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MEDICAL INQUIRIES
AND
OBSERVATIONS.
     BY BENJAMIN JRUSH, M. D.
PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE
   AND OF CLINICAL PRACTICE, IN THE UNIVERSITY
             OF PENNSYLVANIA.
 IN FOUR VpEUME^-—rj~"~~7^~ "'
     T7/-VT ! TT  ^ •** A '' ^ X * "'*'* * ^     '
     VOL SbROro-N GENERAL'S Of HOE  :



THE THIRD, EDITION, |        f *L» \
REVISED AND ENLARGED BY THE APTHfR. ■
PHILADELPHIA:
Published by Thomas and William Bradford, Mathew Carey, Hopkins
 and Earle, Johnson and Warner, Kimber and Conrad, Bradford and
 Inskeep, Benjamin and Thomas Kite, and Bennett and Walton
                  1809. 
<3o« M£r^
<S>.
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Lli :■■>/■ ■ 
CONTENTS OF VOLUME II.
                                           page
AN Account of the Climate of Pennsylvania, and
  its influence upon the Human Body            1
An  Account of the Efficacy of common Salt in
  the Cure of Hemoptysis                    51
Thoughts upon  the Cause and Cure of Pulmo-
  nary Consumption.                         59
An Inquiry into the  Cause and Cure of Pulmo-
  nary Consumption                         77
Observations upon the Cause and Cure of Drop-
                                           Ill
  sies                                     x ' x
An Inquiry into the  Cause and Cure of the In-
   ternal Dropsy of the Brain.                207
Observations upon the Cause  and Cure of the
   Gout                                    245
Observations upon the Cause and Cure of Hydro-
  phobia                                  323
An Inquiry  into the Cause and Cure of the Cho-
   lera Infantum                            359
 Observations upon the Cynanche Trachealis    373
An Account of the Bilious Remitting  Fever, as 
IV
                                            page
   it appeared in Philadelphia in the Summer
   and Autumn of the year 1780               383
An Account of the Scarlatina Anginosa, &c.     403
An Account of the Measles, as they appeared in
  Philadelphia in the Spring of1789          421
An Account of the Influenza, as it appeared in
  Philadelphia in the Autumn of 1789,  in the
  Spring of 1190, and in the Winter of 1191   437 
        AN ACCOUNT







            OF THE







 CLIMATE OF PENNSYLVANIA,







            AND ITS






INFLUENCE UPON THE HUMAN BODY. 
 
            AN ACCOUNT


                 OF THE


CLIMATE OF PENNSYLVANIA, &c.
     IN order to render the observations upon the
epidemic diseases which compose the following
volumes more useful, it will be necessary to pre-
fix to them a short account of the climate of Penn-
sylvania, and of its influence upon the human body.
This account may perhaps serve further, to lead to
future  discoveries, and more extensive observa-
tions, upon this subject.

  The state of Pennsylvania lies between 39° 43'
25", and 42°  north latitude,  including, of course,
2° 16' 35", equal to 157 miles from its southern to
its northern boundary.   The western extremity of
the  state is in the longitude of 5° 23' 40",  and the
eastern, is that of 27° from the meridian of Phila-
delphia, comprehending in a due west course 311 
8
ACCOUNT OF THE CLIMATE
miles,  exclusive of the territory lately purchased
by Pennsylvania from the United States, of which
as yet  no accurate surveys have been  obtained.
The state is bounded on the south by part of the
state of Delaware, by the whole state of Maryland,
and by Virginia to her western extremity.   The
last named state, the territory lately ceded to Con-
necticut, and Lake Erie, (part of which is included
in Pennsylvania) form the western and north-west-
ern boundaries of the state.  Part of  New-York,
and the territory lately ceded to Pennsylvania, with
a part  of Lake Erie, compose the northern,  and
another part of New-York, with a large extent of
New-Jersey (separated from Pennsylvania by the
river Delaware), compose the eastern boundaries
of the  state.   The lands which form  these boun-
daries  (except a part of the states  of Delaware,
Maryland,  and New-Jersey) are in a  state of na-
ture.  A large tract of the western and north-east-
ern  parts of Pennsylvania are nearly  in the same
uncultivated situation.

  The state of Pennsylvania is intersected and di-
versified with numerous rivers and mountains.  To
describe, or even to  name them all, would far
exceed the limits I have proposed to this account
of our  climate.  It will be sufficient only to remark,
that one of these rivers, viz.  the Susquehannah, 
'OF PENNSYLVANIA.
9
begins at the northern boundary of the state, twelve
miles from the river Delaware, and winding seve-
ral hundred miles,  through a variegated country,
enters  the state of Maryland on the southern line,
fifty-eight  miles westward  of Philadelphia; that
each of these rivers is supplied by numerous streams
 of various sizes; that tides flow in parts of two of
them,  viz. in the Delaware and Schuylkill ; that
 the rest rise and fall alternately in wet and dry
 weather ; and  that they descend  with great rapi-
 dity, over prominent beds of rocks in many places,
 until they empty themselves into the bays of Dela-
 ware and Chesapeak on the east, and into the Ohio
 on the western part of the state.

   The mountains form a considerable part of  the
 state of Pennsylvania.  Many of them appear to be
 reserved as perpetual marks of the original empire
 of nature in this country.  The Allegany, which
 crosses the state about two  hundred miles from
 Philadelphia,  in a  north,  inclining to an eastern
 course, is the most considerable  and extensive of
 these mountains.   It is called  by the Indians the
 back-bone of the continent. Its heighth, in different
 places,  is supposed to be about 1,300 feet from the
 adjacent plains. 
10
ACCOUNT OF THE CLIMATE
   The soil of Pennsylvania is diversified by its vi-
 cinity to mountains and rivers.   The valleys and
 bottoms consist of a black mould, which extends
 from a foot to four feet in depth.   But in general
 a deep clay forms the surface of the earth.    Im-
 mense beds  of limestone lie beneath this clay in
 many parts of the state.   This account of the soil
 of Pennsylvania is confined wholly to the lands on
 the east side of the Allegany mountain.   The soil
 on the west side of this mountain, shall be described
 in another place.

  The city of Philadelphia lies in the latitude of
 39° 57', in longitude 75° 8' from Greenwich, and
 fifty-five miles west from the Atlantic ocean.

  It is  situated  about four miles due north from
the conflux of the rivers Delaware and Schuylkill.
The buildings, which consist chiefly of brick, ex-
tend nearly three miles north and south along the
Delaware, and above half a mile due west towards
the Schuylkill, to which river  the limits of the
city extend, the whole of which includes a distance
of two miles from the Delaware.   The land near
the rivers, between the city and  the conflux of the
rivers, is in general low,  moist,  and subject to be
overflowed.   The greatest  part of it is meadou 
OF PENNSYLVANIA.
11
ground.  The land to the  northward and  west-
ward, in the vicinity of the city, is high, and in
general well cultivated.  Before  the year 1778,
the ground between the present improvements of
the city, and the  river Schuylkill,  was covered
with woods.  These, together with large tracts of
wood to the northward of the city, were cut down
during the winter the British army had posses-
sion of Philadelphia.  I shall hereafter mention the
influence which the cutting down of these woods,
and the subsequent cultivation of the grounds m
the neighbourhood of the city, have had upon the
health of its inhabitants.

   The mean height of the ground on which the
city stands, is about forty feet above the river De-
laware.  One of the longest and most populous
streets in the city rises  only a few feet above the
river.   The air at the  north is much purer than
at  the south end  of the city;  hence  the lamps
exhibit a  fainter  flame in its southern, than its
northern parts.

   The tide of the Delaware  seldom  rises more
 than six feet.  It flows four miles in an hour.  The
 width of the river near the city is  about  a mile. 
12
ACCOUNT OF THE  CLIMATE
  The city,  with the adjoining districts of South-
wark and the Northern Liberties, contains between
90 and 100,000 inhabitants.

  From  the accounts whieh  have been handed
down to us  by our ancestors, there is reason to
believe that the climate of Pennsylvania has under-
gone a material change.  Thunder and lightning
are less frequent, and the cold of our winters and
heat  of our summers  are less uniform, than they
were forty or fifty  years ago.   Nor  is this all.
The  springs are much  colder, and the autumns
more temperate than formerly, insomuch that cat-
tle are not housed so soon by one  month as they
were in former years.  Within the last  eight years,
there have been some exceptions to part of these
observations.  The winter of the  year 1779-80,
was  uniformly and uncommonly cold.  The  river
Delaware was ( frozen near  three months during
this  winter, and public roads for  waggons and
sleighs connected the city of Philadelphia in many
places with  the  Jersey shore.   The thickness of
the ice in the river near the city, was from sixteen
to nineteen  inches, and the depth  of the  frost in
the ground was  from four to five feet, according
to the exposure of the ground, and the quality of
the soil.  This extraordinary depth of the frost in
the earth, compared with its depth in more  nor- 
OF PENNSYLVANIA.
13
thern and colder  countries, is occasioned by the
long delay of snow, which leaves the earth without
a covering during the last autumnal and the first
winter months.   Many plants were destroyed by
the intenseness of the cold during this winter. The
ears  of horned cattle  and the feet of hogs exposed
to the air, were frost-bitten; squirrels perished in
their holes, and partridges were often found dead
in the neighbourhood of farm houses.   The mer-
cury in January stood for several hours at 5 ° be-
low 0, in Fahrenheit's thermometer;  and during
the whole of this month (except on one  day), it
never rose in  the city of Philadelphia so high as
to the  freezing point.

   The cold in the winter of the year  1783-4 was
as intense, but not so steady, as it was in the winter
that  has been described. It differed from it mate-
rially in  one particular, viz. there  was a thaw in
the month of January, which opened all our rivers
for a few days.

   The summer which succeeded the winter of
 1779-80, was uniformly warm.  The  mercury in
the thermometer, duringthis summer, stood on one
day  (the 15th of August) at  95°,  and fluctuated
between  93°,  and 80° for  many  weeks.    The
thermometer,  in every reference that has been, or
   vol.  it.            c. 
14
ACCOUNT OF THE CLIMATE
shall be made to it, stood in the shade in the open
air.

  I know it  has been  said by  many old people,
that the winters in Pennsylvania are less cold, and
the summers less warm,  than they were forty or
fifty years ago.  The want of thermometrical ob-
servations before, and during those years, renders it
difficult to decide this question.  Perhaps the diffe-
rence of clothing and sensation between youth and
old age, in winter  and summer,  may  have laid
the foundation  of this  opinion.   I   suspect  the
mean temperature of the air  in Pennsylvania  has
not altered, but that the  principal change in  our
climate consists in the heat and  cold being less
confined than formerly to  their natural seasons.  I
adopt the opinion of Doctor Williamson* respect-
ing the diminution of the cold in the southern, be-
ing: occasioned bv the cultivation of the northern
parts of Europe ; but no such cultivation has taken
place in the countries which lie to the north-west
of Pennsylvania, nor do the partial and imperfect
improvements which have been made in the north-
west parts  of the state,  appeal- to be sufficient to
lessen  the cold, even in the city of Philadelphia.
I have been able to collect no facts, which dispose
* American Philosophical Transactions, vol. I. 
OF PENNSYLVANIA.
15
me to believe that the winters were colder before
the year 1740, than they have been since.  In the
memorable winter of 1739-40, the Delaware was
crossed on the ice, in sleighs, on the 5th of March,
old  style, and  did not open till  the 13th of the
same month.   The ground was covered during
this  winter with a deep snow, and the rays of the
sun  were constantly obscured by a mist,  which
hung in the upper regions of the air.  In the win-
ter of 1779-80, the river was navigable on the 4th
 of March ; the depth  of the snow was moderate,
 and the  gloominess of the cold was sometime sus-
 pended  for a few days by a cheerful siin.  From
 these facts, it is  probable the winter of 1739-40
 was colder than the winter of 1779-80.

   The winter  of 1804-5 exhibited so many pecu-
 liarities that it deserves  a  place in  the history of
 the climate of Pennsylvania.   The navigation of
 the Delaware  was obstructed on the 18th of De-
  cember.  The weather partook of every disagreea-
  ble and distressingproperty of every cold climate on
  the globe.  These were intense cold, deep snows,
  hail, sleet, high winds, and heavy rains.   They
  generally occurred in succession, but sometimes
  most of them took place in the course of four and
  twenty hours.   A serene and star-light evening,
   often preceded a tempestuous day.   The mercury 
16
ACCOUNT OF THE CLIMATE
 stood for  many days, in Philadelphia, at 4° and 6°
 above  0 in Fahrenheit's thermometer.  The  me-
 dium depth of the snow was two feet, but from its
 fall being accompanied with high winds, its height
 in many places was three and four feet, particularly
 in roads,  which it rendered so impassable, as to
 interrupt business and social intercourse, in many
 parts of the  state.   From  the great depth of the
 snow, the  ground was so much protected from the
 cold, that  the frost extended but six inches below
 its surface.   The newspapers daily furnished dis-
 tressing accounts of persons perishing with the cold
 by land and water, and of shipwrecks  on every
 part of the coast of  the United States.  Poultry
 were found dead, or with frozen feet, in their coops
 in many places.

   This intense cold was not confined to Pennsyl-
 vania.  In Norfolk, in Virginia, the mercury stood
 at 18°  above  0 on the 22d of January.   At Lex-
 ington, in Kentucky, it stood at 0 on the 21st of
 the same mouth.  In Lower Canada the snow  was
 seven feet in  depth, which is three feet deeper than
 in common years. And such was the quantity of
 ice collected  in the northern seas, that a ship  was
destroyed, and several  vessels injured, by large
masses of it, floating between the 41st and 42d de-
 grees of north latitude.
 •3) 
OF PENNSYLVANIA.
17
  Great fears were entertained of an inundation in
Pennsylvania, from a sudden thaw of the immense
quantities of snow and ice that had accumulated
during the winter, in every part of the state ; but
happily they both dissolved away so gradually, as
scarcely  to  injure a bridge or a  road.   On  the
28th of February the Delaware was navigable, and
on the 2d  of March no ice was to be seen in it.

  Having premised these general remarks, I pro-
ceed to observe,  that there are seldom more than
twenty or thirty days  in  summer or  winter, in
Pennsylvania, in which the mercury rises above 80°
in the former, or  falls below 30° in the latter sea-
son.  Some old  people have  remarked, that the
number  of extremely cold and warm days in suc-
cessive summers and winters, bears an exact pro-
portion to each other.   This was strictly true in
the years 1787 and 1788.

   The warmest part of the day  in summer is at
two, in ordinary, and at three o'clock in the after-
noon,  in extremely  warm weather.   From these
hours, the heat gradually diminishes till the ensuing
morning.  The coolest part of the four and twenty
hours, is at the break  of day.   There are seldom
more than three or  four nights  in a summer in
which the heat of the air is nearly the same as in 
18       ACCOUNT OF THE CLIMATE
the preceding day.  After the warmest days, the
evenings are generally agreeable, and often delight-
ful.  The higher the mercury rises in the day
time, the lower it falls the succeeding night. The
mercury at  80° generally  falls to  68°, while it
descends, when at 60°, but to 56°.   The dispro-
portion  between the  temperature of the day and
night, in summer is always  greatest in the  month
of August.  The dews at this time are heavy  in
proportion to the coolness of the evening.  They
are sometimes so considerable as to wet the clothes;
and there are instances in which marsh-meadows,
and even creeks, which have been dry during the
summer, have  been supplied with their usual wa-
ters from no other source,  than the dews which
have fallen in this month, or in the first weeks of
September.

   There is another circumstance connected with
the one just  mentioned, which contributes very
much to mitigate the heat of summer, and  that is,
it seldom continues more than two or three days
without being succeeded with showers of rain, ac-
companied sometimes by thunder and lightning,
and afterwards by a north-west wind, which pro-
duces  a coolness in the air that is  highly invigo-
rating and  agreeable. 
            OF PENNSYLVANIA.            iy
  The warmest weather is generally in the month
of July.   But intensely warm days are often felt in
May, June, August, and September.  In the an-
nexed table of the weather for the year 1787, there
is an exception to the first of these remarks.   It
shows that the mean heat of August was greater
by a few degrees than that of July.

   The transitions from heat to cold are often very
sudden,  and  sometimes to  very distant degrees.
After a  day in which the  mercury has stood at
86° and even 90°, it sometimes falls, in the course
of a single night,  to the  65th, and even to the
60th degree,  insomuch that fires have been found
necessary  the  ensuing morning, especially if the
change  in the temperature of  the air has been
 accompanied by rain and a south-east wind.   In
 a summer month,  in the year 1775, the mercury
  was observed to fall  20° in an hour and a half.
 There  are few summers in  which fires are not
 agreeable  during some parts of them.   My inge-
 nious friend, Mr. David Rittenhouse, whose talent
 for  accurate  observation extends  alike to all  sub-
 jects, informed me,  that  he had never passed a
  summer,  during his residence in the country, with-
 out discovering frost in every month of the year,
 except July. 
20      ACCOUNT OF THE CLIMATE
  The weather is equally variable in Pennsylvania
during the greatest part of the winter.   The mer*
cury fell from 37° to 4^° below 0 in four and
twenty hours, between the fourth and fifth of Feb-
ruary, 1788.   In this season nature seems to play
at cross purposes.  Heavy falls of snow are often
succeeded in a few days by a general thaw, which
frequently in a short time leaves no vestige of the
snow.  The rivers Delaware, Schuylkill, and Sus-
quehannah have  sometimes been frozen (so as to
bear horses and carriages of all kinds) and thawed
so as to be passable in boats, two or three times in
the course of the same winter.   The ice is formed
for the most part in a gradual manner, and seldom
till the water has been previously chilled by a fall
of snow.   Sometimes its production is more sud-
den.  On the night  of the  31st of December,
1764, the Delaware was completely frozen over
between  ten o'clock  at night and eight the next
morning, so as to bear the weight of a man.   An
unusual vapour  like a fog was seen to rise from
the  water,  in  its  passage from a fluid to a solid
state.

