A difcharge of worms from the bowels, is, perhaps, the only fymptom that is pathognomonic of their prefence in the inteftines. I fhall now make a few remarks upon anthel- mintic remedies. But I fhall firft give an account of fome experi- ments which I made in the year 1771, upon the common earth-worm, in order to afcertain the an- thelmintic virtues of a variety of fub^ances. I made choice of the earth-worm for this purpofe, as it is, according to naturalifts, exactly the fame in its ftrudture, manner of fubfiftence, and mode of ASD ANTHELMINTIC MEDICINES. 221 of propagating its fpecies, with the round worm, of the human body. In the firft column I fhall fet down, under dif- tinct heads, the fubftances in which worms were placed; and in the fecond and third columns the time of their death, from the action of thefe fub- ftances upon them. I. 'Bitter and Astringent Hours. Minutes. Substances. Watery Infufion of Aloes, 2 1 1 1 1 1 +8 30 17 II. Purges. Watery Infufion of Jalap, • ■ of Gamboge, III. Salts. I. Acids. Vinegar, -Lime Juice, Diluted nitrous Acid, — i% convulfed. 1 2. Alkali. A watery Solution of Salt of Tartar, - 2 convulfed, throw- 3. Neutral Salts. In a watery Solution of com-mon Salt, ... ----of Nitre, ----of Sal Diuretic, - -----of Sal Ammoniac, ■ of common Salt and Sugar, — ing up a mucus on the furface of the water. 1 convulfed. ditto. ditto. ih 4 P 2 4. Earthy 222 OBSERVATIONS UPON WORMS 4. Earthy and Metallic Hours.] Minutes. - Salts. In a watery Solution of Epfom Salt, — '5$ ----of Rock Alum, — 10 ----of Corrofive Subli- mate, _ 1 \ convulfed. ----of Calomel, _ 49 •—- of Turpeth Mineral, — 1 convulfed. —— of Sugar of Lead, — 3 ----of green Vitriol, _ 1 ----of blue Vitriol. __ IO ----of white Vitriol, — 30 IV. Metals. — Filings of Steel, r *S'r Filings of Tin V. Calcareous Earth. 2 Chalk, — VI. Narcotic substances. Watery Infufion of Opium, — u, convulfed, . of Carolina Pink-root, — 33 ■<---of Tobacco, — M VII. Essential Oils. Oil of Wormwood, - - — 3 convulfed. ----of Mint, — 3 ----of Caraway Seed, — 3 .----of Amber, — il ----of Annifeed, — 4r ----of Turpentine, — 6 VIII. Arsenic. A watery Solution of white near Arfenic, 2 — IX. FisR?2Svvrfi Liquors. In Madeira Wine, — 3 convulfed. — Claret, — 10 X. DlJTILLIi AND ANTHELMINTIC MEDICINES. 22j X. Distilled Spirit. Common Rum, XI. The fresh Juices 05 ripe Fruits. The Juice of red Cherries, . ----of black ditto, ----of red Currants, ■ ■ — of Goofeberries, ■ '■ of Whortleberries, —— of Blackberries, ----of Rafberries, ----of Plumbs, ----. of Peaches, ——— of Watermelons, no ef- fect, XII. Saccharine Substan- ces. Honey, MolafTes, Brown Sugar, Manna, - XIII. In Aromatic Substan- ces. Camphor, - Pimento, . - ' - Black Pepper, XIV. Foet*id Substances. Juice of Onions, Watery Infufion of AfTa- fcetida, . ■ ■- Santonicum, or Worm Seed, XV. Miscellaneous Sub- stances. Sulphur mixed with Oil, jEthiops Mineral, Sulphur, Hours. ^3 Minutes. 1 convulfed. 5* 5 3^ 12 7 54 13 2 5 7 7 3° 24 5 Si 45 3t 27 Solution 324 OBSERVATIONS U*ON WORMS Solution of Gunpowder, of Soap, Oxymel cf Squills, Sweet Oil. »9 3* 3<> In the application of thefe experiments to the human body, an allowance muft always be made for the alteration which the feveral anthelmintic fubftances that have been mentioned, may under- go from mixture and diffufion in the ftomach and bowels. In order to derive any benefit from thefe ex- periments, as well as from the obfervations that have been made upon anthelmintic medicines, it will be neceifary to divide them into fuch as act, 1. Mechanically, 2. Chemically upon worms j and, 3. Into thofe which polTefs a power compofed of chemical and mechanical qualities. 1. The mechanical medicines act indirectly and directly upon the worms. Thofe which act indiretlly are, vomits, purges, bitter and aftringent fubftances, particularly aloes, rhubarb, AND ANTHELMINTIC MEDICINES. 2-25 rhubarb, bark, bear's-foot, and worm-feed. Sweet- oil acts indirectly and very feebly upon worms. It was introduced into medicine from its efficacy in dcftroying the botts in horfes; but the worms which iufeft the human bowels, are of a different nature, and poffefs very different organs of life from thofe which are found in the ftomach of an horfe. Thofe mechanical medicines which act direclly upon the worms, are, cowhage * and powder of tin. The laft of thefe medicines has been fup- pofed to act chemically upon the worms, from the arfcnic which adheres to it; but from the length of time a worm lived in a folution of white arfenic, it is probable the tin acts altogether mechanically upon them. 2. The medicines which act chemically upon worms, appear, from our experiments, to be very numerous. Nature has wifely guarded children againft the morbid effects of worms, by implanting in them an early appetite for common fait, ripe fruits and faccluirine fubftances j all of which appear to be. * Dolichos Pruriens, of Linnxus. P 4 among £26 OBSERVATIONS UPON WORMS among the moft fpeedy and effectual poifons for worms. Let it not be faid, that nature here counteracts her own purpofes. Her conduct in this bufinefs is conformable to many of her operations in the human body, as well as throughout all her works. The bile is a neceffary part of the animal fluids, and yet an appetite for ripe fruits feems to be im-, planted chiefly to obviate the confequences of its excefs, or acrimony, in the fummer and autumnal months. The ufe of common fait as an anthelmintic me- dicine, is both ancient and univerfal. Celfus re- commends it. In Ireland it is a common practice to feed children, who are afflicted by worms, for a week or two upon a falt-fea weed, and when the bowels are well charged with it, to give a purge of wort in order to carry off the worms, after they are debilitated by the fait diet. I have adminiftered many pounds of common fait coloured with cochineal, in dofes of half a drachm, upon an empty ftomach in the morning, with great fuccefs in deftroying worms. Ever fince I obferved the effects of fugar and other fweet fubftances upon worms, I have recom- mended AND ANTHELMINTIC MEDICINES. 227 mended the liberal ufe of all of them in the diet of children, with the happieft effects. The fweet fubftances probably act in preventing the difeafes from worms in the ftomach only, into which they often infinuate themfelves, efpecially in the morn- ing. When we wifti to diflodgc> worms from the bowels by fugar or melaffes, we muft give thefe fubftances in large quantities, fo that they may efcape in part the action of the ftomach upon them. I can fay nothing from my own experience of the efficacy of the mineral falts, compofed of cop- per, iron and zinc, combined with vitriolic acid, in deftroying worms in the bowels. ' Nor have I ever ufed the corrofive fublimate in fmall dofes as an anthelmintic. I have heard well-attefted cafes of the efficacy of the oil of turpentine in deftroying worms. The expreffed juices of onions and of garlic are very common remedies for worms. From one of the experiments it appears that the onion juice poffeffes ftrong anthelmintic virtues. I have often prefcribed a tea-fpoonful of gun- powder in the morning upon an empty ftomach, with 32o 0B3EVATI0NS UPON WORMS with obvious advantage. The active medicine here is probably the nitre. I have found a fyrup made of the bark of the Jamaica cabbage-tree*, to be a powerful as well as a moft agreeable anthelmintic medicine. It fomttimes purges and vomits, but its good effects may be obtained without giving it in fuch dofea as to produce thefe evacuations. There is not a more certain anthelmintic than Carolina pink.root f. But as there have been in- ftances of death having followed exceffive dofes of it, imprudently adminiftered ; and as children are often affected by giddinefs, ftupor, and a rednefs and pain in the eyes, after taking it, I acknow- lekge that I have generally preferred to it, lefs certain, but more fafe medicines for deftroying worms. 3. Of the medicines whofe action is compound- ed of mechanical and chemical qualities, calomel, jalap, and the powder of fteel, are the principal. Calomel, in order to be effectual, muft be given in large dofes. It is a fafe and powerful anthcl- * Geoffrea, of Linnseus. t Spigelia Marylandica, of Linnaeus. mintic. AND ANTHELMINTIC MEDICINES. 229 mintic. Combined with jalap, it often brings away worms when given for other purpofes. Of all the medicines that I have adminiftered, I know of none more fafe and certain than the fimple preparations of iron, whether they be given in the form of fteel-filings or of the ruft of iron. If ever they fail of fuccefs, it is becaufe they arc given in too fmall dofes. I generally prefcribe from five, to thirty grains every morning, to chil- dren between one year, and ten years old; and I have been taught by an old fea-captain, who was cured of a taenia by this medicine, to give from two drachms to half an ounce of it, every morn- ing, for three or four days, not only with fafety, but with fuccefs. I fliall conclude this effay with the following remarks. > 1. Where the action of medicines upon worms in the bowels does not agree exactly with their action upon the earth-worms in the experiments that have been related, it muft be afcribed to the medicines being more or lefs altered by the action of the ftomach upon them. I conceive that the fuperior anthelmintic qualities of Pink-root, fteel- Jilipgs and calomel (all of which acted but flowly upoi £$0 OBSERVATIONS UPON WORMS &£. upon the earth-worms compared with many other fubftances) are in a great degree occafioned by their efcaping the digeftive powers unchanged, and acting in a concentrated ftate upon the worms. 2. In fevers attended with anomalous fymptoms, which are fuppofed to arife from worms, I have conftantly refufed to yield to the folicitations of my patients, to abandon the indications of cure in the fever, and to purfue worms as the principal caufe of the difeafe. While I have adhered ftea- dily to the ufual remedies for the different genera and fpecies of fever, in all their ftages, I have at the fame time blended thofe remedies occafionally with anthelmintic medicines. In this I have imitated the practice of phyficians in many other difeafes; in which troublefome and dangerous fymptoms are purfued, without feducing the attention from the original diforder. AN C «3> 1 A N ACCOUNT OF THI EXTERNAL USE OF ARSENIC IN THX Cure of Cancers. Read before the American Philofophical Society, February 3, 1786. AF E W years ago, a certain Doctor Hugh Martin, a furgeon of one of the Pennfylva- nia regiments ftationed at Pittfburg, during the latter part of the late war, came to this city, and advertifed to cure cancers with a medicine which he faid he had difcovered in the woods, in the neighbourhood of the garrifon. As Dr. Martin had once been my pupil, I took the liberty of waiting upon him, and aiked him fome queftions refpecting his difcovery. His anfwers were cal- culated to make mc believe, that his medicine TT„4 232 ACCOUNT OF THE USE OF ARSENIC was of a vegetable nature, and that it was origin- ally an Indian remedy. He (hewed me fome of the medicine, which appeared to be the powder of a well dried root of fome kind. Anxious to fee the fuccefs of this medicine in cancerous fores, I prevailed upon the doctor to admit me to fee him apply it in two or three cafes. I obferved in fome inftances, he applied a powder to the parts affected, and in others only touched them with a feather dipped in a liquid which had a white fedi- ment, and which he made me believe was the ve- getable root diffufed in water. It gave me great pleafure to witnefs the efficacy of the doctor's ap- plications. In feveral cancerous ulcers the cures he performed were complete. Where the cancers were much connected with the lymphatic fyftem, or accompanied with a fcrophulous habit of body, his medicine always failed, and, in fome inftances, did evident mifchief. Anxious to difcover a medicine that promifed relief in even a few cafes of cancers, and fup- pofing that all the cauftic vegetables were nearly alike, I applied the phytolacca or poke-root, the ftramonium, the arum, and one or two others, to foul ulcers, in hopes of feeing the fame effects from them which I had feen from Doctor Mar- tin's powder; but in thefe I was difappointed. They IN THE CURE 0* CANCERS. 211 They gave fome pain, but performed no cures. At length I was furnimed by a gentleman from Pittfburgh with a powder .which I had no doubr, frOm a variety of circumftances, was of the fame kind 2s that ufed by Doctor Martin. I applied it to a fungous ulcer, but without producing the degrees df pain, inflammation; or difcharge, which I had been accuftoraed to fee from the application of Doctor Martini powder. After this, I fhould have fufpected that the powder was not a fimple root, had not the doctor continued upon all occa- fions to affure me, that it was wholly a vegetable preparation. In the beginning of the year 1784, the doctor died, and it was generally believed that his medi- cine had died with him. A few weeks after his death I procured, from one of his adminiftrators, a few ounces of the doctor's powder, partly with a view of applying it to a cancerous fore which then offered, and partly with a view of examining it more minutely than I had been able to do dur- ing the doctor's life. "Upon throwing the pow- der, which was of a brown colour, upon a piece of white paper, I perceived distinctly a number of white particles fcattered through it. I fufpected at firft that they were corrofivc fublimate, but the ufual tefts of that metallic fait foon convinced me «34 ACCOUNT OF THE USE OF ARSENICA that I was miftaken. Recollecting that arfenic was the bafis of moft of the celebrated cancer powders that have been ufed in the world, I had recourfe to the tefts for detecting it. Upon fprink- ling a fmall quantity of the powder upon fome coals of fire, it emitted the garlick fmell fo per- ceptibly as to be known by feveral perfons whom I called into the room where I made the experi- ment, and who knew nothing of the object of my enquiries. After this with fome difficulty I picked out about three or four grains of the white pow- der, and bound them between two pieces of cop- per, which I threw into the fire. After the cop- per pieces became red hot, I took them out of the fire, and when they had cooled, difcovered an evident whitenefs imparted to both of them. One of the pieces afterwards looked like dull filver. Thefe two tefts have generally been thought fuffi- cient to diftinguifti the prefence of arfenic in any bodies; but I made ufe of a third, which has lately been communicated to the world by Mr Bergman, and which is fuppofed to be in all cafes infallible. I infufed a fmall quantity of the powder in a folution of a vegetable alkali in water for a few hours, and then poured it upon a folution of blue vitriol in water. The colour of the vitriol was immc- IN THE CURE OF CANCERS^ 235 immediately changed to a beautiful green, and af- terwards precipitated. I fhall dofe this paper with a few remarks upon this powder, and. upon the cure of cancers and foul ulcers of all kinds. 