1c- 
#9
Though we believe that all Medicines produce 
their influence on the system by Stimulating 
it. Yet we are also of opinion, that 
these substances differ from each other 
as much in the Kind, as the degree of 
stimulation, They are characterized
each by its peculiar power which no 
quantity nor combinations of other medicines,
can resemble, Were all diseases in 
all their horrid varieties, but grades of 
same diseas, and medicines only more 
of less. patient Stimuli, of the same kind
the practitioner, (like David with his 
stone & Sling) might sally forth, A bottle 
of Rum in one pocket. and a lancet
in the other, prepared to conquer, and 
certain of victory.
General Stimulants may be divided
into great classes. 1st Those which are quickly
diffusible, and evanescent influence -

2nd 
Those which are much slower, but more
permanent. in their stimulant effects.
Of these the first is called Narcotic
to be considered. By Cullen they were 
defined substances which diminish the 
action and the powers of the system, without 
occasioning any sensible evacuation
but Brown deemed them powerful stimulant,
exceedingly, diffusiblity (all others 
Perhaps the best deffinition of Narcotics,
is that which combines these two 
and describes them to be substances to be 
substances, whose direct effects are stimulant
but which induce in larger doses
a corresponding debility. When administered
in smaller doses and at smaller
intervales, they prove highly stimulant
exciting both mind, and Body. But in 
great doses and at long intervals they 
diminish the circulation & secretion, lessen
sensibility & muscular power and impair 

3
impair the mental faculties, Sometimes they 
continue their influence farther, producing 
tremors, and oppression either wild, delirium
or profound stupor and lastly death - 
They may notwithstanding these dreadful
catalogue of consequence be of great benefit
in the hands of a judicious practitioner, who
by a proper management may produce
through their agency either stimulant or 
sedatery effects.
They are used to support the actions
and powers of the system, to allay pain and 
irritation, abate spasmodic, action, induce
sleep, and check morbidly increased
evacuations
Their stimulant application is chiefly
indicated in diseases of debility or in 
the low stages of powerful complaints which 
by their violence exhausted the vital powers.
But when under such circumstances they 

4 
they produce head ache, dry skin parched
tongue, and small tense pulse, they 
are to be carefully abstained from -
It is almost always best to begin
with very small doses gradually increasing,
for their power is diminished by habit.
When however the case is urgent and 
the system sinking, let them be boldly
used, for in such cases the asperate is 
the safest course -
2nd. Do not combine too many ingredients
lest one counteract the effects of the other.
3rd. Where combinations is resorted to for
thought necessary let such articles be 
chosen as harmonize with each other 
as wine to vol: alkali:
4th. In the continued use of stimulants
it should be remembered that the 
excitibility is exhaustible and that 
the most successful treatment will 
be 

5 
be. that [cross out] which transfer the application,
from one part of the system
to another, not persisting too long in one 
and trying all in turn. 
It sometimes happens, that the remnant
of excitability is so small that a powerful
stimulant, completes the work of the 
disease and overwhelms the feeble vitality
which distemper has spared.-
Let therefore the medicines be graduated
to the state of the patient
It is to be observed also that the 
most active medicines do not always produce
the most powerful effects. they are found 
to be totally incompetent to while many 
of far less. general actively will be instantly
efficient
Hence the baffled practitioner must 
often apply to small arms, when the Artilery
of his art, has made no impression
for the bullet of a rifle can sometimes find.

6. 
admission, where the most potent shell
by reason of its bulk could never enter.
The last subject of my lectures on 
therapeutics, is Tonics.
As this term embraces every thing
tending to invigorate, the subject might 
be very extensively treated, but we shall
confine ourselves to those substances
only which correct or alleviate debility
The modus operandi of these substances,
was till very early little Known.
They were like other medicines, supposed
to act according to the principles of the 
dormant science of the times, and while 
in one age they were accounted for upon
mechanical principles, the next subjected them
to chemical agency alone.
But the late discoveries of the operation
of the Absorbents, have exposed the fallacy
of all such opinions, as make no allowance
for the modifying influence of vitality 

7 
And have pretty clearly shown that through
the medium of vitality alone or by sympathy
commencing their gentle and gradual excitement
in the stomach, they extend their influence
by means of vital communications
through the system, and as the action was
graduate, its abatement is gradual so that 
the susceptibility to the ordinary stimulus for 
food &c is not impaired
Tonic's are divided into three sections
Bitters, Aromatics & Astringents
of these the last are the most importance
in medicine, Cullen supposed that they 
acted by producing contraction and condensation
of the solids thereby increasing their 
density and force of cohesion! The proof of 
their action, being derived from experiments
on dead matter, cannot be admitted as 
conclusion. Darwin supposed they act by promoting 
absorption. But as this will not 
account -


8.
account for all their effects we cannot
admit his hypothesis.
That their power of suppressing hemorrhaggy
and checking profluria may not depend 
on their mere astringency is probable
from the great influence of Opium &
Ipecac. in the same way. 
Beside the tonic medicine, there 
are other means of invigorating a debilitated
system such as diet, Bathing &
Exercise.
For the proper use of diet let the following
rules be observed
1. Let the diet be appropriate - during 
convalescence the food should be light and 
digestible, as Arrow Root. sago. tapioca &c.
with such condiment as is most agreeable -
2. Let the patient eat more frequently 
than usual, for the stomach like a 
school boy is always doing mischief when 


9. 
he is idle -
3rd. Solid food is to be prefered to fluid or
liquid food - always considering the habits 
of the patient
4th. In many complaints - particularly in 
dyspepsia, one single article is to be 
prescribed with effect.
Of the Bath -
This may be either warm or cold
The hot bath is directly stimulating - while the 
cold bath induces in the first place languor
and debility. which when its application
is salutary is succeeded by an agreeable
reaction, If instead of reaction the patient
feels a chilliness & has a pale face the bath
will rather retard than accelerate recovery.
Rule 1st. It should be employed in the 
morning or at 12 O'clock -
It should be repeated daily and the 
patient, should remain in about a minute 

10 
2 It should never be employed when the person is fatigued
or perspiring
These rules are mostly applicable also to warm bathing
The patient should however remain much longer
in a warm than cold bath a should be ruled
long that he may be perfectly dried and have 
the benefit of friction Salt or Nitric Acid is 
sometimes added to the [cross out] water
Exercise is of these kinds. Active, passive or allined
In great debility the passive exercise is most salutary
such as friction. As strength improves the mixed
exercise such as the cradle chamber horse,
shuttle cock & dumb belles should be used
and lastly riding sailing and other recreations
in the open air 
Rules, 1 Commence with passive exercises
2 Avoid fatigue, by repairing while the patients
falls strength to proceed

10 A



10 B



11 
3 Do not allow your patient to take exercise upon
a full or empty stomach.
4
5 Select a mode of exercise opposed as much as possible
to the ordinary habits of your patient. Adapt it also 
to the kind or seat of the disease - as in diseases of 
the lungs prescribe riding or any mode of gestation
Be very carefull when prescribing exercise to mention
the Kind & quantity
26th Dec. 1816
Before entering into my course of lecture on the 
Practice of Medicine I will make a few 
observations on Pathology.
No work professedly on this subject has been
published since Gaubiuse, about a century
ago gave to the world the system of the 
humeral pathologist 

12 
Pathology is a word of greek origin signifying
simply a discourse on diseases it embraces the history
of the causes, nature, effect, seat, signs, & c. of dises
or it has been defined, "The theory of the disease
state of the body."
The cause of disease are neither. Remot
predisposing, occasional, excitive or Proxim
Or. The causes of dissease are divided into Remot
or Proximate - The remote causes are a again
divided into predisposing and exciting or 
occasional - In some disseases the 
predisposing is also the exciting cause as in 
small pox, tetanuse hydrophobia; poisons
Remote causes may be inherent (constitution
or external - Of these the first are commly
denominated temperaments excepting those 
derived from real conformation & inheritance
There are commonly mentioned four temperaments,
The Sanguine, the Biliouse, the 

13 
the Phlegmatic and the Melancholic
These are distinguished from each other by 
difference in person, figure, countenance &c.
The Sanguine temperament is known by a 
clear florid countenance, blue eyes an agreeable
figure inclined to corpulency & light hair -
This temperament is liable to all the complaints 
arising from fullness of blood - Hemorrhagy
& other inflamitory affection. 
The Biliouse temperament is distinguished
by a brown or yellow complexion, heazle eyes,
Strong black hair cutaneous incing and
a strong well marked countenance. This 
temperament indicates the possession of a daring 
soul, more impressive than sprightly or agreeable
manners - It predisposes to bilious disease in 
all their forms -
The Phlegmatic temperament may be known by 
a fair white skin, clear blue recine, soft flesh 

14 
flaxen hair, a round plump face generally 
without expression - low stature inclined
to corpulency. It renders its possessor liable
to glandular complaints, and diseases of 
obstruction generally - as Dropsy and cutaneous 
diseases -
The Melancholic temperament is only a 
higher degree of the Bilious - a more
yellow countenance, hollow eyes sharp features
& Sunken aspect - The sanguine temperamen
is most commonly seen in cold countries
& high latitudes. The Bilious in warm 
climates during middle life
The Phlegmatic, in low moist lands amidst
a humid atmosphere.
The Melancholic, is generally found in
the decline of the life of a bilious subject.
There are besides there many other less 

14 A



14 B



15
general predisposing temperaments - as 
The Cephalic existing [cross out] in many children
till 6 years of age, rendering then liable to 
diseases of the head, as hydrocephalus -
convulsions &c. Such children are generally
remarkable vivacious & inteligent. In old age
its Subjects to apoplexy vertigo paloge &c.
Other children till 8 or 10 are of a Pectoral
temperament liable to Croup Catarrhs &c
Others of Glandular temperament by nanche 
In Adolescence - Hemorrhogic temperaments
Epistaxis & in a few years it commonly disappears
being succeeded by head Ache &c
In females it is connected with Uterus
rendering them liable to Hemorrhage abutero
Nervous temperament is found in adults
of both sexes but especially in females affecting 

16
affecting them with tremors, palpitation &c
Pulmonary temperament more generally found
in Males rendering them usually liable
to Pneumonic affection
Rheumatic temperament, Tender its possess
liable upon exposed to Rheumatic affection
It arrives most commonly after the meridian 
of life
Intestinal temperament. with liability
to diseases of the intestinal canal, as 
Dysentery &c. Females are most subject to 
these temperament than Males
Menstrual temperament females are more liable
to diseases during menstruation - It is indeed
a prolific source of disease and requires to be 
enquired into by the practitioner when called
to besit females


17
These minor temperaments have not very
distinguishing marks. They must be learned 
from experience alone and observation
27th. Decr. 1816 -
Besides this long catalogue of Internal causes
of disease. I have to enumerate a still longer and 
more extensive [cross out] one of external causes. Of these
the Atmosphere is a very general one. In its 
general state it does not appear to have much
disease - producing virulence, - but it sometimes
hot & sometimes Cold; sometimes loaded with 
vapor and sometimes divested of humidity
Heat has been universally acknowledged to
be capable of producing disease. The historian
and the poet alike concur in ascribing to it
such an influence and the fancy of the 
latter has often seen in the beam of Sinus the 
ensigns of pestilence. It is not however in these 

18
climates that we can properly estimate the 
influence of a summers sun, but the 
inhabitants of more southern climates
is no stranger to its power
The mode of action seems very intiligible
It begins by exciting the actions and powers
of the system to a more vigorous exertion
which naturally induces a subsequent
relaxation & debility, state well calculated
for the Aspiration of infection or disease
Hence intestinal & cutaneous affection
or by violent excitement Apoplexy
Hemorrhagy &c -
Cold is another fruitful source of disease
Its most powerful affect is produced
when it suddenly succeed to great heat
for the lassitude and debility produced
by the latter are well calculated for 


18 A



18 B



19
impression and therefore these sudden changes
produce more disease than any other causes than
with which we are acquainted
Humidity when occasional, is another cause
of disease though from the great health and longevity
of the inhabitant of many moist Climate 
we cannot doubt that general humidity
is rather salutary otherwise -
The opinion of harmlessness of moisture, nay 
of its excellence in some complaints was 
first sugested by Dr Morgan of Philada.
who sent Pulmonary patients to the low 
marshy ground or sea coast, and found
them much benefitted, especially of the 
Miasma excited ague -
Avidity has been morbific especially in 
those tropical regions where great sandy deserts
abstract how the Atmosphere all its humidity

20
Sirocca pevails. - This balefull blast seizes
on every drop of moisture in its progress
depriving the body of its necessary humidity and
parching the faces & skin - In our country
such a degree of Acidity never occurs. On 
the other hand our dry season is healthy
owing perhaps to the absence of noxious
exhalations which somtimes infect our 
Atmosphere. The quantity of Oxygen
contained in the air we breath or in other 
words the density of atmosphere may 
from. Dr Saussuri experiment be an agent
in disease. The accurate and classical
philosopher found that at a certain height
the muscular power was much more easily exhausted
than on the plain; When 14 or 1500 taises
Above the level of the sea, the natives themselves
of the Alps seemed to lose that energy an

21
energy and activity which in a lower region
distinguished them in the Chase. They more 
frequently constrained to rest while he was a 
stranger to the hills, found his legs sink under
him, his eyes severe, his arteries thob and sometimes
after experiencing excessive thirst & nausea
a profound sleepiness or lethergy endanger in 
that cold exposure the life of the traveller
The same effect has been experienced by shcronary
who have been so completely overcome by
drowsiness that at a fearful height they have
slept in utter heedlessness of danger - Baron
Homboldt, also felt these effects and in a more 
excessive degree having been Seized with
violent Homorrhages of the nose and mouth
with inflamed eyes & many such other disorders
He found most relief from rest and cold water 

22
These various phenomena may be explained by 
ascribing them to the lenity and lightness of 
the Airs. In order to affect respiration
there must be a certain quantity of oxygen
to combine with the Calbouofe the blood
Muscular Action by accelerating the circulation
increase the quantity of Carbon
and of course tenacity of the of the air  
on those lofty hills is difficulty obtained
Hence air becomes necessary. - From the experiment 
of Spalding the diver. Lavoisier &c
it appears that the ingestæ have a powefull
influence on the Consumption of Oxygen
by the lungs. - Spalding found when being 
on animal food he consumed the oxygen in 
the diving bell much sooner than when he 
subsisted on vegetable food, The water

22 A



22 B



23-
therefore which Humboldt found usefull
may have supplied oxygen to assist in the 
process of decarbonations
Decr 30th. 1816
Having thru taken as much notice of the
influence of the sencible qualities of the atmosphere
as in our plan permits. I proceed
to the Consideration of the disease prodicing
power of those viatiated states of the Atmosphere
which are not at all cognizable by our senses
of these, Marsh miasmata, or more properly
Keins miasmata have the first place
These may be defined, "Poisonous emissions or
exhalation from vegetable or animal substance 
in a state of putrefaction" This is nearly all we know
of this nature for the most accurate endeometrical
examinations have not been successfull in


24.
detecting them in cognizable quantity in the 
most pestilential atmosphere we know however
that they exist there [cross out] because disease are 
produced by them in the places which they originally
occupied and may be conveyed by a 
current of air, wafting this miasmata to 
a distance of eight or ten miles distance
There have been many disputes on this point 
but we [cross out] think it sufficienly established
by the following facts viz. 1st The inhabitants
of the western side of many of our Rivers areas
the sea coast are sometimes totally exempted
from those autumnal fevers which are ravaging
the eastern bank.- and where there is a 
remarkable difference we can always find the 
common S. West. wind predominate 2ndy. A
thick row of trees or a wood placed between
a farm and the neighbouring marsh or 

25
or river generally the effect of protecting its
occupies from those intermittents which will
affect there more exposed neighbours.
Thus demonstrating both their source & vehicle
In perusing the various disputes of this subject 
we discover a great many curious facts brought
to light by the industry of philanthropy the emulation
of rivalry and the persevering invetary
of professional enmity, but the sum of them all
is, that these miasmata may be conveyed by a 
steady continued wind to a distance of eight or 
ten miles from their source and that in the direction
of the wind while on the other hand those 
places immediately to windward are exempted
by such a wind from disease to which they [cross out]
would otherwise be liable
These marshy exhalations are not always sufficienly
active to induce disease but are subject to incidents