  This account of the variableness of the  weather
in winter,  does not apply to  every part of Penn-
sylvania.  There is  a line about the  41° of the
state, beyond  which the winters are  steady and 
OF PENNSYLVANIA.
21
regular,  insomuch  that the earth there is seldom
without a covering of snow during the three win-
ter months.  In this line the climate of Pennsylva-
nia forms a union with the climate of the eastern
and northern states.

   The time in which frost and ice begin to show
themselves in the neighbourhood of Philadelphia,
is generally about the latter end of October or the
beginning  of November.  But the  intense cold
seldom sets in till about the 20th or 25th of De-
cember ; hence the common saying, " as the day
" lengthens, the cold strengthens."   The coldest
weather is commonly in January.  The navigation
of the river Delaware, after being frozen, is seldom
practicable for large vessels, before the first week
in March.

   As in summer there are often days in which fires
are agreeable, so there are sometimes days in win-
ter in which they  are disagreeable.  Vegetation
has been observed in all the winter months.   Gar-
lic was tasted in butter in January,  1781.   The
 leaves of the willow,  the blossoms  of the peach
 tree, and the flowers of the dandelion and the cro-
 cus, were all seen in February, 1779 ; and I well
recollect,  when a  school-boy,  to have  seen
an apple orchard in full bloom, and small  ap-
   VOT..  TT.            D 
 22  s     ACCOUNT 01  THE  CLIMATE

 pies on  many  of the trees, in the month of  De-
 cember.

  A cold day  in winter is often succeeded by a
 moderate evening.   The coldest part of the  four
 and twenty hours, is generally at the break of day.

   In the most intense  cold  which has been re-
 corded in Philadelphia, within the last twenty years,
 the mercury stood at 5° below 0.   But it appears
 from the accounts published by Messieurs Mason
 and Dixon, in the 58th volume of the Transactions
 of the Royal Society of London, that the mercury
 stood at 22° below 0, on the 2nd of January, 1767,
 at Brandywine, about thirty miles to the westward
of Philadelphia.  They inform us, that on the 1st
of the same month, the mercury stood at 20°, and
on the day before at 7° below 0.  I have to lament
that I am  not able  to procure any record of the
temperature of the air in the same year in Phila-
delphia.  From the variety in the height and qua-
lity of the  soil, and from  the difference in the
currents  of winds and  the  quantity  of rain  and
snow which fall in different parts of the state, it is
very probable  this excessive  cold may not have
extended thirty miles from J;he place where it was
first perceived. 
              OF PENNSYLVANIA.           23
   The greatest degree of heat upon record in Phi-
 ladelphia, is 95°.

   The standard temperature of the air in the city
 of Philadelphia is 52*°, which is the  temperature
 of our deepest wells, as also the mean heat of our
 common spring water.

   The spring in  Pennsylvania is generally less
 pleasant than in many other countries.   In March
 the  weather is  stormy,  variable, and cold.   In
 April, and sometimes  in the beginning of May, it
 is moist, and accompanied by a degree of cold
 which has been called rawness,  and which,  from
 its disagreeable effects upon the temper,  has been
 called the sirocco of this country.   From the vari-
 able nature of the weather in the spring, vegetation
 advances very differently in different years.  The
 colder the spring, the more favourable it proves to
 the fruits of the earth.  The hopes of the farmer
 from his  fruit-trees  in  a  warm spring are often
 blasted by  a  frost  in April and May.   A fall of
 snow is remembered with regret by many of them,
 on the night between the 3rd and 4th of  May, in
 in the year 1774 ; also on the morning of the 8th of
 May, 1803.   Such was  its quantity on the latter
 day, that it  broke down the limbs of many poplar
■trees.   This effect was  ascribed to its not being- 
24        ACCOUNT OF  THE CLIMATE
accompanied with any wind.  The colder the win-
ter, the greater delay we generally observe in the
return of the ensuing spring.

  Sometimes the weather during the spring months
is cloudy and damp,  attended occasionally with a
gentle fall of rain resembling the spray from a cata-
ract  of water.    A day of this kind of weather is
called,  from its  resemblance to a damp  day in
Great-Britain,  " an English day."   This damp
weather seldom continues more than three or four
days.  The month of  May, 1786,  will long be
remembered, for having furnished a very uncom-
mon instance of the absence  of the sun for fourteen
days, and of constant damp  or rainy weather.

  The  month of June is  the only month in the
year which resembles a spring month in the south-
ern countries  of Europe.  The weather is then
generally temperate, the sky is serene, and the ver-
dure of the country is universal and delightful.

  The autumn is the most agreeable season in the
year in Pennsylvania.   The cool evenings and
mornings,  which generally begin about the first
week in September, are succeeded  by a moderate
temperature of the air  during the  day.   This
kind of weather continues with an increase of cold 
OF PENNSYLVANIA.            25
scarcely perceptible,  till  the middle of October,
when  the autumn is  closed by rain, which some-
times  falls in such  quantities as to produce de-
structive freshes in  the  rivers and creeks,  and
sometimes descends in gentle showers,  which con-
tinue,  with  occasional interruptions by a few fair
days,  for two or three  weeks.     The rains are
the harbingers of the winter;  and the Indians have
long ago taught the  inhabitants of Pennsylvania,
that the degrees of cold during the winter,  are  in
proportion to the quantity of rain which falls du-
ring the autumn*.

   From this account of the temperature of the air
in Pennsylvania, it is evident that there are seldom


  * I cannot help agreeing with Mr. Kirwan, in one of  his
remarks upon the science of meteorology, in the preface to
his estimate of the temperature of different latitudes. " This
" science, (says he), if brought to perfection, would enable
" us at least to foresee those  changes in the weather which
" we could not prevent. Great as is the distance between
" such knowledge and our own present attainments, we have
" no reason to think it above the level of the powers of the
" human mind.  The  motions of the planets  must have  ap-
" pearcd as perplexed and intricate to those who first con-
" templated them  ; yet,  by persevering industry, they  are
" now known to the utmost precision.   The present is (as
"the great Liebnitz  expresses it) in every case pregnant 
26          ACCOUNT OF THE CLIMATE
more than four months in which the weather is
agreeable without a fire.

  In  winter  the winds generally come from the
north-west in fair, and from the north-east in wet
weather.  The north-west winds are uncommonly
dry as well as cold.   It is in consequence  of the
violent  action of these winds that trees have uni-
formly a thicker and more compact bark on their
northern than on their southern exposures. Even
brick houses are affected by the force  and dryness
of the north-west winds : hence it is  much more
difficult to demolish the northern than the southern
walls of an old brick house.  This fact was com-
municated to me by an eminent bricklayer in the
city of Philadelphia.

  The  winds in fair weather in the  spring,  and
in warm  weather in the summer, blow from the
south-west and from west-north-west.   The raw
air  before-mentioned comes from the north-east.
The south-west winds likewise usually bring with

" with the future, and the connexion must be found by long
" and attentive observation."

  The influence which the perfection of this science must
have upon health, agriculture, navigation, and commerce,
is too obvious to be mentioned. 
            OF  PENNSYLVANIA.            27
them  those showers of rain in the spring and sum-
mer which refresh the earth.   They moreover
moderate the heat of the weather, provided they
are succeeded 4>y a north-west  wind.   Now and
then  showers of rain come from the west-north-
west.

   There is a common fact connected with the ac-
count of the usual winds in Pennsylvania, which
it may not be improper to mention in this place.
While the  clouds are seen flying from the south-
west, the scud, as it is called, or a light vapour, is
seen  at the  same  time flying below the clouds
from  the north-east.

   The moisture of the air  is much greater than
formerly, occasioned probably by the exhalations
which  in former years fell in the form of snow,
now descending in the form of rain.  The depth
of the  snow is  sometimes between two and three
feet,  but in general seldom exceeds between six
 and nine inches.

   Hail frequently descends  with  snow in winter.
 Once in four or five years large and heavy showers
 of hail  fall  in  the spring  and summer.  They
 generally run in narrow veins (as they are called) 
28
ACCOUNT  OF THE CLIMATE
of thirty or forty miles in length, and two or three
miles in breadth. The heaviest shower of hail that
is remembered in Philadelphia, did not extend in
breadth more than half a mile ndrth and  south.
Some of the stones weighed half an ounce.  The
windows of many houses were broken  by them.
This shower fell in May, 1783.

  From sudden changes in  the air, rain  and snow
often  fall  together,  forming  what is commonly
called sleet.

  In the uncultivated parts  of the state, the snow
sometimes lies on the ground  till the first week in
April.   The backwardness  of the spring has been
ascribed to the passage of the air over the  undis-
solved beds of snow and ice  which usually remain,
after the winter months are past, on the north-west
grounds  and waters  of the  state, and of the adja-
cent country.

 The dissolution of the ice  and snow in the spring
is sometimes so sudden as to  swell the creeks and
rivers in every part of the state to such a degree,
as not only to lay waste the  hopes of the husband-
man from  the produce of his lands, but in some
instances to sweep his barns, stables, and even his 
OF  PENNSYLVANIA.
29
 dwelling  house into their currents *.    The wind,
 during a general thaw, comes from the south-west
 or south-east.

   * The following account of the thaw of the river Susque-
 hannah, in the spring of 1784, was published by the author
 in the Columbian Magazine,  for November, 1786.  It may
 serve to illustrate a fact related formerly in the history of
 the  winters in Pennsylvania,  as well as to exhibit an extra-
 ordinary instance of the destructive effects of a sudden thaw.

   " The winter of 1783-4  was uncommonly  cold,  inso-
 much that the mercury  in Fahrenheit's thermometer  stood
 several times at 5 degrees below 0.  The snows were fre-
 quent, and, in many  places,  from two  to three feet deep,
 during the  greatest part of the winter.   All the rivers in
 Pennsylvania were frozen, so as to bear  waggons and sleds
 with  immense weights.  In  the month of January a thaw
 came on suddenly, which opened our rivers  so as to set the
 ice a-driving, to use the phrase of the country.   In the
 course of one night, during the thaw, the wind shifted sud-
 denly to the north-west, and the weather became intensely
 cold.   The  ice,  which had floated the day before, was sud-
 denly obstructed ;  and in the river Susquehannah, the ob-
 structions were formed in those places where the water was
 most  shallow, or  where it had been  accustomed  to fall.
 This river is several hundred miles in length, and from half
 a mile  to a mile and a half in breadth, and winds through a
 hilly, and in many places a  fertile and highly cultivated
country. It has as yet a most difficult communication with
our bays and the  sea, occasioned by the number and height
of the falls which occur near the mouth of the river.   The
   VOL. ri.             E 
30         ACCOUNT OF THE CLIMATE

   The air, when dry in Pennsylvania, has a pecu-
liar  elasticity, which renders the  heat and cold

ice in many places, especially where there were falls, formed
a kind of dam  of a most  stupendous height.  About the
middle of March our weather moderated, and a thaw be-
came general.   The effects of it were remarkable in all our
rivers ; but in  none  so  much as in the river I have men-
tioned.   I shall therefore endeavour in a few words to de-
scribe them.  Unfortunately the  dams of ice did not give
way  all at once, nor those which lay nearest to the mouth
of the  river,  first.    While the upper dams were set afloat
by the warm weather, the lower ones,  which  were the
largest, and in which, of course, the ice was most impacted,
remained fixed. In consequence of this, the river rose in a
few hours, in many places, above SO feet, rolling upon its
surface large lumps of ice,  from 10 to 40 cubic feet in size.
The effects of this sudden inundation were terrible.  Whole
farms werclaid under water.   Barns, stables, horses, cat-
tle, fences, mills of eveiy kind, and, in one instance, a large
 stone house, 40 by 30 feet, were carried  down the stream.
Large trees were torn up by the roots; several small islands,
covered with woods, were swept away, and not a vestige of
them was left behind.  On the barns which preserved their
shape, in some instances, for many miles were to be seen
living  fowls ;  and, in one dwelling, a candle was seen to
burn for some  time, after it was swept from its foundation.
Where the shore was level, the lumps of ice, and the ruins
of houses and farms, were thrown a quarter of a mile from
the ordinary height of the river.  In some instances, farms
 were ruined by the mould being swept from them by the
 cakes  of ice, or by depositions of sand ;  while others were
 enriched by large depositions of mud.   The damage, upon 
OF PENNSYLVANIA.
31
less insupportable than the same degrees of both
are in moister countries.   It is in those cases only
when summer showers are not succeeded by north-
west winds,  that the heat of the air becomes op-
pressive  and  distressing, from  being combined
with moisture.

   From tradition, as well as living observation, it
is evident, that the waters in many of the creeks
in Pennsylvania have diminished considerably with-
in the last fifty years.   Hence  many mills, erected
upon large and deep streams of water,  now stand
idle in dry weather; and many creeks, once navi-
gable in  large boats, are now impassable even in
canoes.   This diminution of the waters has been

the whole, done to the state of Pennsylvania by this fresh,
was very great.  In  most places it happened in the day
time,  or the consequences must  have been fatal to many
thousands."

  " I know of but one use that can be derived from record-
ing the history of this inundation. In case of similar obstruc-
tions  of rivers, from the causes such as have been describ-
ed, the terrible effects of their being set in motion by means
of a general thaw may in part be obviated, by removing such
things out  of the course of the water and ice as are within
our power; particularly  cattle, hay,  grain, fences, and
farming utensils of all kinds." 
     32       ACCOUNT OF THE CLIMATE
     ascribed to the application of a part of them to the
     purpose of making meadows.

       The mean  elevation of the barometer in Phila-
     delphia, is about 30 inches.   The  variations in
     the barometer are very inconsiderable in the great-
     est changes of the weather, which  occur in the
—   city of Philadelphia.  During the violent and de-
     structive storm which blew from the south-west on
     the  11th of November, 1788, it suddenly fell from
     30  to  29i30.   Mr. Rittenhouse informs me, that
     long and faithful observations have satisfied him,
     that the alterations in the height of the mercury
     in the barometer do not precede but always succeed
     changes in the weather.   It falls with the south
     and south-west, and rises with the north and north-
     west winds.

       The quantity  of water which falls in rain and
     snow, one year with another, amounts to from 24
     to  36 inches.   But to complete the  account of
     variable qualities in the climate, it will be neces-
     sary to add, that our summers and autumns are
     sometimes marked by a deficiency, and sometimes
     by aii excessive quantity of rain.  The summer and
     autumn of  1782  were uncommonly  dry.   Near
     two  months  elapsed without a single shower of
     rain.  There were only two showers in the whole 
OF PENNSYLVANIA.
33
months of September and  October.   In conse-
quence of this dry  weather, there was no second
crop of hay.  The  Indian  corn failed of its in-
crease  in many places, and was cut down for food
for cattle.  Trees newly planted, died.  The pas-
ture fields not only lost their verdure, but threw
up small clouds of dust when agitated by the feet
of men, or beasts.   Cattle in some instances were
driven many miles to be watered, every morning
and evening.  It was remarked during this dry
weather, that the sheep were uncommonly fat, and
their flesh well tasted, while all the other domestic
animals  languished from the want of grass and
water.   The earth became so inflamable in some
places, as to burn above a foot below its  surface.
A complete  consumption of the turf by an acci-
dental fire  kindled  in the adjoining state of New-
Jersey, spread terror and distress through a large
tract of country.  Springs of water and large creeks
were dried up in many parts of the state.  Rocks
appeared in the river Schuylkill, which had never
been  observed before, by the oldest persons then
alive.   On one of them were cut the figures 1701.
The atmosphere, during part of this dry  weather,
was often filled, especially in the mornings, with a
thin mist, which, while it deceived with the expec-
tation of rain, served the valuable purpose of abat-
ing the heat of the sun.   A  similar mist was ob- 
 34         ACCOUNT OF THE.CLIMATE
 served in France by Dr. Franklin, in the summer
 of 1782.   The winter which succeeded it was un-
 commonly  cold in France, as well as in Pennsyl-
 vania.  I am sorry that I am not able to furnish
 the  mean  heat of each of the summer months.
 My notes of the weather enable me to add nothing
 further upon this  subject,  than that the summer
 was " uncommonly cool."

   The summer of the  year  1788 afforded a re-
 markable instance of excess  in the quantity of rain
 which sometimes falls in Pennsylvania.  Thirteen
 days are marked with rain in July, in the records
 of the weather kept  at Spring-Mill.   There fell
 on the 18th and 19th of  August seven inches of
 rain  in the city of Philadelphia.   The wheat suf-
 fered greatly by the constant rains of July in the
 eastern and middle parts of the state.  So unpro-
 ductive a harvest in grain, from wet weather, had
 not been known, it is said, in the course of the last
 70 years.   The heat of the air, during these sum-
 mer  months was very moderate.  I*s mean  tem-
 perature at Spring-Mill was  67,8 in June, 74,7 in
 July, and only 70,6 in August.

  It  is some consolation to a citizen of Pennsylva-
nia,  in  recording facts which seem to militate
against our climate,  to reflect that the difference of 
OF PENNSYLVANIA.
35
the weather, in different parts of the state, at the
same season, is happily accommodated to promote
an increase of the same objects of agriculture; and
hence a deficiency of crops has never been known
in one year throughout the whole state.

   The aurora borealis and meteors are seen occa-
sionally in Pennsylvania.  In the present imperfect
state of our knowledge of their influence upon the
human body, it will  be foreign to the design  of
this history of our climate to describe them.

   Storms and hurricanes are not unknown in Penn-
sylvania.   They occur once in four or five years,
but they are most frequent and destructive  in the
autumn. They are generally accompanied by rain.
Trees are torn up by their roots, and the rivers and
creeks are sometimes swelled so suddenly as to do
considerable damage to the adjoining farms.  The
wind,  during these storms, generally blows from
the south-east  and  south-west.   In  the storms
which occurred in September, 1769, and  in the
same month of the year 1785, the wind veered
round contrary to its usual course, and blew from
 the north.

   After what  has been said, the character of the
 climate of Pennsylvania may be summed up in a 
36       ACCOUNT OF  THE CLIMATE
few  words.   There are no two successive years
alike.   Even the same  successive  seasons  and
months differ from each other every year.   Per-
haps there  is but one steady trait in the character
of our climate, and that is, it is uniformly variable.