1. The ufe of cauftics in cancers and foul ul- cers is very antient, and univerfal. But I believe arfenic to be the moft efficacious of any that has ever been ufed. It is the bafls of Plunket's and probably of Guy's well known cancer powders. The great art of applying it fuceefsfully, is to di- lute and mix it in fuch a manner as to mitigate the violence of its action. Doctor Martin's compofi- tion was happily calculated for this purpofe. It gave lefs pain than the common or lunar cauftic. It excited a moderate inflammation, which fepa- rated the morbid from the found parts, and pro- moted a plentiful afflux of humours to the fore during its application. It feldom produced an efcar; hence it infinuated itfelf into the deepeft receffes of the cancers, and frequently feparated thofe fibres in an unbroken ftate which are gene- rally called the roots of the cancer. Upon this account, I think, in an ulcerated cancer it is to be preferred to the knife. It has no action upon the found fkin. This Doctor Hall proved by confining Vol. I. Q.. a fmall 236 ACCOUNT OF THE USE OF ARSENIC a fmall quantity of it upon hi* arm for many hours. In thofe cafes where Doctor Martin ufed it to ex- tract cancer®us or fchirrous tumours that were not ulcerated, I have raafon to believe that he always broke the fkin with Spanifh flies. 2. The arfenic ufed by the doctor was the pure white arfenic. I fhould fuppofe from the exami- nation I made of the powder with the eye, that the proportion of arfenic to the vegetable powder, could not be more than t? part of the whole com- pound. I have rcafon to think that the doctor employed different vegetable fubftances at differ. ent times. The vegetable matter with which the arfenic was combined in the powder which I ufed in my experiments, was probably nothing more than the powder of the root and berries of the folanum lethale, or deadly nightfhade. As the principal, and perhaps the only defign of the ve- getable addition was to blunt the activity of the arfenic, I ibould fuppofe that the fame proportion of common wheat flour as the doctor ufed of his cauftic vegetables, would anfwer nearly the fame purpofe. In thofe cafes where the Doctor applied a feather dipped in a liquid to the fore of his pa- tient, I have no doubt but his phial contained nothing but a weak folution of arfenic in water. This is no new method of applying arfenic to foul ulcers. IN THE CURE OF CANCERS. 237 ulcers. Doctor Way of Wilmington, has fpoken in the higheft terms to me of a wafh for foulneffes on the ikin, as well as old ulcers, prepared by boil- ing an ounce of white arfenic in two quarts of water to three pints, and applying it once or twice a day. 3. I mentioned, formerly, that Doctor Martin was often unfuccefsful in the application of his powder. This was occafioned by his ufing it in- difcrirainately in all cafes. In fchirrous and can- cerous tumours, the knife fhould always be pre- ferred to the cauftic. In cancerous ulcers attend- ed with a fcrophulous or a bad habit of body, fuch particularly as have their feat in the neck, in the breafts of females, and in the axillary glands, it can only protract the patient's mifery. Moft of the cancerous fores cured by Doctor Martin were feated on the nofe, or cheeks, or upon the furface or extremities of the body. It remains yet to difcover a cure for cancers that taint the fluids, or infect the whole lymphatic fyftem. This cure I apprehend muft be fought for ia diet, or in the long ufe of fome internal medicine. To pronounce a difeafe incurable, is often to render it fo. The intermitting fever, if left to itfelf, would probably prove frequently, and per- Q^2 haps 238 ACCOUNT OF THE USE OF ARSENIC. haps more fpeedily fatal than cancers. And as cancerous tumours and fores are often neglected, or treated improperly by injudicious people, from an apprehenfion that they are incurable, (to which the frequent advice of phyficians " to let them " alone," has no doubt contributed) perhaps the introduction of arfenic into regular practice as a remedy for cancers, may invite to a more early application to phyficians, and thereby prevent the deplorable cafes that have been mentioned, which are often rendered fo by delay or unfkilful ma- nagement. 4. It* is not in cancerous fores only that Doctor Martin's powder has been found to do fervice. In fores of all kinds, and from a variety of caufes, where they have been attended with fungous flefh or callous edges, I have ufed the doctor's powder with advantage. I flatter myfelf that I fhall be excufed in giving this detail of a quack medicine, when the fociety reflect that it was from the inventions and temerity of quacks, that phyficians have derived fome of their moft active and moft ufeful medicines. r 239 i OBSERVATIONS ON THE CAUSE and CURE O F T H E TETANUS. Read before the American Philosophical Society, March 17, 1786. DURING my attendance, as phyfician-gene- ral, upon the military hofpitals of the United States, in the courfe of the late war, I met with feveral cafes of the tetanus. I had frequently met with this diforder in private practice, and am forry to fay, that I never fucceeded with the ordinary remedy of opium in any one cafe that came under my care. I found it equally ineffectual in the army. BafHed in my expectations from a remedy that had been fo much celebrated, I began to in- veftigate more particularly the nature of the dif- order. I found it to be a diforder of warm cli- Q^ 3 mates, 240 OBSERVATIONS ON THE CAUSE mates, and warm feafons. This led me to afcribe it to relaxation. I refolved to attempt the cure of it by medicines in fome meafure the oppofites of moft of thofe which have been employed in that diforder. Soon after I adopted this rcfolu- tion, I was called to vifit Col. John Stone, who was wounded through the foot at the battle of Ger- mantown, on the 4th of Oaober 1777. He was in the third day of a tetanus. His fpafms were violent, and his pains fo exquifite, that his cries were heard near a hundred yards from his quar- ters. His head was thrown a little backwards, and his jaw had become ftiff and contracted. He was under the care of a fkilful regimental furgeon, who was pouring down opium in large quantities with- out effect. Duty and friendfhip both led me to do my ut- moft to five the life of this valuable officer. I im- mediately difmiffed the opium, and gave him large quantities of wine and bark, to the amount of two or three ounces of the latter, and from a bottle to three pints of the iormer in the day. In a few hours I was delighted with their effects. His fpafms and pains were lefs frequent and violent, and he flept for feveral hours, which he had not done for feveral days and nights before. With AND CURE OF THE TETANUS. 24I With the fame indication in view, I applied a blifter between his fhoulders, and rubbed in two or three ounces of mercurial ointment upon the outfide of his throat. He continued to mend gra- dually under the operation of thefe medicines, fo that in ten days he was out of danger, although the fpafm continued in his wounded foot for feve- ral weeks afterwards. In the fummer of the year 1782, I was called to vifit a fervant girl of Mr. Alexander Todd, merchant of this city, who had brought on a te- tanus by fleeping in the evening on a damp brick pavement, after a day in which the mercury in Farenheit's thermometer had ftood at near 90°. The cafe was nearly as violent and alarming as the one I have defcribed. I treated her in the fame manner, and with the fame fuccefs. To the above named medicines, I added only the oil of amber, which fhe took in large dofes, after I fufpected the tonic and ftimulating powers of the bark and wine began to lofe their effects. The good effects of the oil were very obvious. She recovered gra- dually, and has continued ever fince in good health. In the fummer of the fame year, I was called to Alexander Leflie, a joiner who had run a nail (^4 in S42 OBSERVATIONS ON THE CAUSE into his foot. I found him the day afterwards ia extreme pain, with fmall convulfions, and now and then a twinge in his jaw. The wound in his foot was without fwelling or inflammation. I dilated the wound and filled it with lint moiftened with fpirit of turpentine. This in a little while pro- duced a good deal of pain and a great inflamma- tion in his foot. While I was preparing to treat him in the manner I had treated the two former cafes, the pains and fpafms in his body fuddenly left him, and in twenty-four hours after I faw him, he complained of nothing but of the pain and fwel- ling in his foot, which continued for feveral weeks, and did not leave him till it ended in a fuppura- tion. From the hiftory of thefe three cafes, I beg leave to make the following remarks: i. That the predifpofition to the tetanus depends upon a relaxation of the mufcular part of the ner- vous fyftem. This relaxation is generally pro- duced by heat; but exceffive labour, watchings, marches, or fatigue from any caufe, all produce it likewife; and hence we find it more frequent from wounds received in battles, than from fimilar wounds received in any other way. Thefe wounds more certainly produce the tetantis, if they have been preceded for fome time with warm weather. Doctor Shoepft, the phyfician-general of the An- fpach AND CURE OF THE TETANUS. 243 fpach troops who ferved at the fiege of York in the year 1781, informed me of a lingular fact upon this fubject. Upon converfing with the French furgeons after the capitulation, he was informed by them that the troops who arrived juft before the fiege from the Weft Indies with Count de Graffe, were the only troops belonging to their nation who fuffered from the tetanus. There was not a fingle inftance of that diforder among the French troops who had fpent a winter in Rhode- Ifland. 2. As the tetanus feems to be occafioned by relaxation, the medicines indicated to cure it are fuch only* as are calculated to remove this relax- ation, and to reftore tone to the mufcular fyftem. The bark, wine, and blifters, appear to act in this way. But I will go one ftep further. In order to cure this diforder, it is neceffary not only to produce an ordinary tone, but a moderate degree of inflammatory diathefis in the arterial fyftem. The abfence of this diathefis is taken notice of by all authors, particularly by Doctor Cullen *. Mercury appears to act only by promoting this diathefis. Hence it never does any fervice unlefs J * Firft Lines, Vol. III. it 244 OBSERVATIONS ON THE CAUSE it be given time enough to produce a falivation. The irritation and inflammation produced in the mouth and throat, feldom fail to produce the in- flammatory diathefis, as blood drawn in a falivation has repeatedly fhewn. I apprehend that the oil of amber acts as a fti- rnulant chiefly in this diforder. I have heard of a tetanus being cured in the ifland of Grenada by large dofes of muftard. Doctor Wright, lately of the ifland of Jamaica, relates in the fixth volume of the London medical effays, feveral remarkable cafes of the tetanus being 'cured by the cold bath. Both thefe remedies certainly act as ftimulants and tonics. By reafcning h priori, I conceive that electricity would be found to be an equally pow- erful remedy in this diforder. As a general inflammatory diathefis difpofes to topical inflammation, fo topical inflammation dif- pofes to general inflammatory diathefis. Wounds Upon this account are lefs apt to inflame in fum- mer than in winter. In the tetanus, L have uni- formly obferved an abfence of all inflammation in the wounds or injuries which produced it. Doc- tor Stoll of Vienna has made the fame obfervation*. * Pars tertia, Rationis Mcdendt, p. 423. A'fplinter AND CURE OF THE TETANUS. 245 A fplinter under the nail produces no convul- fions, if pain, inflammation or fuppuration fol- low the accident. It is by exciting pain and in- flammation, I apprehend, that the fpirit of turpen- tine acts in all wounds and punctures of nervous and tendinous parts. I have never known a An- gle inftance of a tetanus from a wound, where this remedy had been applied in time. It was to ex- cite an inflammation in the foot of Mr. Leflie, that I dilated the wound and filled it with the fpirit of turpentine. I was not furprifed at its good effects in this cafe, for I was prepared to expect them. I find a remarkable cafe related in Doctor W. Monro's Thefis, publifhed in Edinburgh in the year 1783, of a black girl, who had a tetanus from running a nail in her foot, being perfectly cured by deep and extcnfive incifions made in the wound- ed part by Doctor John Bell, of the ifland of Grenada. It is by producing inflammation in a particular part, and tone in the whole fyftem, I apprehend, that the amputation of a wounded limb fometimes cures a tetanus; and it is becaufe the degrees of both are too inconfiderable to oppofe the violence of the fpafms in the advanced ftages of the teta- aus, that amputation often fails of fuccefs. I have 246 OBSERVATIONS ON THE CAUSE I have been informed by a phyfician who refided fome time at St. Croix, that the negroes on that ifland always apply a plafter made of equal parts of fait and tallow to their frefh wounds, in order to prevent a locked jaw. The fait always pro- duces fome degree of inflammation. However neceffary a certain degree of inflam- matory diathefis may be to impart a tone to the mufcles, there is fometimes fuch an excefs, in this diathefis, as to difpofe to fpafmodic or convulfive motions. A cafe of tetanus from this caufe was communicated to me in a letter dated April 18th 1792, by my learned and'ingenious correfpondent Dr. Hopkins of Connecticut, and I have lately met with a cafe of the fame kind in the " Journal de Medecine" for September 1773, by M. Molmy. They both yielded to blood-letting, after the moft powerful ftimulants had been ufed to no purpofe. If the facts that have been ftated be true, and the inferences that have been drawn from them be juft, how fhall we account for the action of the opium in curing this diforder ? I do not deny its good effects in many cafes, but I believe it has failed in four cafes out of five in the hands of moft practitioners. It is remarkable that it fucceeds only where it is given in very large dofes. In thefe AND CURE OF THE TETANUS. 