26.
which continually modify their virulence
as well as quantity At an atmospherical 
temperament less than 80° miasmata though
evolved do not arise in a sufficient volume
to produce disease
Rain has also considerable influence on these
effluvia, A rainy season is seldom accompanied 
by those disease which are the offspring
of miasmata. For besides obscuring the sun
its keeps the marshy ground under water by 
which means, the vegetable matter is not 
acted on. But when the low ground are 
inundated, moisture enough is poured
on the hilly lands to assist the purification
process there and thus while the inhabitants
of marshy land are free from autumnal
fevers &c those who ocupy higher situations
are sometimes severely affected But rain 


26 A



26 B



27.
is a very common cause of Miasmata drawing
it down from shore higher regions of air to which 
during long droughts it has ascended or washing
away the green pellicle which mantles the stagnant
waters, and thus enable the sun to act with direct
ray upon the accumulated matter beneath
Considerable disputes have also arisen as 
to the length of time during which virus may
remain in the system without producing disease
While some have contended that its influence
excites heat for a few days or hours.
Jackson and others have asserted that it has 
remained then weeks; nay, months, and then
excited disease. Certain it is that complaints
resulting from marsh miasmata have been 
produced, hours, days, weeks, nay, half a year
after the virus, has ceased to impregnate the surrounding
atmosphere but we cannot believe
that any poison has lain dormant (in the system)

28.
in the system for so long a period; And are more
inclined to believe that the predisposition to 
disease produced by that poison has, for want
of an exciting agent remained concealed long
after the cause which gave it birth has ceased
to exist - We have an example analogous to 
this in the variolous and vaccine virus.
which Sometimes do not act sensibly on 
The system for long after the time at which 
they usually manifest themselves
The action of miasmata are promoted
as well as ritardeded by various causes -
Among the accelerating causes, maybe inumerated
Cold and moisture among the counteracting
agents chiefly habit. Long residence
in a country subject to the influence
of miasmata same to weaken its power
and of ten procures entire exemption from its 


29
agency; while a stranger is often and violently
affected; a native is often free from disease or only
slightly attacked and easily cured -
This power of habit is well illustrated by the 
fact that old people who in an unhealthy
country have resisted the virulence of infection
are often unable to reside in a much more salubrious
atmosphere
A vast catalogue of diseases are said 
to result from this source. No part of the Body
it has been asserted is exempted from its influence
It has been thought the remote cause of Bilious fever
in all its forms generally - of all too, intestinal complai
Disease of the liver and Spleen - cutaneous corruptions
especially those which occur in warm weather
Are we warranted it attributing to a single
cause this vast diversity of influence- It is consistent
with the principles of sound philosophy to admit that 


30
that the same cause may produce, under the same
circumstance disease different not only in degree
but nature also? - We cannot get rid of this objection
by supposing the variety to arise from the nature
of the parts affected, for we do not Know anything
Analogous to such a case in the whole circle of 
medical science - We do however see reasons
to believe that from the difference in power of 
one agent, may arise different grades of the same 
disease, and that from the lowest active state 
of miasmata, arise intermittent, from a higher
Bilious from the highest pestilential fevers
Another fruitful source of disease has be demonstrated
Ideo miasmata. These are effluvia arising 
from animal excretions and secretions in a 
state of putrefaction of which the most general is 
perspiration These effluvia produces also, it is 
said a great variety of diseases but we believe 
the most commonly produce low fevers & dysentery 

30 A




30 B



31
They are by no means of such general and extensive
influence as marsh miasmata. They do not proceed
in an active condition to a greater distance
than eight or ten feet from their cause and Dr.
_ of Manchester has proved that beyond
that distance no person can receive the infection
Dr. Chapman saw this demonstrated by Dr.
Gregory and Dr Duncan at Edinburgh
It may be observed hereafter that although the 
atmosphere is so bad a conductor of Idio miasmata
this virus is very adhesive attaching itself
to wool, cotton &c. remaining there in an active
state for a long time. In London it has been
Known to produce malignant fevers by impregnation
from the walls and floor of a house
I three years after any disease of that kind had 
been Known to exist there. It is therefore proper 
after -

32
after the recovery [cross out] from such complaints
the house or rooms which will affecttially destroy 
the poison.
Ground floors will not retain this 
virus and then few floors of earth are ever to 
be prefered in camps especially where such
maladies prevail 
These disease differ much from those 
which arise from Koino miasmata, in the influence
which cold & heat exert upon them.
Malignant fevers &c. always spread
faster in cold than warm weather and are
therefore hardly Known in the West Indies
We believe this is not so much in the 
nature of the infection as in the state of confinement
to which in cold weather it is subject 
Then the doors and window are Kept carefully
closed, no aperture is left by which to permit its 
escape no current of air is excited to drive it 
away & no wonder that thus confined and 

33
concentrated its virulence increases and its 
energy becomes irresistible
31 Dec 1816
Besides these thus are many other
causes which our limited time will not permit
us to consider, We cannot however
dismiss this part of our course without some 
observations upon Epidemic. - These may be 
defined "Disease of general prevalence, spreading
over a considerable tract of District. affecting
a number of people at the same time & nearly
in the same way" These maladies have been
sometimes so fatal and rapid in their progress
that the Ancients unable to discover the cause have
attributed them to the wrath of an incensed
Deity, and instead of endeavouring to arrest
their Career or assuage their virulence by natural
means; vainly attempted to desperate the vengeance 

34
of heaven by prayer and sacrifice
A sounder phylosophy and more accurate
observations have however discovered that 
to the atmosphere alone we are to look for 
a solution of the difficulty
But in most cases we can go no 
further They may sometimes be traced
to real causes, but there have been times
when such diseases have traversed the globe
subjecting both quarters of the world to their
baneful influence.- The cause of these universal
maladies have been sought for in vain
and all that has been discovered is that they 
have been frequenly accompanied or preceeded
by great convulsion of nature of portentious 
signs in the heavens - Volcanic erruptions, 
earthquakes, great tempests and comets have
ushered in (at various times) or attended the 

34 A



34 B



35
march of these terrific visitants. - These are 
but the first link in the chain however - and 
we must confess our ignorance of the changes
which are produced upon the Atmosphere
by such agents
The laws which regulate the 
operation of these diseases, are not to be 
found embodied in any treatise, but an
scattered through the writing of Hippocrates.
Sydenham, Huxam, and particularly
Rush. The works of the last named gentleman
are a treasure of Knowledge on this subject
The 1st law. No two diseases of unequal power can 
exert at anytime together in the same systems
There are some exceptions to this rule.- 
Epidemic is a kind of Monarch, which when 
not powerful enough to drive out another 
disease modifies its actions and forces upon it 


36
its livery - Thus when Yellow fever raged among
so violently every other fever because inflamitory
and was accompanied with gastric uneasiness
the systems of the predominating epidemics
When on the other hand - Typhus Pneumonia
assumed the sway its tendency to reduce
every other malady to its own condition was 
so powerful that for long after the final
departure, the practitioners of our country
were afraid to use the lancet lest this potent
disease should assume the dominion & destroy
the patient weakened by depletion. The 
Salutary influence of habit is no where more
Conspicuous than in divesting these terible
complaints of there malignity. When long 
existing epidemic dissipates their force and 
assumes a milder aspect and are then frequently
repelled by subordinate disease 

37
2nd Law An Epidemic is considerably influenced
by the atmosphere and various causes, hence
the great diversity of opinions among writers, who 
have seen the same epidemic under different
circumstances
This disease fluctuates not only in 
different years in the same place but often
in one season in different sections of the same country
Although usually similar in the same places
and seasons; yet they are sometimes very varied
presenting every form of disease, attacking sometimes
the eaterial system, presenting all Kinds of fevers -
sometimes the intestinal canal, and then we 
have every form of intestinal disease, sometimes
the brain and nerves when Apoplexy, epilepsy
tumours &c. Amidst all these diversity
the practitioners should have regard to the reigning
epidemic and endeavour to assertain how much 
influence it has exerted in all cases for bein chronic 


38
complaints are liable to its modifying
powers These are the most important of 
the laws which govern epidemic the other
may be found in Dr Rush's work
Among the circumstances which have a powerfull
influence upon health, we must not 
overlook in Situation or residence
The two great distinctions are those of town and 
country in a full consideration of which 
we cannot now enter
A country has generally been esteemed healthy
in proportion to its improvement which in a 
certain degree is true 
But when instead of improveing it by such
processes as drawing & cultivating its marshes
&cc the wealth of a country is employed in 
felling its woods and depriving it of its natural 
covering, that country becomes more unhealthy
than before
Dry sandy soils are generally salubrious,

38 A



38 B



39
salubrious, thoug the reflection during Summer is apt 
to induce affection of the eyes - Mountainous
places too, have be recommended for their exemption
from disease but they sometimes prove
more unfriendly than lower situations especially 
when they lie above marshes or other magazines
of exhalations which condenses upon the neighboring 
hills carry with them the severest malady
Proximity to the sea has also been enumerated
among the situations unfriendly to health
Writers on our present subject have found considerable
difficulty for this circumstance which 
Dr Rush ascribes to the intermixture of the sea &
land air. Were the sea air and the Satine particle
alone sufficient to produce this effect, Sailors would 
be as subject to these diseases as those inhabitants
on the coast. But instead of this, they are hardly
ever affected by the diseases incident to such places 



40
till they come upon soundings
Dr Rush related the case of a sea captain
who had long laboured under a 
chronic disease which never affected
him at sea, but which regularly visited
him upon his approach to land, and 
never left him untill his departure -
European writers have always considered 
large cities remarkably injurious
and fatal, representing their inhabitants
as dying in considerable numbers compared
with those of the Country 
1/3. of the Children of London die before 
three Years of Age while in the country
1/2 as not air before 40.
With as there is no such disproportion,
for Phil = is quite as healthy as 
any part of the surrounding country -
Perhaps - 


41.
Perhaps. the superior comfort and 
morality of the poorer, classes among
us, is one great reason of this difference
Novelty of situation has been often
remarked to make powerful impressions 
on our health. Thus Strangers
are more liable to the Maladies, incident
to a country than the inhabitants
themselves. The American students
who formerly resorted to Edinburgh
were remarkably more unhealthy than
the Scotch students, there, They brot. with
them predispositions suddenly operated
on by the strong novel influence to which 
they were exposed
Residences or dwelling houses, have 
some influence upon health, depending
upon their dryness, or dampness,
their proximity to trees, Noxious vapours.


42.
from cellars &c.: therefore when a 
practitioner finds a family unusually
unhealthy, he should
carefully examine the premises
and may do more in removing
the cause, than with all the Materia
Medica 
Dress too has often its effect &
sometimes no inconsiderable one upon 
the Body. arising from its quality
quantity or fashion - 
By being too long worn &c -
it acquires a noxious quality, which if not
removed, by artificial means, remain very 
long in an active state
Wool, silk, and cotton should be worn
next the skin, Flannel keeps a more regular
heat. This was first used for Soldiers by -
Marshall Saxe during the War in -


42 A



42 B



43
Flanders, and after his example, Sir John
Pringle introduce it into the british
Army. Linen should never be worn
by people liable to much exposure
Quantity in dress is often production
of disease, generally by being too light
Brit. Fashion which so often limits the 
quantity as well as the quality of dress
has also much effect on health by its other
forms. By tight ligatures, collar, night caps,
garters, waist bands, &c stays & corsets, it
induces a train of diseases, too long to be
enumerated, among, which, the most
formidable, are Phthisis, Cancerous Breasts,
Dyspepsia, and the long lists [cross out]
of Neurosis derived from it.
If we consider the origin of most of the 
foolish fashions, which we have allowed

44
foreigners to impose upon us, we should
not be so much inclined to follow them
as we are. Besides, if; which is not often
the case, they were suitable to any 
climate, they were suited to any climate
very different from ours, and cannot therefore
be too persisted in with impunity
We shall next proceed to the consideration
of the influence of the Acet. in 
health, which is by no means inconsiderable.
There are various modes by 
which food may injure health.
Idiosyncrasy sometime enters food
usually employed with safety and advantage;
very pernicious -
But excess, where there is no Idiosyncrasy
exists will produce the same effect.
from the use of ordinary food 
[illegible] 

45
Debauchery is a fruitfull scourer of 
misery dragging in its train Plethora
with all the attendant evils -
Dyspepsia Diarrhea, preternatural
Drowsiness. dull intellectual faculties
apoplexy, &cc -
Too little food is no less injurious,
where want resides well be found,
emaciations, slow fevers, and all the 
offspring of debility 
It becomes then a question of 
considerable, interest, what quantity of 
food is sufficient for nourishment -
Much in such cases depends upon
habit, but upon the whole the average
amount is between six and eight pounds
in twenty four hours. Tho' some individuals
will subsist on one half. this quantity
without any diminution of strength or 
[illegible]


46
health. In many diseases especially in 
febrile cases, patients eat very little
They find support from the stimulant
power of the fever, from the 
drinks and medicine.
Indeed when high excitement
agitate the frame, people in full health
have lived upon water alone, as in the 
cases of many enthusiasts in religion
who found sufficient stimulant power
from religious favour, to enable them
to bear the want of food for a much
longer time, than in ordinary circumstances -
Defect of quality in food has sometimes
occasioned great distress among armies &c 
But disease from this cause is not confined to 
war alone, whole countries have suffered
in consequence of infused crops in bad seasons - 

46 A



46 B



47-
The Secale Cornutum has more than once 
produced among the people of various parts
of France, grievous maladies, and on 
our own lines, during the late war, grain
affected with the same disease, induced
Dysentery, Diarrhea, and sometimes
Gangrene -
To improper and unwholesome
food, may be attributed many of the disorders
incident to the poorer class of European
communities, and to the use of unripe fruit
are attributed many complaints of our own
Country.
Ill baked bread, and ill cooked
meats have some influence in exciting
disease, but indulgence in highly seasoned
strong food, especially when accompanied
(as usual) with strong drinks produces at 
last Gout, cuticular disease especially of the 

48
Face, and many more equally disagreeable
and fatal.
Attention should be paid by those 
who value health, to the time of eating
food, and also to the kind of food adapted
to their time of life; for habit, if not 
nature, has taught us that, that food which 
is suited to breakfast is not suited to dinner 
and that that food which may be easily
digested by an adult may be highly injurious
2 to a child. - Dr. Rush says that he was 
hardly ever called up at night to attend
a person taken suddenly ill who had not 
been attacked in consequence of having eat 
3 a hot meal supper -
The proper times and qualities
of meals habit seems to regulate hence dinner 
is in general the most substantial meal
[illegible] 

49
breakfast so - 4
49
Of Sleeping & Watching
Too much sleep produce habitude and 
sometime even fatuity, and has an equally
injurious effect upon the body -
Watching impairs the appetite, augments
the sensibility to impression, a sense of weight
fatuity, insanity, and the train of neurosis
But there is in different individuals a 
vast difference in the power of watching
Of Exercise. Excessive motion by arbitrating,
increases the susceptibility to 
noxious influence, those producing rheumatism
in winter, Intermittent in Autumn, 
and billious fevers in Summers -
Hence Solders, and sailors so often feel
the ravages of pestilence, being so much
exposed to the debilitating effects of 
ex

50
excessive exercise.-
This may in some measure too account
for the more frequent complaints
of day labourers, men who are constantly
exposed to exciting causes under unfavourable
circumstances -
Motion may be injurious, by its nature
as well as quantity, these rotatory motions
induces lassitude, vertigo, nausea
and even vomiting while there are many
persons who cannot ride backwards in 
a carriage without experiencing similar
sensation
Rest like sleep has also influence on 
our health inducing, when much indulged
in, debility, corpulency &c -
But when we consider its effect in the 
vast divesity of sedentary employments we 
have


50 A



50 B



50 C
have a better notion of its disease exciting 
power. Dyspepsia, thoracic affections, Urinary
calculi &c form a part of the hort. of 
calamities, following the footpath of Rest
The large Manufacuring towns of Europe
affords woeful examples of the 
baneful effects of confinement, there the 
poor labourer passes his time in languid
employment, amidst an infected atmosphere
and only once in seven 
days enjoys the sickly indulgence a 
purer air and freer circulation -
Of Retention, of excretions, and evacuations.
Suppression of customary secretions
is the cause of the last at least one half
the complaints in which we are liable
Thus suppressed, perspiration produces a 
variety of Maladies. Cephalic, Intestinal
Hemorrhoidal &c &c suppressed catamenia 


51
Chlorosis, Phthisis, Hemorrhagy &c suppressed
saliva, excretion, many febrile affection
As much arises from inordinate excretion
as from its suppression, This cause
induces emaciation, debility and the 
long list of Chronic affection -
We have now cursorily considered
those causes of disease which are 
derived from matter either organised
or unorganised, and have now to take 
only a like view of those derived from 
the mind
These may be divided, according
to their effect into two classes Viz hurtful
and salutary passions, for all
mental influence is passion -
Some passions as hatred every malice,
fear &c are in their very nature -
inimical to health, while others as [cross out] lone,