  To  furnish the reader  with a succinct view of
the weather in Pennsylvania,  that includes all the
articles that have been mentioned, I shall here sub-
join a table containing the result of meteorological
observations made near the river Schuylkill, forone
year, in the neighbourhood of Philadelphia, by an
ingenious French gentleman, Mr. Legeaux, -who
divides his time between  rural employments, and
useful  philosophical pursuits.   This table is ex-
tracted from the Columbian Magazine, for Febru-
ary, 1788.   The height of Spring-Mill above the
city of Philadelphia, is supposed to be about 70
feet. 

 55

 >
 l-J
 J*
 CO

 %
 W
 P,

Oh
O
METEOROLOGICAL OBSERVATIONS, made at S				'ring-Mill	13 miles NNW. of Phil							adelphia. Result of the vear 1787.	
	THERMOMETER.		BAROME-	T)	DAYS					WATER			
3 o			TER. mean height	SB 3 I	0 -h C	o 3*	0 C	o 0 O	0 —> n> 3	of and	RAIN SNOW.		WEATHER
	of Fahrenheit,	de Reaumur,											
K	mean degree	degrcsmoyens			O"		o.		r				
	D. 1 0 16	D. i 0 10	in.pts.^	o	•1		^		r*	in.	?ts.	i in	
January	35 1	1 4	29 9 9	Variable still		7	1	4		3	10	10	Fair, still, cold, and snow.
rebruary	33 8	8	29 9 9	NE		3		o	2	3	7	3	Fair, overcast.
March	45 1	5 8	29 9 7	W		6		3		2	4	2	Fair, windy. Fair, and very dry. F°ggy> cold, and wet.
April	54 3	9 9	29 9 6	Still, SW		o	2	1	2	1	2	13	
May	61 2	13	29 9 2	Still, WSW	1	14	6		2	4	11	4	
June	70 7	17 2	29 8 2	WNW		y	1			1	10	4	Very fair and growing weather.
July	72 2	17 9	29 9 10	WWSWvar.	1	5	2			3	1	11	Fair, and overcast.
August	74 5	18 9	29 10 6	W		11 4			1	5	2	3	Very fair, and cloudy. Fair weather.
September	64 7	14 5	29 10 4	WNW		6 1			1	2	7	8	
October	51 1	8 5	29 11 9	WNW vari.	1	4|					7	10	F°ggy> fair> and dry weather. Very fair. Very fair, and very dry.
November	45 1 5 8		29 11 1	Still vari.	1	5				2	fi	10	
December	34 | 9		29 7 7	WNW		1		1	1		9		
	10 Feb. great-10 Feb. D. du		8 Mar. great-										
	est D. of cold.	plus gr. froid.	est elevation.										
	5	12 0	30 10										TEMPERATURE
													
1 W	>J uly greatest	3 July plus G.	2 Febr. least										
	D. of heat.	D. de chaud.	elevation.										OF
	96 1	28 5	29	WNW	4	73	17	12	9	32	8	14	THE YEAR 1787. Very fair, dry, abundant in
	Variation.	Variation.	Variation.										
	91 1	40 5	1 10										every thing, and healthy.
	1'emperature	Temperature.	Mean elevat.										
	53 5	9 6	20 9 9										
 
38          ACCOUNT OF THE  CLIMATE
  It is worthy of notice, how near the mean heat
of the year,  and of the month of April, in two
successive years,  are to each other in the same
place.  The mean heat of April, 1787, was 54°3,
that  of April, 1788,  was 52°2.  By the table of
the mean heat of each month in the year,  it ap-
pears that  the mean  heat  of 1787  was 53°5 at
Spring-Mill.

  The following accounts of the climates of Pekin
and  Madrid, which lie within  a  few minutes of
the same  latitude  as  Philadelphia, may serve to
show how much climates are altered by local and
relative circumstances.  The account of the tem-
perature of the air at Pekin will  serve further to
show, that with all the advantages of the highest
degrees of cultivation which have taken place in
China, the winters are  colder, and the summers
warmer there than in  Pennsylvania, principally
from a cause which will probably operate upon the
winters of Pennsylvania for many  centuries to
come, viz. the vicinity of an uncultivated north-
west country.

   " Pekin, lat. 39° 54', long.  116° 29' W.

   " By five years observations, its annual mean
temperature was found to be 55°  5'. 
OF PENNSYLVANIA.
39
January	20°,75	July	84°,8
February	32	August	83
March	48	September	63
April	59	October	52
May	72	November	41
June	83,75	December	27
  " The  temperature of the  Atlantic under this
parallel is 62, but the standard of this part of the
globe  is  the North Pacific, which is here 4 or 5
degrees colder than the Atlantic.   The Yellow
Sea is the nearest to Pekin, being about 200 miles
distant from it; but it is itself cooled by the moun-
tainous country of Corea, which interposes between
it and the ocean, for a considerable part of its ex-
tent.   Besides, all the northern parts of China (in
which  Pekin lies)  must be cooled by the vicinity
of the mountains of Chinese Tartary among which
the cold is said to be excessive.

  " The Greatest cold usually experienced during
this  period was  5°,  the greatest  heat  98°:   on
the 25th  of July,  1773,  the  heat arose to 108°
and  110°; a N. E. or N.  W. wind produces the
greatest cold, a S. or S.  W. or S.  E. the greatest
heat*."
* « 6. Mem. Scav. Etrang. p. 528." 
40          ACCOUNT OF THE CLIMATE

  « Madrid, lat. 40° 25', long. 3° 20' E.

  " The usual heat in summer is said to be from
75° to 85°; even  at  night  it seldom falls below
70°; the mean  height of the barometer  is 27,96.
It seems to be about 1900 feet above the level of
the sea*."

   The  above accounts  are extracted from  Mr.
Kirwan's useful and elaborate estimate of the tem-
perature of different latitudes.

   The  history which has been given of  the cli-
mate of Pennsylvania,  is confined chiefly to the
country  on the east side of the Allegany moun-
tain.   On  the west side of this mountain, the cli-
mate differs materially  from that of the south-
eastern parts  of the state  in  the temperature of
the air,  in the effects of the winds upon the wea-
ther, and  the quantity of rain and snow which
falls every year.  The winter seldom breaks up on
the mountains before the 25th of March.   A fall
 of snow was once perceived upon it, which  mea-
 sured an inch and a half, on the 11th day of June.
 The trees which grow upon it are small,  and In-
 dian corn is with difficulty brought to maturity,
* "Mem. Par. 1777, p. 146." 
             OF PENNSYLVANIA.            *±
even at the foot of the east side of it.   The south-
west winds on the west side of the mountain are
accompanied by cold and rain.  The soil is rich,
consisting of near a foot, in  many places, of black
mould.  The roads in this country are muddy in
winter, but seldom  dusty  in summer.   The ar-
rangement of strata of the earth on the west  side,
differs materially from their arrangement on the
east side the mountain. " The country (says Mr.
" Rittenhouse, in a letter to a friend in  Philadel-
" phia*), when viewed from the western ridge of
" the Allegany, appears to  be one vast extended
 " plain.  All  the various strata of stone seems to
 " lie  undisturbed in  the situation in which they
■" were first formed, and the layers of stone,  sand,
 " clay, and coal, are nearly horizontal."

    The temperature of the air on the west  is sel-
 dom so hot, or so cold, as on the east side of the
 mountain.  By comparing the state of a thermo-
 meter examined by  Dr.  Bedford at Pittsburg,
 284  miles  from Philadelphia, it appears that the
  weather was not so cold by twelve degrees in that
  town, as it was in Philadelphia, on the 5th of Feb-
  ruary, 1788.
* Columbian Magazine, for October, 1786. 
42      ACCOUNT OF THE CLIMATE
   To show the difference between the weather at
Spring-Mill and  in Pittsburg,  I  shall here sub-
join  an account of it, in  both places,  the  first
taken by  Mr. Legaux,  and the other by Doctor
Bedford. 
en
METEOROL		OC	;ICAL OBSERVATIONS,			made at Spring-Mill, 13 miles NN'W. of Philadelphia. April, 1788.								
d o	THEP		OMETER.		BAROMETER.			DAYS o o o o o					WATER.	I
								—5		-*>	**>	~5		i
i-	of		de					£5		ET	en 3		Of RAIN	f
o 3 o	Fahrenheit, mean degree		Reaumur, degres moyens		mean height			pi a-o -s	5"	c 3 CL ft	O *5	3 ■a n	and snow.	WEATHER i i
9 9	D. _I_ 0 10		D. _L 0 10		in. pts.	1 io"	5 0	n		;-*		r.	in. pts. _L 16	1
1	58 1		11 6		29 10	5	w.							Overcast, fair.
2	46 9		6 9		30 1		Calm.							Overcast and windy.
3	40 3		3 7		30	o	Changeable.		1				1 15	Overcast, rainy.
4	51 3		8 6		29 11	7	sw.							Jvercast.
5	51 1		8 5		30	7	E.							Overcast, fair.
6	55 7		10 5		29 11	7	Calm.		1				1 3	Overcast, rainy.
7	51 3		8 6		30 2		NE.		1				2 7	Overcast, rainy.
8	42 1		4 5		29 11		E.		1				1 4	Rainy.
9	63 5		14		29 8		W.							Overcast, windy.
10	46 7		6 5		29 IP		W.							Fair.
11	53 8		9 7		30 2		W.							Very fair.
12	44 5		5 5		29 10		Calm.		1				1 11	Overcast, rainy.
13	60 5		12 7		29 10	3	SW.							Very fair.
14	50 2		8 1		29 9		E.		1				1 14	Fair, overcast, rainy.
15	58 1		11 6		29 9		SW.		1				2 13	Foggy, rainy.
	METEOROl	.0	GICAL OBSERVATIONS			made at Pittsburg, 284 miles W. of Philadelphia. April, 1788.								
1	46						SW.		1					Cloudy.
2	42						NE. by N.							Clear.
O	43						SE.		1					Cloudy.
4	64						Calm.							Clear.
5	80						SE. by S.		1	1				Cloudy.
6	52						SW.		1					Cloudy.
7	48						NE. by N.							Cloudy. !
8	66						SE. bvS.		1	1				Cloudy.
9	56						NW. by N.							Cloudy. |
10	60						SW.							Cloudy, with wind
H	62						Calm.							Clear. 1
12	67						SW.							Cloudy, with wind
13	62 60						Calm.							Clear.
14							Variable.		1					Cloudy.
 
44
ACCOUNT OF THE CLIMATE
   From a review of all the facts which have been
 mentioned,  it appears that the climate of Pennsyl-
 vania is a compound of most of the climates in the
 world.   Here we  have the moisture of  Britain in
 the spring, the heat of Africa in summer, the tem-
 perature of  Italy in June, the sky of Egypt in the
 autumn, the cold and snows of Norway and the
 ice of Holland in the winter, the tempests  in a
 certain degree of the West-Indies in every season,
 and the variable winds and weather of Great-Bri-
 tain in every month of the year.

   From  this history of the climate of Pennsylva-
nia, it is easy to ascertain what degrees  of health,
and what diseases prevail in the state. As we have
the climates, so we have  the health,  and the acute
diseases, of all the countries that have been men-
tioned.   Without  attempting to enumerate  the
diseases, I  shall only add  a few words upon the
time and manner in which they are produced.

   I.  It appears from the testimonies of many aged
persons, that pleurisies and inflammatory diseases
of all  kinds  are less frequent now than they were
forty or fifty years ago.

   II.  It is a  well known fact, that intermitting and
bilious fevers have increased in Pennsylvania in 
             OF PENNSYLVANIA.           45
proportion as the country has been cleared of its
wood, in many parts of the state.

   III. It is equally certain that these fevers have
lessened or disappeared, in proportion as the coun-
try has been cultivated.

   IV. Heavy rains and freshes in the spring sel-
dom  produce fevers,  unless they are succeeded
by unseasonably warm weather.

   V. Sudden changes from great heat to cold, or
cool weather, if they occur before the 20th of Au-
gust, seldom produce fevers. After that time, they
are generally followed by them.

   VI. The same state of the atmosphere, whether
cold or warm, moist or dry, continued for a long
time,  without any material  changes,  is  always
healthy.  Acute and inflammatory fevers were in
vain  looked for in the cold winter of 1779-80.
The dry summer of 1782, and the wet summer of
1788, were likewise uncommonly healthy in the
city of Philadelphia.  These facts extend only to
those diseases which depend upon the sensible qua-
lities of the air, for diseases from miasmata and con-
tagion, are less influenced by the uniformity of the
weather. The autumn of 1780 was very sickly in
   vol.  n.            r- 
46
ACCOUNT  OF THE  CLIMATE
Philadelphia, from  the  peculiar situation of the
grounds  in  the neighbourhood of the city,  while
the country was uncommonly healthy.   The dry
summer  and autumn of 1782 were uncommonly
sickly in the country,  from the extensive sources
of morbid exhalations which were left by the di-
minution of the waters in the creeks and rivers.

   VII. Diseases are often generated in one season
and produced in another.   Hence we frequently
observe fevers of different kinds to follow every
species of the weather that was mentioned in the
last observation.

   VIII. The excessive  heat in Pennsylvania has
sometimes proved fatal to persons who have been
much exposed to it.  Its morbid effects discover
themselves by a difficulty of breathing,  a general
languor,  and,  in some instances, by a numbness
and immobility of the extremities;   The exces-
sive  cold in Pennsylvania has more frequently
proved fatal, but it has been  chiefly to those per-
sons who have sought a defence from it, by large
draughts of spirituous liquors.  Its operation in
bringing on sleepiness previous to death, is well
known.  On the  5th  of  February, 1788, many
people were affected by the cold.   It produced a
violent pain in the head  ; and,  in one instance, a 
             OF PENNSYLVANIA.            *<
sickness at the stomach, and a vomitting appeared
to be the consequence  of it.   I have frequently
observed that a greater number of old people die,
during the continuance of extreme cold and warm
weather, than in the same number of days in mo-
derate weather.

   IX. May and  June are usually  the healthiest
months in the year.

  X. The influence of the winds upon health, de-
 pends very much upon  the nature of the country
 over which they pass.   Winds which passover
 mill-dams and marshes in August and September,
 generally carry with them the seeds of fevers,

   XI. The country in the neighbourhood of Phi-
 ladelphia was formerly more sickly than the central
 parts of the city, after the 20th of August.  Since
 the year 1793, the reverse of this has been the case.

    XII. The night-air is always unwholesome from
  the 20th of August, especially during the passive
  state of the  system in sleep.  The frequent and
  sudden changes of the air from heat to cold render
  it unsafe to  sleep with open windows, during the  -
  autumnal months. 
48
ACCOUNT OF THE CLIMATE
  XIII. Valetudinarians  always enjoy the most
health in Pennsylvania in the summer and winter
months.  The spring, in a particular manner, is ve-
ry unfavourable to them.

  I shall conclude the account of the influence of
the climate of Pennsylvania upon the human body,
with the following observations.

  1. The sensations of heat and cold are influenced
so much by outward circumstances, that we often
mistake the degrees of them by neglecting to use
such conveniencies as are calculated to obviate the
effects of their excess.  A native of Jamaica often
complains less of the heat, and a native of Canada
of the cold in their respective countries, than they
do under certain  circumstances in Pennsylvania.
Even a Pennsylvanian frequently complains less of
the heat in Jamaica,  and  of the cold in Canada,
than in  his native state.   The reason of this is
plain.   In countries where heat and cold are in-
tense and  regular, the inhabitants guard  them-
selves, by accommodating their houses and dresses
to each of them.   The instability and short dura-
tion of  excessive heat and cold in Pennsylvania,
have unfortunately led its inhabitants, in many in-
stances, to neglect adopting customs, which arc
used  in  hot and cold countries to guard against 
              OF PENNSYLVANIA.           49
them.   Where houses are  built with a southern
or a south-western front exposure, and where other
accommodations to the climate are observed in
their  construction,  the disagreeable excesses of
heat and cold are rendered much less  perceptible
in Pennsylvania.   Perhaps the application of the
principles of philosophy and taste to the construc-
tion of our houses, within the last thirty or forty
years, may be another reason why  some old peo-
ple have supposed that  the  degrees  of heat and
cold are less in Pennsylvania  than they were in
former years.

   2.  The  variable nature of the climate of Penn-
sylvania does not render it necessarily unhealthy.
Doctor Huxham has taught us, that the healthiest
seasons in Great ^Britain have  often been accompa-
nied by the  most  variable weather.   His words
 upon this subject convey a reason  for the fact.
 " When the constitutions of the year are frequently
 " changing,  so that by the contrast a sort of equi-
 " librium is kept up, and health with it; and that
 " especially if persons are careful  to guard them-
 " selves well against these  sudden  changes*."
 Perhaps no climate or country is unhealthy, where
 men acquire from experience, or tradition, the arts
    *  Observations on the  Air and Epidemic Diseases,
 vol. 1. p. 5. 
50     ACCOUNT OF THE CLIMATE, &C.
of accommodating themselves to it.  The history
of all the nations of the world,  whether savage,
barbarous, or civilized, previously to a mixture of
their  manners by an intercourse with strangers,
seems to favour this opinion.  The climate of Chi-
na  appears, in many particulars to resemble that
of Pennsylvania.  The  Chinese wear  loose gar-
ments of different lengths, and increase or diminish
the number of them, according to the frequent and
sudden changes of their  weather;  hence they have
very few acute diseases  among them.   Those in-
habitants of  Pennsylvania who have acquired the
arts of conforming  to  the changes and extremes
of our weather in dress, diet, and manners, escape
most of those acute diseases which are occasioned
by the sensible qualities of the air;  and faithful
inquiries and observations have proved, that they
attain to as great ages as the same, number of peo.
pie in any part of the world.   *)
t 
       AN ACCOUNT





           OF THE






EFFICACY OF COMMON SALT,





        IN THE CURE OF





       HAEMOPTYSIS. 
 