247 thefe cafes I would fuppofe that it acts only as a ftimulant. It is upon a footing, therefore, with the ftimulating medicines that have been men- tioned ; but from its being of a more diffufiblc nature, it is probably inferior to moft of them. I am the more inclined to adopt this opinion, from an account I once received from Doctor Robert, of the ifland of Dominique, who informed me, that after having cured a negro man of a tetanus with large dofes of opium, he was afterwards feized with a diforder in his ftomach, of which he died in a few days. Upon opening him, he found his ftomach inflamed and mortified. I do not forbid the ufe of opium in this diforder. I think fmall dofes of it may be given to eafe pain, as in other fpafmodic diforders; but as a radical remedy, I think it ought to yield to ftimulants of a more du- rable nature. To the cafes that have been mentioned, I could add many others, in which I have reafon to be- lieve that the excitement of a topical inflamma- tion by artificial means, has effectually prevented a tetanus. To this account of the tetanus, I beg leave to fubjoin a few words upon a diforder commonly called the jaw-fall in infants, or the trifmus nafcen- tium 248 observations on the cause tium of Doctor Cullen, which is nothing but a fpe- cies of tetanus. I have met with three cafes of it in this city, all of which proved fatal. The ftage of the diforder in which I was confulted, and the age and weak- nefs of the infants, forbad me to attempt any thing for their relief. I have introduced the fubject of this diforder in children, only for the fake of men- tioning a fact communicated to me by the late Doctor Cadwallader Evans of this city. This gen- tleman practifed phyfic for feveral years in Jamaica, where he had frequent opportunities of feeing the tetanus in the black children. He found it in every cafe to be incurable. He fuppofed it to be connected with the retention of the meconium in in the bowels. This led him invariably to purge every child that was born upon the eftates com- mitted to his care. After he adopted this practice, he never met with a fingle inftance of the tetanus among children. Perhaps it may tend to enlarge our ideas of the tetanus, and to promote a fpirit of inquiry and experiment, to add, that this diforder is not con- fined to the human fpecies. I have known feveral inftances of it in horfes, from nails running in their feet, and other accidents. It is attended with a rigidity AND CURE OF THE TETANUS. 249 rigidity of the mufcles of the neck, a ftiffnefs in the limbs, and fuch a contraction of the jaw as to prevent their eating. It is generally fatal. In two cafes I had the the pleafure of feeing the difeafe perfectly cured by applying a potential cauftic to the neck under the mane, by large dofes of oil of amber, and by plunging one of them into the river, and throwing buckets of cold water upon the other. How far the reafonings contained in this paper may apply to the hydrophobia, I cannot deter- mine, having had no opportunity of feeing the dif- eafe fince I adopted thefe principles ; but from the fpafmodic nature of the diforder, from the feafon of the year in which it generally occurs, and above all, from the cafe related by Doctor Fothergill, of a young woman having efcaped the effects of the bite of a mad cat by means of the wound being kept open, (which from its feverity was probably connected with fome degrees of inflammation) is ic not probable that the fame remedies, which have been ufed with fuccefs in the teranus, may be ufed with advantage in the hydrophobia ? In a difeafe fo deplorable, and hitherto fo unfuccefsfully treat- ed even a conjecture may lead to ufeful experi- ments zuid inquiries. C 25* ] ADDITIONAL OBSERVATIONS UPON THE Tetanus and Hydrophobia. SINCE the publication of the foregoing obfer- vations, in the fecond volume of the Ameri- can Philofophical Tranfactions, I have received letters from feveral phyficians in the United States, and in the Weft Indies*, and one from Doctor James Currie of Liverpool, in Great Britain ; in each of which are contained cafes that confirm the efficacy of tonic remedies, more efpecially of wine and the cold bath, in the cure of tetanus. My own experience has furnifhed feveral cafes, in addition to' thofe which are publiflied, in favour of the firft of thofe remedies, joined with mercury. I am, notwithftanding, obliged to own, that the method * Viz. Dr. Conyngham of Virginia, Dr. Shaeff, and Dr. Stocket of Maryland, Dr Campbell of New Jerfey, Dr. Bet- ton, and Dr. Broadbelt of Jamaica, and Dr. Alexander An- derfon of the Ifland of St. Vineents. Vol, I. R o{ 252 ADDITIONAL OBSERVATIONS UPON THE of cure above-mentioned has failed, in fome in- ftances, in the hands of feveral refpectable practi- tioners in Philadelphia; but I have reafon to be- lieve it was only where it was not ufed in the firft ftage of the diforder, or where every poffible ad- vantage has not been taken of the combined pow- ers of all the tonic remedies that have been men- tioned, or where fuch a regard has not been had to the ftate of the pulfe, as to aflift thofe remedies, by moderate blood-letting. The Rev. Dr. Henry Muhlenberg, principal of the,German college in Lancafter, informed me in the month of June 1787, that he had often met with the trifmus nafcentium among the children of poor people belonging to his congregation. After reading the account of Doftor Evans's fuccefsful method of preventing that diforder in Jamaica, by means of gentle purges, he recommended that practice to the parents of children, where he fuf- pected the difeafe might take place, and always with fuccefs. The more I have confidered the caufes and fymp- toms of hydrophobia, the more I am difpofed to afcribe it to the fame proximate caufe as the teta- nus. 1. They both affect the mufcles of deglu- tition. I have lately feen a tetanus brought on by a fractured leg, in which an attempt to fwallow the finalleft / TETANUS AND HYDROPHOBIA. 253 fmalleft quantity of any liquid, produced the fame fudden and general convulfions which occur in the hydrophobia. 2. They both proceed from caufes which appear to be related to each other, viz. from wounds, and from the action of cold after the body has been previoufiy weakened by heat and exer- cife. Of the laft, we have a remarkable proof in an account of a fpontaneous hydrophobia, pub- liflied by Mr. Arthaud, prefident of the circle of Philadelphians at Cape Francois, in the firft vo- lume of the tranfactions * of that new and enter- prizing fociety. 3. They both fometimes appear as fymptoms of the fame idiopathic diforder, viz. the hyfteria. 4. They both yield to the fame re- medies, viz. to the excitement of an inflammation in the wounded part of tlie body, or to a long con- tinued difcharge of matter from it, and to mer- cury. Of the efficacy of each of thefe remedies, there are proofs, not only in Mr. Arthaud's ob- fervations upon the hydrophobia, before men- tioned, but in Vanfwieten's commentaries upon Boerhaave's aphorifmsf. To thefe facts I fhall add one more, which may ferve ftill further to eftablilh the famenefs of the * Recherches, Memoires, et Obfervations fur les Mala- dies Epizootiques, de Saint Domingue, p. 220. \ Aphorifm 1145, No. 1. R 2 ,«Jndi~ 254 ADDITIONAL OBSERVATIONS, Szc. indications of cure in the tetanus and hydrophobia. In the London medical journal for the months of April, May, and June, 1784, I find the following account publiflied by Doctor De Mathiis, phyfi- cian to the king of Naples' army. " During his " refidcnce in Calabria, (the doctor tells us) that " having one day caught a viper in the fields, he " had occafion in his way home to pafs by a farm- " yard, where he faw a dog chained that was faid : to be mad: He offered water to this dog, upon " which he immediately fell into convulfions. Re- " collecting his viper, he was tempted to try its " effects by applying it to the dog's throat. This " was accordingly done, and the confequences " were, the head of the dog fwelled, the fymp- " toms of the hydrophobia ceafed, and the animal " recovered." If more facts fhould occur, which fliall fhew the relation that the tetanus and hydrophobia have to ■ each other, perhaps we may be led to conclude, that the wound inflicted by the teeth of a dog fometimes acts in the fame manner in producing hydrophobia, that wounds made by a nail, or any obtufe lacerating inftrument act, in producing te- tanus ; and that both difeafes may be prevented, or cured, with equal certainty by the fame tonic remedies. THE T H E RESULT O F OBSERVATIONS MADE UPON THE DISEASES WHICH OCCURRED IN THE Military Hofpitals of the United States, DURING THE LATE WAR. i. rT^i H E army when it lay in tents was always A more fickly, than when it lay in the open air. It was likewife more healthy when it was kept in motion, than when it lay in an en- campment. 2. Young men under twenty years of age were fubjeft to the greateft number of camp difeafes. 3. The fouthern troops were more fickly than the northern or eaftern troops. 4. The native Americans were more fickly than the natives of Europe who ferved in the Ameri- can army. +~ R 3 5, Men %$6 OBSERVATIONS UPON THE 5. Men above thirty, and five and thirty years of age, were the hardieft foldiers in the army. Perhaps the reafon why the natives of Europe were more healthy than native Americans, was, they were more advanced in life. 6. The fouthern troops fickened from the want of fait provifions. Their ftrength and fpirits were reftored only by means of falted meat. I once faw a private in a Virginia regiment, throw away his ration of choice frefh beef, and give a dollar for a pound of falted bacon. 7. Thofe officers who wore flannel fhirts or waiftcoats next to their fkins, in general efcaped fevers and difeafes of all kinds. 8. The principal difeafes in the hofpitals were the typhus gravior and mitior of Doctor Cullen. Men who came into the hofpitals with pkuni:es or rheumatifms, foon loft the types of their ori- ginal difeafes, and fuffered, or died, by the above- mentioned fever. 9. This fever always prevailed moft, and with the worft fymptoms in winter. A free air, which could only be obtained in fummer, always pre- vented, or mitigated it. 10. In DISEASES OF MILITARY HOSPITALS. 257 io. In all thofe cafes, where the contagion was received, cold feldom failed to render it ac- tive. Whenever an hofpital was removed in win- ter, one half of the patients generally fickened on the way, or foon after their arrival at the place to which they were fent. 11. Drunken foldiers and convalescents were moft fubject to this fever. 12. Thofe patients in this fever who had large ulcers on their back or limbs, generally recover- ed. 13. I met with feveral inftances of buboes, alfo of ulcers in the throat, as defcribed by Doctor Donald Monro. They were miftaken by fome of the junior furgeons for venereal fores, but they yielded to the common remedies of the hofpital fever. 14. There were many inftances of patients in this fever, who fuddenly fell down dead, upon being moved, without any previous fymptoms of approaching diffolution. This was more efpecially the cafe, when they arofe to go to ftool. R4 15. The 238 OBSERVATIONS UPON THE 15. The contagion of this fever was frequently conveyed from the hofpital to the camp, by means of blankets and clothes, 16. Thofe black foldiers who had been pre- vioufly flaves, died in a greater proportion by this fever, or had a much flower recovery from it, than the fame number of white foldiers. 17. The remedies which appeared to do moft fervice in this diforder were vomits of tartar eme- v tic, gentle dofes of laxative falts, bark, wine, vola- tile fait, opium, and blifters. 18. An emetic feldom failed of checking this fever if exhibited while it was in a forming ftate, and before the patient was confined to his bed, 19. Many caufes concurred to produce, and increafe this fever; fuch as the want of cleanlincfs, exceffive fatigue, the ignorance or negligence of officers in providing fuitable diet and accommo- dations for their men, the general ufe of linen inftead of woollen clothes in the fummer months, and the crouding too many patients together in one hofpital, with fuch other inconveniences and abufes, as ufually follow the union of of the pur- veying DISEASES OF MILITARY HOSPITALS. 259 veyingzud directing departments of hofpitals in the fame perfons. But there is one more caufe of this fever which remains to be mentioned, and that is, the fudden affembling of a great number of per- fons together of different habits and manners, fuch as the foldiers of the American army were in the year 1776 and 1777. Doctor Blane informs us, in his obfervations upon the difeafes of feamen, " that it fometimes happens that a fhip with a " long eftablifhed crew fhall be very healthy, yet 6i if ftrangers are introduced among them, who " are alfo healthy, ficknefs will be mutually pro- " duced." The hiftory of difeafes furnifhes many proofs of the truth of this affertion*. It is very remarkable, that while the American army at Cambridge in the year 1775, confuted only of New-Englandmen (whofe habits and manners were the fame) there was fcarcely any ficknefs among them. It was not till the troops of the eaftern, middle and fouthern ftates met at New-York and * " Cleanlinefs is founded on a natural averfion to what' is unfeemly and offenfive in the perfons of others; and there feems alfo to be an inftin&ive horror at ftrangers implanted in human natiare foi the fame purpofe, as is vifible in young children, and uncultivated people. In the early ages of Rome, the fame word fignified both a ftranger and an enemy." Dr. Jilane, p. 225. Ticondero^i 200 OBSERVATIONS UPON THE Ticonderoga in the year 1776, that the typhus became univerfal, and fpread with fuch peculiar mortality in the armies of the United States. 20. The dyfentery prevailed in the fummer of ""1777 in the military hofpitals in New-Jerfey, but with very few inftances of mortality. This dyfen- tery was frequently followed by an obftinate diarr- hoea, in which the warm bath was found in many cafes to be an effectual remedy. 21. I faw feveral inftances of fevers occafioned by the ufe of the common ointment made of the flour of fulphur and hogs lard for the cure of the hch. The fevers were probably brought on by the expofure of the body to the cold air, in the ufual method in which that ointment is aplied. I have fince learned, that the itch may be cured as fpeedily by rubbing the parts affected, two or three times with the dry flour of fulphur, and that no inconvenience and fcarcely any fmell, follow this mode of ufing it. 22. In gun-fliot wounds of the joints, Mr. Ranby's advice of amputating the limb was fol- lowed by fuccefs. I faw two cafes of death where this advice was neglected. 23. There DISEASES OF MILITARY HOSPITALS. 261 23. There was one inftance of a foldier who loft his hearing, and another of a foldier who had been deaf who recovered his hearing, by the noife of artillery in a battle. 24. Thofe foldiers who were biletted in private houfes, generally cfcaped the contagion of the hofpital fever, and recovered fooneft from all their difeafes. 25. Hofpitals built of coarfe logs, with ground floors, with fire-places in the middle of them, and a hole in the roof, for the difcharge of fmoke, were found to be very conducive to the recovery of the foldiers from the jail fever. This form of a military hofpital was introduced into the army by Dr. Tilton of the ftate of Delaware. 