52
joy, hope &c. are when moderately indulged
sources of genuine invigoration, and 
promotive of health 
There is not much difficulty
in distinguishing these two classes from 
each other, for while the one is denoted
by a pale and downward look, the heavy
eye and all the marks of inward agony,
the other is known by the light and 
airy step, the lively countenance and 
eye. the glowing cheek, and every sign
of heavenly cheerfulness. -
Dr Chapman have drew a beautiful
portrait of the individual passions
painting the feature with palled fear
of thrilling joy of frantic jealously, and describing
in emphatic eloquence, the pure delight
of well spent Love, the dread effects 
of hope, well gone, and hatred long [illegible]

53
indulged; the whirlwind force of 
overwhelming anger, in whose train
are mania, wild and fatal apoplexy
He then described in depreciating
style the baneful influence of lone
indulgence, and of the solitary pleasure
dearly purchased by remorse and misery
Having then shortly adverted to the 
effects of profession, on health, he observed,
that the sedentary professions in 
close apartments, were truly hurtful
and that these bad effects were 
much influenced by the position
of the sitter -
Farmers, & house carpenters
among tradesmen, and Lawyers and 
Physicians, among professional men
enjoyed from the dive intermixure of 
exercise and rest and arrive generally
at a good old age -


53 A



53 B



54
And he concluded this part of his 
cause with a few remarks upon
amusement, which in his opinion
have much influence on health
Women being more the slaves
of fashion than men are therefore
often subject to disease arising from 
this cause -
Practice


55
We are now about to enter upon the 
Practice of Physic. This is by far the 
most important department of our 
art: to this all others [cross out] tend; this is 
the common centre to which they converge,
and which while it calls on
me for greater exertions, demands
from you more profound attention
Ever since the time of Sydenham
medical writers have been accustomed
to use some nosological arrangement 
which has been in general
regulated by rules similar to those 
used in natural science -
I will not have even enumerate
the great variety of schemes
which ingenuity has devised for 
this purpose. All of them are liable


56
to great objections, while each perhaps
is distinguished by peculiar merit
and though not unobjectionable
Cullens is by far the most valuable
Brown aware of the difficulty of producing
a perfect system of nosology, 
and actuated by a bold spirit of innovation,
denounced all such attempt
and declared that there was no difference
of disease but that arising from 
degree of excitement
His generalizement admitted but 
of two classes, Sthenic and Asthenic
This is not however an original notion
for it was long ago proposed under the 
name of rigidity and relaxation of fibre
But our own school has produced
a still more intrepid generalizes in 
Rush who boldly renounced all distinction
and called all diseases an Unit - 

57
We cannot however relinquish a 
system which notwithstanding its difficulties,
has produced such good effects,
nor are we inclined to neglect the 
cultivation of nosology, because it has 
not been brought to complete perfection,
no one denies the use of classification
of diseases natural history
and yet it has been subjected to great
difficulties and been made the subject 
of ridicule
We have less difficulty in acknowledging 
the advantages of derived
from an arrangement than in deciding
on the comparative merit of many 
systems we have read. On this subject
great contrariety of opinion exists
in the medical world; we are however
inclined to prefer that system in 
which diseases are arranged according


57 A



57 B



58
to the legions of the system which they
occupy. And therefore proceed to 
divide them into the circulatory
or diseases of the heart and arteries
2nd- Digestive or those of the alimentary
canal - 
3 Respiratory or the organs of respiration
4 - Absorbents, or the [cross out] lymphatic
and Lacteals
5. Secretory - of the glands -
6 Sensitive of Nerves, brain & spinal marrow
7 Muscular, of the muscles tendons, and 
aponeurosis - 
8 Cutaneous, of the skin & envelopes of 
the body -
9. Osseus, of the bones and appendage 
10. Generative, of organs of Generation
&c. parts subservient - these will comprehend 
all the diseases to which the 
body 

59
body is liable
I will therefore treat of diseases
without regard to their natural affinities,
but will retain the names 
which have been hitherto in use,
for they are as convenient as any 
other and are already familiar to 
you. 
We shall now begin with 
an inquiry what is the nature
of diseases of the first class viz fevers -
The question has long proposed
though still unanswered -
Nor have the changing garb and 
variable character of these maladies
yet submitted them to a 
satisfactory explanation
Cullen who is most generally
followed has under the name
Pyrexia -


60
Pyrexia defind them thus "Post rigorem calor
auclus preleus Frequens.
This is as unexceptionable as any we have seen
and yet he had not enumerated a single symptom
which peculiarly characterizes the class -
We must always therefore take the whole assemblage
of symptoms as our guide in practice.
Fevers may be divided into three kinds. 
Intermittents Remittents and continued fevers.
The first consist of a series of paroxysms with
intervening cessation denominated Apyrexia.
The diseases under this head have been denominated
according to the length of Apyrexia as Quotidians
Tertians and Quartans of which there are infinite
varieties: as intervals of 5, 6, 7, 8 or nine days, mostly
nay even yearly - Whether such as last mentioned
do ever occur is not well ascertained, but we had better
consider all under the three heads First mentioned.
The Tertian agree occurs generally in Spring  


61
and most of agues 
and of easiest cure. The Quotidian
is less frequent and the Quartan or Fall fever least frequent
and of most difficult cure. Cullen is certainly contradicted
by our experience in his assertion of the more frequent
occurrence of Quartan than Quotidian intermittents.- 
These complaints are preceded by &c. (see Cullen) whose
description of these diseases is unrivalled 
Cleghorn and Senaca detail many very anomalous
cases of this class. As that in some they have not observed
a cold, in others a hot stage that the hot
stage has sometimes preceded the cold stage, and 
Jackson has seen cases in which the paroxysm
has departed by urinary and alvine instead of severing 
discharges. Another very remarkable circumstan
regarding these complaints is that they sometimes
attack a part only of the system and confine
themselves to a limb an eye &c. Dr. Rush has bee
much ridiculed for this opinion but our experien
has assured us of its accuracy and truth
There was formerly much diversity of opin

61 A




61 B



62
respecting the cause of these complaints but it is now 
generally admitted to be miasmata which Lanscisci
first asserted. We are however much in the dark
as to the nature of this cause which we know 
to exist, but which our most exact observations
have not enabled us to detect.- We know its origin
We know that it arises from vegetable or animal
matter in a state of putrefaction & that this subtle
poison can be wafted 8 or 10 miles by a steady 
gale. 
There are other causes also of periodic
fevers, of which cold is the chief, especially when 
aided by moisture, particularly as in damp rooms
beds or clothing And fatigue excessive evacuations
and all debilitating circumstances have a power 
of producing them. 
In the treatment of these diseases we consider
them as divided into two states the Paroxysm
& Apyrexia and the former as consisting 
of the cold and hot stages
When called your first care will be 

to place your patient in a warm bed, and having 
applied warm bricks &c to his feet, give him warm
beverage as wine whey &c. In this the cold stage
Trotur has warmly recommended opium, of the 
efficacy of which experience affords us abundant
proof. its immediate effect is to quiet the rigors relieve
the affection of the head & in fine to restore
nature to the system &c.
About twenty years ago Kelly proposed the
application of the Tourniquet to the arm and leg
of opposite sides asserting its power to be great in 
preventing the progress of intermittents - The manner
in which this instrument acts seems sufficiently intelligibl
for by concentrating the blood in the heart and great blo
vessel, these are stimulated to greater action and the cold
stage departs being succeeded by a mild hot stage.
Notwithstanding the possibility of this theory its 
practical utility has not equalled our expectation, for [illegible]
have seen it tried at Edinburgh without any succ
Dr Kelly has insisted on its advantage in a late 

64
publication affording another proof how differently the 
same agents act under different hands.-
Emetics in the cold stage have been much extolled &
are undoubtedly useful, but their disagreeable action would
lead us to reject them unless the case is harardous.-
The indications in the hot stage of intermittents
are to remove irritations and to promote perspiration
Accumulated Bile in the stomach is the most common
cause of the first indication and may be removed
by the exhibition of emetics. These are unnecessary
when spontaneous vomiting takes place which should
be promoted by diluent drinks.-
The medicines termed Diaphoretics are used for the 
second indication.
European writers extol the virtue of James Powders
for this purpose. In this country we seldom meet
with this medicine which has been completely superseded
by other antimonial preparations especially
Tart emetic. Among the country practitioners Eupatorium 
perfoliatum in tea has from its convenience been
much used. Dr. Lend has recommended opium in 

the hot stage and says there is less danger of congestion by 
using it. We cannot deny credit to the assertion of so respectable 
a writer as Dr. Lind, but do not think opium
uncombined can be used in our intermittents without 
increasing the symptoms of these diseases. In our 
practice we have always combined it with Ipecac or 
Antimony and have thus derived from it the greatest
advantage But by far the most appropriate diaphoretic
in this disease is Acetate of Ammonia, or 
Spiritus Minderi in the dose of a table spoonfull to 
be repeated if necessary. This medicine is not only 
quicker and more certain in its operation than any 
other but is also much more grateful and will
relieve gastric uneasiness.
This is the treatment to be pursued in ordinary
cases; but there is often a considerable inflammatory
diathesis present on such occasions which demands
a more active course. The disease in 
Spring and during the prevalence of inflammatory epidemics
is of this nature. It discovers itself in the strong
full pulse flushed face difficult respiration and pain


65 A



66
in the head and side. When such symptoms present
themselves an appeal to the lancet becomes necessary whose
depleting effects must be seconded by evacuation of the alimentary
canal by means of emetics or powerful mercurial
purges. Also by mild Diaphoretics as opium with spirit 
of Nitre or Mindereri -
Having by all or any of the foregoing means overcome
the paroxysms some means are necessary to present its
return.
Among the best remedies for this purpose is Peruvian
Bark which is so truly beneficial in these fevers as to be 
by many considered a specific -
The time and manner of administering this medicine
formerly occasioned much dispute Many writers
among whom we mention Boerhave thought that 
the disease should be permitted to go on a few days before
the Bark should be given, and that the time of administering
should be as near the beginning of a paroxysm
as possible. We think that the earlier Bark is applied
the better and have more confidence of success when we 
administer it in the commencement than towards the 
end of the intermission - The condition of the alimentary

67
alimentary canal should however be attended to and Bark will
always be most successfully exhibitted after evacuations by 
emetics or cathartics The best medicines for the purpose
are Tart Emet. and Calomel. With us emetics have been
almost entirely superseded by the use of Murcurial
purges but cases sometimes occur in which emetics are necessary.
Cleaning the Stomach is often indicated at first and where
this is the case to give Bark is fruitless. Let the system
be by depletion prepared for its reception and then this 
Bark is really almost a specific.- 
Fevers of this type are often associated with viscera
obstructions which Cullen thought contra indicated Bark
but unless there is inflammation present I have found
more harm from desisting from than in containing the 
use of Bark.- When pain and inflammation are 
present blisters and salivation must be resorted to -
After which if the disease is not removed Bark may 
be again applied.
Cullen was of opinion that the most proper
time to administer the bark is first before the 
Paroxysm while Clarke and others contended for 

68
its excellence at all periods. We have ever found it
injurious where the febrile symptoms were at all perceptible
and have been in the habit of desisting from 
its use so soon as the accession appeared.- 
We have been many modes of giving Bark
but the following are among the best viz.
1 or 2 ʒ in milk as the stomach can bear. In the West
Indies as much as ℥j is given early in the morning
and no more for the day. Many stomachs are too
weak to bear this medicine in substance which is therefore
combined variously to obviate this. Aristolochia
serpentaria is often used for this purpose and indeed
seems better adapted to cure these complaints in children
and delicate women than Bark alone.-
Bark sometimes constipates and often purges.
Rhubarb in the first case, and opium in the 
latter, will by a combinations of Bark
prevent these consequences
Where from acidity of the stomach, 
the Bark is not agreeable it may
be combined with either the Vegetable
or 

or mineral Alkali or Magnesia
The English practitioners speak very
highly of its combination with the last 
article, of whose value we cannot 
Judge, having no experience; but from 
the Known powers of many combination
we are inclined to recommend it for trial
In consequence of the irritability
of the stomach and other causes, we 
sometimes find it impossible to administer 
the Bark by the mouth & in 
such cases injections have been resorted
to. I have never used it in this way
except in the cases of children, for adults
will hardly ever submit to a repetition
Its good effects in this way are not 
very apparent, and the pipe soon irritates
the rectum so much that it will not retain
the injection. As cases do occur in which 
this is necessary prescription. I will only
say that the best enemeta is that in 

69 A



69 B



70
which 2 or 3 oz of bark are entangled in as
much mucileage of Gum Arabic Starch
or any thing of the mucilag kind- 
combined with Laudanum &cc
It has been variously applied externally,
as in Cataplasms to the region of 
the Stomach, in decoction to the feet
(for which in the cases of children I have
substituted, Black oak Bark), the quilted
Jacket to be worn sometimes -
All these external applications
are too feeble in common cases, but 
have been useful to children and delicate
women.
Bark thus externally applied operates
by communicating a sympathetic
impression from the surface to the Stomach,
and then in the usual manner,
interrupting the chain of morbid
associations expels the disease -
There is a great number of tonics.
of -


71
of Superior power to bark, which have
been each in its turn much recommended,
either alone or in combination
with Bark. 2nd- Serpentaria Virginiana
has the great authority of 
Sydenhan for its Utility in Intermittents 
we do think it exerts much power 
alone, but it adds much to the power
of the Bark and the combination will
sometimes effect a cure when Bark
alone has totally failed -
ꝶ Peruv. Bark ℥ss
Pulv. Serpent. ʒj
Carb Soda - xxx ss -
[illegible] in Chart IV -
It is not easy a priori to shew the 
reason of the superior excellence of such
combination, but we Know the fact 
that a weaker medicine, will in combination
with a stronger of the same 
class, often produce a more powerful 


72
effect than that stronger one given alone
This powder has been in use in this city
for 50 years, & will effect cures when no 
other medicine will do good.
3 Eupatorium perfoliatum. thoroughwort
cow tongue boneset is also an useful medicine
proving emetic diuretic tonic and diaphoretic
and is well suited to those cases
where no complete intermission appearing
Bark would be improper. It may be 
given at my period with advantage.
We have used it in the Alms house in 
our winter intermittents and been much
pleased with its virtue. Dr Hosack of 
New York uses it almost exclusively.-
4 Eupatorium Pylosum or hoarhound
has also been used but is less powerful.
The Eupator. perfol. is given in powder in a 


dose of 20 or 30 grs or in doses of a wine
glass full of a strong decoction. -
5 Centaury chironia angulasis is different
from the common centaury of 
the shops.- Like the Eupatorium it 
may be given when Per Bark is contraindicated.
Its dose is a tumbler full
of a strong decoction as often as the 
stomach will bear it.
6 Dog Wood. cornus florida and cornus
ceracea are closely allied in chemical
composition to Peruvian Bark and 
is administered in powder in the same 
dose.
7 Prunus Virginiana, or wild
cherry tree has been recommended by 
Dr Barton & some country practitioners
We have had no experience 

73 A



73 B



74
of it.
8 Prunus Verticillatus black alder
of the swamps. Its bark is given in strong
decoction.
9 The Bark of many of the Oaks, as the 
White Oak, whose chemical composition
is very analogous to that of Peruv. Bark-
though its power is much inferior
to that of Black and Chesnut oaks
bark. These are given as Peruv. Bark -
The Willows of every kind I have used in the Alms
house with success, given in decoctions adlibertum 
11 Liriodendron Tulipifer. common Poplar 
of which Dr Barton had so good an opinion
that he placed it next to Peruv Bark, Since his 
recomdation it has been much used & amidst
contradictory opinions we believe there is authority
for its usefulness, It is given in decoctions or 

75
substance like the Bark
These are the tonics which are to be found
in our own country many of which though not 
of great power are usefull on account of the rare
will which they may be procured
12 Among the remedies of this Class brought from
foreign lands may be enumerated
The Bark of Angustura, cusparia febrifi 
introduced 20 years ago, it fell into disrepute
by the English practitioners, who extol it.
It is a grateful astringent and well suited to 
case of irritable bowels when Peruv Bark cannot
be administered. Also in Intermittent
with dysentery Dose 20 or 30 grains
13. Not many years ago. Dr Roxburgh mentioned
a species of mahogany called
Swietenia febrifuga, as a good medicine
of this class
14: Several species cinchona floridendra