AN  ACCOUNT, &c.
     FROM the present established opinions and
practice  respecting the  cause and  cure  tit  he-
moptysis, the last medicine that would occur to a
regular-bred physician for the cure of it, is com-
mon salt ; and yet I have seen and heard of a
great number of cases,  in which it has been ad-
ministered with success.

  The mode  of giving it is to pour down from a
tea to  a  table-spoonful of clean fine salt,  as soon
as possible after the hsemorrhage begins from the
lungs.   This quantity generally stops it;  but the
dose must be repeated daily for three or four days,
to prevent a return of the disease.   If the bleed-
ing continue, the salt must be continued till it  is
checked,  but in larger doses.   I have heard of se-
veral instances in which two table spoons-full were
taken at  one time for several days.
   VOL. II.            II 
54
THE EFFICACY  OF COMMON  SALT
  It sometimes excites a sickness at the stomach,
and never fails to produce a burning sensation in
the throat,  in its passage into the stomach,  and
considerable thirst aferwards.

  I have found this remedy to succeed equally
well in haemorrhages, whether they occurred in
young or in old people,  or with a weak or active
pulse.

  I  had prescribed it for  several years before I
could satisfy myself with a theory, to account for
its  extraordinary action upon the human  body.
My inquiries led me to attend more particularly
to the following facts :

  ,1. Those persons who have been early instruct-
ed in vocal music, and who use their vocal organs
moderately through life,  are seldom affected  by a
haemorrhage from the lungs.

   2. Lawyers,  players,  public cryers, and city
watchmen, all of whom exercise their lungs either
by long or loud speaking, are less affected by this
disease, than persons of other occupations.

   I acknowledge I cannot extend this observation
 to  the public teachers of religion.   I have known 
       IN  THE CiRE OF HEMOPTYSIS.     55
several instances  of their being  affected by hae-
moptysis ;  but never but one in which the disease
came on  in the pulpit,  and that was in a person
who had been recently cured of it.  The cases
which I have seen,  have generally been brought
on by catarrhs.

  To this disease, the  practice  of some of our
American preachers disposes them in  a peculiar
manner; for it is very common with this class of
them, to expose themselves to the cold or evening
air,  immediately after  taking what a celebrated
and eloquent preacher used to call a pulpit sweat.

  3. This  haemorrhage  chiefly occurs in debili-
tated habits, or in persons afflicted by such a pre-
disposition  to  consumption,  as indicates a weak
and relaxed state of the lungs.

  4. It generally  occurs when the lungs are in a
passive state ;  as in sitting, walking, and more fre-
quently in lying.   Many of the cases that I have
known, have occurred during sleep, in the middle
of the night.

  From  these facts,  is  it not probable that the
common salt,  by acting primarily and with  great
force upon the throat, extends its stimulus to the 
56    THE EFFICACY  OF COMMON  SALT
bleeding vessel, and by giving it a tone,  checks
the further effusion of blood ?

  I  shall  only add to this conjecture, the  follow-
ing observations:

   1.  I  have never known the common salt per-
form a cure where the haemorrhage from the lungs
has been a symptom of a confirmed consumption.
In this case, however,  it gives a certain tempora-
ry relief. But the bleeding, so unfavourable in the
close of this disease, often prevents consumption
when it occurs in its early stage, by depleting di-
rectly from the lungs.

  2. The  exhibition of common salt in the hae-
moptysis, should by no means supersede  the use
of occasional bleeding when indicated by plethora,
nor of that diet  which  the state of the pulse or of
the stomach, may require.

  3. I have given  the common salt in one case
with success, in a haemorrhage from the stomach,
accompanied by  a vomitting; and have heard of
several cases in which it has been supposed to have
checked a discharge of blood from the nose and
uterus, but I can say nothing further in its favour 
       IN  THE CURE OF  HEMOPTYSIS.      57

in these  last haemorrhages, from my own expe-
rience.

  It may perhaps serve to lessen the prejudices
of physicians against adopting improvements in
medicine, that are not recommended by the autho-
rity of colleges or universities, to add, that we are
indebted to an old woman, for the discovery of the
efficacy of common salt in the cure of haemoptysis. 
 
       THOUGHTS






          UPON





    THE CAUSE AND CURE





         OF THE






PULMONARY CONSUMPTION 
 
THOUGHTS, &c.
       THE ancient Jews used to say, that a man
does not fulfil his duties in life who passes through
it, without building a house, planting a tree, and
leaving a child behind him.  A physician, in like
manner,  should consider his obligations to  his
profession and society as undischarged,  who  has
not  attempted to lessen the number of incurable
diseases.  This is  my apology for presuming to
make the consumption  the object of a medical in-
quiry.

   Perhaps I may suggest an idea, or fact, that may
awaken the  ideas and facts which now lie useless
in the memories or" common-place books of other
physicians;  or I  may direct their  attention to
some useful experiments upon this subject.

   I shall begin my observations upon the consump-
tion, by remarking,
     vol. II.             I 
 62   THOUGHTS ON THE CONSUMPTION.
   1. That it  is unknown among the  Indians in
 North-America.

   2. It is scarcely known by those citizens of the
 United States, who live in the first stage of civi-
 lized life, and who have lately obtained the title of
 the first settlers.

   The principal occupations of the Indians consist
 in war,  fishing, and hunting.  Those of the first
 settler, are fishing, and hunting, and the laborious
 employments of subduing the earth, cutting down
 forests, building a  house and barn,  and distant
 excursions in all kinds of weather, to mills and
courts, all which tend to excite  and preserve in
the system, something like  the Indian vigour of
constitution.

   3. It is less common in country places than in
cities,  and increases in both, with intemperance
and sedentary modes of life.

   4. Ship and house carpenters,  smiths, and all
those artificers whose business requires great ex-
ertions of strength in the open air,  in all seasons of
 the year, are less subject to this disease, than men
who work under cover, and  at occupation which
 do not require the constant action of their limbs. 
      THOUGHTS  ON THE CONSUMPTION.    63
  5. Women, who sit more than men, and whose
work is connected with less exertion, are most sub-
ject to the consumption.

  From  these facts it would seem, that the most
probable method of curing the consumption,  is
to revive  in  the constitution, by means of exer-
cise  or labour,  that vigour which belongs to the
Indians,  or to mankind  in their first stage of civi-
lization.

   The efficacy of these means of curing consump-
tion will appear, when we inquire into the relative
merit of the several  remedies which  have been
used by  physicians in this disease.

   I  shall not produce among these remedies the
numerous receipts for syrups, boluses, electuaries,
decoctions, infusions, pills, medicated waters, pow-
ders,  draughts,  mixtures, and  diet-drinks, which
have so  long and  so steadily been  used in this
disease; nor shall  I mention as a remedy,  the best
accommodated diet, submitted to with the most
patient self-denial; for not one of them all, without
the  aid  of exercise, has ever, I believe, cured  a
single consumption. 
64   THOUGHTS ON  THE  CONSUMPTION.
  1.  Sea-voyages have cured consumptions ;
but it has been only when they have been so long;
or so frequent, as to substitute the long continu-
ance of gentle, to violent degrees of exercise of a
shorter duration, or where they have been  accom-
panied by some degree of the labour and  care of
navigating the ship.

  2. A change of climate has often been pre-
scribed for the cure of consumptions, but I do not
recollect an instance of its having succeeded, ex-
cept when it has been accompanied by exercise, as
in travelling, or by some active laborious  pursuit.

  Doctor Gordon of Madeira,  ascribes the inefn-
cacy of the air of Madeira in the consumption, in
part to the difficulty patients find of using exercise
in carriages, or even on horseback, from the bad-
ness of the roads in that island.

   3. Journeys have often performed cures in the
consumption, but it has been chiefly when they
have  been long, and accompanied by difficulties
which have roused  and invigorated the powers of
the mind and body.

   4. VoMITSandNAUSEATlNG MEDICINEshaVC
been much  celebrated for the  cure of consump- 
THOUGHTS ON  THE  CONSUMPTION.
65
tions.  These, by procuring a temporary determi-
nation to the surface of the body, so far lessen the
pain and cough,  as to enable patients to use pro-
fitable exercise. Where this has not accompanied
or succeeded the exhibition of vomits, I believe
they have seldom afforded any permanent  relief.

   5. Blood-letting has often relieved con-
sumptions ;  but it has been  only by removing the
troublesome symptoms of inflammatory diathesis,
and thereby enabling the patients to use exercise,
or labour, with advantage.

  6.  Vegetable bitters and some of the sti-
 mulating gums have in some instances afforded
 relief  in  consumptions;  but they have done so
 only in those cases where there was great debility,
 accompanied  by a total absence of  inflammatory
 diathesis.   They have most probably   acted by
 their tonic qualities, as substitutes for labour and
 exercise.

    7. A plentiful and regular perspira-
 tion,  excited by means of a flannel shirt, worn
 next to the skin, or by means of a stove-room, or
 by a warm climate, has in many instances prolonged
 life in consumptive habits ; but all these remedies
 have  acted as palliatives only, and thereby have 
 66   thoughts on  the consumption.
 enabled the consumptive patients to enjoy the more
 beneficial effects of exercise.

   8. Blisters, setons, and issues, by deter-
 mining the perspirable  matter  from the lungs to
 the  surface of the body, lessen pain and cough,
 and thereby prepare the system for the more salu-
 tary  effects of exercise.

  9. The effects of swinging upon the pulse and
respiration, leave us no room to doubt of its being
a tonic remedy, and therefore" a safe and agreeable
substitute for exercise.

  From all these facts it is evident, that the reme-
dies  for consumption must be sought for in those
 exercises and employments which give the greatest
vigour to the constitution.  And here I am happy
in being able to produce several facts which de-
monstrate the safety and certainty of this method
 of cure.

  During the late war, I saw three instances  of
 persons in confirmed consumptions, who were per-
fectly cured by the  hardships of a  military life.
 They had been my patients  previously to their
entering  into the army.  Besides  these,  I have
heard of four well-attested cases  of similar reco- 
      thoughts  on the consumption.    67

veries from nearly the same remedies.  One of
these was the son of a farmer in New-Jersey, who
was sent to sea as the last resource for a consump-
tion.  Soon after  he left the American shore, he
was taken by a British cruiser, and compelled to
share in all the duties and hardships of a common
sailor.   After serving in this capacity for twenty-
two  months, he  made his escape, and landed at
Boston,  from whence he travelled on foot to his
father's  house (nearly four hundred miles), where
he arrived in perfect health.

  Doctor Way of Wilmington informed me, that
a certain Abner Cloud, who was reduced so  low
by a pulmonary consumption as to be beyond all
relief from  medicine, was so much relieved by
sleeping in the open air, and by the usual toils of
building a hut, and improving a farm, in the un-
settled parts of a  new  country in Pennsylvania,
that he thought him in a fair way of a perfect re-
covery.

  Doctor  Latimer of Wilmington had been long
afflicted with a  cough and an occasional haemop-
tysis.  He entered into the American army as a
surgeon, and served in that capacity till near the
end  of the war;   during which time he was per-
fectly free from  all pulmonary  disease.   The 
68    thoughts  on the consumption.
spitting of blood returned soon after  he settled in
private practice.  To remedy this complaint, he
had recourse to a low diet, but finding it ineffec-
tual, he portook liberally of the usual diet of healthy
men, and he now enjoys a perfect exemption from
it.

  It would be very easy  to add many other cases,
in which labour, the employments of agriculture,
and a life of hardship by sea and land, have  pre-
vented, relieved, or cured, not only the consump-
tion, but pulmonary diseases of all kinds.

  To the cases that have been mentioned, I  shall
add only one more, which was communicated  to
me by the venerable Doctor  Franklin, whose con-
versation at all times conveyed instruction, and not
less in medicine than upon other subjects.  In tra-
velling,  many  years ago, through New-England,
the doctor overtook the post-rider; and after some
inquiries into  the history of his life, he informed
him that he was bred a shoemaker;  that his con-
finement, and other circumstances, had brought on
a consumption, for  which he was ordered  by a
physician  to  ride on horseback.  Finding  this
mode of exercise  too expensive, he made interest,
 upon the death of an old post-rider, to succeed to
 his appointment, in which he perfectly recovered 
     thoughts on the consumption.    69
his health in two years.   After this he returned to
his old trade, upon which his consumption return-
ed.  He again  mounted his horse, and rode post
in all seasons and weathers, between  New-York
and Connecticut river (about 140 miles), in which
employment he continued upwards of thirty years,
in perfect health.

   These facts, I hope,  are sufficient to establish
the advantages of restoring the original vigour of
the constitution, in every attempt to effect a radical
cure of consumption.

   But how shall these remedies be applied in the
time of peace, or  in a country where the want of
woods, and brooks without bridges, forbid the at-
tainment of the laborious pleasures of the Indian
mode of hunting;  or where the universal extent of
civilization does not admit of our advising the toils
of a new settlement, and improvements upon bare
creation ?  Under these circumstances, I conceive
substitutes may be  obtained  for  each of them,
nearly of equal  efficacy,  and attainable withmuch
less trouble.

   1.   Doctor  Sydenham  pronounced  riding on
horseback, to be as certain a cure for consumptions
   VOL.  II.            k 
70    thoughts on  the  consumption.
as bark is  for an intermitting fever.   I have no
more doubt of the truth of this assertion,  than I
have that inflammatory fevers are now less frequent
in London  than  they were in the time of Doctor
Sydenham.  If riding on horseback in consump-
tions  has ceased to be a remedy in Britain, the
fault is in the patient, and not in the remedy.  "  It
" is a sign that  the stomach requires milk (says
" Doctor Cadogan), when it cannot bear it."  In
like manner, the inability of the patient to bear this
manly and wholesome exercise, serves only to de-
monstrate the necessity and advantages of it.  I
suspect the same objections to this exercise which
have been made  in Britain,  will not occur in the
United  States  of America; for  the  Americans,
with respect to the symptoms and degrees of epi-
demic and chronic diseases,  appear to be nearly  in
the same state that the inhabitants of England were
in the seventeenth century.   We find, in propor-
tion to the decline of the vigour  of the body, that
many occasional  causes produce fever and inflam-
mation, which would not have done it a hundred
years ago.

  2. The laborious employments of agriculture,
if steadily pursued, and accompanied at the same
time by the simple,  but wholesome diet of a farm-
house, and a hard bed, would probably afford a 
      thoughts  on  the consumption.   71

good substitute for the toils of a savage or mili-
tary life.

   3. Such occupations  or professions as require
constant labour or exercise in the open air, in all
kinds of weather, may be easily chosen for a young
man who, either from hereditary predisposition, or
an accidental affection of the lungs, is in danger of
falling into a consumption.   In this  we should
imitate the advice given by some wise men, always
to prefer those professions for our sons, which are
the least favourable to the  corrupt inclinations of
their hearts.  For example, where an undue pas-
sion for money,  or a crafty disposition, discover
themselves in early life, we are directed to oppose
them by the less profitable or more  disinterested
proffessions of divinity or physic, rather than che-
rish them, by trade,  or the  practice of the law.
Agreeably to this analogy, weakly children should
be trained to the laborious, and the robust, to the
sedantary occupations.   From  a neglect of this
practice, many  hundred apprentices to taylors,
shoemakers,  conveyancers,  watchmakers, silver-
smiths, and mantua-makers, perish every year by
consumption.

  4. There is a case recorded by Dr. Smollet, of
the efficacy of the cold bath in a consumption; and 
72    THOUGHTS ON THE CONSUMPTION.
I have heard of its having been used with success,
in the case of  a negro man, in one of the West-
India islands.   To render this remedy useful,  or
even safe, it will be necessary to join it  with la-
bour, or to use it in degrees that shall prevent the
alternation of the system with vigour and debility ;
for I take the cure of consumption ultimately to de-
pend upon the simple and constant action of tonic
remedies.   It is to be lamented that it  often re-
quires so much time, or such remedies to remove
the inflammatory diathesis, which attends the first
stage of consumption, as to reduce the patient too
low  to make  use  of those tonic  remedies after-
wards, which  would effect a radical cure.

  If it were  possible to graduate  the tone of the
system by means of a scale, I would add, that to
cure consumption, the system should be  raised to
the highest degree of this scale.  Nothing short of
an equilibrium of tone, or free and vigourous ac-
tion of every muscle and viscus in the body, will
fully come up to a radical cure of this disease.

  In regulating the diet  of consumptive  patients,
I conceive it to be as necessary to feel the pulse,
as it is in determining when and in what quantity
to draw blood.   Where inflammatory  diathesis
prevails, a vegetable diet is certainly proper;  but 
      THOUGHTS  ON THE  CONSUMPTION.   73

where the patient has escaped, or passed this stage
of the disease,  I believe a vegetable diet alone to
be injurious ; and  am sure a moderate quantity of
animal food may be taken with advantage.

   The  presence  or absence of this inflammatory
diathesis, furnishes the indications for administer-
ing or refraining from the use of the bark and bal-
samic medicines.   With all the testimonies of
their having done mischief, many of which I could
produce, I have known several cases in which they
have been given with obvious advantage; but it was
only when there was a total absence of inflammatory
diathesis.

   Perhaps the remedies  I have recommended, and
the opinions I have delivered, may  derive some
support from attending to  the analogy of ulcers on
the legs, and in other parts of the body.  The  first
of these occur chiefly  in habits debilitated by  spi-
rituous liquors, and the last frequently in habits de-
bilitated by  the scrophula.   In curing  these  dis-
eases, it is in vain  to depend upon internal  or ex-
ternal medicines.   The whole  system must be
strengthened, or we do  nothing ;  and this is to be
effected only by exercise  and a generous diet. 
74    THOUGHTS ON  THE CONSUMPTION.
  In relating the facts that are contained in this
inquiry, I wish I could have avoided reasoning upon
them; especially as I am confident of the certainty
of the facts, and somewhat doubtful of the truth of
my reasonings.

  I shall only add, that if the cure of consumptions
should at last be effected by remedies in every re-
spect  the opposites of those palliatives which are
now fashionable and universal, no more will happen
than what we have already seen in the tetanus, the
small-pox, and the management of fractured limbs.