26. In fevers and dyfenteries, thofe foldiers re- covered moft certainly, and moft fpeedily, who lay at the greateft diftance from the walls of the hof- pitals. This important fact was communicated to me by the late Dr. Beardfley of Connecticut. 27. Soldiers are but little more than adult children. That officer, therefore, will beft per- form his duty to his men, who obliges them to take the moft care of their health. 28. Hofpitals 262 OBSERVATIONS, &C. 28. Hofpitals are the finks of human life in an army. They robbed the United States of more citizens than the fword. Humanity, ccconomy, and philofophy, all concur in giving a preference to the conveniences and wholefome air of private houfes; and fhould war continue to be the ab- furd and unchriftian mode of deciding national difputes, it is to be hoped that the progrefs of fcience will fo far mitigate one of its greateft ca- lamities, as to produce an abolition of hofpitals for acute difeafes. Perhaps there are no cafes of ficknefs in which reafon and religion do not forbid the feclufion of our fellow-creatures from the offices of humanity in private families, except where they labour under the calamities of madnefs and the venereal difeafe, or where they are the fubjects of fome of the operations of furgery. AN [ a«3- 3 A N ACCOUNT OF THE INFLUENCE OF THE MILITARY AND POLITICAL EVENTS OF THE AMERICAN REVOLUTION UPON THE HUMAN BODY. THERE were feveral circumftances peculiar to the American revolution, which fhould be mentioned previoufiy to an account of the in- fluence of the events which accompanied it, upon the human body. i. The revolution interefted every inhabitant of the country of both fexes, and of every rank and age that was capable of reflection. An in- different, or neutral fpectator of the controverfy, was fcarcely to be found in any of the ftates. 2. The 204 INFLUENCE OF THE REVOLUTION 2. The fcenes of war and government which it introduced, were new to the greateft part of the inhabitants of the United States, and operated with all the force of novelty upon the human mind. 3. The controverfy was conceived to be the moft important of any that had ever engaged the attention of mankind. It was generally believed by the friends of the revolution, that the very ex- iftence of freedom upon our globe, was involved in the iffue of the conteft in favour of the United States. 4. The American revolution included in it the cares of government, as well as the toils and dan- gers of war. The American mind was, there- fore; frequently occupied at ihe fame time, by the difficult and complicated duties of political and military life. 5. The revolution was conducted by men who had been horn free, and whofe fenfe of the bleffings of liberty was of courfe more exquifite than if they had juft emerged from a ftate of flavery. 6. The greateft part of the foldiers in the ar- mies of the United States had family connections and property in the country. 7. The UPON THE HUMAN BODY. 26> 7. The war was carried on by the Americans againft a .nation, to whom they had long been tied by the numerous obligations of confanguini- ty, laws, religion, commerce, language, intereft, and a mutual fenfe of national glory. The re- fcntments of the Americans of courfe rofe, as is ufual in all difputes, in proportion to the num- ber and force of thefe ancient bonds of affection and union. 8. A predilection to a limited monarchy, as an effential part of a free and fafe government, and an attachment to the reigning king of Great- Britain, (with a very few exceptions) were uni- verfal in every part of the United States. 9. There was at one time a fudden diffolution of civil government in all, and of ecclefiaftical eftablifhments in feveral of the ftates. 10. The expences of the war were fupported by means of a paper currency, which was conti- nually depreciating. From the action of each of thefe caufes, and frequently from their combination in the fame perfons, effects might reafonably be expected, both upon the mind and body, which have feldom oc- curred ; 266 INFLUENCE OF THE REVOLUTION curred ; or if they have, I believe were never fully recorded in any age or country It might afford fome ufeful inftruction, to point Out the influence of the military and political events of the revolution upon the underftand- ings, paffions, and morals of the citizens of the United States; but my bufinefs in the prefent in- quiry, is only to take notice of the influence of thefe events upon the human body, through the medium of the mind. I fhall firft mention the effects of the military, and fecondly, of the political events of the revolu- tion. The laft muft be confidered in a two-fold view, accordingly as they affected ihe friends or the enemies of the revolution. I. In treating of the effects of the military events, I fhall take notice, firft, of the influence of aclual war, and, fecondly, of the influence of the military life. In the beginning of a battle, I have obferved thirft to be a very common fenfation among both officers and foldiers. It occurred where no exer- cife, or action of the body, could have excited it. 4 Marty UPON THE HUMAN BODY. 267 f Many officers have informed me, that after the firft onfet in a battle, they felt a glow of heat, fo univerfal as to be perceptible in both their ears. This was the cafe in a particular manner, in the battle of Princeton, on the third of January in the year 1777, on which day the weather was remark- ably cold. A veteran colonel of a New-England regiment, whom I vifited at Princeton, and who was wound- ed in the hand at the battle of Monmouth, on the 28th of June, 1778, (a day in which the mercury ftood at 90 ° of Farenheit's thermometer) after de- fcribing his fituation at the time he received his wound, concluded his ftory by remarking, that " fighting was hot work on a cold day, but much " more fo on a warm day." The many inftances which appeared after that memorable battle, of foldiers who^were found among the flain without any marks of wounds or violence upon their bo- dies, were probably occafioned by the heat excited in the body hf the emotions of the mind, being added to that of the atmofphere. Soldiers bore operations of every kind immedi- ately after a battle, with much more fortitude than they did at any time afterwards. Vol. I. S The 268 INFLUENCE OF THE REVOLUTION The effects of the military life upon the human body come next to be confidered under this head. In another place * I have mentioned three cafes oj pulmonary confumption being perfectly cured by the diet and hardfhips of a camp life. Doctor Blane, in his valuable obfervations on the difeafes incident to feamen, afcribes the ex- traordinary healthinefs of the Britifh fleet in the month of April 1782, to the effects produced on the fpirit of the foldiers and feamen, by the vic- tory obtained over the French fleet on the 12th of that month; and relates, upon the authority of Mr. Ives, an inftance in the war between Great- Britain and the combined powers of France and Spain in 1744, in which the fcurvy, as well as other difeafes, were checked by the profpect of a naval engagement. The American army furnifhed an inftance of the effects of victory upon the humtai mind, which may ferve to eftablifh the inferences from the facts related by Doctor Blane. The Philadelphia mi- litia who joined the remains of General Wafhing- ton's.army, in December 1776, and fliared with * Page 201. then UPQN THE HUMAN BOX>Y. 269 them a few days afterwards in the capture of a large body of Heflians at Trenton, confifted of 1500 men, moft of whom had been accuftomed to the habits of a city life. Thefe men flept in tents and barns, and fometimes in the open air during the ufual colds of December and January; and yet there were only two inftances of ficknefs, and only one of death, in that body of men in the courfe of nearly fix weeks, in thofe winter months. This extraordiny healthinefs of fo great a num- ber of men under fuch trying circumftances, can only be afcribed to the vigour infufed into the human body by the victory of Trenton having produced infenfibility to all the ufual remote caufes of difeafes. Militia officers and foldiers, who enjoyed good health during a campaign, were often affected by fevers and other diforders, as foon as they return- ed to their refpective homes. I knew one inflance of a militia captain, who was feized with convul- fions the firft night he lay on a feather bed, after fleeping feveral months on a mattrafs, or upon the ground. Thefe affections of the body appeared to be produced only by the fudden abftradtion of that tone in the fyftem which was excited by a fenfe of danger, and the other invigorating objects of a military life. S 2 The 270 INFLUENCE OF THE REVOLUTION The nostalgia of Doctor Cullen, or the hme-fieknefs, was a frequent difeafe in the Ame- rican army, more efpecially among the foldiers of the New-England ftates. But this difeafe was fufpended by the fuperior action of the mind un- der the influence of tfye principles which governed common foldiers in the American army. Of this General Gates furnifhed me with a remarkable inftance in 1776, foon after his return from the command of a large body of regular troops and militia at Ticonderoga. From the effects of the noftalgia, and the feeblenefs of the difciplinc, which was excrcifed over the militia, defertions were very frequent and numerous in his army, in the latter part of the campaign; and yet during the three weeks in which the general expected every hour an attack to be made upon him by General Burgoyne, there was not a fingle defcrtion from his army, which confifted at that time of 10,000 men. The patience, firmnefs, and magnanimity with which the officers and foldiers of the American army endured the complicated evils of hunger, cold, and nakednefs, can only be afcribed to an infenfibility of body produced by an uncommon tone of mind excited by the love of liberty and their country. Before UPON THE HUMAN BODY. ZJ\ Before I proceed to the fecond general divifion of this fubject, I fhall take notice, that more in- ftances of apoplexies occurred in the city of Phi- ladelphia, in the winter of 1774-5, than had been known in former years. I fhould have hefitated in recording this fact, had I not found the obfer- vation fupported by a fact of the fame kind, and produced by a nearly fimilar caufe, in the appendix to the practical works of Doctor Baglivi, profeffor of phyfic and anatomy at Rome. After a very wet feafon in the winter of 1694-5, he informs us, that " apoplexies difplayed their rage; and " perhaps (adds our author) that fome part of " this epidemic illnefs was owing to the univerfal " grief and domeftic care, occafioned by all Europe " being engaged in a war. All commerce was " difturbed, and all the avenues of peace blocked " up, fo that the ftrongeft heart could fcarcely bear " the thoughts of it." The winter of 1774-5? was a period of uncommon anxiety among the ci- tizens of America. Every countenance wore the marks of painful folicitude, for the event of a petition to the throne of Britain, which was to determine whether reconciliation, or a civil war, with all its terrible and diftrefling confequences, were to take place. The apoplectic fit, which de- prived the world of the talents and virtues of Pey- ton Randolph, while he filled the chair of Con- S 3 grefs 272 INFLUENCE OF THE REVOLUTION grefs in 1775, appeared to be occafioned in part by the preffure of the uncertainty of thofe great events upon his mind. To the name of this illuf- trious patriot, feveral others might be added, who were affected by the apoplexy in the fame memor- able year. At this time a difference of opinion upon the fubject of the conteft with Great-Bri- tain, had fcarcely taken place among the citizens of America. II. The political events of the revolution pro- duced different effects upon the human body, through the medium of the mind, accordingly as they acted upon the friends or enemies of the re- volution. I fhall firft defcribe its effects upon the former clafs of citizens of the United States. s Many perfons of infirm and delicate habits, were reftored to perfect health, by the change of place, or occupation, to which the war expofed them. This was the cafe in a more efpecial man- ner with hyfterical women, who were much inte- refted in the fuccefsful iffue of the conteft. The fame effects of a civil war upon the. hyfteria, were obferved by Doctor Cullen in Scotland, in the years 1745 and 1746. It may perhaps help to extend UPON THE HUMAN BODY. 273 extend our ideas of the influence of the paffions upon difeafes, to add, that when either love, jea- loufy, grief, or even devotion, wholly engrofs the female mind, they feldom fail, in like manner, to cure or to fufpend hyfterical complaints. An uncommon cheerfulnefs prevailed every where, among the friends of the revolution. De- feats, and even the lofs of relations and property, were foon forgotten in the great objects of the war. The population in the United States was more rapid from births during the war, than it had ever been in the fame number of years fince the fettle- ment of the country. I am difpofed to afcribe this increafe of births chiefiy to the quantity and extenfive circulation of money, and to the facility of procuring the mean3 of fubfiftence during the war, which favoured marriages among the labouring part of the peo- ple*. But I have fufficient documents to prove, that marriages were more fruitful than in former * Wheat which was fold before the war for feven (hil- lings and fixpence, was fold for feveral years during the war for four, and in fome places for two and fixpence Penn- fylvania currency per buftiel. Beggars of every defcription S 4 dilap* *74 INFLUENCE OF THE REVOLUTION years, and that a confiderable number of unfruit- ful marriages became fruitful during the war. In 1783, the year of the peace, there were feveral children born of parents who had lived many years together without iffue. Mr. Hume informs us, in his Hiftory of Eng- land, that fome old people upon hearing the news of the reftoration of Charles the lid. died fuddenly of joy. There was a time when 1 doubted the truth of this affertion ; but I am now difpofed to believe it, from having heard of a fimilar effect from an agreeable political event, in the courfe of the American revolution. The door-keeper of Cotigrefs, an aged man, died fuddenly, immedi- ately after hearing of the capture of Lord Corn- wall's army. His death was univerfally afcribed to a violent emotion of political joy. This fpecies bf joy appears to be one of the ftrongeft emotions that can agitate the human mind. Perhaps the influence of that ardour in trade and fpeculation, which feized many of the friends of the revolution, and which was excited by the fallacious nominal amount of the paper money, difappeared in the year 1776, and were Teldom feen till near the cjofe of the war, fhould UPON THE HUMAN BODY. 275 fhould rather be confidered as a difeafe than as a paflion. It unhinged the judgment, depofed the moral faculty, and filled the imagination, in many people, with airy and impracticable fchemes of wealth and grandeur. Defultory manners, and a peculiar fpecies of extempore conduct, were among its characteriftic fymptoms. It produced infcnfi- bility to cold, hunger, and danger. The trading towns, and in fome inftances the extremities of the United States, were frequently vifited in a few hours or days by perfons affected by this difeafe; and hence " to travel with the fpeed of a fpecu- " lator," became a common faying in many parts of the country. This fpecies of infanity (if 1 may be allowed to call it by that name) did not require the confinement of a bedlam to cure it, like the South-Sea madnefs defcribed by Doctor Mead. Its remedies were the depreciation of the paper »oney, and the events of the peace. The political events of the revolution produced upon its enemies very different effects from thofe which have been mentioned. The hypochondriafis of Doctor Cullen, occur- red in many inftances in perfons of this defcription. In fome of them, the terror and diftrefs of the re- volution 276 INFLUENCE OF THE REVOLUTION volution brought on a true melancholia*. The caufes which produced thefe difeafes, may be re- duced to four heads. 