76
and Jamaicensis, have been substuted
for the Peruvian bark of whose virtue
I know little. 
15. Wood of Timarouba, has been highly
spoken of for cases of intermittents fever
connected with Dyspepsia & bowel
affections - I have used with little [illegible]
16. Gum Kins was introduced as a remedy
in Intermitt by Dr John Fothergill
who esteemed it above the peruvian bark
and all tonic. The recipe is kino ℥ij Rad:
Gent. ℥ss. Opium 2. or 3. gr. 12 pulv. 1:4 times
a day
17 Carbon. Charcoal has been much recommended
lately by Dr Colbert of the british
army who derived his knowledge from Dr
Calcana of Palermo It is said to be most 
particularly useful in those cases accompanied
by a disagreeable taste, nausea 

77
and vomiting and altho' it constipates,
it promotes appetite and digestion
the dose the same as the Bark. and is 
also given till three oz have been taken -
If this medicine be so useful it will form its
cheapness be of great service to the poor -
18. Sulphur has been lately a good deal 
employed tho' Dr Grainger used it 20 yrs
ago. It is given in doses of ʒj in ardent spt -
2 once tho'ught. the spirits alone operated
but I am now satisfied of the virtue
of Sulphur, which will prove as effectual
with milk as with spirits, The poorer
class in our city make use of this medicine
very generally
Blue vitriol sulph cupir, has been
used by Dr Adam & Donald Munro
in the British Army in the Netherland
and is said to be highly useful -
We know its powers in long protracted


77 A



77 B



78
Intermittents, particularly in the Quartan
type. ꝶ. Sulph cupir. 4 gr. Ext cinchona
32 grs. syrup grs. dried in 16 pills, one every
3 or 4 hours - 
20. Cuprum Ammoniacus, in doses from 
1/2 gr to 1 or 2. grs., From the effects in 
Epilepsy. I think it would be useful in 
Intermittents, tho' it is now very little used 
21. Sulph argil Potassque. Cullen prescribed
it with nutmeg & other aromatics -
Lind of ample experience places it next 
to peruvian Bark. Dose from 8 to 12 gr
Darwin reccomend it in bowels complant
22. Sacchar. Saturni, has sometimes enjoyed
great reputation, Dr Barton places it 
in the first of the tonics except Arsenic -
I have had but little experience with 
it, but that little is not in its favour
Dose from 1/2. to 2 grs.
23. Arsenic, This drug has been most loud 

79
loudly approved by many & almost 
all places it next the Peruvian bark
but he who expects from it will be disapointed.
Whether this is owing to the 
medicine or to the practitioners. I pretend
not to determine, But certain it is that 
in the intermittent of weak people arising 
from debauchee age &c. it is very
injurious. This arises from its debilitating
influence which renders the placing
it among tonics improper -
If preserved in, it induces adematous
swellings, pallid skin, subsultus
tendinum & all the signs of debility
which renders it unfit for patient already
too weak, nor do I much like
it for any case of Intermit. fever
where better tonics can be administered,
but children will not take 
Bark & other bitter, and in such case 

80
cases, Arsenic may be resorted to -
Of late its combination with Bark
has been much extolled, and I believe
this way of administering it will produce
good effects. Some Writers say 
that in obstinate cases of intermittents
the Bark, useless before, had been rendered
active by the use of arsenic
for a few days, and after it give the 
Bark, we like the theory, but have
not tried its practical utility -
24. Spiders Webs. Dr Jackson, a gentleman
who has been long at the head of the 
British Army and enjoyed great reptation 
there, reccommended this remedy
to me in strong terms, He says that two 
grains of the web made up in a pill
with Gum Arabic excited a gentle
glow, composes both the mental and composed 

81
composed both mental and corporeal
irritation and inquietude
And that the medicine might 
be given at any period of the disease
with intent to prevent a paroxysm
or to cure the disease and with general
success.
He reccommended it also 
in the cases of Nervous irritation
These are I believe are all the useful
medicines, and remedies applied
in the cure of Intermittent form.
I have been constrained to omit a great deal 
that of more time were left, might be said 
on the application of each to its particular
case; but this case be well taught only
by experience and attentive observation,
during long practice and must therefore
be left to time and industry - 

81 A



81 B



82
In enumerating the medicines used in intermittents
I omitted one which altho' not 
of great importance deserves to be mentioned
I mean Gelatin or animal mucilage -
This has been much thought of by the French
practitioners who gave it in the shape
of common glue - We have administered
it in a more agreeable way by prescribing
the calf's foot Jelly which an Old physician
of this city has in his own family found
useful in one case, We have no yet tried
its sufficiency.
Notwithstanding the many instruments 
already placed in your hands
cases of this fever will sometimes withstand
all their force & baffle every attempt to eliminate
them. When such occur we may 
reasonably conclude that they are 
accompanied

83
accompanied by congestion and 
obstruction of some of the great viscera,
or have been too strongly
rivetted by habit, but last appear
then to Mercury for nothing but a 
strong impression will be useful 
Its full effect is best obtained by gently
susurrating it into the system and 
keeping up a moderate Pyalism for 
several weeks 
Blisters have been substituted
for Mercury and often with success
They should be Kept open for some
time & not suffered to dry
By these strong impression we may 
succeed in interrupting the [cross out]
powerful concatenations of Morbid
association upon which the disease
depends

84
This brings me to the second indication viz to anticipate
a threatened paroxism
The Patient must be laid in bed and a dose of 
Opium administered, and to promote its sodorific
effect diluent drinks warm liquids must 
be given. Ether in a warm diffusible stimulant 
& very useful for our present indications
The Stomach should not be loaded with food
at this period for such a circumstance
increases the violence of the paroxysm and 
produces more nausea or vomiting and we have 
Known the fasting 5 or 6 hours prevent the threatened 
attack. Some practitioners peruse a 
different plan and choose to stimulate powerfully
giving strong draughts & copious which
in some cases do well, Stimulants of any 
Kind even Terror have prevented a paroxysm
Nauseating Emetics not administered for the 
purpose of evacuation but of impression and 
Blisters 

85
Blisters have been found usefull
I have been more minute than usuall 
because intermittent fevers are very common
in our country and often prove very
intractable, and when of long continuance
produce other diseases of a very serious nature
They sometimes run into fevers of a more continued 
type especially typhoid. In children
Hydrocepalus is a consequence 
A more remote consequence of protracted
intermittents is congestion in the great
viscera scirrhus, jaundice, Dropsy &c-
Boerhave and the old physicians were 
of Opinion that intermittents were so useful
in many cases of disease that nature
intended them as restoratives and that
therefore they ought not to be suddenly
arrested, but should rather be permitted
to proceed for a time.

85 A



85 B



86
This opinion is very erroneous and a dangerous
too, for as we have already said these
complaints are productive when neglected
of others still more dangerous, and then become
more unmanageble -
It is true however, that gout, rheumatism
& Chronic cutaneous and spasmodic 
and nervous affections have 
been cured by a fit of ague, and now
and then Mania & Melancholia 
The European practitioners often expose
their phthisical patients to miasmatic
influence -
As the predisposition to disease
fevers, often remain long after then disease has disappeared
it is proper to caution convalescents, do carefully
avoid all exciting causes, particularly cold &
moisture, & to continue the use of tonics 

87 
I am next [illegible] Remittent fevers
Cullen finds fault with the old, nosologist for 
distinguishing this class from intermittents
Asserting their close relationship arising from 
the same cause being Epidemic at the same 
time yielding to the same remedies and often
alternating with each other -
We however are of opinion that they require
very different kind of treatment and should not 
be confounded. Thomas's definition of 
Remittents, page 18th. Dr Hosacks edition
As laid down by the above authority Remittents
are sometimes of an inflamitory at others of a 
typhoid type In our country they most
usually assume the former shape and of 
course demand our first attention
When accompanied by a strong full pulse
flushed face & difficult respiration & and other
signs of inflamitory action, Bleeding is 
to 

88 
to be immediately resorted to. After having 
thus abated the febrile action Emetics are to be 
given. Of these the best as tart. Emet. which
not only evacuate better but makes a stronger
impression on the Stomach than any other medicine
of the same Class - I am much more particular 
in mentioning this, because it has been much the
fashion of late to exalt Ipecacuanha at the 
expense of the Antimonial Emetics
After having done this let Mercurial purges
be administered of which Calomel is undoubtly
the best. Having thus produced direct
evacuations to a considerable external - the milder
diaphoretics may be used, of which I prefer
antimonial preparations, Saline mixture
and Spiritus Mindereri.
A disease thus treated will most probably
intermit or remit in two or three days, but 
if such an event do not take place recourse
must again be had to Emetics - Blistering

89
of the extremities &c -
During the course of the fevers attention must 
be carefully paid to the subordinate Symptoms
If the skin is uncomfortably hot, applying cold 
water of benegar over the surface with a sponge
has a happy effect, allaying the uneasiness
and removeing restlessness - If a determination
to the head be indicated Knownly 
the flush, the wild eye, and tendency
to delirium, the head should be deprived
of its hair and if this does not abate these 
symptoms cold water or even ice should 
be applied to it & if convenient lecturing
and cupping 
The nausea or vomiting commonly 
accompanying these complaints
arises either from the presence of bile in the 
stomach or from a morbid irritability of that 
organ For the removal of the first cause, use 
evacuations by emetics and cathartics, for 



89 A



89 B



90
The Second we resort to several remedies, as the 
common effervesing draughts, small quantities
of mint tea, (lime water & milk of each a table spoonfull)
a table spoonful of infusion of serpentaria
has been used by Dr Kuhn with great advantage 
Where the stomach appears to have lost its tone
a tea spoonful of the tincture of cloves every half
hour as necessary and if none of these applications
prove effectial apply sinapisms to the feet
fomentations or blisters to the epigastric regions
The best fomentation for this purpose is that 
of Cloves in hot Brandy.
When by all these means the fever
has departed, the Peruvian Bark must be 
used, but if there remains a slight degree
of febrile action. I prefer Serpentaria quarsia
&c. Too much eagerness to get at the 
use of tonics has been of very mischievous 

89
90 A
tendency, and should never be applied
untill an intermission or considerable remission
has taken place
Where intermission Barks but if only 
remission, Serpentaria, Quassia &c -
There is only one exception to this rule
and that is where there is typhoid symptoms
which always demand a tonic 
plan of treatment but as this is a distinct
disease more of this again.
Continued Fevers 


91
Continued Fevers
Nosological writers have given different arrangement
of these diseases, but I divide them into two classes
Tynocha & Typhus. The most common form of continued 
fevers in our country is Bilious inflamitory
fever. They are found in every section of the United
States but are most prevalent to the South
It arises from in across miasmata and various
other causes. Indeed from this circumstance
and from their existing at the same season & demanding
the same Remedies. Intermittent Remittent
and continued Bilious fevers are supposed to
be the same disease varied on by in type.
With regard to the management of Bilious
inflamitory fevers.- A question at first arises
wether we can arrest the progress of these complaints
or can only paliate symptoms of severity. Cleghorn 
Hellary, Pringle & Fordyce, have discussed this 
question

92
question & all concur in asserting that when the 
fever is once formed it will run its course
and that tho' we may alleviated we cannot cure 
In support of this viceae they instance Small
Pox & measles diseases which may be divested
of much of their severity but when once begun
run their Course. 
These examples are by no means
pertinent, Small pox & measles are diseases
of a peculiar nature different entirely from 
those under consideration, & governed by
peculiar rules, while every practitioner of 
any experience have seen such fevers yielding 
to blood letting, purging, vomiting and 
such strong impressions.- Such an opinion
is not only erroneous, [cross out] but highly
dangerous in as much as it is likely to introduce
a feble practice at that period of the disease which 
is most favorable for the application of usefull 


92 A





92 B





(93
remedies & it is there permitted to break down
the constitution & acquire the inveteracy which 
age always confers, This opinion is the more dangerous,
that its advocates appear to found it 
in part upon an acknowledged fact, the existence
of critical days.- All of you Know that by critical 
days is under stood a disposition in the 
disease to terminate on one or other of a certain
number of days or to change its type on these days.
Hyppocrastes, the first writer who took notice of 
this phenomenon, and he called the, 3. 5. 7. 9. 11.
14. 17 & 20th day critical but some later writers
say the 21st day is also critical
Every practitioner has observed this disposition
to give way or remit on one or other of these days 
but we do not find them so distinctly marked
as Hyppocrastes alledged This may arise from 
the peculiarities of our variable climate 


94
This ought not to be treated as a mere matter
of speculation, for it has a very important
influence on our practice, inducing us so to 
apply our remedies as to favor this natural
tendency of these complaints to produce-
solutions.- The best explanation of this 
phenomenon is derived from the hypothesis
that they are disguised intermittents, being 
first quoledian then tertian and finally
Quartan becoming Quartan on the eleventh
day - As we cannot deny the fact we ought
so to employ our remedies as to favor this tendency
As I observed before these fevers are in
our country most usually inflamitory
and when this is the case, our most obvious
indication is to reduce pulse to its natural
standard. For this purpose we first apply
to the lancet - Much discretion however
is necessary in the use of this instrument 

95
and we should be very carefull not to apply our remedies
for the name only of the disease, for the same disease
is liable to infinite modification from climate
season, idiosyncrasy & a thousand causes
which diversify the practice very much
This class of disease affords an illustration of this 
for while in our section of Country we generally
bleed in them, the practitioners to the South
seldom use the lancet & if at all, very sparingly
But whenever you find a full strong pulse,
hot skin, and other symptoms of inflamtory action
you need not fear depletion.
Your next care will be to evacuate the alimentary 
Canal. This is necessary in all febrile diseases,
but especially so in this, on account of the 
redundancy of Bile. For this purpose the best 
Emetics is a combination of Antimonium Tart.
& Ipecac for which the Ipecac gives celerity to the whole 

96
the Tart. emet. more completely evacuates the 
stomach. Dose 2 grs Tart. emet. & 20 grs Ipec.
You thus see that I prefer in all fevers emetics
to purges, but thus full effect can only be 
obtained by perseverance and when the 
disease is obstinate I am in the habit of 
continuing them daily, nay; sometimes twice
a day 
Fashion which is so general a tyrant
has often had its influence on Medicine
Many years ago Emetics which had been 
much in vogue in this malady gave place
to cathartics, which being a less disagreeable
means of evacuation was generally prefered
but of late they seem to be giving place once
more to Emetics.- The Physician of the 
European nations whose armies fought in 
Egypt soon found that the fashionable
per annum were powerful enough to 

96 A



96 B



97 
control the vigorous fevers of that country and 
were at length constrained to resort entirely to Emetics
When early applied to our common cases of Bilious
fever they seldom fail to remove the pain in the head
the disagreeable sensations and by induring
a pleasant diaphoresis afford a prompt solution of 
the disease - There are but a few objections to 
the exibition of emetics & these are when the patient
is Short necked & inclined to apoplexy or where
rupture or pregnancy exists
Next in Efficacy & order are purges
which are also useful in evacuating the Bile
and besides this relieve the Alimentary Canal
of any irritating contents.
The best combination for this purpose
are those of Calomel with Jalap or Rhubarb
It is well to remark that you should choose the 
period of remission for their exhibiting when 


98 
2
when they will generally prove effectial 
& act proptly, but if you administer them 
amidst strong febrile symptoms they 
will either be rejected or lie inactive
in the Stomach. The Mercurial purgative
may be succeeded by the saline
which are less stimulating and seem to 
have know power of acting on the quantity
of fluid contained in the vessels.
The best combination of this Kind is 
the following R Sulph soda ℥j Tart.
emet. 1 gr lime or lemon juice or vinegar
℥j & aq pura. ℥iij. Mixe one table spoonfull
every hour as may be necessary
This mixture gently evacuates the bowels and 
at the same time induces an agreeable diaphoresis,
As the disease advances we prescribe 

99 
enemata, which may either substituted for 
Cathartics or used to assist their operation
which from the obstinate constipation of 
the bowels in these maladies is often extremely
necessary. The common enama is warm
water a pint, table spoonful of common salts
and same quantity lard common or castor
oil.- After having used all these direct evacuations,
we attempt to produce diaphoresis
Diaphoretics are of much use in febrile distempers,
but no set of remedies require more discrimination,
care in their administration
nor produce worse consequences when improperly
exibited, This has been so frequently the result
of their use that medical men have been afraid
to apply them and much more seldom administer 
than formerly. - They are 