  Should this be the case, we shall not be sur-
prised to hear  of physicians, instead of prescribing
any one, or  all of the medicines  formerly enume-
rated for consumptions, ordering their patients  to
exchange the amusements, or indolence of a city,
for  the  toils of  country life;  of their advising
farmers to exchange their plentiful tables, and com-
fortable  fire-sides, for  the scanty  but solid subsist-
ence, and midnight exposures of the herdsman ;  or
of their recommending, not so much the exercise
of a passive  sea voyage, as the active labours and
dangers of a common sailor.   Nor should it sur-
prise us, after what we have seen, to hear patients
relate the pleasant adventures of their excursions 
      THOUGHTS ON THE CONSUMPTION.    75
or labours, in quest of their recovery from this dis-
ease, any more than it does now to see a strong or
well-shaped limb that has been broken; or to hear
a man talk of his studies, or pleasures, during the
time of his being inoculated and attended for  the
small-pox.

   I will not venture to assert, that there  does not
exist a  medicine which shall supply, at least in
some degree,  the place of the labour or exercises,
whose usefulness in consumptions has been esta-
blished by  the  facts that have been mentioned.
Many instances  of the analogous effects  of medi-
cines, and of exercise  upon the human body, for-
bid the supposition.  If there does exist  in nature
such a medicine, I am disposed to believe it will
be found  in the  class of tonics.   If this should
be the case, I conceive its strength, or its dose,
must far exceed the present state of our knowledge
or practice, with respect to the efficacy or dose of
tonic medicines.

   I except  the  disease, which arises from recent
abscesses in the lungs, from the general observa-
tion which  has  been made, respecting the  ineffi-
cacy of the remedies that were formerly enume-
rated for the cure of consumptions without labour 
76    THOUGHTS  ON  THE  CONSUMPTION-
or exercise. These abscesses often occur without
being preceeded by general debility, or accompa-
nied by a consumptive diathesis, and are frequent-
ly cured by nature, or by very simple medicines. 
       AN INQUIRY






            INTO





    THE CAUSE AND CURE






           OE THE






PULMONARY CONSUMPTION
VOL. II. 
 
AN  INQUIRY, &c.
      IN the preceeding Inquiry, I attempted to
show that  this disease was  the  effect of causes
which  induce general debility, and that the only
hope of discovering a cure for it should be direct-
ed to such remedies as act upon the whole sys-
tem.   In the following inquiry, I shall endeavour
to establish the truth of each of  those opinions,
by a detail of facts and reasonings, at which I on-
ly hinted in the foregoing pages.

 The method I have  chosen for this purpose, is
to deliver, and afterwards to support, a few gene-
ral propositions. 
80
ON  PULMONARY
CONSUMPTION.
  I shall begin by remarking,

  I.  That the pulmonary consumption is induced
by predisposing debility.

  This I infer, 1st, From the remote and exciting
causes which produce it.  The remote causes are
pneumony, catarrh, haemoptysis, rheumatism, gout,
asthma,  scrophula, chronic  diseases  of the sto-
mach, liver, and kidneys, nervous and intermitting
fevers, measles, repelled humours from the surface
of the body, the venereal disease, obstructed men-
ses, sudden growth about the age of puberty, grief,
and all  other  debilitating passions of the  mind ;
hypochondriasis, improper lactation, excessive eva-
cuation of all kinds,  more  especially by stool*,
cold and damp air, a cough,  external violence act-
ing upon the bodyf ;  and finally, every thing that

  * Sir George Baker relates, in the second volume of the
Medical Transactions, that Dr.  Blanchaid had informed
him, that he had seen the consumption brought on ten per-
sons out of ninety, by excessive purging used to prepare the
body for the small-pox.  I have seen a case of consumption
in a youth of 17, from the spitting produced  by tnc intem-
perate use of segars.
  t Dr. Lind says, that out of 360 patients whom he at-
tended between July 1 st, 1758, and July 1st, 1760, in con-
sumptions, the  disease was brought on one fourth of them 
        ON  PULMONARY CONSUMPTION.    81
tends, directly or indirectly, to diminish the strength
of the system.

   The most frequent exciting cause of consump-
tion is the alternate application of heat and cold to
the whole external surface of the body ; but all the
remote  causes which have been enumerated, ope-
rate as exciting  causes of consumption,  when they
act on previous  debility.  Original injuries of the
lungs seldom excite this disease, except they first
induce a debility of the whole system,  by a trou-
blesome and obstinate cough.

   2.  From the debilitating occupations and habits
of persons  who are most  liable to this disease.
These are studious men, and mechanics who lead
sedentary lives  in confined places ;  also women,
and all persons of irritable habits, whether of body
or mind.

   3.  From the period in which persons  are most
liable to be affected by  this disease.   This is ge-
 nerally between the  18th and 36th year of life, a
period  in which the system is liable,  in a peculiar
manner, to most diseases which induce it, and in

by falls,  bruises, and strains, received a year  or two before
the disease made its appearance. 
 82     ON PULMONARY CONSUMPTION.
 which there  is a greater expenditure of strength,
 than in any other stage of life, by the excessive
 exercises of the body and mind, in the pursuits of
 business or pleasure.

   I have conformed to authors, in fixing the period
 of consumptions between the 18th and 36th year
 of life ;  but it is well known that it sometimes ap-
 pears in children, and frequently in persons beyond
 the 40th,  or even 60th year of life.

   II. The pulmonary consumption is a primary
 disease of the whole system.   This I infer,

   1.  From the causes which produce it, acting
 upon the whole system.

  2. From the symptoms of general debility which
 always precede  the affection of the lungs.   These
 symptoms are a quick pulse, especially  towards
 evening; a heat and burning in the palms of the
 hands; faintness, head-ach,  sickness at stomach,
and an occasional diarrhaea.  I have frequently ob-
served each of these symptoms for several months
before I have heard  of a single complaint in the
breast. 
       ON PULMONARY CONSUMPTION.     83
  3. From the pulmonary consumption alternating
with other diseases which obviously belong to the
whole system.   I  shall briefly mention these dis-
eases.

   The rheumatism.  I have seen many cases
in which this  disease and the consumption  have
alternately, in different seasons or years, affected
the system.   In the winter of 1792, three  clinical
patients  in the Pennsylvania hospital exemplified
by their complaints the truth of this observation.
They were relieved several times of a cough by
rheumatic pains in their limbs, which seemed for a
while to promise a cure to  their  pulmonic com-
plaints.

   The gout  has often been observed to alternate
with the pulmonary consumption, especially in per-
sons in the decline of life. Dr. Sydenham describes
a short cough continuing through the whole win-
ter,  as a symptom of gouty habits.  A gentleman
from Virginia died under my care in the spring of
 1788, in the 45th year of his age, with all the
symptoms of pulmonary consumption, which had
frequently alternated  with pains and a swelling in
his  feet. 
 84    ON PULMONARY  consumption.
   The pulmonary consumption has been observed
to alternate with madness.  Of this I have seen
two instances, in  both of which the cough and
expectoration  were wholly suspended during the
continuance of the derangement of the mind.  Dr.
Mead mentions a melancholy case of the same kind
in a  young lady, and similar cases are to be met
with in other authors.  In all of them the disease
proved fatal.   In one of the cases which came un-
der my notice, the symptoms of consumption re-
turned before the death of the patient.

   I have likewise witnessed two cases in which the
return of reason after madness, was  suddenly suc-
ceeded by a fatal pulmonary consumption.  Per-
haps the false hopes,  and even  the  cheerfulness
which so universally occur in this disease, may be
resolved into a morbid state of the mind, produced
by a general derangement of the whole system.  So
universal are the delusions and hopes of patients,
with respect to the nature and issue of this disease,
that I have never met with but one man, who, up-
on being asked what was the matter with him, an-
swered unequivocally, " that he was in a consump-
" tion."

   Again :   Dr.  Bennet  mentions  a case of " A
" phthisical patient, who was seized with a violent 
        ON PULMONARY CONSUMPTION.    83

" pain  in  the  teeth  for two days, and in
 •whom, during that time, every symptom of a
*« consumption, except the leanness of the body,
" altogether vanished:" and he adds further, " that
" a defluction on the lungs had often been relieved
" by salivary  evacuations*."

  I have seen several instances in  which the pul-
monary symptoms have alternated with headach
and dyspepsia; also with pain  and noise in one
ear.   This affection of the ears sometimes con-
tinues throughout the whole disease, without any
remission of the pulmonary symptoms.  I have
seen one case of a discharge of matter  from the
left ear, without being accompanied by either pain
or noise.

  In all our books of medicine are to  be found
cases of consumption alternating with eruptions
ON  THE SKIN.

  And who has not seen the pulmonary symptoms
alternately relieved and reproduced by the appear-
ance or cessation of a diarrhaea,  or pains  in the
bowels ?

  *  Treatise of the  Nature and Cure of Consumptions,
Exercitation X.
  VOL. II.            M 
86     on  pulmonary consumption.
  To these facts I shall only add, under this head,
as a proof  of the consumption being a disease of
the  whole system, that it is always more or less
relieved by  the change which is induced in the
system by pregnancy.

  4. I infer that the pulmonary  consumption is a
disease of the whole system from its analogy with
several other diseases, which, though accompanied
by  local affections,  are obviously  produced by a
morbid state of the whole system.

  The rheumatism, the gout, the measles, small-
pox, the different species of cynanche,  all furnish
examples of the connexion of local affections with
a general disease;  but the apoplexy, and the
pneumony, furnish the most  striking analogies
of local affection, succeeding  a  general  disease of
the system in the pulmonary  consumption.

   The most frequent predisposing cause of apo-
plexy is a general debility of the system, produced
by intemperance in eating and drinking.  The phe-
 nomena of the disease are produced by an effusion
 of blood or serum, in consequence of a morbid dis-
 tension, or of a rupture of the  vessels of the brain.
 The pulmonary consumption begins and ends in
 the same way, allowing only for the difference of 
       ON  pulmonary consumption.     87

situation and  structure of the brain  and lungs.
Alter the production of predisposing debility from
the action of the remote causes formerly enumerat-
ed, the fluids are determined to the weakest part of
the body.   Hence effusions of serum or blood take
place in the lungs.   When  serum is effused,  a
pituitous or purulent  expectoration alone takes
place ; when blood is discharged, a disease is pro-
duced which  has been called haemoptysis.   An
effusion of blood in the brain, brought on by the
operation of general debility, has been called by Dr.
Hoffman, with equal propriety, a haemorrhage of
the brain.  The effusion of blood in the lungs, in
consequence of the rupture of a blood-vessel, is less
fatal than the same accident when it occurs in the
brain, only because the blood in the former case is
more easily discharged from the system.  Where
no rupture of  a blood-vessel is produced, death is
nearly as speedy and  certain in the one  case as in
the other.  Dissections show many cases of suffo-
cation and death, from the lungs being preternatu-
rally filled with blood or serum.  From this great
analogy beween the remote and  proximate causes
of the two diseases which  have been described, I
have  taken the liberty to  call them  both by the
name of   apoplexy.   The only symptom which
does not accord with the derivation of the term, is,
that in the apoplexy of the lungs, the patient does 
88
ON  pulmonary
consumption.
 not fall down as if by an external stroke, which is
 most frequently the case in the apoplexy of the brain.

   The history of the remote and proximate causes
 of pneumony will furnish us with  still more re-
 markable analogy of the connexion between a lo-
 cal affection, and a general disease of the system.
 The pneumony is produced by remote exciting
 causes which act on the whole system. The whole
 arterial system is frequently agitated by a fever in
 this disease before a pain is perceived in the breast
 or  sides,  and this fever generally constitutes  its
 strength and danger.   The expectoration  which
 terminates the disease in health, is always the  ef-
 fect of effusions produced by a general disease, and
 even the vomicas, which sometimes succeed a de-
ficiency of bleeding, always depend upon the same
 general cause.   From this view of the analogy be-
tween pneumony and pulmonary consumption, it
would  seem that the two diseases differed from
each other only  by the shorter or longer operation
of the causes which induce them, and by the great-
er or less violence and duration of their symptoms.
The pneumony  appears to be an acute consump-
tion, and  the consumption a chronic  pneumony.
From the analogy of the pulmonary consumption
with the diminutive term of certain fevers, I have
taken the liberty of calling ita  pneumonicula. 
       ON  pulmonary  consumption.     89

  5. I infer that the pulmonary consumption is a
disease of  the  whole system, from its existence
without ulcers in the lungs.   Of this  there  are
many cases recorded in books of medicine.

  Dr. Leigh informs us, in his Natural History of
Lancashire, that the consumption was a very com-
mon disease on the sea coast of that country;  but
that it was not accompanied either by previous in-
flammation or ulcers in the lungs.   It was  gene-
rally attended, he says, by an unusual peevishness
of temper.

  6. I infer that the pulmonary consumption is a
disease of the whole system, from its being reliev-
ed, or cured, only by remedies which act upon the
whole  system.    This will appear,  I hope, here-
after, when we come  to treat of the cure of this
disease.

  Let us now enquire how far the principle I have
laid down will apply to the supposed causes of con-
sumption.   These causes have been said to be,
an abscess  in the  lungs,  haemoptysis,  tubercles,
without and with ulcers, catarrh, hereditary diathe-
sis, contagion,  and the matter of cutaneous erup-
tions, or sores repelled, and thrown upon the lungs.
I shall make a few observations upon each of them. 
90      ON PULMONARY CONSUMPTION.
  1. An abscess in the lungs is generally the con-
sequence of a neglected,  or half-cured pneumony.
It is seldom fatal, where it is not connected with
a predisposition to consumption from general debi-
lity, or where general debility is not previously in-
duced by the want of appetite, sleep, and exercise,
which sometimes accompany that disease of the
lungs.  This explanation of the production of con-
sumption by an abscess  in the lungs, will receive
further  support from  attending to  the  effects  of
wounds in the lungs.  How  seldom are they fol-
lowed by pulmonary consumption ; and this only
because they are as seldom accompanied by pre-
disposing general debility.   I do not recollect a
single instance of this disease having followed a
wound in the  lungs, either by the bayonet, or a
bullet, during  our revolutionary war.  The reco-
veries which have succeeded such wounds, and
frequently under the most unfavourable circum-
stances, show  how very improbable it is  that a
much slighter affection of the lungs should become
the  cause of a pulmonary consumption.

  A British officer, whom  I met in the  British
camp, a few days after the battle of Brandy wine,  in
September,  1777,  informed  me that the surgeon-
general  of the royal  army  had assured  him, that
out of twentv-four soldiers who had been admitted 
       ON  PULMONARY  CONSUMPTION.     91
into the hospitals, during the campaign  of 1776,
with wounds in their lungs, twenty-three of them
had  recovered.  Even  primary diseases of the
lungs often exist with peculiar violence, or con-
tinue for many years without inducing a consump-
tion.   I have never known but one instance of the
whooping-cough ending in consumption,  and all
our books  of medicine contain  records of the
asthma continuing for  twenty and  thirty years
without terminating in that disease.  The reason
in both cases, must be ascribed to  those two ori-
ginal disease's of the lungs not being accompanied
by general debility.   One fact more will serve to
throw still further light upon the subject.  Millers
are much afflicted with a cough from floating par-
ticles of flour constantly irritating their lungs, and
yet they are not more subject to consumptions
than other labouring people.  Hence " a miller's
 " cough" is proverbial in some places, to denote a
cough  of long continuance without danger.

   2. The haemoptysis is either a local disease, or
 it is the effect of general debility of the whole sys-
 tem.   When it is local, or when it is the effect of
 causes which induce a temporary or acute debilitv
 only in the system, it is seldom followed by con-
 sumption. The accidental discharge of blood from
 the  lungs, from injuries, and from an obstruction 
92     ON  PULMONARY  CONSUMPTION.
of the menses in women  is of this kind.   Many
persons are affected by this species of haemorrhage
once or twice in their lives, without suffering any
inconvenience  from it afterwards.  I have  met
with several cases in which  it has  occurred for
many years every time the body was exposed to
any of the  causes which  induce sudden debility,
and yet no consumption has followed it.  The late
king of Prussia informed Dr.  Zimmerman that he
had been frequently attacked by it during his seven
years war, and yet he lived, notwithstanding, above
twenty years afterwards without any pulmonary
complaints. It is only in persons who labour under
chronic debility, that haemoptysis is necessarily
followed by consumption.

  3. I yield to the popular mode of expression
when I speak of a consumption being produced by
tubercles.   But I maintain that they are the effects
of general debility communicated to the bronchial
vessels which cause them to secrete a preternatural
quantity of mucus.  This mucus is sometimes
poured into the trachea from whence it is discharg-
ed by hawking, more  especially in the  morning;
for it is secreted more copiously during the languid
hours of sleep  than in the  day time.   But this
mucus is frequently secreted into the substance of
the  lungs, where it  produces those tumours wc 
ON  PULMONARY CONSUMPTION.    93
call tubercles.  When this occurs, there is either
no cough* or a very dry one.  That tubercles are
formed in this way, I infer from the dissections
and experiments of Dr. Starkf,  who tells us, that
he found them to consist of inorganic matter ; that
he was unable to discover any  connexion between
them and the pulmonary vessels, by means of the
microscope or injections ; and that they first opened
into the trachea through the bronchial vessels.  It
is remarkable  that the colour and consistence of
the matter  of which they are composed, is nearly
the same as the matter which is discharged through
the trachea, in the moist cough which occurs from
a relaxation of the bronchial vessels, and which has
been called by Dr. Beddoes a bronchial gleet.