1. The lofs of former power or influence in government. 2. The deftruction of the hierarchy of the Englifh church in America. 3. The change in the habits of diet, and company and manners, produced by the annihilation of juft debts by means of depreciated paper money. And, 4, The neglect, infults, and oppreffion, to which the loyaliftV were expofed, from individuals, and in feveral inftances, from the laws of fome of the ftates. It was obferved in South-Carolina, that feveral gentlemen who had protected their eftates by fwearing allegiance to the Britifh government, died foon after the evacuation of Charlefton by the Bri- tifh army. Their deaths were afcribed to the neglect with which they were treated by their an- cient friends, who had adhered to the government of the United States. The difeafe was called, by the common people, the Proteclion fever. From the caufes which produced this hy- pochondriafis, I have taken the liberty of dif- * Infania partialis fine dyfpepfia, of Doctor Cullen. tinguifhing UPON THE HUMAN BODY. 277 tinguifhing it by the fpecific name of Revolu- tiana. In fome cafes, this difeafe was rendered fatal by exile and confinement; and, in others, by thofe perfons who were afflicted with it, feeking relief from fpirituous liquors. The termination of the war by the peace in 1783, did not terminate the American revolution. The minds of the citizens of the United States were wholly, unprepared for their new fituation. The excefs of the paflion for liberty /inflamed by the fuccefsful iffue of the war, produced, in many people, opinions and conduct which could not be removed by reafon nor reftrained by government. For a while, they threatened to render abortive the goodnefs of heaven to the United States, in delivering them from the evils of flavery and war. The extenfive influence which thefe opinions had upon the underftanclings, paffions and morals of many of the citizens of the United States, confti- tuted a fpecies of infanity, which I fhall take the liberty of diftinguifhing by the name of Anarchia. I hope no offence will be given by the freedom of any of thefe remarks. An inquirer after philo- fophical truth, fhould confider the paffions of men in 278 INFLUENCE OF THE REVOLUTION, &C. in the fame light that he does the laws of matter or motion. The friends and enemies of the Ame- rican revolution muft have been more or lefs than men, if they could have fuftained the magnitude and rapidity of the events that characterifed it, without discovering fome marks of human weak- nefs, both in body and mind. Perhaps thefe weak- neffes were permitted, that human nature might receive frefh honours in America, by the contend- ing parties (whether produced by the controver- fies about independence or the national govern- ment) mutually forgiving each other, and uniting in plans of general order, and happinefs. AN [ 279 ] A N INQUIRY INTO THE Relation of Tajles and Aliments TO EACH OTHER; AND INTO THE INFLUENCE OF THIS RELATION UPON Health and Pleafure. IN entering upon this fubject, I feel like the clown, who, after feveral unfuccefsful attempts to play upon a violin, threw it haftily from him, exclaiming at the fame time, that " there was mu- fic in it," but that he could not bring it out. I fhall endeavour, by a few brief remarks, to lay a foundation for more fuccefsful inquiries upon this difficult fubject. Attraction and repulfion feem to be the active principles of the univerfe. They pervade not only the 280 THE RELATION OF TASTES AND the greateft but the minuteft works of nature. Salts, earths, inflammable bodies, metals, and ve- getables, have all their respective relations to each other. The order of thefe relations is fo uniform, that it has been afcribed by fome philo- fophers to a latent principle of intelligence pep- vading each of them. Colours, odours, and founds, have likewife their refpedtive relations to each other. They become agreeable and difagreeable, only in proportion to the natural or unnatural combination which takes place between each, of their different fpecfes. It is remarkable, that the number of original colours and notes in mufic is exactly the fame* All the variety in both proceeds from the difference of combination. An arbitrary combination of them is by no means productive of pleafure. The rela- tion which every colour and found bear to each other, was as immutably eftablifhed at the creation, as the order of the heavenly bodies, or as the re- lation of the objects of chemiftry to each other. But this relation is not confined to colours and founds alone. It probably extends to the objects of human aliment. For example; bread and meat, meat and fait, the alkalefcent meats and acefcent vege- ALIMENTS TO EACH OTHER. 28l vegetables, all harmonize with each other upon the tongue; while fifh and flefli, butter and raw onions, fifh and milk, when combined, are all offenfive to a pure and healthy tafte. It would be agreeable to trace the analogy of founds and taftes. They have both their flats and their fliarps. They are both improved by the con- trail of difcords. Thus pepper, and other condi- ments, (which are difagreeable when taken by themfelves) enhance the relifh of many of our ali- ments, and they are both delightful in proportion as they are fimple in their composition. To illuf- trate this analogy by more examples from mufic, would lead us from the fubject of the prefent in- quiry. It is obfervable that the tongue and the fto- mach, like inftindt and reafon, are, by nature, in unifon with each other. One of thofe organs muft always be difordered, when they difagree in a fin- gle article of aliment. When they both unite in articles of diet that were originally difagreeable, it is owing to a perverfion in each of them, fimilar to that wjhich takes place in the human mind, when both the moral faculty and the conscience lofe their natural fenfibility to virtue and vice. Unfor- 282 THE RELATION OF TASTES AND Unfortunately for this part of fcience, the tafte and the ftomach are fo much perverted in infancy and childhood by heterogeneous aliment, that it is difficult to tell what kinds and mixtures of food are natural, and what are artificial. It is true, the fyftem poffefles a power of accommodating itfelf both to artificial food, and to the moft difcordant mixtures of that which is natural; but may we not reafonably fuppofe, that the fyftem would pre- ferve its natural ftrength and order much longer, if no fuch violence had been offered to it ? If the relation of aliments to each other follows the analogy of the objects of chemiftry, then their union will be influenced by many external circum- ftances, fuch as heat and cold, dilution, concen- tration, reft, motion, and the addition of fubftances which promote unnatural, or deftroy natural mix- tures. This idea enlarges the field of inquiry be- fore us, and leads us ftill further from facts and certainty upon this fubject, but at the fame time ft does not preclude us from the hope of obtaining both; for every difficulty that arifes out of this view of the fubject, may be removed by obferva- tion and experiment. I come now to apply thefe remarks to health and pleafure. I fhall felect only a few cafes for i this ALIMENTS TO EACH OTHER. 283 this purpofe; for if my principles are true, my readers cannot avoid difcovering many other illus- trations of them. 1. When an article of diet is grateful to the tafte, and afterwards difagrees with the ftomach, may it not be occafioned by fome other kind of food, or by fome drink being taken into the fto- mach, which refufes to unite with the offending article of diet ? 2. May not the uneafinefs which many perfons feel after a moderate meal, arife from its having confifted of articles of aliment which were not re- lated to each other ? 3. May not the delicacy of ftomach which fome- times occurs after the fortieth or forty-fifth year of human life, be occafioned by nature recovering her empire in the ftomach, fo as to require fimpli- city in diet, or fuch articles only of aliment as are related ? May not this be the reafon why moft peo- ple, who have paffed thofe periods of life, are un- able to retain or to digeft fifh and flefh at the fame time, and why they generally dine only upon one kind of food ? 4. Is not the language of nature in favour of fimplicity in diet, difcovered by the avidity with Vol. I. T which 2$4 THE RELATION OP TASTES AND which the luxurious and intemperate often feek relief from variety and fatiety, by retreating to fpring water for drink, and to bread and milk for aliment ? 5. May not the reafon why plentiful meals of fifh, venifon, oyfters, beef or mutton, when eaten alone, lie fo eafily in the ftomach, and digeft fo fpeedify, be occafioned by no other food being taken with them ? A pound, and even more, of the above articles, frequently opprefs the fyftem much lefs than half the quantity of heterogeneous aliments. 6. Does not the facility with which a due mix- ture of vegetable and animal food digefts in the ftomach, indicate the certainty of their relation, to each other ? 7. May not the peculiar good effects of a diet wholly vegetable, or animal, be occafioned by the more frequent and intimate relation of the articles of the fame kingdoms to each other ? And may not this be the reafon why fo few inconveniencies are felt from the mixture of a variety of vegetables in the ftomach ? 8. May not the numerous acute and chronic dif- eafes of the rich and luxurious, arife from hete- rogeneous ALIMENTS TO EACH OTHER. 2o*5 rogeneous aliments being diftributed in a diffufed, inftead of a mixed ftate, through every part of the body ? 9. May not the many cures which are afcribed to certain articles of diet, be occafioned more by their being taken alone, than to any medicinal quality inherent in them ? a diet of oyfters in one inftance, of ftrawberries in another, and of fugar of rofes in many inftances, has cured violent and dangerous diforders of the breaft*. Grapes, ac* cording to Doctor Moore, when eaten in large quantities, have produced the fame falutary effect. A milk diet, perfifted in for feveral years, has cured the gout. I have feen many cafes of dyfpep- fia cured by a fimple diet of beef and mutton, and have heard of a well attefted cafe of a diet of veal alone having -emoved the fame diforder. Squaflies, and turnips likewife, when taken by themfelves, have cured that diftrefling Complaint in the fto- mach. It has been removed even by milk, when taken by itfelf in a moderate quantity f. The far- ther the body, and more efpecially the ftomacn, recede from health, the more this fimplicity of diet becomes neceffary. The appetite in thefe * Vanfweiten, 1209. 3. f Medical Obfervations and Inquiries, Vol. VI. p. 310. 319. T 2 cafes 286 THE RELATION OF TASTES AND cafes does not fpeak the language of uncorrupted nature. It frequently calls for various and impro- per aliment; but this is the effect of intemperance having produced an early breach between the tafte and the ftomach. Perhaps the extraordinary cures of obftinate dif- eafes which are fometimes performed by perfons not regularly educated in phyfic, may be occa- fioned by a long and fteady perfeverance in the ufe of a fingle article of the materia medica. Thofe chemical medicines which decompofe each other, are not the only fubftances which defeat, the in- tention of the prefcriber. Galenical medicines, by combination, I believe, frequently produce ef- fects that are of a compound and contrary nature to their original and fimple qualities. This remark is capable of extenfive application, but I quit it as a digreffion from the fubject of this inquiry. 10. I wifh it to be obferved, that I have con- demned the mixture of different aliments in the ftomach only in a few caSes, and under certain cir- cumftances. It remains yet to determine by ex- periments, what changes are produced upon ali- ments by heat, dilution, addition, concentration, motion, reft, and the addition of uniting fubftances, before we can decide upon the relation of aliments to ALIMENTS TO EACH OTHER. 287 to each other, and the influence of that relation upon health. The olla podrida of Spain, is faid to be a pleafant and wholefome difh. It is proba- bly rendered fo, by a previous tendency of all its ingredients to putrefaction, or by means of heat producing a new arrangement, or additional new relations of all its parts. I fufpect heat to be a pow- erful agent in difpofing heterogeneous aliments to unite with each other ; and hence the mixture of aliments is probably lefs unhealthy in France and Spain, than in England, where fo much lefs fire is ufed in preparing them than in the former coun- tries. As too great a mixture of glaring colours, which are related to each other, becomes painful to the eye, fo too great mixture of related aliments op- preffes the ftomach, and debilitates the powers of the fyftem. The original colours of the fky, and of the furface of the globe, have ever been found the moft permanently agreeable to the eye. In like manner, I am difpofed to believe that there are certain fimple aliments which correfpond, in their fenfible qualities, with the intermediate co- lours of blue and green, that are moft permanently agreeable to the tongue and ftomach, and that every deviation from them is a departure from the fimplicity of health and nature. T3 11. While 288 THE RELATION OF TASTES AND 11. While nature feems to have limited us to fimplicity in aliment, is not this reftriction abun- dantly compenfated by the variety of taftes which fhe allows us to impart to it in order to diverfify and increafe the pleafure of eating ? It is remark- able that fait, fiigar, muftard, horSe-radifh, capers, and fpices of all kinds, according to Mr. Goffe's experiments, related by Abbe" Spallanzani*, all contribute not only to render aliments favory, but to promote their digeftion. 