100 
They are either internal medicine or 
external application. They are numerous 
and suited to different indications and 
circumstances but in the present instance
Antimonial preparations are by far
the most suitable
These preparations were first introduced
by Dr James, discoverer of the celebrated
Jame's powders, the virtue of which have
been affirmed by Cullen and Sir 
George Fordyce. There have been 
many disputes about the comparitive
value of the different preperations of 
Antimony.- The Antimonial powder
is much prized, but none is superior
to the tart emet given in doses of from 1/8 to 1/12
of a grain 

100 A



100 B



101- 
A question has also been agitated whether
the nausea usually produced by this medicine
is useful or not, Cullen decides that antimony
never does much good unless it nauseates
But I am disposed to believe this opinion
incorrect, for the nauseating doses of other
drugs will not produce half the effect which 
is derived from Tart emet. even when it induces
no nausea. - Nausea too, by a law 
of the Animal oconemy, it is said induces
reaction and accelerates the febrile symptoms
& whether this law be existent or not, I have taken
it for granted in practice and have always
endeavoured to administer the medicine
so as no to offend the Stomach
Antimonials seem therefore to act with 
specific influence & not simple to producing

102
diaphoresis or nausea, they make a powerful
impression on the Stomach interrupting
by its superior energy the morbid concatenation
But cases occur in which 
they are inadmisable, as, where from the 
irritability of the Stomach it wont retain
them. In such cases we substitute their
Kindred remedies among which the Saline
mixture is best. R. acid of lime, lemon
or vinegar ℥ij saturated with sull carbonate
of potash, to which is added
℥ij aquapura & Some loaf sugar, one two
or three tablespoonfuls every one, two, or three
hours at best. this will not only diminish
the force of the fever but also sooth & calm the 
irritated stomach If greater power is wanted
Dulcified spt of nitre or if the stomach will
bear it. Antim. wine may be added- 

103 
Besides these diaphoretics here are many others with 
which you are well acquainted. The combination
of Ipecac with opium has been much extolled
but tho' highly useful in the phlegmasia it does
not seem beneficial for our present complaint.
One general rule for external application
to produce diaphoresis is that they should always 
be moist, for dry heated applications always
stimulate and thus increase the febrile
symptoms. - Heated bricks moistened with vinegar
wrapped up and placed under the bed clothes
make a good vapour bath -
14th January 1817
In the progress of the last Lecture I had arrived
at the consideration of diaphoretics. As I then
observed when judiciously administered they are
remedies of very great importance, they determine
the blood from the great viscera to the surface of 
the body prevent congestion and obviate constriction
of the cutaneous vessels promote their discharges and 

104 
thus diminish the quantity of the circulating fluids
Of all remedies this is most popular among the 
common people - They are used by the vulgar under
every variety of circumstances, and considered by 
them to be more prompt as well as effectual than
any other set of applications.- But their popularity
is not confined to the vulgar. For every class of society
values them more or less. Such indiscriminate
usage cannot but be injurious and even dangerous
as may be seen from the foregoing observations -
When the system is in an inflammatory condition,
we should never resort to any active or stimulating 
diaphoretic medicines or means, but let 
me impress it upon your minds that this class of 
remedies should never interfere with the direct depleting
measures, nor be used 'till these have been
fully tried and the inflammatory symptoms considerably
abated and then Diaphoretic may be 
applied with signal advantage. Still however active
or stimulating means should not be used but 

104 A



104 B





105 
let the milder diaphoretics be employed particularly
Antimony.- It is now universally enjoined by writers
not to extort sudorific effects by force, but rather
to solicit the discharge by lenient measures.
Notwithstanding the great and manifest advantages
of these remedies many practitioners prefer the neutral
salts, commonly called refrigerants to them. At the head 
of the refrigerants stands Nitras Potassae or Nitre.-
How these substances produce their effect is not 
yet ascertained. Some late writers explain their operation
upon chemical principles which although
at first sight it appears plausible affords no satisfactory
explanation of the difficulty. Certain it is however
that they reduce the force of circulation and 
sometimes produce an agreeable moisture and are
therefore well adapted to the inflammatory state 
of the system. Nitre is administered either alone
or in combination with calomel and Tart. emet.
R Nitre potas. ʒ 1 Calomel gr 12 Tart emet gr 1
Nuce il divide in acts chartas, One given every 


106
hour. 2 or 3 hours as necessary. This rarely
proves diaphoretic but reduces the force of 
circulation and is a useful prescription
in most inflamitory fevers, It is very apt
to purge and if such an effect is not desirable
the Calomel may be lessened or left out
Nausea also is often a consequence & where
this happens the Tart emet. too may be 
omitted and the nitre given alone with good 
effect.
To cooperate to the same end viz' to 
lesson arterial action and diminish the disagreeable
hotness of the skin, Cold water has
been much recommended as an application
to the surface.- As in my next lecture I shall
dwell on this topic, I will here only observe that it 
has been applied in three different ways, by 
dashing it over the body by immersing the 
body in it, or by rubbing it over the surface 

107
with a sponge. Of these these methods I much
prefer the last. because both more agreeable and 
less hazardous. It should never be applied unless
there exist great action and much heat on the 
surface when it will be found eminently useful
It then removes the uncomfortable temperateture
subdues the violence of the arterial action, disposes 
the cutaneous vessels to diaphoresis, and quiet the 
turbulence of all the symptoms and restlessness of 
incident to such a state. If on the other hand
it is applied to a skin already cooled by the 
abatement of the disease, it becomes not only
useless but perilous, for the system is then in a state
almost incapable of reaction, in which case
these cold application increase the exhaustion
and other symptoms of danger.- Never therefore,
for negligince is perilous, forget this distinction
During the progress of Bilious inflamitory fever, the 

108
the patient is often much distressed by excessive
thirst and dryness of the fauces. A question
has been agitated whether the patient should
be indulged or not in his disposition to drink
freely - The Physicians of old seem to be 
much divided in their opinions on this 
subject, and while one party totally prohibited
liquids, the other, allowed their patients to make
as free use of them as they chose. - The former
is still in practice in some parts of Europe-
especially in Spain & Portugal. In this as 
well as most other disputes, truth lies between
and our experience answers, that a restrained
use of Cooling beverages, is highly beneficial
If we deny our patient the means of allaying 
his thirst, the pain & distress will inevitably
aggravate the symptoms of action and if on
the other hand we permit him to have an 
unlimited quantity of a liquid, the fullness 
 

108 A



108 B



109
of Stomach will undoubtly produce nausea
or vomiting and equally bad effects. I therefore
recommend the use of a very small quantity
of beverage at a time allowing my patient a 
table spoonfull, or a wine glass at a time of acidulated
water, lemonade, Apple water, toast
and water, weak sage or balm tea, cold &c &c 
As such drinks as these are sufficient to support
the strength of the patient, and consort will
with the depleting remedies, simultaneously
operating they should alone constitute the ingesta
at this period nor should more solid or stimulating
food be permitted.
After having tried every remedy heretofore
suggested the disease will somtimes continue its course
& mock our efforts. But we have reason in such cases
to conclude that this intractability arises from 
visceral obstruction and our last appeal must 
be to Mercury - Urged to a gentle Ptyalism its 

110
will most commonly arrest the progress of the 
disease & affect a cure but if we use the mercury
when the action is high, the disease will have terminated
before it can operate. It is therefore
only admissible when the complaint has lasted
some time and resisted the other remedies
treated of - Then when something like chronic
action has supervened we find Mercury
truly beneficial
Much has been said of the advantage
of blistering at this period of an obstinate
case and much has been said of the mischevious
effect of such practice 
Sir George Fordyce whose opinion ought
ever to be respected, declares that Blisters
never display the least power of interrupting the 
course of the disease
Perhaps this great contrarity of opinion
has arisen from the injudicious use of the 

111
the remedy, by no means useless if properly applied
we do not desire to see them anticipate the more
useful depletions, nor, in any degree supercede
bleeding, vomiting, purging &c. But as the tenor
of experience approve their utility we recommend
these after application when they will equalize the 
excitement, destroy the broken and irregular
action of the disease & reestablish the regular
order of health, If indeed we are to precipitate in 
using them, we shall certainly experience the same
bad result which Sir George Fordyce met with 
There is time for all things" said the wisest of men
and this simple truth might have taught Sir 
George if he had tried its value, an useful lesson
for he would found a time where Epispastics were
of high advantage.

112
Jany 17. 1817
Of Typhus fever
This term is derived from a greek word signifying
Stupor, or heaviness, a prominent symptom of 
Typhus fever
By nosological writers Typhus
has been divided into two classes, gravis &
mitior, but as the one is but an aggravated
case of the other I see no necessity to retain
the distinction
Typhus has been so often
and so well defined in the numerous writing 
on the subject, that I drew a history of 
it here unnecessary. It is too, a disease
I have had little experience for it is far from 
being a common and in this City or indeed in 
any part of the United States. It is of 
malignant aspect generally found in crowded
places, as hospitals Ships & faces &c 



112 A



112 B



113
the offspring of confined filth & wrechedness and
the means which produce also propagate it. 
confining and concentrating its virulence and 
retaining its victims within the sphere of its malignity
Such sources of its power are never found in
our happy country nor has the malady of [cross out]
the means of propagation. Hence our personal
acquaintance with it is very slight and that 
is for the most part, remembered, having been
acquired in the hospitals of Europe.
Much difference of opinion has existed
as to the cause of Typhus fever. Some writers
ascribe it altogether to contagion as 
who asserts that out of thirty exposed to its pestilential
atmosphere not one escaped the disease
This example of infection hardly equalled by 
small pox, and can have arisen from the crowded
apartments & filth of a jail or hospital, for free

114 
free ventilation, diverts it of its power in this
respect. - proved [cross out] by the limited influence it
capable of exerting in Summer, or in tropical
climates when open doors and windows give 
free passage to the air, while it is always most 
potent in winter, when every avenue to a 
purer atmosphere is cut off, and by the 
same barriers the poison is prevented from
escaping But the most common causes of 
Typhus here and elswhere are miasmata
farting, fatigue, watching & every debilitating
power. 
Deluded by the symptoms of incipient
Typhus the practitioners of former
times were in the habit of treating it as 
an inflamatory affection and from 
Sydenham to Huxam the current of authority
prescribed the same course
A more enlightened and rectified view 
of the subject has shown us that we must 

115 
must not be guided in the complaint by any symptoms 
to a depleting practice, and no practitioner
now a days could dream of such a thing
We must usually commence our operations
in this complaint by the exibition of Emetics
And medicine of this class will answer
but Tart emet. or Ipec. is preferred. - When
timely administered, an emetic most commonly
obtains a solution of the disease but even
where it does not, effect this, it allays the most 
distressing symptoms and paves the way to the 
more easy operations of other remedies -
It was the custom formerly to follow up
emetics, by nauseating doses of Antimony
a practice sanctioned by Cullen and adopted
by his followers. - Dr Hamilton of Edinr
having himself frequently baffled in this practice
threw off the tramels of authority, and had the 



the honour of introducing a much better 
mode of treatment than that formerly
used. He found cathartics more efficient
After vomiting he administered powerful
purges, continued for several days, and 
experienced the happiest results
He gave calomel alone or in combination
with jalap or Rhubarb, continuing 
the use of the medicine till he had 
completely evacuated the contents of the 
intestinal canal. This is a practice of 
acknowledge excellence & I have seen its
utility in several instances, Large accumulations
of feces are allways found to exist
in the bowels in this complaint and the 
disordered state of the whole prima via is 
shewn by an encrusted tongue foul faecus
and dark offensive discharges It is a 


116 A



116 B



117
Rule therefore to be well remembered that 
you should never quit cathartics till you 
have completely eliminated these foul accumulations
& restored the alvine discharges
to a natural condition, We should at first 
thought imagine that such a practice would
by producing or increasing debility aggravate
the symptoms of the fever but on the other hand
we have found it increase the strength of 
the patient, while the fever if suffered to 
remain would inevitably induce greater
debility Along with purges application of cold
water have been much recommended
Celsus and other writers of his time mention
this remedy but in the course of years it was 
laid aside. About a ago a writer who revered
the use of water in fevers termect it febri fugum
magnum. It is only very recently however

118 
that the application of water has been 
regularly practised in such cases
Dr Rice of Jamaica, 30 years ago considered
it a valuable remedy but till Dr Currie
published his work it was not generally known 
It has now become a general practice
as regards the practitioners of the United
States, effusion has been too much neglected
not perhaps from ignorance, but a
preference for other remedies -
It would no doubt be most useful in 
on autumnal, of which, more, again,
It is I think obvious that cold water
can be useful only when the system
is capable of reacting, when heat &
consequently restlessness exhausts the
patient and when there is no perspiration
on the surface to be checked by the coldness; 


119 
Accordingly Currie prescribed it only when 
the fevers is high when thirst, anxiety & restlessness
disturb the patient, should we venture to 
employ it in more advanced stages of the 
complaint we should be careful to rouse
the slumbering energies of the system to 
meet its excitement by brandy & water, wine
or any diffusible stimulant given sometime
before, but never apply it to a pale skin
or chilly surface, nor where the least perspiration
exists. Dr Jackson of whom I have formerly
spoken so respectfully has taken quite a 
different view of this subject. Denying 
altogether that cold water produces its 
beneficial results by simply abstracting
the heat, & thus allaying oppression, and contending
that it is only a stimulant, he ventures to 
disregard the stage of the disease and at any 
period applies cold water to the skin having 

120 
first used the warm bath and stimulation
whether his views are correct or not we 
are not able to determine, but so much
skill and nicety must be employed
in administering it on his principles
that till supported by more numerous
facts than hitherto, I cannot 
reccommend it to your adoption
the use of affusion in a late stage of 
Typhus 
There are several modes of 
applying water to the surface. viz.
by dashing it on from a bucket, by
means of the shower bath, or by 
sponging. The water should be reduced 
to 40 or 50° of Farenh: of these
methods above mentioned. Dr Currie
whose ample experience entitles
him to respect, has prefered the 
first 


120 A



120 B



121-
first and with this opinion Dr Gregory
of Edinburgh coincides -
Their practice is to dash a bucket of cold
water, holding from 2 to 3 gallons, 3 or 4 
times A day over the patient
Extraordinary as this practice may 
appear. I have witnessed it in the Royal
Infirmary of Edinburgh. The fleet under
the command of Admiral Juneau
stationed in the North sea, put into 
Leith Roads in distress, many of his sailors
were affected with a malignant Typhus
and sent to the Infirmary, where Dr Gregory
employed the above modes of treatment
In most of the cases the practice was 
effectual, operating as a talismania
charm, & drawing off disease -
But in other cases he was unsuccessful
and even done mischief: in these the 
sym


122 
[cross out] system either acted feebly or 
not acted at all -
All I learned from this circumstance
was, that though dashing water
on the patient will often cure 
yet there is much hazard in doing
so, and it is better to apply the water 
with a sponge, This latter posseses the 
advantage of the other modes, and has 
the appearance of being much less perilous.
But Currie and the other writers on 
this subject seem to be troubled with no 
fears or doubts. I therefore esteem it my
duty to warn you of the danger, which 
from the experience I obtained at Edinburgh.
I Know to be considerable -
If by all the means mentioned we are not 
capable of arresting the progress of the disease
our 

123 
our next resort must be to diaphoretics
once indeed no remedy in Typhus fever
was so much confided in a sudorifics
The humoral pathology then required
triumphant, and from the dark ages
of the healing art a set of notions had 
descended which favoured much the 
favourite theory. From remote time 
fevers were concerned to arise from a 
morbid matter floating in the system
and the humoral pathologists attempted
to eliminate the matter of Typhus fever
by the use of sudorifics
They therefore, began the treatment
with diaphoretics applications, and had 
the utmost confidence in their efficacy
if early resorted to & long continued
In the present improved state of our art
we can easily see the folly of such practice,

practice, and find another lamentable 
instance how apt a false theory is 
is to produce an erroneus & fatal
practice.
I do not mean by the foregoing
observations, to discountenance the 
use of diapphoretics; for I believe there
is a stage of Typhus when they are useful,
but I intend only to caution
you against [cross out] any anticipation
of the more direct depletions, already
pointed out to you -
After having obtained the complete
evacuations of the Alimentary canal and 
[cross out] tried the influence of affusion, without
success, Diaphoretics are of much utility
and may then be resorted to -
We Know not that in the disease they 
exert any peculiar action, and we 