   I am aware that these tumours in the lungs have
been ascribed to scrophula.  But the frequent oc-
currence of consumptions in persons in whom no
scrophulous taint existed, is sufficient to refute this
opinion.-   I have frequently directed my inquiries
after this disease in consumptive patients, and have
met with very few cases which were produced by
it.  It is probable that it may frequently be a pre-

  * See Med. Com. Vol. II.
  f Clinical and Anatomical Observations, p. 26,27. See
also Morgagni, letter xxii. 21.
   VOL.  II.            N 
94
ON  PULMONARY  CONSUMPTION.
    disposing cause of consumption in Great Britain,
    but I am sure it is not in the United States.   Baron
    Humboldt informed me, that the scrophula is un-
    known in Mexico, and yet consumptions, he said,
    are very common in that part of Spanish America.
    That tubercles are  the effects, and not the cause
    of pulmonary consumption, is further evident from
    similar tumours being suddenly formed on the in-
    testines by the dysentery, and on the omentum by
    a yellow fever.  Cases of the former are to be met
    with in the dissections of Sir John Pringle,  and
    one of the latter is mentioned by Dr. Mackittrick,
    in his  inaugural dissertation upon the yellow fever,
    published in Edinburgh in the year 1766*.

      4. The catarrh is of two kinds, acute and chro-
    nic, both of which are connected with general de-
    bility, but  this debility is most obvious in  the
    chronic catarrh:  hence we  find it increased by
    every thing which acts  upon  the whole  system,
    such as cold and damp weather, fatigue, and, above
    all,  by old age, and relieved or cured by exercise,
    and every thing else which invigorates the whole
    system.   This species of catarrh often continues
    for twenty or thirty years without inducing pulmo-
    nary consumption, in  persons who pursue active
    occupations.
/                    * Pages 7, 8. 
       ON PULMONARY CONSUMPTION.      95
   5. In the hereditary consumption there is either
 a hereditary debility of the  whole system, or a
 hereditary mal-conformation of the breast.   In the
 latter case, the consumption is the effect of weak-
 ness communicated to the whole system,  by the
 long continuance of difficult respiration, or of such
 injuries being done to the lungs as are incompati-
 ble  with health and life.  It  is remarkable, that
 the  consumptive diathesis is  more frequently de-
 rived from paternal, than maternal ancestors.

   6. Physicians, the most distinguished charac-
 ters, have agreed, that the pulmonary consumption
 may be communicated by contagion.   Under the
 influence of this belief, Morgagni informs us, that
 Valsalva, who was prediposed to the consumption,
 constantly avoided  being present at the dissection
 of the lungs of persons who had died of that dis-
 ease.  In some parts of Spain and Portugal,  its
 contagious nature is so  generally  believed, that
 cases of it are reported to the magistrates of those
 countries, and the clothes of persons who die of it
 are burned by their orders.  The doctrine of nearly
all diseases spreading by  contagion, required but a
short and simple act of the mind, and favoured the
indolence and timidity which characterized the old
school'of medicine.  I adopted this opinion, with
respect to the consumption, in  the early part of my 
96     ON  PULMONARY  CONSUMPTION.
life; but I have lately been led to call its truth in
question, especially in the unqualified manner in
which it has been taught.   In most of the cases in
which  the disease has been said to be propagated
by contagion,  its limits are always confined to the
members of a single family.  Upon examination,
I have found them to depend upon some one  or
more of the following causes :

  1. Mal-conformation of the breast, in all  the
branches of the diseased.family.   It is not neces-
sary that this organic predispostion should be here-
ditary.

  2. Upon the debility which is incurred by nurs-
ing and the grief which follows the loss  of rela-
tions who die of it.

  3. Upon some local cause undermining the con-
stitutions of a whole family.   This may be exhala-
tions from a foul cellar,  a privy, or a neighbouring
mill-pond, but of so feeble a nature as to produce
debility only, with an acute fever, and thus to ren-
der the consumption a kind of family epidemic.  I
was consulted, in the month of August, 1793, by
a Mr. Gale,  of Maryland, in a  pulmonary com-
plaint.  He informed me, that he had lost several
brothers  and sisters  with  the consumption,  and 
       ON PULMONARY CONSUMPTION.     97
that none of his ancestors had died of it.  The
deceased persons, five in number, had lived in a
place that had been subject to the intermitting fever.

  4. Upon some peculiar and unwholesome arti-
cle of diet, which exerts slowly debilitating effects
upon all the branches of a family.

  5. Upon a fearful and debilitating apprehension
entertained by the surviving members of a family,
in which one or two have  died  of consumption,
that they shall perish by the same disease.   The
effects  of all the passions,  and especially of fear,
acted upon by a lively  imagination,  in  inducing
determinations to particular parts of the body, and
subsequent disease, are so  numerous, as to leave
no doubt of the  operation of this cause, in  pro-
ducing a number of successive deaths in the same
family, from pulmonary consumption.

  In favour of its depending upon one or more of
the above causes, I shall add two remarks.

  1. There is often an interval of from two to ten
years,  between the sickness and deaths which oc-
cur in families  from  consumptions, and this we
know  never takes place in any  disease which is
admitted to be contagious. 
98
ON  PULMONARY
CONSUMPTION.
  2. The consumption is not singular in affecting
several branches of a family.   I was lately con-
sulted by a young physician from Maryland, who
informed me, that two of his brothers, in common
with himself, were afflicted with epilepsy.   Mad-
ness, scrophula, and a disposition to haemorrhage,
often affect,  in succession, several branches of the
same family ; and who will say that any one of the
above diseases is propagated by contagion ?

  The practise of the Spaniards and Portuguese,
in burning the clothes of persons who die of con-
sumptions, no more proves the  disease to be con-
tagious, than the same acts sanctioned by  the ad-
vice or order  of public  bodies in  the  United
States, establish the contagious nature of the yellow
fever.  They are, in both countries, marks of the
superstition of medicine.

  In  suggesting  these  facts,  and the inferences
which have been drawn from them, I  do not mean
to deny the possibility of the  acid and foetid va-
pour, which is discharged by breathing from an
ulcer or abscess in the lungs,  nor of the hectic
sweats, when rendered putrid by stagnating in
sheets, or blankets,  communicating this disease to
persons who are long exposed to them,  by sleep-
ing with consumptive patients; but that such cases 
        ON  PULMONARY  CONSUMPTION.     99
rarely occur I infer, from the persons affected often
living at a distance from each other, or when they
live  under  the same roof, having no intercourse
with the sick.  This was  the case with the black
slaves, who were supposed to have taken the dis-
ease from the white  branches  of a family in Con-
necticut, and which was mentioned,  upon  the
authority of Dr. Beardsley, in a former edition of
this inquiry.  Admitting  the above morbid mat-
ters now and then  to act as a remote cause of con-
sumption, it idoes not militate  against the theory I
have aimed to establish, for if it follow the analogy
of common  miasmata and contagions, it must act
by first debilitating  the whole system.   The  ap-
proach of the jail and bilious fevers is  often indi-
cated by general langour. The influenza and the
measles are always accompanied by general debi-
lity, but the small-pox  furnishes an analogy to the
case in question more directly  in point.   The con-
tagion of this  disease, whether  received by the
medium of the air or the  skin, never fails of  pro-
ducing  weakness  in the whole system, before it
discovers itself in affections of those parts of the
body on which  the  contagion produced its  first
operation.

   7.  I grant that cutaneous humours, and the mat-
ter of old sores, when repelled, or suddenly hoe: led, 
100    ON  PULMONARY CONSUMPTION.
have in some cases fallen upon the lungs, and pro-
duced consumption.  But I believe, in every case
where this has happened,  the consumption was
preceded by general debility, or that it was not in-
duced, until the whole system had been previously
debilitated by  a tedious and distressing cough.

  If the reasonings founded upon the facts which
have been mentioned be just, then it follows,

  III. That the abscess, cough, tubercles, ulcers,
and purulent or bloody discharges which occur in
the pulmonary consumption, are the effects, and
not the causes  of the disease; and, that all attempts
to cure it, by inquiring after tubercles and ulcers,
or into the quality of the discharge from the lungs,
are as fruitless as an attempt would be to discover
the causes or  cure of dropsies, by an examination
of the qualities of collections of water, or to find out
the causes  and cure of fevers, by the quantity or
quality of the  discharges which take place in those
diseases from the  kidneys and skin.    It is to be
lamented, that it is not in pulmonary consumption
only, that the effects of a disease have been mistaken
for its cause.  Water in the brain, a membrane in
the trachea, and a preternatural  secretion of bile,
have been accused of producing hydrocephalus in-
ternus, cynanche  trachealis, and  bilious  fever, 
        ON  PULMONARY  CONSUMPTION.    101

 whereas we now know they are the effects of those
 diseases onlv, in the successive order in which each
 of them has been mentioned.  It is high time to
 harness the steeds which drag the car of medicine
 before, instead of behind it.  The earth, in our
 science, has stood still long enough.  Let us at last
 believe, it revolves round its sun.  I  admit that
 the cough, tubercles,  and ulcers, after they are
 formed, increase the danger of a consumption, by
 becoming new causes of stimulus to the system, but
 in this they are upon a footing with the water, the
 membrane, and the bile that  have been alluded to,
 which, though they constitute no part of the dis-
 eases that produce them, frequently induce symp-
 toms, and atermination of them, wholly unconnect-
 ed with the original disease.

   The tendency of general debility to  produce a
 disease of the lungs appears in many cases, as well
 as in the pulmonary consumption. Dr.  Lind tells
 us, that the last stage of the jail fever was often
 marked by a cough.  I have seldom been  disap-
 pointed in looking for a cough and a copious ex-
 cretion of mucus and phlegm after the 14th or 15th
days of a chronic typhus fever. Two cases of hy-
pocondriasis under my care, ended in fatal diseases
of the lungs.  The debility of old age is generally
accompanied by a troublesome cough, and the de
   VOL. II.             o 
102    ON PULMONARY CONSUMPTION.
bility which precedes death, generally discovers its
last symptoms in the lungs.   Hence most people
die with what are called the rattles.   They are
produced by a sudden and copious effusion of mu-
cus in the bronchial vessels of the lungs.

   Sometimes the whole force of the consumptive
fever falls  upon the trachea instead of  the lungs,
producing in it defluxion, a hawking of blood, and
occasionally a considerable discharge of blood, which
are often followed by ulcers, and a spitting of pus.
I have called it a tracheal, instead of a pulmonary
consumption.   Many people pass through a long
life with a mucous defluxion upon the trachea, and
enjoy in other respects tolerable health.  In such
persons the disease is  of a local nature.   It is only
when it is accompanied with debility of the whole
system, that it ends in a consumption.  Mr.  John
Harrison, of the Northern Liberties, died of this dis-
ease under  my care,  in the year 1801, in conse-
quence of the discharge of pus from an ulcer which
followed a haemorrhage from the trachea being sud-
denly suppressed. I have seen another  case of the
same kind in a lady in this city, in the  year 1797.
Dr. Spence, of Dumfries, in Virginia, in a letter
which I received from him in June, 1805, describes
a case then under his care, of this form of consump-
tion.  He calls it, very properly, " phthisis trache- 
       ON  PULMONARY CONSUMPTION.     103

alis." I have met with two cases of death from this
disease, in which there were tubercles in the tra-
chea.  The patients breathed with great difficulty,
and spoke only in a whisper.   One of them died
from suffocation.  In the other, the tubercle bursted
a few days before his death, and discharged a large
quantity of foetid matter.

   Should it be asked, why does general debility
terminate by a disease in the lungs and trachea ra-
ther than in any other parts of the body? I answer
that it seems to be the law of the system, that gene-
ral debility should always produce some local dis-
ease.  This local disease sometimes manifests itself
in dyspepsia, as in the general  debility which fol-
lows grief; sometimes it discovers itself in a diarr-
hoea,  as in the general debility  which succeeds to
fear.  Again it appears in the brain, as in the general
debility which succeeds intemperance, and the con-
stant or violent exercise of the understanding, or of
stimulating passions;  but it more frequently ap-
pears in the lungs, as the consequence of general
debility.   It would seem as if the debility in the
cases of consumption is seated chiefly in the blood-
vessels, while that debility which terminates in dis-
eases of the stomach and bowels, is confined chiefly
to  the  nerves, and that the local affections of the
brain arise from a debility, invading alike the ner- 
104     ON PULMONARY  CONSUMPTION.
vous and arterial system.    What makes it more
probable that the arterial system is materially affect-
ed in the consumption is, that the disease most fre-
quently occurs in those periods of life, and in those
habits in which a peculiar state of irritability or ex-
citability is supposed to be present in the arterial
system; also in those climates in which there arc
the most frequent vicissitudes in the temperature
of the weather.   It has been observed, that the de-
bility in the inhabitants of the West-Indies, whe-
ther produced by the heat of the climate or the ex-
cessive pursuits of business or pleasure, generally
terminates in dropsy, or in some disease of the ali-
mentary canal.

   I have said, that it seemed to be a law of the sys-
tem,  that  general debility should always produce
some local affection.   But to this law there are
sometimes exception:  the atrophy  appears to be
a consumption  without an affection of the lungs.
This disease is frequently mentioned by the writers
of the 16th and 17th centuries by the name of tabes.
 I have seen several instances of it in adults, but
 more in children, and a greater number in the chil-
 dren of black than of white parents.  The hectic
 fever,  and even the night sweat, \vere as obvious
 in several  of these  cases, as in those consumptions 
      ON  PULMONARY CONSUMPTION.     105

where general debility had discovered itself in an
affection of the lungs.

  I come now to make a few observations upon
the cure of consumption; and here I hope it will
appear,  that the theory which I have delivered ad-
mits of an early and very important application to
practice.

  If the consumption be preceded by general de-
bility, it becomes us to attempt the cure of it be-
fore it  produce the active symptoms of cough,
bloody or purulent discharges from the lungs, and
inflammatory or hectic fever.   The symptoms
which mark its first stage, are too seldom observ-
ed ; or if observed, they are too often treated with
equal neglect by patient and physicians.   I shall
briefly enumerate these symptoms.   They are  a
slight fever increased by the least exercise ; a burn-
ing and dryness in  the palms of the  hands, more
especially  towards  evening; rheumy eves upon
waking from sleep ; an increase of urine ; a dry-
ness of the skin, more especially of the feet in the
morning*; an occasional flushing in one, and some-

  * The  three last-mentioned symptoms are taken notice
of by Dr. Bennet, in his Treatise upon the Nature and Cure
of the Consumption, as precursors of the disease. Dr. Boer-
haave used to tell his pupils that they had never deceived
him. 
106   ON PULMONARY CONSUMPTION.
times in both cheeks ; a hoarseness* ; a slight or
acute pain in the breast; a fixed pain in one side,
or shooting pains in both  sides; head-ach; occa-
sional sick and fainty fits; a deficiency of appetite,
and a general indisposition to exercise or motion
of every kind.

  It would be  easy for me to mention cases in
which every  symptom that has been enumerated
has occurred within my own observation.  I wish
them to be committed to memory by young prac-
titioners ;  and if they derive the same advantages
from attending  to them, which  I have done, I am
sure they will  not regret  the trouble  they  have
taken for  that purpose. It is  probable,  while a
morbid state of the lungs is supposed to be the
proximate cause of this disease, they will not de-
rive much reputation or emolument from curing it
in its forming stage ; but let them remember, that
in all attempts to discover  the causes and cures of
diseases, which have  been  deemed incurable, a
physician will do nothing effectual until he acquire
a perfect indifference to his own interest and fame.

  * t have  seen the hoarseness in one'case the first symp-
tom of approaching consumption.  In this symptom it pre-
serves the analogy of pneumony, which often comes on with
a hoarseness, and sometimes with paraphonia. 
ON  PULMONARY  CONSUMPTION.
107
  The remedies for consumption, in this stage of
the disease,  are simple  and certain.  They con-
sist  in a desertion of all its  remote  and exci-
ting causes,  particularly sedentary employments,
damp or cold  situations, and  whatever tends to
weaken the system.  When  the disease has not
yielded to this desertion of its remote and exciting
causes, I have  recommended the cold bath, steel,
and bark with great advantage.  However impro-
per, or even  dangerous, these remedies may be
after the disease assumes an inflammatory or hectic
type, and produces an affection of the lungs, they
are perfectly safe and extremely useful in the state
of the  system which has been described.  The use
of  the  bark  will readily be admitted by all those
practitioners who believe the pulmonary consump-
tion to  depend upon  a scrophulous diathesis.
Should even the lungs be affected by scrophulous
tumours, it is no objection to  the use of the bark,
for there is no reason why it should not be as use-
ful in scrophulous tumours of the lungs, as of the
glands of the  throat, provided it be given before
those  tumours have produced inflammation; and
in this case, no prudent practitioner will ever pre-
scribe it in scrophula, when seated even in the ex-
ternal  parts  of the  body.    To these remedies
should be added a  diet moderately stimulating,
and gentle exercise. I shall hereafter mention the dif- 
 108    ON  PULMONARY CONSUMPTION.
 ferent species of exercise, and the manner in which
 each of them  should be used, so as to derive the
 utmost advantage  from them.   I can say nothing
 of the use of salt water or sea air in this stage of
 the consumption, from my own experience.  I have
 heard them commended by a physician of Rhode-
 Island ; and if they be used before the disease has
 discovered itself in  pulmonary  affections, I can
 easily conceive they may do service.

  If  the simple remedies which  have been men-
 tioned have been neglected, in the first stage of the
 disease, it generally terminates, in different periods
 of time, in pulmonary affections, which show them-
 selves under one of the three following forms :

  1.  A fever, accompanied by a cough,  a hard
 pulse, and a discharge of blood, or mucous matter
 from  the lungs.

  2.  A fever of the hectic kind, accompanied by
chilly fits, and night sweats, and a  pulse  full,
quick, and occasionally hard.    The discharges
from the lungs, in this state of the disease, are fre-
quently purulent.

  3. A fever with a weak frequent pulse, a trou-
blesome cough, and copious purulent discharges 
       ©N  PULMONARY CONSUMPTION.    109
from the lungs, a hoarse and weak voice, and chilly
fits and night sweats alternating with a diarrhoea.