12. When we confider, that part of the art of cookery confifts in rendering the tafte of aliments agreeable, is it not probable that the pleafure of eating might be increafed beyond our prefent knowledge upon that fubject, by certain new ar- rangements or mixtures of the fubftances which are ufed to impart a pleafant tafte to our ali- ment ? 13. Should philofophers ever ftoop to this fub- ject, may they not difcover and afcertain a table of the relations of fapid bodies to each other, with the fame accuracy that they have afcertained the relation of the numerous objects of chemiftry to each other ? * Diflertations, Vol. I. p. 326. 14. When ALIMENTS TO EACH OTHER. 2^9 14. When the tongue and ftomach agree in the lame kinds of aliment, may not the increafe of the pleafure of eating be accompanied with an increafe of health and prolongation of life ? 15. Upon the pleafure of eating, I fhall add the following remarks. In order to render it truly ex- quifite, it is neceffary that all the fenfes, except that of tafte, fhould be as quiefcent as poffible. Thofe perfons miftake the nature of the appetite for food, who attempt to whet it by accompanying a dinner by a band of mufic, or by connecting the dining table with an extenfive and delightful prof. pect. The excitement of one f.;nfe, always pro- duces collapfe in another. Even converfation fometimes detracts from the pleafure of eating; hence great feeders love to cat in filence, or alone; and hence the Speech of a paflionate Frenchman, while dining in a talkative company, was not fo improper as might be at firft imagined. " Hold your tongues, (faid he) I cannot tafte my dinner." I know a phyfician, who, upon the fame principle, always fliuts his eyes, and requefts filence in a fick chamber, when he wifhes to determine by the pulfe the propriety of blood-letting, in cafes where its indication is doubtful. His perceptions become more diftinct, by confining his whole attention to the fenfe of feeling. T4 It 29© THE RELATION OF TASTES, &C. It is impoffible to mention the circumftance of the fenfes acting only in fucceffion to each other in the enjoyment of pleafure, without being ftruck by the impartial goodnefs of Heaven, in placing the rich and the poor So much upon a level in the pleafures of the table. Could the numerous ob» jects of pleafure, which are addreffed to the ears and the eyes, have been poffefled at the fame time, with the pleafure of eating, the rich would have commanded three times as much pleafure in that enjoyment as the poor •, but this is fo far from be- ing the caSe, that a king has no advantage over a beggar, in eating the fame kind of aliment. THE C »9*""J The NEW METHOD OP INOCULATING FOR THE Sm#// Pox. Delivered in a Le&ure in the Univerfity of Pennfylvania, «n the aoth of February, 1781. GENTLEMEN, IT muft afford no fmall pleafure to a benevo- lent mind in the midft of a war, which daily makes fo much havoc with the human fpecies, to re- flect, that the Small-pox which once proved equally fatal to thouSands, has been checked in its career, and in a great degree Subdued by the practice of Inoculation. It is foreign to my purpoSe to deliver to you the hiftory of this art, and to mark the various fteps that have attended its progrefs to its pre- fent. 292 NEW METHOD OP INOCULATING fent ftate of improvement. We have yet to la- ment the want of uniformity and of equal fuccefs in the practice of it among phyficians. A great number of pamphlets have been written upon the fubject without exhaufting it. There is ftill ample room left for the man of genius to exercife his talents for observation and reasoning upon it. The facts 1 mean to lay before you are fo inconfider- able, compared with what ftill remain to be known upon this fubject, that I have to requeft, when your knowledge in it is completed, that you would bury my name in Silence; and forget that ever I ventured to lay a fingle ftone in this part of- the fabric of fcience. In treating upon this fubject, I fhall I. Confider the proper fubjects and feafons for inoculation. II. I fhall defcribe the method of communis eating the diforder. III. I fhall confider the method of preparing the body for the finall-pox. IV. I fliall mention the treatment proper du- ring the eruptive Sever -, and, V. Point * FOR THE SMALL-POX. 293 V. Point out a few cautions that are necef- fary after the difeafe is over. I. Formerly there were great difficulties in the choice of the Subjects for Inoculation. But experience teaches us that it may be practifed in every ftage of life, and in almoft every condition of the human body. In infancy the periods be- fore and after dentition are to be preferred. But we feldom fee any great inconveniences from fub turning to the general neceffity of inoculating children between the ages of three months and two years. Indeed we often See children cut three or Sour teeth during the preparation and eruptive Sever, without the leaft addition being made to any of the troublefome Symptoms which accompany the Small-pox. There is one inconve- nience attending the choice of the firft months of infancy for inoculating, and that is, the mat- ter often fails of producing the diforder in Such young Subjects. I have frequently failed in two or three attempts to communicate the diforder to children under four months old with the fame matter that has Succeeded in a dozen other patients inoculated at the Same time. When the inoculation Succeeds in Such tender Subjects, they generally have lefs fever, and fewer puftules, than are common in any future period of life. Although 294 NEW METHOD OF INOCULATING Although a phyfician would prefer a patient in good health to any other as a Subject for inocula- tion, yet cafes often occur in which it is neceffary to communicate the fmall-pox while the body is affected with fome other diforder. I can with pteaSure inform you, that the fmall-pox is rendered fo perfectly fafe by inoculation, that there are few chronic difeafes which fhould be confidered as ob- ftacles in the way of it. I have inoculated patients labouring under a tertian fever, obftructed vifcera, the hooping cough, the hypochondriafis, the afth- ma, the itch, and other cutaneous diforders, and even pregnant women, with the fame, and in fome inftances, with greater fiicceSs than perSons in perfect health. Doctor Cullen informs us that he has feen inoculation Succeed in Scrophulous pati- ents. A phyfician in Jamaica informed me that he had inoculated Negroes with fiicceSg in the worft ftage of the yaws. To thefe facts I muft add one more extraordinary than any that has been yet mentioned : Doctor Brown, my late col- league in the care of the military hofpitals, in- formed me, that he had feen inoculation fucceedn patients who were feized, aSter the infection was communicated, with the hofpital fever. The pre- paration of the body fliould be accommodated to the difeaSe which affects it. Some phyficians have thought ;he fmall-pox, received in this way, was FOR THE SMALL-POX. 295 was a remedy for other difeafes, but my experi- ence has not confirmed this opinion. On the contrary, I am difpoSed to think that no other change is produced by inoculation, than by the regimen and medicines that are uSed to prepare the body for the fmall-pox. Nor does the Small- pox, during its continuance, afford any Security againft the attacks of other difeafes. I have feen the moft alarming complication of the fmall-pox and meafles in the fame perfon. The feaSons commonly preferred for inoculation in this country are, the fpring and fall. It may be practifed with equal Safety in the winter, a due regard being had to the temperature of the air in the preparation of the body. The principal objection to inoculating in the fummer months in this climate, ariSes Srom the frequency of bilious diforders at that feaSon, to which the preparation neceffary Sor the Small-pox probably diSpoSes the body. This caution applies more directly to children who at a certain age are more Subject than grown people to a diSorder in their bowels in warm weather. II. The methods of communicating the fmall-pox by inoculation, have been different in different countries, 20.6 NEW METHOD OF INOCULATING countries, and in the different aeras of its progrefs towards its prefent ftage of improvement. The fcab, doffel of lint, and the thread impregnated with variolous, matter and bound up in a gafh in the arm, have been laid afide. We are indebted to Mr. Sutton for the mode of communicating it by a flight puncture with the point of a lancet, or needle, dipt in frefh matter. As it is difficult fometimes to procure matter in a frefh ftate, I have been led to ufe it with equal fucceSs by preServing it on lint in a box, and moiftening it with cold water juft before I ufed it. Matter may be kept in this way for a month with- out lofing its infectious quality, provided it be not expofed to heat or moifture. The former deftroys its power of infecting as certainly as the fait of tartar deftroys the acidity of vinegar. Moifture, by remaining long upon the matter, probably de- ftroys its virulence by Subjecting it to fermenta- tion. The longer matter has been kept in a ge- neral way, the longer the diftance will be between the time of communicating the diforder and the eruptive fever. It will be proper always to yield to the prejudices of our patients in favour of mat- ter taken from perfons who have but few puftules. But I am perfuaded Srom repeated observations, that the diSeaSe is no ways influenced by this cir- cumftance. FOR THE SMALLiPOX. 297 cumftance. I am Satisfied likewife that there is no difference between the effects of the matter, whether it be taken ia its watery and purulent ftate. The puncture fhould not be larger than is Sufficient to draw one drop of blood, but it fhould always be made by a fharp lancet, for the fudden inflammation and fuppuration, excited by a dull lancet, fometimes throw off the matter fo as to prevent its infecting the body*. No plafter or bandage fhould be applied over the puncture. It fhould be made in the left arm of all fubjects. The objections to inoculating.in the leg are too obvious to be mentioned. I have heard of the difeafe being communicated by rub- bing the dry fkin with the matter. My own obfer- vations upon this fubject give me reafon to fufpect the facts that are contained in books relative to this mode of infecting the body. I have bound large pieces of lint dipt in frefh matter for twenty- four hours upon the arm, without producing the diforder. A practitioner of phyfic in New-Jer> * I am difpofed to believe that the external aplicatiaas which are ufed by the Indians for the cure of the bite of poifonous fnakes, a we oblige our patients to conform to it. For this reafon, -when we are called upon to inoculate per- fons who have lived -more than three or. four weeks upon a low diet, "we fhould always direct them to live a few days upon animal food before we communicate the diforder to them. By thefe " means we may produce all the good effefts of the fudden:change in the diet I have already mention- ed. 2. The medicines moft commonly ufed to prepare the body for the Snull-pox are antimony and mercury. The latter has had the preference, and has been given in large quantities undcu* a notion of its being a-fpecific antidote to-the vari- olous matter. Many objections might be made to this opinion ; I fhall mention only three. 1. We often fee the diforder in a high degree after the fyftem is fully impregnated with mercury. 2. We often fee the fame falutary effects of mer- cury when c>iven before the diforder is communi- cated to the body, that we perceive when it is given after inoculation; in which cafe we are Sure K Vol. I. U the 300 NEW METHOD OF INOCULATING* the mercury cannot enter into the mixture with the variolous matter fo as to deftroy it. 3. If mercury acted Specifically in deftroying the variolous matter, it would render every other part of the preparation unneceffary, but this we know is not the cafe, for the neglect or improper ufe of the vegetable diet or cool regimen is often attend- ed with an extraordinary number, or virulence of the fmall-pox, even in thofe cafes where mercury is given in the largeft quantity. The way in which mercury prepares the body for the fmall-pox, feems to be by promoting the feveral excretions, particularly that by perfpi- ration, which, by diminifhing the quantity of the fluids and weakening the tone of the folids, ren- ders the Syftem lefs liable to a plentiful eruption of the fmall-pox. But 1 object to the ufe of this medicine for the following reafons: 1. It effectually deprives us of all the benefits of the cool regimen ; for mercury we know, al- ways difpofes the fyftem to take cold. 2. All the good effects of mercury may be pro- duced by purges, which do not fubject the body to the above-mentioned inconvenience. The FOR THE SMALL-POX. 30J The purges may be fuited to the conftitutions, and in Some caSes, even to the inclinations of our patients. I have feen jalap, rhubarb, Senna, man- na, aloes, Soluble tartar, glauber and EpSom Salts, and the butternut pill, all given with equal SucceSs. The quantity fhould be Sufficient to procure three or four ftools every day. A little magnefia fhould always be mixed with rhubarb and jalap in pre- paring children. It will be fufficient for the mo- thers and nurfes of infants to conSorm ftrictly to the vegetable diet. I have never Seen any advan- tages from giving them even a fingle dofe of phyfic. It is hardly neceffary to obferve, that the qua- lity, dofe, and number of purges are to be deter- mined by the age, fex, and habits of our patients. A conftitution enfeebled with a previous difeafe for- bids the ufe of purges, and requires medicines of a reftorative kind. Patients afflicted with cuta- neous diforders bear larger and more frequent dofes of phyfic than are indicated in more healthy Subjects. In adult Subjects of a plethoric habit, blood- letting is very ufeful on the third or fourth day after inoculation. We are not to fuppofe, that every fat perfon labours under a plethora. A mo- U 2 derate ?02 NEW METHOD OF INOCULATING derate degree of fat is fo far from rendering the dif- eafe more violent, efpecially in children, that I thir.k I have generally found fuch Subjects have the finail-pox more favourably than others. Moderate exercife in the open air fliould be ufeci during the preparation. But hard labour, and ever)- thing that promotes Sweat or fatigue, as alfo the extremes of heat and cold, fliould be avoided. IV. We come now to confider the treatment of the body during the eruptive fever. On tha eighth clay after inoculation our patients are generally feized with the common Symptoms of fever. Some- times this fever a; pears on the Sixth and Seventh day after inoculation. But when it is irregular, it is often delayed till the ninth and tenth days. I have Seen many inftances of it on the fourteenth, a few on the fifteenth and Sixteenth, and one cafe in wlikh it did not come on till the eighteenth day after the inScctlr.n was communicated to the body". The place where the puncture was made * Jr.. ;c th'e publication of the fit ft edition of tins lecture, I have L^.rd of two cafes, in one of which the fever did not ctme on till the twentieth, and in the other till the twer.ty-ilrft day after the infection was communicated to the body. In fome of thzfi tedious cafes, I have feen an ir.fl. am- FOR THE SMALL-POX. <^,7 with the lancet, or needle, generally Serves as an harbinger of the approaching fever. A flight inflam- mation appears about it and a pock rifes up in the centre. But this remark is liable to Some objec- tions. I have feen four inftances in which the fever came on at the expected time, and the diforder went through all its ftages with the greateft regularity, and yet there was no Sign of an inflammation or pock near the Spot where the puncture was made: even the puncture itfelf became invifible. On the other hand, we fometimes fee an inflammation and pock on the arm appear on the eighth and ninth days without any fever accompanying them. Some phyficians pretend that this inflammation and Soli- tary pock are Sufficient to conftitute the difeafe; but repeated experience has taught me to be very cautious in relying upon thefe equivocal marks. It is true, I have Sometimes Seen patients Secured againft the fmall-pox both in the natural way and by inoculation where thefe marks have appeared; but I have as often Seen Such patients Seized after- wards with the Small-pox in the natural way, to the great diftrefs of families and mortification of phy- inflammation and fuppuration on the punctured part of the arm on the eighth day without an/ fever. Peihaps i.i thefe cafes the inflammation and fuppuration are only cuti- cular, and that the fmall-pox is taken from the matter which is formed by them. U t, ficians. 