124 A



124 B



125 
therefore see no reason to prefer one remedy
of this Kind to another on this account
But attention must be paid to this state
of the system for on this depends the choice
of mild or stimulating measures -
It is usual, from the nature of this 
malady, to make choice of the milder
Diaphoretics, of which the saline draught
is perhaps in this case the best -
The Antimonial preparations have 
been reccommended, but so many respectable
writers condemn them that, though
I see no reason for this opinion, theory must
give way to experience, and as mine is too 
limited. I submit the testimony of others
to your consideration, and have you to 
judge for yourselves.
When the saline draught is administered,
its operation should be assisted
by -

126 
by external means of which the vapor bath
formerly mentioned is best.
At this late period of the disease
great debility is always present and there
is a considerable excitement, demanding
a very opposite course of proccedure 
We have hitherto depleted, but now 
we must resort to means for suppurting
our patient, and alleviating the effects
of debility Of all the stimulants applied
to weaken susceptibility, Carb:
ammonia is the most valuable -
When given in small doses frequently
repeated, it restores the departing strength
arouses the latent spark of sensibility, and 
enables the patient to withstand, the effects
of debility. 
There are various modes of 
preparing the medicine, of which the 
following is best.
ꝶ -

127
ꝶ: Vol: Alkali ℥j
Gum Arab - ʒij
Sac Alb - ʒj Arise in Mortano -
Aq purae - ℥VI.
With a view to promote the effect of this 
medicine, we usually administer the 
win whey. There is such an affinity 
between different remedies that the 
greatest benefit sometimes results from
their combinations; which is illustrated
by the remedy in question
Wine whey is made by taking 2 parts
of Wine, and one of milk, which by being
boiled, is turned by the wine, then
poured into it. If these made it appears
too strong for your purpose, we may 
dilute with water.
As the effects of vol: Alkali are very
evanescent, it is necessary to give it 
every -

128
every 3 or 4 hours, or if urgent every hour
or half hour. 
Under the same circumstances
in which we resort to vol: Alk: -
camphor. is also indicated.
This medicine is by many prefered
to be prefered to the vol: Alk: but although
both are excellent medicines
under these circumstances, I prefer myself
the vol: Alkali:
When however the case is protracted,
and the susceptibility of the system
to impression, from one seems declining,
I then employ the other, & so on alternately.
Camphor. is given in various modes
In the form of Bolus, to which nausea
is an objection, in shape of Camphorated
mixture of the shops, which is a neat 

128 A



128 B



129 
preparation; but deficient in Camphor.
The best preparation is that with milk
which easily solves it, and obviates nausea
lying well on the Stomach
ꝶ Camph. ʒj
Myrrh. - ʒss
Sac. Alb - ʒij
Aq Font - ℥vi
After having employed the above measure,
Blisters, are found to be of service -
As in Inflamatory fevers, the use of blisters
has been condemned by writers of respectable 
authority among whom are Fordyce
Pringle and the late Dr Moore. But on 
the other hand we have others, [cross out]
as Cullen Lind &c. who were well acquainted 
with Typhus fever, for the Practice
we believe that if there be lone point in medical
Science clear and certain it is that under these 

130 
these circumstances - Blisters may be 
carefully applied to both extremities
Some have asserted that if the only indication
be to sustain the excitement Sinapisms 
would answer better, This is not the case
As we wish to sustain the excitement, we 
do it better by means of Blisters which are
more endurable stimulants, It is also 
objected to Blisters, that in a disease
whose prominent feature is debility
the evacuation produced from Blisters cannot 
be harmless. The discharge is too slight to 
have the least effect, & to talk of its prostrating
power is Sale & I have never felt this 
effect. But even admitting the objection
to Blisters applied in this way we cannot
doubt of or a moment of their excellent
power in Delirium so often accompanying
this Malady. Blisters are here the chief resource 

131 
To be efficient they should be large enough to 
cover the head & should remain at least 24 
hours. But there are found men, readdy to 
condemn even this practice. Darwin in his
Toonomia, and Thomas in his practice, both
disapprove of remedy. But they stand alone
What shall I say of Opium in Typhus
Fever. There is no point in the science of medicine
more controverted than this 
Brown of famous memory, placed it at the 
head of the Stimulants and deemed it by far
the best remedy in all low stages of disease
He was followed in this practice by all his 
disciples and thus Wine & Opium became
fashionable in typhus, nor till Fordyce published
his work, does a single doubt of the correctness
of the practice appear to have been made 
He alledges that his ample experience of the 
system of practice & convinced him that it is 

132 
either inert or injurious. The weight of his 
authority had a great effect in impairing
the reputation of Opium in such cases,
but we cannot help thinking that when judiciously
used it is calculated to meet some 
indications of the disease; We have only to be 
acquainted with the wonderful qualities
of this medicine, to know how much its 
powers are modified by the dose and manner
of administering. When given in large doses
the system sinks under its narcotic
power and there is no development
of excitability, but small doses
& at short intervals proves highly stimulating.
I formerly mentioned that 
in Turkey where the Prophets laws
prohibits the use of wine, Opium is 
used in its stead, and is a substitute 
for our stimulating remedies
When employed with this view 

132 A



132 B



133
it is to give small doses frequently
repeated, as 1 grain every two or three 
hours as required
But it is said, why use the Opium,
as an incitant, when we have 
so much better, as wine &c.
This is to a certain extent true, but
when low delirium accompanies Typhus
opium is preferable to wine -
Delirium when early produced generally
arises from an Inflamatory action, but 
when it arises in an advanced stage it 
proceeds from an opposite cause, and in 
the latter case opium is particularly indicated.
When delirium in such cases is 
associated with restlessness, watchfulness,
anxiety &c Opium display unrivalled
power. And when Diarrhea in the later
stage, accelerates exhaustion and 


134 
prevent recourses to other remedies
opium becomes indispensable. It is 
given either alone or in the form of 
the Chalk Julep -
In all other cases wine is certainly
preferable, being as diffusible and 
more necessaries, it is also more grateful
to the stomach, and is therefore
more readily taken -
Madeira and Sherry wine are 
certainly when good, the best, for such
a purpose, altho' the Claret & other light
wines have lately become very fashionable.
Cases may indeed occur where choice
or Idiosyncracy may call for the latter
It is important to remember that 
in the advanced stage of Typhus there
is always a very great deficiency of excitability
and that therefore these stimulants

135 
stimulants must be used largely
wine is of little advantage in a smaller
quantity, than a quart in a day, while
many cases demands several bottles -
20 - Jany 
Towards the last lecture I had taken 
into consideration the remedies applicable
to the second stage of Typhus fever
and therefore treated of diffusible stimulants.
As a remedy calculated to meet 
this indication Peruvian bark was once
in high estimation: but it has since lost 
much of its former reputation, At present 
we have the most contradictory
opinions on this subject.
While one party affirms the superiority
of this medicine over any other, the others
denies that it posses any virtue at all -
It is possible that this contrariety of opinion

136
has arisen from the administration
of the Bark under very different circumstances.
There is in almost every
Typhus fever, especially when arising
from Miasmita, at one period of 
the disease, a disposition of the disease 
to remit or Intermit -
This commonly occurs near the 
middle stage of Typhus neither very early,
nor when far advanced; and a 
careful watchfulness will discover this 
when it happens; Then is Peruvian Bark
of vast utility, and should not be neglected
It may be given in substance but 
as yet I have not found, a stomach
in Typhus capable of retaining it in 
this form; and therefore it is more commonly
given in the manner formerly 

136 A



136 B



137
mentioned being more grateful -
But even in this way a too irritable
stomach will reject it; when resource
must be had to some of the bitters or 
aromatic stimulants
Of these the best is the Serpentana
which is very stimulating, and at 
all times agreeable
At one time no slender confidence
was reposed, in carbonic acid 
given in the form of Yeast -
The old practitioners [illegible] led probably
to its use, by an opinion, that it 
had the power of obviating a tendency
to putrescency, which they supposed
to be characterized of this disease -
No such tendency we now Know exists
in the living subject, nor does a person
who dies of Typhus decay so soon as usual 

138
[cross out]
[cross out]
after death, yet the practice is a good
one, Carbonic Acid is grateful to the 
stomach, restoring its tone and invigorating
the whole system: but it is not commonly
nowadays, given in the form
of yeast. Sodæ water, Effervescent Mixture,
Porter & Ale are the forms in which 
we administer it, Of all these for the 
low state of Typhus. London porter is 
the best. It not only stimulates, but exerts 
a tonic influence also, and for
these reasons is sometimes preferable
to wine, Ammonia or the other Stimulants.
If you wish to use yeast give it 
in doses of a table spoonful every hour &c
About 


139
About half a century ago the Mineral
Acids, were introduced into
the treatment of low fevers, probably
from the same theoretical views
which detected the use of carbonic 
acid
They did not however obtain
a full establishment till Fordyce
gave them the sanction of his respectable
name, He first employed them 
in Cynanche Malegna, accompanied
with low fever, and having
been much pleased with his success
in that complaint, he extended
the application to all low fevers
His practice was [cross out] first to evacuate
by purges, and emetics and 

140
then at once resort to the Mineral
Acids, Almost all the reports of 
the English practitioners, are in 
favour of these remedies, and on 
the continent of Europe, they are
still more extensively employed -
In the late 

141

142


143
[illegible]
German war Professor Richt who was at the head of the 
Prussian Hospital Department was so successful in the use
of these acids in the cure of Typhus that his master the
king presented him with 50.000 crowns for his merit &
services 
Notwithstanding this weight of authority I am inclined
to think the virtues of this remedy overrated.  During the 
period I passed in Europe I had many opportunities of seeing
them administered and although I cannot deny them some
virtue I yet think much better remedies have been already
pointed out which while convenient should never be 
superseded by mineral acids - These latter are I believe
very useful in allaying thirst and removing the uncomfortable
dryness of the mouth and fauces and have also
some tonic power but as I said before let them not supersede
better remedies. The muriatic acid is the best of the acids &
is given in diseases of 12 or 15 drops, in an infusion of columbia
bark or other bitters once every hour two or three
hours as necessary
I have now pretty fully enumerated the 
remedies applicable to the first and second stages of Typhus
fever. When all of them have applied without 

144
success the system sinks very rapidly and imperiously
demands a new mode of treatment. In these diseases
remember that perseverance is very often rewarded
with success and while life still holds one spot of earth
never despair. The spark still left may be blown into
a flame whose feeble fire would soon have sunk beneath
a careless hand - Let us renew our efforts try all resources
of our art and strive to call into action the feeble remnant
of vitality. For in the very gates of death we often
have arrested the patient and drawn him back to life.
Augment therefore all or most of the foregoing
remedies - Let the vol. Alk. be given in larger
doses as ten grains every hour or 1/2 hour if necessary.
Pour Madeira into the stomach. Let Cayenne
peper be used of this remedy much has been lately said 
by the West India practitioners who first used it in Cynache 
Maligna & afterwards in all low fevers with success.
Dose 4 or 5 grains in pill every hour &c.
Blisters do not appear to be of any use in this 
state of affairs but much benefit is found in friction

144 A



144 B



145
with acrid liniments among which the best is Cayenne
pepper a table spoonful in 2 or 3 table spoonful's of 
Brandy. This applied by friction to every part of the 
body excites a pleasing glow increases strength and often
restores the pulse lately unfelt.
Here too a decoction of Cantharides in Turpentine
is of great importance. Take ℥j of Cantharides and boil
it in ℥IV or 5 of turpentine and dipping folded rags
into the decoction, apply them to those parts you desire
to irritate which they hardly ever fail to do. -
Antispasmodics have been recommended at 
this period of the disease as Musk Castor Assafoetida &c
Of these the first is reputed most useful. It is given 
either in Bolus or Jalep of which the Jalep is preferable 
All the Dispensatorics contain recipes for this preparation,
but I would recommend to you the following.
ꝶ. Musk ʒ4, - Gum Arab ʒi. Loaf sugar
ʒi and aqua pura ℥VI
Table spoonful as required. -

146 142
Of Castor I know little or nothing in this case;
but I have used assafoetida successfully. It also is prepared
variously in pills, in tincture in watery solution.
I prefer the latter prepared by dissolving
Gun assafoet. ʒij in.} a table spoonful
aqua lepida ℥VI} as of Musk mixture.
The immediate advantage to be expected from 
these fetid medicines is the quieting nervous tremors
overcoming the low delirium and assisting respiration.
I do not think however that they are preferable to 
opium in such cases; but certainly they sometimes
produce the effect which opium has failed to accomplish.
The main difficulty to be encountered
in this low state of the system is the almost total
absence of susceptibility to impression. The whole
functions are either arrested or proceed with an 
imperceptible languor the stomach is no longer under
the influence of habitual stimuli for the small 

147
Small remnant left has been exhausted
by powerful medicines -
But we must not despairs let us 
try a new surface, let us desert the lifeless
and exhausted stomach, and make 
our attack upon the rectum. This is said 
to be the Ultimam Moriens, & if so we
should find here more of life and susceptibility
than elsewhere and almost 
all the remedies formerly applied to the 
stomach may in their turn be thrown into 
the rectum. Opium in particular is well
calculated for such administration, & long
after the Stomach has ceased to feel its influence 
it is capable of existing an effect on 
the rectum
You will perhaps feel a little
surprised that [cross out] any one should be 
found to reccom: the Mercury at this 
debilitated period of the disease -

148
But so it is! In the commencement of 
Typhus fever, as I formerly observed, the 
primæ viæ seems loaded with debilitating
matter & the same remark is 
applicable to this stage, also, for not 
only the Stomach & intestines, but 
even the mouth and fauces are covered with
a dark black acrid substance indicative of approaching
dissolution - To remove this irritating 
matter and to alter the state of 
the excretions Mercury has been recommended.
For this purpose Calomel is 
usually given in.
The immediate advantages
are to relieve the bowels from the acrid
matter and excite a mercurial fever which
subverts the old one and produces one 
nearer to a state of health.  

148 A



148 B



149
Whilst we are pursuing this course we must 
keep in view the exhausted state of the system
and continue to operate on the faint sensibility
by all our stimulating measures. A good 
combination for both these purposes is that
of Calomel with volatile Alkali.
This is not a new practice. Eight
or ten years ago it was in use in the advanced
stages of Typhus and the success which it 
has met with justifies our making the experiment.
I have now enumerated all the 
approved medicines useful in Typhus fever,
but there are other circumstances to be attended
to, in the treatment. A great deal
indeed depends upon those who nurse
the patient in removing external causes
of debility -

150 
The apartment should be well ventilated
the bed clothes and chess of the patient
changed every day, the excrement should be 
removed as soon as discharged and the floor should
be sprinkled every hour or so with water, vinegar
or ardent spirit which is to be prefered.
Company should be excluded, a custom
useful in all febrile affections but particularly
so in a disease which has so strong
a tendency to delirium. Company not only
deteriorates the air of the room more quickly,
but assists in distracting the mind. That 
ventilation is of the first importance is well
proved by the fact, in the West Indies simply
removing a patient from his own to another 
apartment, has had the effect of converting
the typhoid action into that of simple remittent
fever -


146 
151
As this removal is not always practicable
we usually content ourselves with carefully
ventilating the apartment and removing 
all debilitating
These have I cursorily, for it would
be in vain (to dose fully) treated of the 
management of Typhus fever. In warm [cross out] 
climates the disease seldom lasts more 
than ten or twelve days, but in temperate
latitudes, as ours, it is often protracted
to a period of 5 or 6 weeks, during
which time we must be on the watch,
for our treatment will vary almost 
every day. But we must preserve &
use all our Judgement, for rules cannot
be laid down or remembered, to guide
the practice under every change of the 
combinations of symptoms
I have therefore chosen to give you
only general instructions: for the 


152
for the treatment of typhus is like
a voyage to distant land, subject to 
such unknown accidents that unless instructions
are general they are totally nugatory
and while they profess greater
accuracy are divested of perspicuity -

152 A



152 B



153 
Of Typhus Pneumonia
I observed formerly when treating of Typhus
fever that is far from being a common
disease, in this or any other section of the 
United States. Our happy country is fortunately,
as yet free from those crowded
scenes of want and wretchedness from
which issue this dreadful distemper, and 
the abundance and comfort of our fellow
citizens, divests it of half its forms when
it does make its inroads
In its place however, we have been 
for several years past, vestted by a pestilence,
whose wide wasting power has often
desolated the fairest portions of our land -
Proceeding from the state of New Hampshire,
it ravaged in turn, almost every
stop of our country from East to West 

154
and from North to South.
In tracing its history & making its 
progress we learned, that in the Year
1806 the people of New hampshire were 
struck with the appearance of some 
psoradic cases of a peculiar malignant
disease, After lingering a short time
in that part of the country and becoming 
more general, it gradually
extended itself through the surrounding
districts, and in two or three years had 
traversed New England and Canada
and then entered the city of New York.
It again paused; and seeming to gather
new strength from its remission
perused its path thro' the western part 
of Pennsylvania, Kentucky, and Ohio
falling more severely on the southern.