  From this short history of the symptoms of pul-
monary consumption there are occasional devia-
tions.  I have seen four cases, in which the pulse
was natural, or slower than natural, to the last day
of life.  Mrs. Rebecca Smith, the lovely and ac-
complished wife of Mr. Robert Smith, of this city,
passed through the whole course of this disease, in
the year 1802, without a single chilly fit.   Two
other cases have come under my notice, in which
there was not only an absence of chills, but of fever
and night sweats.   A  similar case is recorded in
the Memoirs of the Medical Society of London;
and lastly, I have seen two cases which terminated
fatally, in which there was neither cough nor fever
for  several  months.   One of them was  in Miss
Mary Loxley, the daughter of the late Mr. Benja
min  Loxley, in  the  year  1785.   She  had com-
plained of a pain in her right side, and had frequent
chills with  a fever  of the  hectic  kind.   They all
gave way to frequent and gentle bleeding.   In the
summer of 1786,  she was seized with the same
complaints, and as she had great objections  tP
bleeding, she consulted a  physician who gratified
her, by attempting to cure her by recommending
exercise and country air.   In  the autumn she re-
  VOL. II.            p 
 110   ON  PULMONARY CONSUMPTION.
 turned to the city, much worse than when she left
 it.  I was again sent for, and found her confined
 to her bed with a pain in her right side, but with-
 out the least cough or fever.  Her  pulse was pre-
 ternaturally slow.  She cnnld lie only on her left
 side.   She sometimes complained of acute flying
pains in her head, bowels, and limbs.    About a
month before her death,  which was on the  3d of
May,  1787,  her pulse became quick, and she had
a little hecking cough, but without any discharge
from her lungs.  Upon my first visit to her in the
preceding autumn, I told her friends that I believed
she had an  abscess in  her lungs.    The want of
fever and cough afterwards, however, gave me rea-
son to suspect that I had been  mistaken.   The
morning after her death, I received a message from
her father, informing me that it had been among
the last requests of his daughter, that the cause of
her death should be ascertained, by my opening
her body.   I complied with this request,  and,  in
company with Dr. Hall, examined her  thorax.
We found the left lobe of the lungs perfectly sound;
the right lobe adhered to the pleura, in separating
of which, Dr. Hall plunged his hand into a large
sac, which contained about half a pint of purulent
matter, and which had nearly destroyed the whole
 substance of the  right lobe of the lungs. 
       ON  PULMONARY  CONSUMPTION.    Ill

  I have never seen a dry tongue in any of the
forms or stages of this disease.

  The three different forms of the pulmonary affec-
tion that I have mentioned, have been distinguished
by the names of the first, second, and third stages
of die consumption ; but as they  do not always
succeed each other in the order in which they have
been mentioned, I shall consider them as different
states of the system. I

  The first I  shall call the inflammatory, the
second the  hectic, and  the  third the typhus
state.  I have seen the pulmonary consumption
come on sometimes with all the symptoms of the
second, and sometimes with most of the symptoms
of the third state; and I have seen two cases in
which a hard pulse, and other symptoms of inflam-
matory action, appeared in the last hours of life.
It is agreeable to pursue the analogy of this dis-
ease with a pneumony, or an acute inflammation of
the lungs.  They both make their first appearance
in the same seasons of the year.   It is true, the
pneumony most frequently attacks with inflamma-
tory symptoms ; but it sometimes occurs with
symptoms which forbid blood-letting, and I have
more than once seen it  attended by symptoms
which required the use of wine and bark.  The 
 112   ON PULMONARY CONSUMPTION.
 pneumony is attended at first by a dry cough, and
 an expectoration of streaks of blood ; the cough in
 the consumption,  in like manner, is at first dry,
 and attended by a discharge  of blood from the
 lungs, which is more copious than in  the pneu-
 mony, only because the lungs are more relaxed in
 the former than in the latter disease.  There are
 cases of pneumony in which no cough attends.   I
 have just now mentioned that I had seen the ab-
 sence of that symptom in pulmonary consumption.

   The pneumony terminates in different periods,
 according to  the degrees of inflammation, or the
 nature of the effusions  which take place in the
 lungs : the same observation applies  to the pulmo-
 nary consumption.  The symptoms of the different
 forms of pneumony frequently run into each other;
 so do the symptoms of the three forms of consump-
 tion which have been mentioned.    In short, the
 pneumony and consumption are alike in so many
 particulars, that they appear to resemble shadows
 of the same substance.   They differ only as the
 protracted shadow of  the evening does from that
iof the noon-day sun.

   I know that it will be objected here that the
 consumption is sometimes produced by scrophula,
 and that this creates an essential difference between 
        ON PULMONARY CONSUMPTION.   llo

it and pneumony.  I formerly admitted scrophula
to be one of the remote causes of the consumption;
but this does not invalidate the parallel which has
been given of the two diseases.   The phenomena
produced in  the  lungs are the same as  to  their
nature, whether they be produced by the remote
cause of scrophula, or by the sudden action of cold
and heat upon them.

  No more happens in the cases of acute and chro-
me pneumony,  than what happens in dysentery
and rheumatism.   These two last diseases are for
the most part so acute, as to confine the patient to
his bed or his room, yet we often meet with both
of them in patients who go about their  ordinary
business,  and in some instances, carry their dis-
eases with them for two or three years.

  The parallel which has  been drawn between the
pneumony and consumption, will  enable us to un-
derstand the reason why  the latter disease termi-
nates in such different periods of time.  The less
it partakes of pneumony, the longer it continues,
and vice versa.   What is commonly called in this
country a galloping consumption, is a disease com-
pounded of different degrees of consumption and
pneumony.   It terminates  frequently in two or
three months, and without many of the symptoms 
114    ON  PULMONARY  CONSUMPTION.
which  usually attend the  last  stage of pulmonary
consumption.   But there are  cases in which pa-
tients in a consumption are suddenly snatched away
by an attack of pneumony.   I have met with one
case  only, in which,  contrary to my expectation,
the patient mended after an attack of an acute in-
flammation of the lungs, so  as to live two years
afterwards.

  It  would seem from these facts, as  if nature had
preferred a certain gradation in diseases, as well as
in other parts of her works.  There  is scarcely a
disease in which there is not  a certain number of
o-rades,  which mark, the distance between health
and the lowest specific deviation from it.   Each
of these grades has received different names, and
has been considered as a distinct disease, but more
accurate surveys of the  animal economy   have
taught us, that they frequently depend upon the
same original causes, and that they are only greater
or less degrees of the same disease.

   I shall now proceed to say a few  words upon
the cure of the different states of pulmonary con-
sumption.   The remedies for this  purpose are of
two kinds, viz. palliative  and radical.  I
shall first  mention the palliative remedies which
belong  to each  state,  and then  mention  those 
       ON  PULMONARY  CONSUMPTION.    115
which are alike proper in them all.  The palliative
remedies for the

  I. Or INFLAMMATORY STATE, are

  1. Blood-letting.   It may seem strange to
recommend this debilitating remedy in a disease
brought  on by debility.   Were it proper in this
place,  I could prove that there is no disease in
which bleeding is prescribed, which is not induced
by predisposing debility, in common with the pul-
monary consumption.   I shall  only remark  here,
that in  consequence of the exciting cause acting
upon the system (rendered extremely excitable by
debility) such a morbid  and excessive excitement
is produced in the arteries, as to render a diminu-
tion of the stimulus of the blood absolutely neces-
sary to reduce it.   I have used this remedy with
great success, in every  case of consumption at-
tended by a hard pulse,  or a pulse  rendered weak
by a laborious transmission of the  blood through
the lungs.  In the months of February and March,
in the y%ar 1781, I bled a Methodist minister, who
vyas affected by this state  of consumption, fifteen
times in the course of six weeks.    The quantity
of blood drawn at each  bleeding was  never less
than eight ounces, and it was at all times covered
with an inflammatory  crust.  By the addition of 
 116    ON PULMONARY CONSUMPTION.
country air, and moderate exercise, to this copious
evacuation, in the ensuing spring he recovered his
health so perfectly, as to discarge all the duties of
his profession for many years, nor  was he  ever
afflicted afterwards with a disease in his breast.  I
have, in another instance, bled a citizen of Phila-
delphia eight times in two weeks, in this 'state of
consumption, and with the happiest effects.   The
blood drawn at each bleeding was always sizy, and
never less in quantity than ten ounces.   Mr.  Tra-
cey of Connecticut informed me, in the spring of
 1802, that he had been bled eighty-five times in
six months, by order of his physician, Dr. Sheldon,
in the inflammatory state of this disease.   He as-
cribed his recovery  chiefly to this frequent use of
the lancet.   To these cases I might add many
others of consumptive persons who have been per-
fectly cured by frequent, and of many others whose
lives have been prolonged by occasional bleedings.
But I am sorry to  add, that I could relate many
more cases of consumptive patients, who have died
martyrs to their prejudices against the use of this
invaluable remedy.   A common objection»to  it is,
that it has been used without success in this dis-
ease.  When  this  has been  the case, I suspect
that it has been used in one  of the other two statee
of pulmonary consumption which have been men-
tioned,  for it has unfortunately been too fashion- 
ON  PULMONARY CONSUMPTION.
117
able among physicans to  prescribe the same  re-
medies  in  every stage and  form  of the  same
disease,  and this I take to be the reason why the
same medicines, which, in the hands of some phy-
sicians, are cither inert or instruments of mischief,
are, in the hands of others, used with more or less
success in every case in which they are prescribed.
Another objection to bleeding in the inflammatory
^tate of consumption, is derived from the apparent
and even sensible weakness of the patient.  The
men who urge this  objection, do not hesitate to
take from sixty to a hundred ounces of blood from
a patient in a pneumony, in the course of five or six
days, without considering that the debility in the
latter case is such as to confine a patient to his bed,
while, in the former case, the patient's strength is
such as  to enable him  to walk about his house,
and even to attend to his ordinary business. The
difference between the debility in the two diseases,
consists in its being acute in the one, and chronic
in the other.   It is true, the preternatural  or con-
vulsive  excitement  of the arteries  is somewhat
greater*in the pneumony, than in the  inflammatory
consumption; but the plethora, on which the ne-
cessity of bleeding is partly founded, is certainly
greater  in the inflammatory consumption  than in
pneumony.   This is evident from  women, and
even nurses,  discharging from four to six  ounces
   VOL.  II,             o 
118
ON  PULMONARY
CONSUMPTION.
of menstrual blood every  month, while they are
labouring with the most inflammatory symptoms of
the disease; nor is it to be wondered at,  since the
appetite is frequently unimpaired, and the genera-
tion of blood continues to be the same as in perfect
health.

   Dr. Cullen recommends the use of bleeding in
consumptions, in order to lessen the inflammation
of the ulcers in the lungs, and thereby to dispose
them to heal.  From  the  testimonies of the re-
lief which  bleeding affords in external ulcers and
tumours accompanied by inflammation, I am dis-
posed to expect the same benefit from it in inflamed
ulcers and tumours in the  lungs:  whether,  there-
fore, we adopt Dr. Cullen's theory of consumption,
and treat it as a local disease, or assent to the one
which I have delivered, repeated bleedings appear
to be equally necessary and useful.

   I have  seen two cases  of inflammatory con-
sumption, attended by a  haemorrhage of a quart
of blood from the  lungs.   I agreed at first with
the friends  of these patients in expecting a rapid
termination  of their disease in death,  but  to the
joy and surprise of all connected with them, they
both recovered.  I ascribed their recovery wholly
to the inflammatory action of their systems being 
        ON  PULMONARY CONSUMPTION.    119

suddenly reduced by  a spontaneous discharge  of
blood.  These facts, I hope, will serve to establish
the usefulness of blood-letting in the inflammatory
state  of consumption, with those physicians who
are yet disposed to trust more to the fortuitous
operations of nature, than to the decisions of rea-
son and experience.

   I have always found this  remedy  to  be more
necessary in the winter and first spring months,
than at any other season.  We obtain  by means of
repeated bleedings, such a mitigation of  all the
symptoms  as enables the patient to use exercise
with advantage as soon as the weather becomes  so
dry  and settled, as to admit of  his going  abroad
every day.

   The relief obtained by bleeding,  is so  certain
in this state of consumption, that I often use it as
a palliative remedy, where I  do  not expect it will
perform a cure. I was lately made happy in find-
ing, that I am not singular in this practice.  Dr.
Hamilton, of Lynn Regis, used it with success in
a consumption, which was the effect of a most de-
plorable  scrophula, without entertaining  the least
hope of its performing a cure*.    In those cases
* Observations on Scrophulous Affections. 
120    ON PULMONARY  CONSUMPTION.
where  inflammatory action attends the last scene
of the  disease, there  is often more relief obtained
by a little bleeding than by  the  use  of opiates,
and it  is always a more humane prescription, in
desperate cases, than the usual remedies of vomits
and blisters.

  I once bled a sea captain, whom I had declared
to be within  a few hours of  his  dissolution, in
order to relieve him  of uncommon pain, and diffi-
culty in breathing.  His pulse was at the same time
hard.  The evacuation, though it  consisted of but
four ounces  of blood, had the wished  for effect,
and his death, I have reason to believe, was  ren-
dered  more easy by  it.  The blood, in this case,
was covered with a buffy coat.

  The quantity of blood drawn  in every  case of
inflammatory consumption, should be determined
by the force of the pulse, and the habits of the pa-
tient.  I have seldom taken more than eight, but
more frequently but six ounces at a time.    It is
much  better to repeat the bleeding once or twice
a week, than to use it less frequently, but in larger
quantities.

  From  many years experience of the efficacy of
bleeding in this state of consumption, I feel  my- 
       ON  PULMONARY CONSUMPTION.    121
self authorised to assert, that where a greater pro-
portion of persons die of consumption when it
makes its first appearance in the lungs, with symp-
toms  of inflammatory diathesis, than die of ordi-
nary pneumonies (provided exercise be used after-
wards), it must, in nine cases out often, be ascri-
bed to the ignorance, or erroneous theories of phy-
sicians, or to the obstinacy or timidity of patients.

  In speaking thus confidently of the necessity and
benefits of bleeding in the inflammatory state of
consumption, I  confine myself to  observations
made  chiefly in the state of Pennsylvania.   It is
possible the inhabitants of European countries and
cities, may so far have passed the  simple ages of
inflammatory diseases,  as never to exhibit those
symptoms on which I have founded the indication
of blood-letting.   I suspect moreover that in most
of the southern states of America, the inflammatory
action of the arterial system is of too transient a
nature to admit  of the repeated bleedings in the
consumption which are used with so much advan-
tage in the middle and northern states.

  In  reviewing the prejudices against this excel-
lent  remedy in consumptions,  I have frequently
wished to discover such a substitute for it as would
with equal safety and certainty take down the mor- 
 122    ON PULMONARY CONSUMPTION.
 bid excitement, and action of the arterial system.
 At present we know of no  such  remedy; and
 until it  be discovered, it becomes us to combat
 the prejudices against bleeding ; and to derive all
 the advantages from it which have been mentioned.

   2.  A second remedy for the inflammatory state
 of consumption  should  be sought for in a milk
 and vegetable diet.  In those cases where the
 milk  does not lie easy on the stomach, it should
 be mixed with water, or it should be taken with-
 out its cheesy or oily parts, as in whey or butter-
 rmlk, or it should be taken without skimming;
 for there are cases in which milk will agree with
 the stomach in this state, and  in no  other.   The
 oil of the milk probably helps to promote the  so-
 lution of its curds in the stomach.   It is seldom
 in the power of physicians to prescribe ass' or
 goat's milk in this disease ; but a good substitute
 may be  prepared for them by adding to cow's
 milk a little sugar,  and a  third or fourth part of
 water, or of a weak infusion of green tea.   The
 quantity of milk taken in  a day should not exceed
a pint, and even less than that quantity when  we
 wish to lessen the force of the pulse by the abstrac-
tion of nourishment.  The vegetables which are
eaten  in this state of "the disease, should contain as
 little stimulus as possible.  Rice, in all the ways in 
ON
PULMONARY CONSUMPTION.
123
which it is usually prepared for aliment, should be
preferred to  other grains, and the less saccharine
fruits to those which abound with sugar.  In those
cases where the stomach is disposed to dyspepsia,
a little salted meat, fish, or oysters, also soft boiled
eggs, may be taken with safety, mixed with vege-
table aliment.  Where there is no morbid affection
of the stomach, I have seen the white meats eaten
without increasing the inflammatory symptoms of
the disease.   The transition from a full diet to milk
and vegetables should be gradual, and the addition
of animal to  vegetable  aliment, should be made
with the same caution.  From the neglect of this
direction, much error, both in theory and practice,
has arisen in the treatment of consumptions.

   In every case  it  will be better for  the patient
to eat four or five, rather  than but two or three
meals in a day.   A less stimulus is by this means
communicated  to the system, and less  chyle  is
mixed with the blood in a given time. Of so much
importance do I conceive this direction to be, that
I seldom prescribe for a chronic disease of any kind
without enforcing it.

  3.  Vomits have  been  much commended  by
Dr.  Read in this disease.  From their indiscrimi-
nate  use in every state of consumption, I  believe 
 124   ON PULMONARY  CONSUMPTION.
they have oftener done harm than good.   In cases
where a patient  objects to bleeding, or where a
physician doubts  of its propriety, vomits may al-
ways be  substituted in its room with great  advan-
tage.  They are said to do most service when the
disease is the effect of a catarrh.

  4.  Nitre, in moderate doses  of ten or  fifteen
grains, taken three or four times a day, has some-
times been useful in this disease ; but it  has been
only when the disease has appeared with inflamma-
tory symptoms.   Care should be taken not to per-
severe too long in the use of this remedy, as it is
apt to impair the appetite.   I have known one case
in which  it produced an obstinate dyspepsia, and a
disposition to the cholic;  but it removed,  at the
same time, the symptoms of pulmonary consump-
tion.