304 NEW METHOD OF INOCULATING ficians. Upon this account I make it a conftant practice to advife a Second or third inoculation where a fever and eruption have been wanting. As the abfence of thefe Symptoms is probably occafioned by the weaknefs or age of the va- riolous matter, or the too high ftate of pre- paration of the body, we fliould always guard againft both, by making the puncture the fecond time with frefh matter, by Subjecting our pati- ents to a lefs abftemious diet, and by giving Sewer doSes of phyfic. I have heard it remarked, that if a flight rednefs and a fmall pimple appeared on the arm on the third day after inoculation, it was a fign the matter had infected the whole conftitu- tion. I acknowledge I have often feen a greater degree of rednefs on the third than on the Second day after inoculation, but I have not been able to eftablifh a diagnoftic mark from it; for I have feen the difeaSe produced on the uSual days where the rednefs has appeared on the fecond day, and in Some caSes where it has not appeared until the eruptive fever, I am led here unwillingly to difcuSs the old quef- tion, Is it poffible to have the fmall-pox in the natural way after inoculation ?—In many of the cafes fuppofed to be the fmall-pox from inoculation, it is probable the matter has been taken from the chicken- FOR THE SMALL-POX. 305 chicken-pox, which refembles the finall-pox in ma- ny of its peculiarities, but in none more than that of leaving pits or marks on the fkin. But there are certainly cafes where there are the moft irre- fragable proofs of the infection implanted by in- oculation being of a variolous nature, where the diforder has been afterwards taken in the natural way. In thefe caSes I would SuppoSe the variolous matter produced only a topical or cuticular diSor- der. We See Something analogous to this in nurSes who attend patients in the Small-pox. But Surther, this topical or cuticular infe£tion may be produced by art in perfons who have had the fmall-pox in the natural way. Some years ago I made a punc- ture on my left hand with a lancet moiftened with variolous matter. On the eighth day an inflam- mation appeared on the place, accompanied by an efflorefcence in the neighbourhood of it, which extended about two inches in every direction from the Spot where the puncture was made. On the eleventh day I was SurpriSed to find two pocks (if I may venture to call them Such) the one on the outfide of the fourth finger of my left hand, and the other on my forehead. They remained there for feveral days, but without filling with matter,., and then dropped off rather in the form of a foft wart, than of acommon fcab. Doctor Way, of Wilmington, repeated the fame experiment upon hinifelf, but with an iflue to his curiofity more ex- U 4 traordinary 306 NEW METHOD OF INOCULATING traordinary than that I have juft now related. On the eighth day aSter he had made a puncture on his hand, a pock appeared on the Spot, which in the uSual time filled with matter, from which he inoculated Several children, who Sickened at the ufual time, and went through all the common ftages and fymptoms of the Small-pox. It would Seem from thefe facts, that it is neceffary the fmall-pox fliould produce fome impreffion upon the whole fyf- tem, in order to render it ever afterwards incapable of receiving an impreffion of a Similar nature. A fever and an eruption therefore feem neceflary for this purpofe. As the inflammation of the arm on the eighth day is a fign of the topical and cuticular infection, fo an eruption (though ever fo fmall) feems to be the only certain fign of the infection of the whole fyftem. The eruption is the more decifive in its report in proportion as it comes out and goes off in the ufual manner of the fmall-pox in the natural way. In thofe cafes where patients have been Secured againft a fecond attack of the diforder, when there have been no obvious fever or vifible eruption, I think I have obferved an un- ufual inflammation, and a copious and long con- ., tinued difcharge of matter from the arm. Perhaps this may ferve as an outlet of the matter, which in other cafes produces the fever ar.d eruption. I am the more difpofed to embrace this opinion from the teftimony which Several authors have left us of FOR THE SMALL-roX. %oJ of the effecTs of ulcers in Securing the body from the infection of the plague. The effe&s of iffues are ftill more to our purpofe. We obferve a plentiful difcharge of matter from them every time the body is expofed to cold, and the febrile effects of it upon the fyftem are thereby frequently ob- viated. How Sar a ratio exifts between the de- grees of inflammation and the difcharge of matter from the arm, and the degrees of tever and erup- tion, muft be determined by future and very accu- rate obfervations. If it fliould appear, that there are the leaft inflammation and fmalleft difcharge, where there have been the higheft fever and moft copious eruption; and oil the contrary, if it fhould appear, that there are the greateft inflammation and difcharge where there have been the leaft fe- ver and fmalleft eruption, I muft beg leave to add, without attempting in this place to explain the rea- Sons oS it, that the remark, if generally true, is liable to Some exceptions. But the Subject is in- volved in darkneSs; I fhall be Satisfied if I have brought you within fight of the promifed land. Your own ingenuity, like another Jewifh leader, muft conduct you thither. The indications in the treatment of the body during the eruptive fever are, i ft. To 308 NEW METHOD OF INOCULATING ift. To regulate the degree of fever. ad. To mitigate troublefome and alarming fymptoms. The fever which produces the eruption is ge- nerally of the inflammatory kind. It fometimes therefore comes on with the fymptoms of great heat, preceded with chillinefs, and determination to the head and breaft, and a full hard pulfe. The remedies proper in this cafe are, a. Blood-letting. The quantity to be drawn muft be regulated by the violence of the Symp- toms, the conftitution, habits, and even country of the patient, and by the feafon of the year. I have never found more than one bleeding, to the quantity of twelve or fourteen ounces, neceffary in any ftage or degree of the eruptive fever of the Small-pox by inoculation. b. Cool air is of the utmoft confequence in the eruptive fever. The ufe of this remedy in fevers marks an aera, not only in the management of the fmall-pox, but in medicine. The degrees of cold fhould always be increafed in proportion to the violence of the fever. Stove-rooms, fo com- mon in this country, fhould be carefully avoided. The FOR THE SMALL-POX. 309 The more we oblige our patients to fit up and walk in the open air, the better. Even in thofe cafes where they languifh moft for the bed, they fhould be encouraged rather to lie upou, than un- der the bed-clothes. Children fhould be ftript of flannel petticoats that come in contact with their fkins ; and even clouts fhould be laid afide if pof- fible, without great inconvenience, and at any rate they fhould be often removed. Great and obvi- ous as the advantages oS cold air appear to be in the eruptive fever, it has Sometimes been uSed to an exceSs that has done miSchieS. There are few cafes where a degree of cold below forty of Fah- renheit's thermometer is neceffary in this ftage of the fmall-pox. When it has been ufed below this, or where patients have been expofed to a damp atmoSphere Some degrees above it, I have heard of inflammations of an alarming nature being pro- duced in the throat and breaft. c. The bowels, more efpecially of children, fhould be kept open with gentle laxatives. And, d. Cool fubacid drinks fhould be plentiSulIy uSed until the eruption be completed. Sometimes the Small-pox comes on with a fever the reverfe of that which we have defcribed. The heat 310 NEW MfeTHOD OF INOCULATING heat is mconfiderable, the pulfe is weak, and fcarcely quicker than ordinary, and the patient complains of but flight pains in the back and head. Here the treatment fhould be widely different from that which has. been mentioned when the fever is of the inflammatory kind. Bleeding in this cafe is hurtful, and even cool air muft be admitted with caution. The bufinefs of the phyfician in this cafe is to excite a gentle action in the Sanguiferous fyf- tem, in order to produce the degree of fever which is neceffary to the eruption of the pock. For this purpofe he may recommend the ufe of warm drinks, and even of a warm bed with advantage. If the eruption delays beyond the third day, with all the circumftances of debility that have been mentioned, I have frequently ordered my patient? to eat a few ounces of animal food, and to drink a glafs or two of wine, with the moft defirable fuc- cefs. The effects of this indulgence are moft ob- vious where the weaknefs of the fever and the delay of the eruption in children, have made it neceffary to allow it to mothers and nurfes. The Small-pox by inoculation fo Seldom comes on with the Symptoms of what is called a putrid fever, that little need be faid of the treatment pro- per in Such caSes. I fhall only obScrve, that the cold regimen in the higheft degree, promiSes more SucceSs FOR THE SMALL-POX. 3H fuccefs in thefe cafes than in any others. I have repeatedly been told, that when the fmall-pox ap- pears confluent among the Africans, it is a com- mon practice for mothers to rub their children ali over with pepper, and plunge them immediately afterwards into a Spring of cold water. This, they Say, deftroys a great part of the pock, and difpo- Ses the remainder to a kindly Suppuration. From the SucceSs that has attended the uSe of the cold bath in putrid fevers in Some parts* of Europe, mentioned in a former lecture, I am difpoSed to be- lieve in the efficacy of the African remedy. The fever generally lafts three days, and the 'eruption continues for a fimilar length of time, counting the laft day of the fever as the firft day of the eruption. But this remark is liable to ma- ny exceptions. We fometimes obferve the erup- tion to begin on the firft, and often on the fecond day of the fever; and we fometimes meet with * In a differtation entitled " Epidemia verna qua Wrahfla- mam, Anno. 1737 afjlixit" publiflied in the appendix to the Acla Nat. Curios, Vol. X. it appears, that wailiing the body all over with cold water in putrid fevers, attended with great debility, was attended with fuccefs at Breftaiv in Sit fa. The practice has fmce been adopted, we are told, by feveral of the neighbouring countries. Cullen's first lines of THE PRACTICE OJ PHYSIC. „ cafes 312 NEW METHOD OF INOCULATING caSes in which a Second eruption comes on after the fever has abated for feveral days, and the firft eruption confiderably advanced in its progrefs to- wards a complete Suppuration. This is often oc- cafioned by the application of exceffive cold or heat to the body, or by a fudden and premature ufe of ftimulating drinks or animal food. I come now to treat of the beft method of mi- tigating troublefome and alarming Symptoms. The only alarming Symptom is convulfions, to which children are Subject during the time of den- tition. Thefe have been lefs frequent, fince the liberal and judicious uSe oS cool air in the eruptive fever than formerly. They are often relieved by putting the feet iu warm water. But a more ef- fectual and fpeedy method of curing them, is to expofe our patients Suddenly to the open air. The colder the air the quicker relieS it affords in thefe caSes. To prevent the return of the fits, as well as to allay any difagreeable and troublefome ftart- ings, a few drops of laudanum fliould be given. They generally yield in a little while to this excel- lent ranedy. The next fymptom which demands the aid of oui art, is the inflammation and fore on the arm. Pool- FOR THE SMALL-POX. ^IJ Poultices of all kinds fhould be laid afide, as tend- ing to increafe the inflammation and fore. Inftead of thefe, the part affected fhould be wafhed three or four times a day with cold water*. This ap- plication is not only agreeable to our patients, but foon checks the progrefs of the inflammation, and difpoSes the Sore to heal about the time the erup- tion is compleated. The eyes fhould likewiSe be wafhed frequently with cold water, to Secure them from puftules and inflammation. With refpect to thoSe alarming or troubleSome Symptoms which occur in thofe cafes where the pocks are nume- rous, or confluent, they happen fo Seldom in ino- culation, that they do not come properly under our notice in this place. They are moreover fully difcufled by Doctors Boerhaave, Huxham, Hillary, and other practical writers. V. I come now, in the laft place, to deliver a few directions that are neceffary after the eruption and fuppuration are over. It is well known that eruptions of an obftinate nature fometimes follow the fmall-pox. Thefe I * Where the inflammation on the arm has been fo confi- derable as not to yield immediately to the application of cold water, I have ufed the vegeto-mineral water with advantage. 