155 
Southern district of Virginia
Philadelphia had till the close of the winter
of 1813 no visit from this dreadful guest. No premonitory 
signs warned us of its approach. No peculiarity
of Weather No unusual occurrence
We heard indeed of a pestilential fever which 
was desolating the shores opposite our city but 
we were unusually healthy and paid little
regard to the reports. At last however the 
Cloud which had been hovering above burst
on our heads but as the Season was far
advanced we suffered comparetively speaking
very little, Those who were attacked 
suffered a cruel death, but the disease was 
still only sporadic, - The next winter (1814)
was ushered in by another visit of the Epidemic
and all the woe and misery. Known
only by name now fell upon ourselves 


156 
A disease which prevailed so universally
over an immense extent of country & modifying
diseases of every Kind imposed on them
its own livery cannot be easily described in 
all its wild varieties - I will therefore only
detail to you those cases which fell under
my own observation, or who were particularly 
detailed to me by those in whom I could
confide - All practitioners agree in asserting
the Proteus like nature of this malady
It assumed every shape it demanded every
method of treatment. But amidst all 
its mutations it was ever characterized
by a great prostration of strength and 
generally by thoracic derangement entitling 
the disease to the application Pneumonia
Typhoides. In most case it commenced 
with chills or heats, the skin becoming
hot & cold in a rapid succession. Soon 

156 A



156 B



157
soon it assumed a mottled apearance the 
face contracted the skin dry, the eyes wild and glassy
and every symptom indicating anxiety and great
distress. Pulse became slow & depressed
weak, tremulous, and finally imperceptible
From the common cement of the complaint
the head was affected inducing wild delirium
Stupor & profound lethargy. Sometimes the 
operation of the disease was so rapid and violent
that people in good health labouring in the 
field were struck dead as with lightning
when its progress was more gradual, it frequently
commenced with flying pains especially
of the joints, side, stomach, back neck or 
head resembling the pain from the sting
of a hornet or the beating of a hammer
These pains generally settled in the head at 
last afflicting the eyes with blindness or 

158
dimness of vision, succeeded by coma paralysis
& convulsions. This form of the disease was
not a frequent one. More commonly the
pains of the head were succeeded by a great
lassitude of both the mind and body followed
by fever dry skin, feeble pulse and 
foul tongue. If not arrested here all
the symptoms increased, the pains in the 
head is attended with a vertigo stricture
or sense of tension at the forehead in 
some cases morbid vigilance, in others
with somvalescency so profound as to 
resemble apoplexy in almost all cases
with delirium in all its grades from
slight incoherence to wildest Rhapsody
If sense is left it only serves to render its possessor
more wretched for he becomes depressed
sighs heavily and, complains in mournfull 

159 
accents of the gloomy phantoms presented by 
fancy to his bewildered senses -
Indeed description is beggared by the Keenness of 
suffering and agony of wretchedness endured by 
the unhappy victim of this baneful distemper
They call for our own deepest sympathy
Sometimes it appears without any local symptoms,
or determination, with restlessness, uneasiness
about the præcordia and tenseness
of foreheat - No Chill nor fever although
the pulse beats 150 Strokes in a minute
After it approaches so insidiously as to lull all
apprehension nor does the victim dream of 
danger, till it developes itself in full malignity
Directly the reverse of this is often the case, the 
disease being ushered in by all the symptoms
of Pneumonic congestion with chill, fevers
pain in the Side or breast difficult respirations 


160
cough & bloody expectoration flushed face
red suffused and wandering eyes -
In many cases especially to the South, and
in those of the Students at this University
from that quarter, there was always much
gastric distress accompanied by almost 
unremitting vomitings of Bile with full
voluminous strong pulse; although Soft &
susceptible of compression & without
any symptoms of inflamation
These cases resemble very much the common
bilious pleurisy of this Country
Indeed so strong is the resemblance that 
practitioners called at the commencement
of such a would be very apt to treat it as 
like an inflamitory affection
In a day or two or perhaps in a few hours he 
would have cause to repent of his precipitate or 


160 A



160 B



161 
for the increased action gradually, sometimes
suddenly declines, and the disease assumes all the 
livery of our epidemic. The Pneumonic
symptoms increase muscular power is lost 
the mind previously excited, sinks into a 
torpid state, with stertorous slumbering
If the mouth is examined the tongue and 
fauces will appear covered with a dark dry
incrustation, the skin too appears spotted
the extremities are cold and the petechiæ
and vibices have given this case the name
of the spotted fever. This however is the rarest
form of this disease not occurring more than 
once in an hundred instances
There are other instances in which the throat seem 
to be the seat of the complaint and these were 
most commonly in the south particularly
in Virginia - Nearly all the cases of the Pneumonic

162
Pneumonic Typhoides which I saw during 
my visit to that state were of this Kind
No peculiar symptoms marked its attack
It commenced like a common cold
with a slight affection of the throat
but the rapid progress of disease soon
gave cause of alarm - A great prostration 
of Strength, difficulty of breathing
and a great restlessness and anxiety, indicated
the rapid march of destruction and 
excited the most dreadfull apprehensions
The inflamation unlike that of a common
anginose affections was of a dark mahogony
colour and there was no enlargement
of the tonsils - Of all the forms of this direfull
disease this was certainly the most malignant 
and destructive - So dreadfull
did it seem to those who witnessed its power

163 
powers that regardless of the ties of humanity benevolence
nay even of consanguinity they fled were from the abode of 
disease & fearfull of infection left in many cases 
the unhappy victim to linger on to death without
a hand to close his eyes, or to sympathize with
him in the hour of his departure
What gentlemen is this extra or malady?
I confess it is difficult almost impossible to convey
to you a satisfactory answer - The disease often
exhibited not one symptom of a febrile affection
There was often no augmentation of temperature
no Chill, no frequency of pulse, no apparent
derangement of functions and yet the patient
was about to depart forever. In this city it 
was almost all ways attended with inflamation
of the great cavities but of a weak erysiphatious
nature, somewhat resembling the appearance
of incipient gangrene. In the brain as well
as elsewhere, dark, thin, grumous blood, lymph
or serum was effused - External appearances as 


164 
as well as actual inspection after death seemed
to place this disease on our cases at least among
typhoid affections although very unlike them
in some respects. Anomalous as the 
complaint at first seemed to be I find
something very like it both in Sydenham
and Huxam especially the latter.
The paralell though not complete is as 
much so as it is usually is between two
Cases of the same disease affecting countries
so distant from each other
The cause of this like those of most epidemics
seem buried in complete obscurity we 
Know that the disease prevailed in the 
winter Season alone and disappears in the 
Spring which might lead us to attribute
it to a cold and besides this we have seen
many cases of a disease like this in Alms house 
patients who had been exposed to excessive cold

164 A



164 B



165
165
They were hardly operated on by the most powerful
stimulants having almost entirely lost the 
power of reaction - If this reaction can be induced
a low fever is generally the result, and it resembles
very closely some forms of the late epidemic
The low delirium, glassy eyes, dilated or contracted
pupils, small pulse and lank haggard expression
of the countenance, characterizes both diseases and 
seem to indicate a common origin - But on 
the other hand cold cannot be sole agent in 
producing it and we must once more resort 
to the gratuitous assumption of an infected
atmosphere to help us to an explanation
That it has not its origin in contagion is I
think sufficiently proved by the extent of its operation
by its obeying all the laws of an Epidemic and by 
its forcing every other disease to cover its livery
and suffer no modification driving the lancet 

166 
from practice almost entirely from practice 
and giving even yet to the practitioner some 
uneasiness in applying it to biliernal disease
There have been cases I confess which have
almost induced me to deem it contagious
but I am at last fully satisfied it is not so.
Some of my friends yet differ from me on this
point, and assert its contagiousness, stating
that strong proff of this were seen on our lines
among our troops there. The Malitia it is 
said might be traced in these [cross out] route by
the march of this disease in their rear -
But admitting that a disease existed
among them of a contagious nature It 
appear to me to have been of the common
Typhus Fever of camps, which certainly is 
under certain circumstances - contagious 
Although

167
Although the predisposing cause of Pneumonia
Typhoides is unknown its exciting causes are sufficiently
obvious, being the same as common Typhus
as fatigue watching or any other debilitating
agent. 
After a great deal of controversy two
modes of treatment divided the practitioners
of the country and while one party professed
to cure by the use of the direct Stimulants, Wine
Brandy, Ammonia. Camphor &c the other trusted
almost altogether to diaphoretics - Having 
carefully tested both modes of practice we have
no hesitation in giving the preference to the 
latter for though cures may be effected by 
Stimulation, We never produced diaphoretics
and Kept it up for 24 hours without obtaining
a complete solution of the Complaint
You are already acquainted with the best means
of producing diaphoretics, nothing is better
in this case than Davey Powders administered

168 
every three hours, aided by strong wine whey
and hot fomentations to the lower extremities,
trunk & arm pits for which purpose
boiled corn is excellent - If the debility be
not very great the wine whey may be Sufficiently
stimulating, but is the debility be great
hot tody is preferable. As the disease
advances, or if we are called late it becomes
necessary to combine the two systems of treatment
above mentioned and to add to the diaphoretic
applications the use of the 
emphatically termed cordial stimulants
or incitants, of which Vol. Alk.
in the chief, being like the ancient hero"
apec. Agem." - Let it be given with a 
fearless hand in doses of 5 or even 10 grs
at a time, let hot tody be copiously used
If not all sufficient let fomentation of 
cantharides & turpentine be applied. 

168 A



168 B



169
and friction with a decoction of Cayenne
pepper in brandy. This is the simple form
of the disease which when complicated with 
bilious and anginose affections require a 
treatment somewhat different. Here emetics
are used both to produce evacuation and to make 
a salutary impression on the System -
To give it effect it must be repeated several
times in the most active medicine as tartar
emet. be employed - For impression
Jame's powders answer well, but where
there is a reduncancy of Bile, it is proper
to follow up this treatment with combination
of Calomel & apecacuanna.- After this
end has been attained the treatment is precisely
similar to that of the simplest form of 
the disease If any topical pains are complai
of large blisters are to be applied to the part -
If - 

170 
If Pneumonia, on the breast & if cephalic
to the head always taking care to cover the 
part - Much has been said concerning
the use of the lancet, and some are found
who contend for its propriety. But for 
my part I have always found its application
fatal and therefore disapprove
its use - Symptoms in the incifiency
of the complaint, sometimes seemed to 
demand it seen in these cases its use
was followed by fatal consequences
This is no singular opinion, Every practitioner
of the City will concur with me
It may however have required such a 
treatment elsewhere and it would be 
presuming to assert that no modification
of this wide spreading malady ever improved
under such a treatment or practice 


171 
The Ordinary prognosis, can hardly be
judged of in this anomalous complaint
the pulse fails us as a guide and while
a person apparently in health is suddenly
cut down another returns as it were from the 
grave. But there are some symptoms less
dubious. When the countenance exhibits
an aspects of peculiar wretchedness or appears
placid and inanimate or when the skin
is polished and smooth, with a bronze
or leaden hue, we may safely pronounce
our patient part recovery -
Indeed the bronzed forehead is an unequivocal
mark of certain depolution
I have thus briefly finished the history
of pestilence, which for ten years has been
desolating our land, and which while 
it terrified alike the peasant & philosophy 


172
baffled for a time the utmost skill & efforts
of our act. But I cannot believe it 
to be necessary fatal, for at last it often
yields to our remedies and became
easily managed - All that was 
wanting was vigilance & perseverance
and of late death could almost allways
be traced to negligence or remissness -

173


174


22 Jany 1817 
175
Of Yellow Fever -
Continuing the history of those epidemics 
to which our Country is liable I shall
next treat of the Yellow fever.
It is not my intention to occupy
your time with the history of this disease
because you will find it most fully laid
down in the works of the late Dr Rush
and to him I refer you for detail -
As you all know this disease is 
endemial in all tropical countries, but
especially oft in the West Indies. It has however
often visited more temperate regions
and, has visited the United States at various
times ever since the earliest period
of its history. It was not however till
the year 1793. that it occupied much of 
public attention and yet there is not.

176
one point concerning the origin -
Nature and treatment of the diseases, which
has been already the subject of great
controversy. These disputes I am sorry
to say sometimes rose to raucous and 
often descended to scurrility but I do 
not mean to entertain you with personal
envictions, nor is it my wish to 
revive dispute, now I hope hushed forever.
It is my duty however to give you 
as far as in my power, every possible
information on the subject, and therefore
to examine some of those points concerning
which so much animosity was 
excited
The dispute as to the contagious
mode of introduction appears to me to 
have been merely verbal or a difference 
about the meaning of words. 

176 A



176 B



177
3
All I believe admitted, that it was first 
introduced by some means connected
with the arrival of ships from a 
warmer climates, and in 1793 it 
was attributed to a cargo of Coffee which
in the state of putrefaction was thrown
upon the wharf.
It is true that some have imputed it 
to local filth as a primary or accessory
cause: but the former opinion predominated.
I doubt whether local filth
under any peculiarity of circumstances
could have produced this kind of disease
Were exhalations from our Docks or the 
rubbish of the city sufficient to produce
such effect we should have a visit of 
Yellow fever every summer; for there are 
at all times abundant scources of exhalations.

178
4
exhalations. But besides general reasoning
on this subject we have strong
facts to support this opinion
Dr Rush asserted that of fifty eight
scavengers who resided in Philadelphia
only one was affected with Yellow fever
in 1798. and yet they were by occupation
more exposed to the influence of 
exhalations than any class of people
in the city. It has been objected, that 
they had been so long accustomed to 
the effluvia that they could not be 
affected by them; and the objection
would be unanswerable if correct
in its premises, but the scavengers were
not long in office, and in that year
a member of new hands were employed
so that the greater part were not accustomed


179
accustomed to the business. 
But while we so far concede the 
question concerning the importation of 
the causes of Yellow fever; we wish it to
be understood, that we do not admit, the
importation of the disease in a palpable
or ready formed shape; but only that
from the effluvia arising from imported
filth, sprung the disease, which was
not the offspring of contagion -
Whether the same causes would
produce this effect under all circumstances,
we do not pretend to determine but
think it probable that a certain condition,
of the Atmosphere may be necessary
to give them power or direction -
Much contrary of opinion has also
been 

180
been expressed concerning the contagiousness
of yellow fever
That it is not contagious generally
and uniformly is proved by a variety
of circumstances. I do not mean in this 
place to take up the time, with every
argument on this head, but to give
you a few of the strongest reasons on 
both sides. It is said that the disease
is not contagious, because it is a real
epidemic, either excluding al other
complaints or imposing on them its 
peculiar hue and livery
2. Because it did not extend beyond 
our city into the neighbourhood country,
and where one thousand patients 
were confined to a single 
hospital 

180 A



180 B



181
hospital, there was no instance of its
being imparted -
3rd- Because it uniformly disappeared
when cold weather approached -
But on the other hand, appears
facts too striking to be overlooked
Those who support, the belief of a contagious
nature, assert 1st- That the disease
began at a point and extended
around in every direction, that it 
always commenced in one ward
of the city and gradually spread
over the whole.
2nd.- that some respectable practitioners
asserted, that in several cases the disease
had been conveyed into the country
by the removal of the patients

182
8
Dr Wistar has also furnished me with some 
cases of this kind, when whole families were
affected in this way.
3rd.- That in some cases the disease had 
been communicated by the clothes of 
those who had died of it.
These are one or two instances of this 
related by Dr Rush and others in the reports
of the College of physicians there -
4nd- That Yellow fever observes a general
law of contagious disease being taken
only once by the same person
This last assertion has been flatly
contradicted by the other party who
gave numerous instances in which
the disease was twice taken, but Dr 
Griffith whose experience is very ample,  

183
9
ample, says that he attended thousands
in this complaint, not one of which had
it a second time, The West India
writers do not appear more unanimous 
on this head, though in general they
incline to the first opinion
The question has of late engaged
much attention. The British government,
in consequence of the ravages
made among their troops in the Mediterranean 
station, by this disease
they instituted a board of the most respectable
Physicians of England, to give
the matter a thorough examination
After a very full and minute investigat 
having heard much or at testimony 