1 believe 314 NEW METHOD OF INOCULATING, &C believe are often occafioned by a too fudden and fpeedy uSe of animal food. To guard againft thefe difagreeable confequences of inoculation, it is of the utmoft importance to enjoin a cautious and gradual return to the free ufe of an animal diet; and at the fame time it will be neceffary to give our patients a dofe or two of purging phyfic. Thus, gentlemen, have I delivered to you a fhort hiftory of the new method of inoculating for the Small-pox. I am aware that prejudices are entertained againft fome parts of it by phyficians of the moft ancient name and character among us. I have witneffed the effects of the old and new me- thods of preparing the body upon many thoufand patients, and I am Satisfied not only from my own observations, but from the experience of gentlemen upon whofe judgments I rely more than upon my own, that the new method is by far the fafeft and moft fuccefsful. Added to this, I can affure my pupils, that I have never known a Single inftance of a patient, prepared and treated in the manner I have defcribed, that ever had an abfeefs after the fmall-pox, or even fuch an inflammation or fore upon the arm as required the application of a poultice. 2 APPEN- APPENDIX CONTAINING OBSERVATIONS ON THi Duties of a Phyfician ^ AND THE METHODS OF IMPROVING MEDICINE. ACCOMMODATED TO THE PRESENT STATE OF SOCIETY AND MANNERS IN THE UNITED STATES. DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA, FEBRUARY 7, 1789, AT THE CONCLUSION OF A COURSE OV LECTURES UPON CHEMISTRY AND THE PRACTICE OF PHYSIC. PUBLISHED AT THE REQUEST OF THE CLASS, Vol. I. X .APPENDIX. % GENTLEMEN, I SHALL conclude our courfe of lectures, by • delivering to you a few directions for the regu- lation of your future conduct and ftudies, in the line of your profeffion. I fhall, firft, fuggeft the moft probable means of eftablifhing yourfelves in bufineSs, and of be- \ coming acceptable to your patients^ and refpec"t> able in life*. Secondly. I fhall mention a few thoughts which have occurred to me on the mode to be purSued, in the further profecution of your ftudies, and for the improvement of medicine. I. Permit me, in the firft place, to. recommend to fuch of you as intend to fettle in the country, to eftablifli yourfelves as early as poffible upon farms. My reafons fof this advice are as follow: X 2 i. It APPENDIX. i. It will reconcile the country people to the liberality and dignity of your profeflion, by (hew- ing them that you affume no fuperiority over them from your education, and that you intend to (hare with them in thofe toils, which were imnofed upon man in confequence of the lofs of hyour life by vifit- ing a patient in a contagious fever, than for curing a pleurify, You have a right likewife to be paid for your anxiety. Charge the fame Services, there- fore, higher to the mafter or miftrefs of a family, or to an only fon or daughter, who call Sorth all your Seelings and induftry, than to leSs important members of a family and of fociety. If a rich man demands more frequent vifits t.han are necef- fary, and if he impofes the reftraints of keeping to hours by calling in other phyficians to confult with you upon every trifling occafion, it will be juft to make him pay accordingly for it. As this mode of charging is ftrictly agreeable to reafon and equi- ty, it feldorn Sails of according with the reafon and fenSe of equity of our patients Accounts made out upon thefe principles, are Seldom complained of by them. I fhall only remark further upon this Sub- ject, that the Sooner you Send in your accounts after your patients recover, the better. It is the duty of a phyfician to inform his patient of the amount of his obligation to.him at leaft once a year. But there are times when a departure from this rule may be neceffary. An unexpected mif- /brtune in bufinefs, and a variety of other acci- dents, 33° , APPENDIX. dents, may deprive a patient of the money he had allotted to pay his phyfician. In this cafe, delica- cy and humanity require, that he fhould not know the amount of his debt to his phyfician, till time had bettered his circumftances. I fhall only add, under this head, that the poor of every defcription fhould be the objects of your peculiar care. Dr. Boerhaave ufed to fay, " they " were his beft patients, becaufe God was their " paymafter." The firft phyficians that I have known, have found the poor the fteps by which they have afcended to bufineSs and reputation. DiSeaSes among the lower claSs of people are gene- rally fimple, and exhibit to a phyfician the beft cafes of all epidemics, which cannot fail of adding to his ability of curing the complicated difeafes of the rich and intemperate. There is an inseparable connection between a man's duty and his intereft. Whenever you are called, therefore, to vifit a poor patient, imagine you hear the voice of the good Samaritan founding in your ears, " Take care of " him and I will repay thee." I come now to the fecond part of this addrcfs, which was to point out the beft mode to be pur- Sued, in the further profecution of your ftudies, and the improvement of medicine. a I. Give APPENDIX. 33I I. Give me leave to recommend to you, to open all the dead bodies you can, without doing violence to the feelings of your patients, or the prejudices of the common people. Preferve a regifter of the weather, and of its influence upon the vegetable productions of the year. Above all, record the epidemics of every feaSon ; their times of appear- ing and disappearing, and the connection of the weather with each of them. Such records, if publiflied, will be ufeSul to Soreigners, and a trea- sure to pofterity. PreServe, likewiSe, an account of chronic cafes. Record the name, age and oc- cupation of your patient; defcribe his diSeaSe ac- curately, and the changes produced in it by your remedies; mention the doSes of every medicine you adminifter to him. It is impoffibie to tell how much improvement and facility in practice you will find from following thefe directions. It has been remarked, that' phyficians feldom remember morejthan the two or three laft years of their prac- tice. The records which have been mentioned, * will fupply this deficiency of memory, efpecially in that advanced ftage of. life when the advice of phyficians is fuppofed to be moft valuable. II. Permit me to recommend to you further, the ftudy of the anatomy (if I may be allowed the expreflion) of the human mind, commonly called Vol. I. Y metaphy- 332 APPENDIX. metaphyfics. The reciprocal influence of the bo- dy and mind upon each other, can only be afcer- tained by an acurate knowledge of the Saculties of the mind, and of their variqus modes of combina- tion and action. It is the duty of phyficians to affert their prerogative, and to reScue the mental Science from the usurpations of Schoolmen and divines. It can only be perfected by the aid and difcoveries of medicine. The authors I would recommend to you upon metapyfics, are, Butler, Locke, Hartley, Reid, and Beattie. TheSe inge- nious writers have cleared this Sublime fcience of its technical rubbifh, and rendered it both intel- ligible and ufeful. III. Let me remind you, that improvement in medicine is not to be derived only from colleges and univerfities. Syftems of phyfic are the pro- ductions of men of genius and learning ; but thofe facts which conftitute real knowledge, are to be met with in every walk of life. Remember how many of our moft ufeful remedies have been dis- covered by quacks. Do not be afraid, therefore, of converfing with them, and of profiting by their ignorance and temerity in the practice of phyfic. Medicine has its Pharifees, as well as religion. But the fpirit of this feet is as unfriendly to the ad- vancement of medicine, as it is to chriltian cha- rity. APPENDIX. 333 rity. By converfing with quacks, we may convey inftruction to them, and thereby leffen the mif- chieS they might otherwiSe do to Society. But Surther.—In the purSuit of medical knowledge, let me advife you to converSe with nurSes and old women. They will oSten Suggeft Sacts in the hif- tory and cure of difeaSes which have eScaped the moft Sagacious obServers of nature. Even Ne- groes and Indians have fometimes ftumbled upon difcoveries in medicine. Be not afhamed to in- quire into them. There is yet one more means of information in medicine which fhould not be neglected, and that is, to converfe with perSons who have recovered from indifpofitions without the aid of phyficians. Examine the ftrength and exertions of nature in thefe cafes, and mark the plain and home-made remedy to which they afcribe their recovery. I have found this to be a fruitful fource of inftruction, and have been led to con- clude, that if every man in a city, or a diftridt, could be called upon to relate to perSons appointed to re- ceive and publifli his narrative, an exact account of the effects oSthoSe remedies which accident or whim has fuggefted to him, it would furnifh a very uSe- ful book in medicine. To preferve the facts thus obtained, let me advife you to record them in a book to be kept for that purpofe. There is one Y 2 more 334 APPENDIX. more advantage that will probably attend the in- quiries that have been mentioned ; you may dis- cover diSeafes, or Symptoms of difeaSes, or even laws of the animal economy, which have no place in our Syftems of nofology, or in our theories of phyfic. IV. Study fimplicity in the preparation of your medicines. My reafons Sor this advice are as follow: i. Active medicines produce the moft certain effects in a fimple ftate. 2. Medicines when mixed frequently deftroy the efficacy of each other. I do not include che- mical medicines alone in this remark. It applies likewife to Galenical medicines. I do not fay, that all thefe medicines are impaired by mixture, but we can only determine when they are not, by actual experiments and obfervations. 3. When medicines of the fame claSs, or even of different claffes, are given together, xheftrongeft only produces an effect. But what are we to fay to a compound of two medicines which give ex- actly the fame impreffion to the fyftem? Probably, if APPENDIX. 2,2,5 if we are to judge from analogy, the effecl: of them will be fuch as would have been produced by nei- ther, in a fimple ftate. 4. By obferving fimplicity in your prefcriptions, you.will always have the comi.vmd of a greater number of medicines of the fame clafs, which may be ufed in f\ 'CcdTion to each other, in proportion as habit renders the Syftem inSenfible of their' action. 5. By ufing medicines in a fimple ftate you will obtain an exact knowledge of their virtues and dofes, and thereby be able to decide upon the numerous and contradictory accounts which exift in our books, of the character of the fame medi- cines. Under this head, I cannot help adding two more directions. 1. Avoid Sacrificing too much to the tafte oS your patients in the preparation of your medicines. The nature of a medicine may be wholly changed by being mixed with fweet fubftances. The au- thor of nature feems to have had a defign, in ren- dering medicines unpalatable. Had they been more agreeable to the tafte, they would probably have 33^ APPENDIX. have yielded long ago to the unbounded appetite of man, and by becoming articles of diet, or con- diments, have loft their efficacy in difeafes. 2. Give as few medicines as poffible in tinctures made with diftilled Spirits. Perhaps there are few cafes in which it is fafe to exhibit medicines pre- pared in Spirits, in any other form than in drops. Many people have been innocently feduced into a love of ftrong drink, from taking large or frequent dofes of bitters infufed in Spirits. Let not our profeffion be reproached in a Single inftance, with adding to the calamities that have been entailed upon mankind by this dreadful Species of intem- perance. V. Let me recommend to your particular at- tention, the indigenous medicines of our country. Cultivate or prepare as many of them as poffible, and endeavour to enlarge the materia medica, by exploring the untrodden fields and forefts of the United States. The ipecacuanha, the Seneka and Virginia Shake-roots, the Carolina pink-root, the Spice-wood, the Saffafras, the butter-nut, the tho- roughwort, the poke, and the ftrammonium are but a finall part of the medicinal productions of America. I have no doubt but there are many hundred other plants which now exhde invaluable medicinal APPENDIX. 337 medicinal virtues in the defert air. Examine, likewife, the mineral waters, which are fo various in their impregnation, and fo common in all parts of our country. Let net the properties of the infects of America efcape your inveftigation. We have already difcovered among fome of them, a fly * equal in its bliftering qualities to the famous fly of Spain. Who knows but it may be referved for America to furnifh the world, from her produc- tions, with cures for fome of thofe difeafes which now elude the power of medicine ? Who knows but that, at the foot of the Allegany mountain there blooms a flower that is an infallible cure for the epilepSy ? Perhaps on the Monongahela, or the Potowmac, there may grow a root that fhall Supply by its tonic powers, the invigorating effects of the favage or military life in the cure of con- fumptions. Human mifery of every kind is evi- dently on the decline. Happinefs, like truth, is an unit. While the world, from the progrefs of intellectual, moral and political truth, is becoming a more SaSe and agreeable abode for man, the vo- taries of medicine fhould not be idle. All the doors and windows of the temple of nature have been thrown open by the convulfions of the late American revolution. This is the time, therefore, to prefs upon her altars. We have already drawn from them difcoveries in morals, philofophy, and 2 govern- 338 APPENDIX. government; all of which have human happinefs for their object. Let us preferve the unity of truth and happinefs, by drawing from the fame Source, in the preSent critical moment, a know- ledge of antidotes to thofe difeafes which are flip- poSed to be incurable. I have now, Gentlemen, only to thank you for the attention with which you have honoured the courfe of lectures which has been delivered to you, and to affure you, that I fhall be happy in render- ing you all the Services that lie in my power, in any way you are pleaSed to command me. Accept of my beft wiflies for your happinefs, and may the bleffings of hundreds and thouSands that were ready to perifh, be your portion in life, your com- fort in death, and your reward in the world to come. THE END. Med. Hist. Wz 270 Ji«^ / . \ •■■■ '!; S3 i> ''vdl: ';,X d It^iW'-fitytfjifti, ■ ~' - V," V'*!' v *lw< ■#d^fli 1:,'..;..: ■;■$■ <^\^-iWM^ d« ^* M^^MW'i d-d: ',;,feM-l ■. ■■■•;'■*■-ml ... --X-rd.d