184
and examined many documentary reports,
the Board gave the following
as their deliberate opinion- 
1st That the disease is eminently
contagious. 2nd. That it cannot be taken
more than once by the same person 
Proofs among all the inhabitants
and soldiers at Gibraltar & Cadiz not 
one was known to be twice affected -
The Physician general of the troops
at Cadiz having learned in the West
Indies that such was the case, employed
as nurses for the rest, those soldiers
who had the disease there, and in no
instance was a nurse attacked -
If these facts be true, they go far to 

184 A



184 B



185
prove the proportion, for which adduced 
From this board we derive much
direct evidence concerning the origin
of the disease. At Cadiz it was traced
to a vessel from the West Indies
It did not arise from ordinary filth
for the dirty parts of the city were not 
first affected, nor from Miasmeta 
for that part of the city bordering 
on a marsh, and consequently very
liable to ordinary bilious fevers were 
totally exempt from the Yellow fever -
But strong as these facts are in support
of the point, we have yet stronger -
The town of Gibraltar is situated
on a very high rock far beyond the 
reach of Miasmeta. The streets are 

186
12
Kept peculiarly clean by the strictness
of the military police, and there 
is no accumulation of filth to account
for this disease, and yet here 
it raged with enormous fury -
Upon investigating its cause, it also 
could be traced to a vessel, from 
Cadiz where the pestilence then prevailed -
We have now stated enough
to show the mass of contradictory
opinion and evidence, nor do we 
find it very easy amidst so much
contrariety of sentiment and fact
to come to a satisfactory conclusion
But upon the whole it evinces how 
unsafe it is in medical science 
to 

187
13
to trust to a priori reasonings, for 
these would have led to somewhat
a different, conclusion as to the 
nature of this complaint, and might
have prevented salutary precautions
But if we do trust to them in the 
case it might yet be admitted that 
Yellow fever may be sometimes
contagious, Of this Typhus fever affords
a good illustration
Altho' this has been said to possess
no direct contagious influence, [cross out]
[cross out] producing itself only by putrid
accumulations around the patient
I for one believe it to be directly
contagious, for I saw it exert this 

188
influence in the great hospital of Europe
where the greatest pains were taken to 
remove all offensive matter and to 
preserve perfect cleanliness
Beside, were Typhus fever communicated 
in this way, we should have
as many varieties of the complaints as 
the scources, from which they came; 
the Urine, the feces, the perspiratory
matter would each where putrescent
produce a different complaint -
But we always find Typhus fever of 
an hospital, as uniform as possible, only
affected by idiosyncrasy &c or differing
in violence. Added to this 
Dr Gregory & Haygarth have discovered  

188 A



188 B



189
discovered the range of Typhoid contagion
within which the person exposed certainly
took the disease
Does not this show that Typhus fever
is directly contagious, and does not 
affect by intermission -
Yet we know that in well ventilated,
apartments or in warm
climates, where a free ventilation 
is always promoted -
Typhus fever, which may be contagious 
under some circumstances, and 
not so under others.-
Contagion as I formerly told to you 
is the result of a secretory action, modified
by Stimuli, and varying in its 
nature according to the [illegible]

190
16 16
modifying circumstances -
Hence Syphilis & Small pox. unlike
as they are, result from the same action
difficulty modified. Typhus
fever results from the same cause
and Yellow fever is as like Typhus
as syphilis is like small Pox -
But altho' I acknowledge its 
contagiousness I am inclined to think
it only possesses that quality when 
protracted, taking on a typhoid action
Dysentery & some other disease
exemplify this not being contagious
till by protection they assume a typhoid
form -
I do not see much force in the objection,
that Yellow fever is not contagious,

191
14
contagious, because there is no instan
of its having been imparted by dissection.
Many fevers confessedly contagious 
are deprived of this power
at times. As I observed before Typhus
is rarely contagious in ventilated
apartments or in the West Indies
Even the plague which I believe to 
be eminently contagious, is not propagated
by dissection.
The patient while alive freely imparts
the disease but death diverts him of the 
power. This was the unanimous opinion of the
medical man in the French and English armies
which contended in Egypt.- 
I have trees laid before you the principal
facts & reasonings arrayed by each party against
the other and pressing no dogma upon you leave 


192
you to judge for yourselves -
I however must say we have too
readily abandoned the opinion of the contagious
power not only of yellow fever but of many other
diseases.- I believe almost all fevers possess
this power in some stage or under some circumstances
but especially when intermingled with typhoid
symptoms. -
Enough escaped me yesterday to shew that.
almost every point connected with yellow fever is 
yet the subject of much diversity of opinion. It 
is my deliberate conviction that although not imported
in a ready formed state the Epidemic was derived
from exhalation from vessels of a tropical country.
I have been led to this conclusion by the facts which 
are almost incontestable - In 1793, the first year
of its occurrence it could be traced to a cargo of 
coffee thrown upon the wharf. - No dispute arose
on this head in 1798 except as to the question

192 A



192 B



193
question which of two vessels, one from France the other
from a tropical climate had produced the complaint.
I do not pretend to say that under all
circumstances such would have been the result
or whether a peculiar state of the atmosphere or 
the concurrence of many other causes may not 
be necessary to its production
As to the question of contagion I am equally
satisfied but I do not mean to assert this to be
the uniform character of the disease; but so far
from it I think it never assumes such power 
till it has been long protracted and has become
typhoid. It is I think a general law of diseases
that whatever may have been their primordial
nature they acquire a contagious character as 
they degenerate into a typhoid state. I am as 
fully satisfied of this as of any truth in medical
science. 

194
20
As relates to the nature and treatment
of this complaint there exists scarcely less diversity
of opinion. One party maintaining that it is 
a fever of a low type and weak action gave
it the name of Typhus Icterodes whilst their 
opponents looked on it as a disease of a 
highly inflammatory nature. -
What is the sentiment in the West Indies
on this point I know not but it is in this city
and indeed throughout the United States a complaint
of a steady inflammatory complexion.
This to be sure was variously modified by circumstances
and assumed every variety of appearance
but still they were modifications of inflammatory
action and required depletion
in some form or other to reduce them - The 
opinion of yellow fever being a typhus disease
originating in the West Indies prevailed here 

195
21
for a time but was soon refuted. To Dr Rush is due
the credit of having dissipated this error but yet I
confess his first theory was hardly less erroneous.
During his life he insisted that yellow fever was no
thing but an aggravated shape of our common bilious 
inflammatory fever. - That the opinion of 
Dr Rush is erroneous was proved by the earliest 
symptoms of the Epidemic. The Hepatic functions
are to borrow the Dr's own words the seat and
throne of our Autumnal fever which is a fact
so generally admitted that it would be a loss of 
time to prove it. But the Epidemic on the other
hand exhibited not one single symptom of bilious
accumulation or hepatic disorder incident to 
the former while every indication pointed to 
the stomach as the primary and chief seat
of the yellow fever.- This which at first was 

196
only conjecture was soon most fully demonstrated.
Dissections were frequently made by 
Dr Physick who during its prevalence had ample
opportunity being their physician to the city
hospital of examining the bodies of the dead.
He reports that the morbid symptoms were 
confined to the stomach that he could trace
inflammation there from a light suffusion
or blush to ephacelation; being extensive in 
some cases and in others producing only
a few streaks near the pylorus -
What was called black vomit was 
shewn to be an altered secretion of 
the Stomach, and not as was supposed,
a vitiated secretion of Bile.
This might have been Known however
without inspection, being an 
accompaniment of all Gastric inflamation,


196 A



196 B



197
inflamation, Also in Hydrophobia a
disease affecting that organ chiefly
and in repelled gout and inflamation
in the Stomach from virulent
poisons. In the Liver or its appendages 
on the other hand, every thing
appeared natural and without
disease, and except in a few cases
apparently accidental no vestage
of disorder was discoverable in any 
of the great cavities. The Brain was 
sound, exhibiting no trace of disease. 
Admitting the accuracy of 
these accounts, and we have no 
cause to doubt, for they were never
contradicted, and were contradicted
and were strongly corroborated
we must conclude that the common


198
billious and epidemic fevers are 
totally and essentially different diseases.
But acting on an opinion of 
their identity led to a practice, by 
no means improper altho' that opinion
was entirely hypothetical and 
erroneous. Those who thought in 
this way resorted to depleting remedies,
applying the lancet to weaken
arterial irritation action and 
following up the system by evacuating
the alimentary canal. For
some time the latter indication
was fulfilled by emetics, but in time
mercurial purgatives were prefered
Calomel with the drastic, adjuncts, 
Colocynth. Jalap & Gamboge 
was usually employed. To these 
primary 

199
primary object were added remedies
suited to this inferior, or secondary
symptoms which always attended
the complaint, Whilst this practice
was pursued by the majority of the 
most respectable physicians of the City
the French practitioners among us 
tried a very different plan of treatment
Disclaiming the utility of all active
evacuation they contented themselves
with addressing to the Stomach soothing
remedies, deeming that organ 
the seat of the disease - Their first 
object always to check the vomiting 
and next to remove the offensive
matter, supposed to be there, which 


200
they attempted by copious use of 
mild diluent remedies, and the 
ordinary means viz fomentations
to the pit of the stomach, and the 
warm bath -
What was the comparative
merit of these two modes of Practice?
If we are to decode by their
success, we shall find some difficulty
in determining, for the 
mortality was very great under 
both systems of treatment -
The French


201


202


203
The French physicians however acquire much
popularity in consequence of the agreeableness 
and simplicity of their practice which some
of them still retain. Encouraged by the 
successful use of Mercury in the Yellow fever
of the West Indies, our physician tried its
efficacy in our City. The fevers of tropical
Climates seems to yield to Mercury more readily
than to any other remedy, for which we have the
concurrent testimony of all their writers
Many confide in it altogether. Dr Chisholm
exhibited it in very large doses and the amount
sometimes given almost exceeds belief. The intention
was to produce salivation as promptly as
possible, for which purpose, Mercury was 
poured into the system through every avenue
This is certain the most approved practise
in the West Indies Yellow fever and as it is 

204
is a bilious fever and connected with an 
affection of the liver, the treatment is certainly
judicious. Where this mode of treatment
was first adopted, it was deemed so singularly
efficacious, as to exclude all other remedies 
It was triumphantly avered that when
salivation convened the disease was conquered.
But in Spite of all this we are completed
to double the propriety of the practice when 
applied to our Epidemic. - It is indeed
true that a case always succeeded a 
salivation, and we admit that two such
diseases as the Epidemic and Mercurial
fevers cannot coexist in the system, that 
where the latter is produced the former must 
depart. But the difficulty is to [cross out] produce the 
mercurial fever, or to get the mercury to 
opperate with Sufficient promptness. The 
course of the yellow fever here was so violent 

204 A



204 B



205
and rapid, that in most cases it was impossible
to produce any beneficial effect from Mercury
Long before salivation could be hoped for, the disease
had arrived at its natural termination. The 
patient perished! These in some cases salivation
did appear and the disease departed, but these
were milder cases, and perhaps would have
done well without such assistance
I formerly mentioned that dissection had 
shewn the Seat of the disease to lie in the stomach.
The symptoms exhibited by the patient
labouring under yellow fever, also lead to the same 
conclusion, for it is always accompanied by 
gastric distress. The ordinary appearance of 
this disease is in the aspect so very like that resulting
from [cross out] poisons, that they have often
been compared & we will Know that gastric
inflamation is the chief effect of such [cross out] poison
So soon as the Pathology of the disease was fully
understood a much more certain and efficatious


206
treatment was deduced from that Knowledge.
The Practitioner called in the primordiac 
state of the fever endeavoured in the 
first place to subdue the inflamitory state
of the system and so to arrest the affects on 
the Stomach - The lancet is sufficient
to meet this indication, Twenty or thirty
ounces of Blood should be quickly drawn
from the patient and as much more as 
soon as possible, "so onward" - Dr Jackson
of whom I have frequently spoke to you
informed me that had often taken Sixty or 
a hundred ounces from a patient at 
a single bleeding. This may appear
incredable but he asserted it before 
many of the faculty here, I must say 
that his character demands our belief if not 
our irritation, He did not regard syncope
at all, but rousing his patient permitted 


207
permitted the blood to stream afresh and he 
says he had after this any disease to contend with
and that except debility the patient was without 
complaint. Although I believe there is 
no remedy equal to the lancet freely used I 
do not pretend to advise you to follow his example, for 
of such prodigious venesection I have no experience.
It is not proper in this complaint to 
trust to the pulse as a guide to depletion for 
it is often obstructed or locked up by the 
violence of the action itself and in such cases
the pulse will contra indicate bleeding
altho' more than usually necessary
As auxiliary to the lancet evacuations
of the alimentary canals are necessary
This was at first performed by emetics, but 
after the true nature of the disease was understood
they were laid aside and mercurial purges
substituted in their place, Calomel with its 


208
its drastic accompaniments have been used
but I like not the adjuncts prefering Calomel
alone.- This medicine may be given in 
the wildest inflamitory action with a much
safety as the gentlest laxative But where 
the action is high the dose [cross out]
is comparatively large, for at any 
rate in Yellow fever there is always
a deficiency of susceptibility to purgative
influence. I have in such cases
seen ʒj of calomel administered without
producing more than a common
evacuation. I [cross out] however generally
contented myself with ten or fifteen
grains repeated frequently untill
operation after which contending
the discharge by milder laxative as 
the soluble tarter -

208 A



208 B



209
Much benefit is derived from Diaphoretics
application, so much as as 
to induce some practitioners to trust
to them entirely, to the exclusion of 
all others
But it is very imprudent to permit
such treatment to anticipate 
the more directly depleting measure.
Although when succeeding to them
they prove very serviceable. The Diaphoretics
in such cases there be of 
an active kind, and of these the 
external means as the vapour
Bath &c. are to be prefered -
The Stomach is in generable too
irritable to bear most of our diaphoretic
medicines and therefore
Nitre 

210
Nitre and antimony &c always
produce vomiting. Dover's powders
has been reccommended, but I believe
the Eupatorum, Spt Minderere the
saline mixt are most generally approved -
To allay the uncomfortable
heat of the skin attending many
cases of Yellow fever, affusion or 
sponging the body as formerly
mentioned will answer and in
the west Indies is much used -
Amidst this density of general
remedies let us not forget that the 
primary seat of the disease is local
and that local applications are 
consequently in dieased. Indeed
we have been prescribing for sympathited
affections alone, and must 


211
now attend to the primary disease
For this purpose let large Blisters
be applied to the region of the Stomach
and again and again repeated
As the disease advances blisters
should be applied also in other 
places especially to the extremities.
These often equalized the motions
of the pulse, compose the patient
to sleep, and sometimes by abstracting 
susceptibility, from the injured
parts restore to them the regular action
of health -
Among the local affections the 
most affecting is the incessant nausea
and vomiting uniformly accompanying
the disease, to relieve which 

212
[cross out] Know no better remedies than
those formerly mentioned for this
purpose. All of them have in turn
been tried. If in the early stage
of the complaint, effervescent draught
lime water and milk, mint
tea, and infusion of Serpentaria
are the best, but when further advanced
10 or 15 drops alum Terb:
or some tinct of Cloves -
These however repeat are to stimulating
to be admissible till the disease is 
far advanced. After all, as these
symptoms indicate an inflamed
condition of the Stomach, the above
are only palliatives, and the disease
tho' alleviated cannot be removed 


212 A



212 B



213
by them. Another local affection in 
many cases is Delirium for which we
use topical application, leeches, cups,
incision of the temporal artery, cold
and blisters.
As Yellow fever has sometimes
exhibited a tendency to remit or 
intermit, at particular times, Bark
has been thought to be indicated
But in consequence of the great irritability
of the stomach it was after
trial abandoned, and Quassia
a much less irritating and more 
agreeable tonic substituted
No great advantage however has 
been derived from either
Opium also was once used 
in 

214
in this complaint, to allay irritation
and procure rest, but time
has not sanctioned its utility. &
it is now admitted to be of little
advantage, increasing the fever & 
aggravating all the symptoms of 
inflamation. It has however
proved useful when thrown into
the rectum in doses of ʒj or ʒij -
You have thus gentleman before
you an outline of the practice
most generally approved and adopted;
after however much wrangling
and disrespectable contention -
If you are called early, and pursue
this system of treatment steadily
you will be as successful as a 
man

215
man accustomed to disease, can 
reasonably hope to be, by any practice
in so violent a distemper
But he who asserts, as some
have done, that the Yellow fever
is a manageable complaint, and 
cases of cure, May in the language
of the good Book have it
said of him; that he [cross out] deceives
[cross out] and the truth is not in him
Finis
3
February 12th 1817
End of vol: first 
Plague


Indexes
1. Stimulants
Testes on Plague



215 A



215 B



215 C