  5.  Cold and dry  air, when combined with
the exercise of walking, deserves to be mentioned
as an antiphlogistic remedy.    I have repeatedly
prescribed it in this species of the consumption with
advantage, and have often had the pleasure of find-
ing a single walk of two or three miles in  a clear
cold day, produce nearly the same diminution  of
the force  and frequency of the pulse, as the  loss of
six  or eight ounces of blood. 
      ON PULMONARY CONSUMPTION.    1^

  I come now to  treat of the palliative remedies
which are proper in the

  II. Or hectic  state of consumption.  Here
we  begin to behold the disease in a new and more
distressing form than in the state which has been
described.   There is in this state of consumption
the same complication of inflammatory and typhus
diathesis which occurs in, the  typhiod and puer-
perile fevers, and  of course the same  difficulty in
treating  it successfully; for the same remedies do
good and harm, according as the former or latter
diathesis prevails in the system.

   AU that I shall  say upon this state  is,  that  the
treatment of it should be accommodated to the
predominance  of inflammatory or typhus symp-
toms, for the hectic state  presents each of them
alternately every  week, and sometimes every day
to the hand, or eye of a physician.   When a hard
pulse with acute pains in the side and;breast occur,
bleeding and other remedies for the inflammatory
state must be used; but when the disease exhi-
bits a predominance of typhus symptoms, the re-
medies  for diat  state to be mentioned  immedi-
 ately, should be  prescribed in moderate  doses.
There are several palliative medicines which have
been found useful in the hectic state, but they are
   VOL.  II.            R 
 126   ON PULMONARY  CONSUMPTION.
 such as belong alike to the other two  states; and
 therefore will be mentioned hereafter in a place as-
 signed to them.

  I am sory, however,  to add, that where bleed-
 ing has not been indicated, I have seldom been able
 to afford  much relief by medicine in  this state of
 consumption.   I have used alternately the most
 gentle, and the most powerful vegetable and metal-
lic tonics to no purpose.  Even arsenic has failed
 in my hands of affording the least alleviation of the
hectic fever.   I conceive the removal  of this fever
to be  the  great  desideratum in the cure of con-
 sumption ; and should it be found, after  all our
researches, to exist only in exercise, it will be no
departure from a law of nature, for I believe there
 are no diseases produced by equal degrees of chronic
debility, in which medicines are of any more effi-
 cacy, than they are in the hectic fever of the  pul-
monary consumption.

  I proceed  now to speak of the palliative reme-
 dies which are proper in the

  III.  Or typhus state of the pulmonary con-
 sumption. 
       ON PULMONARY CONSUMPTION.     127
  The first  of these are  stimulating medi-
cines.  However just the complaints of Dr. Fo-
thergill may be against the use of balsams in the
inflammatory and mixed states of consumption,
they appear to be not only safe, but useful like-
wise, in mitigating the symptoms of weak morbid
action in the arterial system.  I have therefore fre-
quently prescribed opium, the balsam of copaivte,
of Peru, the oil of  amber, and different prepara-
tions of turpentine and tar, in moderate doses, widi
obvious advantage.  Garlic,  elixir of vitriol, the
juice of dandelion, a strong tea made of horehound,
and a decoction of the inner bark of the wild cherry
tree*, also bitters of all kinds, have all been found
safe and useful tonics in this state of consumption.
Even the Peruvian bark and the cold bath, so often
and so generally condemned in consumptions, are
always innocent, and frequently active  remedies,
where there is a total absence of inflammatory dia-
thesis in this disease.  The bark is said to be most
useful  when the consumption is the consequence
of an intermitting fever, and when it occurs in old
people.  With these remedies should be combined

  2. A cordial and stimulating diet. Milk
and vegetables, so proper in the inflammatory, are
* Prunus Virginiana. 
128    ON  pulmonary  consumption.
improper, when taken alone, in this state of con-
sumption.   I believe they often accelerate that
decay of appetite and diarrhoea, which form the
closing scene of the disease.    I have lately seen
three persons recovered  from the lowest stage of
this  state of consumption,  by the use of animal
food and cordial drinks, aided by frequent doses of
opium, taken during the day as well as in the night.
I should hesitate in mentioning these cures, had
they not been witnessed by more than a hundred
students of medicine in the  Pennsylvania hospital.
The history of one 6f them is recorded in the 5th
volume of the  New-York  Medical  Repository,
and of the two others in Dr. Coxe's Medical Mu-
seum.  Oysters, it has been said, have performed
cures of consumption.  If they have, it must have
been only when they were eaten in that state of it
which is now under consideration.    They are a
most savoury and wholesome article of diet, in all
diseases of weak morbid action.  To the cordial
articles of diet belong sWeet vegetable  matters.
Grapes, sweet apples, and the juice of the sugar
maple tree, when taken in large quantities, have all
cured this disease.   They all appear to act by fill-
ing  the blood-vessels, and thereby imparting tone
to the whole system.  I have found the same ad-
 vantage from dividing the meals in  this state of
 consumption, that  I  mentioned under  a  former 
        ON PULMONARY  CONSUMPTION.    129

nead.  The exhibition of food in this case, should
not be left to the calls of appetite, any more than
the exhibition of a medicine.   Indeed food may
be made to supply the  place of cordial medicines,
by keeping up a constant and  gentle action in the
whole system.   For this reason, I have frequently
advised my patients never to suffer their stomachs
to be empty, even for a  single hour.  I have some-
times  aimed to keep  up  the  influence of a gentle
action in the  stomach upon the whole system, by
advising them to eat in the night, in order to ob-
viate the increase of secretion into the lungs and
of the cough in the morning, which are brought
on in part by the increase of debility from the long
abstraction of the stimulus of aliment during the
 night.

   However safe, and even useful, the cordial me-
dicines and  diet that  have been mentioned  may
appear, yet I am sorry to  add, that we seldom see
any other advantages from them than a mitigation
of distressing symptoms,  except when they have
been followed by suitable and long continued ex-
ercise.  Even under this favourable circumstance,
 the}- are often ineffectual;  for there frequently oc-
curs, in this state of consumption, such a destruc-
tion of the substance and functions of the lungs, as
to preclude the possibility of a recovery by the use 
130   ON PULMONARY  CONSUMPTION.
of any of the remedies which have been discovered.
Perhaps, where this is not the case, their want of
efficacy may be occasioned by their being  given
before the pulse is completely reduced to a typhus
state.  The weaker the pulse,  the greater  is the
probability of benefit being derived from the use
of cordial diet  and medicines.

  I have  said  formerly,  that the  three  states of
consumption do not  observe  any regular course in
succeeding each other.   They are not only com-
plicated in some instances, but they often appear
and disappear half a dozen times in the course of
the disease, according to the influence of the wea-
ther, dress, diet, and the passions upon the system.
The great secret, therefore, of treating this disease
consists in accommodating  all the remedies  that
have  been mentioned to the  predominance  of any
of the three different states of the system, as mani-
fested chiefly by the pulse.  It is in consequence
of having observed the evils which have resulted
from the ignorance or  neglect of this practice, that
I have sometimes wished that it were possible to
abolish the seducing nomenclature of disease alto-
gether in order  thereby to oblige physicians to
conform exactly to the fluctuating state of the sys-
tem in all their prescriptions;  for it is not more
certain, that, in all cultivated languages, every idea 
ON  PULMONARY CONSUMPTION.
131
has its appropriate word, than that every state  of
a disease has its appropriate dose of medicine, the
knowledge and application of which can alone con-
stitute  rational,  or secure uniformly successful
practice.

   I come now to say a few words upon those pal-
liative  remedies which are alike proper in nearly
every state of the  pulmonary consumption.

   The first remedy under this head isaDRY situ-
 ation.  A damp air, whether breathed in a room,
 or out  of doors, is generally hurtful in every form
 of this  disease.   A kitchen,  or a bed-room, below
 the level of the ground, has often produced, and
 never fails  to increase, a pulmonary consumption.
 I have often observed a peculiar paleness (the first
 symptom of general debility) to show  itself very
 early in the faces of persons who work or sleep in
 cellar kitchens  or shops.

    2. Country air.   The higher and drier the
 situation which is chosen for the purpose of enjoy-
 ing the benefit of this remedy, the better.  Situa-
 tions exposed to the sea, should be carefully avoid-
 ed ; for it is a singular fact, that while consumptive
 persons  are benefited  by the sea-air,  when they
 breathe  it  on  the ocean, they are always injured 
132    ON PULMONARY CONSUMPTION.
by  that  portion  of it which they breathe on the
sea-shore.   To show  its influence, not only in ag-
gravating consumptions, but in disposing to them,
and in adding to the mortality of another disease of
the lungs, I shall subjoin the following facts. From
one  fourth  to one half of the adults who die in
Great Britain, Dr. Willan  says, perish with this
disease.  In Salem, in the state of Massachusetts,
which is situated near the sea, and exposed, during
many months of the year, to a moist east wind,
there died,  in  the year 1799,  one hundred and
sixty persons; fifty-three died of the consumption,
making in all nearly one third of the inhabitants
of the town.  Eight more died of what is called a
lung fever, probably of what is called in Pennsyl-
vania the  galloping grade of that disease.   Con-
sumptions  are more  frequent in Boston,  Rhode-
Island, and New-York, from their damp winds,
and vicinity to the sea-shore, than they are in Phi-
ladelphia.   In the neighbourhood,  of Cape  May,
which lies near the sea-shore of New-Jersey, there
are three religious societies, among whom the in-
fluenza prevailed  in the year 1790.   Its mortality,
under equal circumstances, was in the exact ratio
to their vicinity to the sea. The deaths were most
numerous in that society which was nearest  to it,
and  least so in  that which was most remote from
it.   These unfriendly effects of the sea-air, in the 
       ON PULMONARY CONSUMPTION.   133
above pulmonary  diseases, do  not  appear to  be
produced simply by its moisture.   Consumptions
are scarcely known in the moist atmosphere which
so generally prevails in Lincolnshire, in England,
and in the inland parts of Holland and Ireland.

   I shall not pause to inquire, why  a mixture of
land and sea air is so hurtful in the  consumption,
and at the same time so agreeable  to persons in
health, and so medicinal in  many other diseases,
but shall dismiss this head by adding a fact which
was communicated to me by Dr. Matthew Irvine,
of South-Carolina,  and that is, That those situations
which are in the  neighbourhood of bays or rivers,
where the salt and fresh waters  mix  their streams
together, are more  unfavourable  to consumptive
patients than the sea-shore,  and therefore should
be more carefully avoided by them in exchanging
city for country air.

  3. A change of climate.   It is remarkable
that climates  uniformly cold or warm, which sel-
dom produce consumptions,  are generally fatal to
persons who visit them in that disease.   Countries
between the 30th aud 40th degrees of latitude are
most friendly to consumptive people.
VOL.  II.
s 
134    on  pulmonary consumption.
  4. Loose dressses, and a careful accom-
modation OF them to the changes  in the
weather:  Many  facts might be mentioned to
show the influence of compression and of tight liga-
tures of every kind,  upon the different parts of the
body ;  also of too much, or too little  clothing, in
producing,  or increasing diseases of every kind,
more especially those which affect the lungs. Tight
stays, garters, waistbands, and collars, should all
be laid aside in the consumption, and the  quality
of the clothing should  be suited to the weather.
A citizen of Maryland informed me, that he twice
had a return of a cough and spitting of blood,  by
wearing his summer clothes  a week after the wea-
ther became cool  in the month of September.  But
it is not sufficient to vary the weight or quality of
dress with the seasons.   It should be varied with
the changes which take place in the temperature of
the air every day, even in the summer months, in
middle latitudes.   I know a citizen of Philadelphia,
who has laboured under a consumptive diathesis
near thirty years,  who believes that he  has lessened
the frequency and violence of pulmonic complaints
during that time, by a careful accommodation of
his dress to the  weather.  He has been   observ-
ed frequently to change his waistcoat and  small
clothes twice or three times in a  day, in a summer
month. 
        ON  pulmonary  consumption.    135
   A  repetiton of colds, and thereby an increase
of the disease, will be prevented by wearing flan-
nel next to the skin in winter, and muslin in the
summer, either in the form of a shirt or a waist-
coat :  where these are objected to,  a piece of flan-
nel, or of soft sheepskin,  should be  worn next to
the breast. They not only prevent colds, but fre-
quently remove chronic pains from that part of the
body.

   5.  Artificial evacuations,  by means of
blisters and issues.  I suspect the usefulness
of these remedies to be chiefly confined to the in-
flammatory and hectic states of consumption.   In
the typhus state,  the system is too weak to sustain
the discharges of either of them.  Fresh blisters
should be preferred to such as are perpetual, and the
issues, to be  useful  should be large.   They are
supposed to afford relief by diverting  a preternatu-
ral secretion and  excretion of mucus or pus from
the lungs, to an artificial emunctory in a less vital
part of the body.   Blisters do most service when
the disease arises from repelled eruptions, and when
they are applied between the  shoulders, and the
upper and internal parts of the arms.  When it
arises from rheumatism and  gout,   the  blisters
should be applied to the joints, and such other ex- 
 136    ON pulmonary consumption.
 ternal parts of the  body as had been previously
 affected by those diseases.

  6. Considerable relief will  often be  obtained
 from  the patient's sleeping  between blan-
 kets in winter, and on a mattrass in summer.
 The former prevent fresh cold from night sweats ;
the  latter frequently checks them altogether.  In
cases where a sufficient weight of blankets to keep
up  an agreeable  warmth cannot be borne, with-
 out restraining easy and full acts of inspiration,
the  patient should sleep under a light feather bed,
 or an eider down coverlet.   They both  afford
more warmth than double or treble their weight of
blankets.

  However comfortable  this mode  of producing
 warmth in bed may be, it does not protect the
lungs from the morbid effects of the  distant points
 of temperature of a warm parlour in  the day time,
 and a cold bed-chamber at night.  To produce an
 equable temperature of air  at all hours, I have
 frequently  advised my patients, when going to a
 warm climate  was not practicable,  to  pass their
 nights as well  as days in an open stove room, in
 which nearly the  same degrees of heat were kept
 up  at all hours.   I  have found this practice, in 
      ON  PULMONARY  CONSUMPTION.     137

several cases, a tolerable substitute for a warm cli-
mate.

   7. The moderate use of the lungs, in read-
ing, PUBLIC  SPEAKING, LAUGHING, and SING-
ING.   The lungs, when debilitated, derive equal
benefit with the limbs, or other parts of the body;
from moderate exercise.   I have mentioned, in an-
other place*, several facts which support this opi-
nion.   But too much pains cannot be taken to in-
culcate upon our patients to avoid all excess in the
use of the lungs, by long, or loud reading, speak-
ing, or singing, or by sudden and violent bursts of
laughter.   I shall long lament the death of  a fe-
male  patient,  who had discovered many hopeful
signs of a recovery from a consumption, who re-
lapsed,  and died,  in consequence of bursting a
blood-vessel in her lungs, by a sudden fit of laugh
ter.

   8. Are  there  any 'advantages to  be derived
from the  excitement of certain passions in the
treatment of consumptions?  Dr. Blane tells us,
that many consumptive persons were  relieved, and
that some recovered, in consequence  of the  terror

   # An Account of the Effects of Common Salt in the Cure
of Haemoptysis. 
 138    ON  PULMONARY  CONSUMPTION.
 which was excited by a hurricane in Barbadoes,
 in the year  1780.  It will be difficult to imitate,
 by artificial means, the accidental cures which are
 recorded by Dr.  Blane ;  but  we  learn enough
 from them to inspire the invigorating passions of
 hope and confidence in  the minds of our patients,
 and to recommend to them such exercises as pro-
 duce exertions of body and mind analogous to
 those which are produced by terror. Van Sweiten
 and Smollet relate cures of consumptions, by pa-
 tients falling into streams of cold water.  Perhaps,
 in both instances,  the cures were performed only
 by the fright and consequent exertion produced by
 the fall.   This is only one instance out of many
•which might be mentioned, of partial and unequal
 action being suddenly  changed  into general and
 equal excitement in every part of the system. The
 cures of consumptions which have been performed
 by a camp life, have probably  been much assist-
 ed by the commotions in the passions which were
 excited by the various and changing events of war.

   9. Salivation  has  lately  been  prescribed
 in this disease with success.    An accident  first
 suggested its advantages, in the Pennsylvania hos-
 pital, in the year  1800*.   Since that time, it has

    * Medical Repository of New-York.  Vol. V. 
       ON  PULMONARY  CONSUMPTION.    139

performed  many  cures in different parts of the
United States.   It is to be lamented, that in a ma-
jority of the cases in which the mercury has been
given, it has failed of exciting a salivation. Where
it affects the mouth, it generally succeeds in re-
cent cases, which is more than can be said of any,
or of all other  remedies for this disease.   In its
hectic state, a salivation frequently cures, and even
in its typhus and last stage, I have more than once
prescribed it with  success.  The same regard to
the pulse should regulate the use of this new reme-
dy in consumption, that has been recommended in
other febrile diseases.   It should never be advised
until the inflammatory diathesis of the system has
been  in a great degree reduced, by the depleting
remedies formerly mentioned.

   During the use of the above remedies, great care
should be taken to relieve the patient from the in-
fluence of all those debilitating and irritating causes
which induced the disease.   I have said elsewhere
that decayed teeth are one of them.  These should
be extracted where diere is reason to suspect they
have produced, or that they increased the disease.

   I have hitherto said nothing of the digitalis as a
palliative remedy in pulmonary consumption.  I
am sorry to acknowledge that,  in many cases in. 
 140    ON PULMONARY CONSUMPTION.
 which I have prescribed it,  it has done no good,
 and in some it has done harm. From the oppo-
 site accounts of physicians of the most respectable
 characters  of the effects of this medicine, I have
 been inclined to ascribe its different issues, to a dif-
 ference in the soil in which it has been cultivated,
 or in the times of gathering, or in the manner of
 preparing it, all of which we know influence the
 qualities of many other vegetables.  If the theory
 of consumption which I have endeavoured to esta-
 blish be admitted, that uncertain and unsafe medi-
 cine will be rendered unnecessary by the remedies
 that  have been enumerated, provided they are ad-
 ministered at the times, and in the manner that has
 been recommended.

  Before I  proceed to  speak of the radical cure
 of the consumption, it will be necessary to  observe,
 that  by means of the  palliative remedies which
 have been mentioned, many persons have  been re-
 covered, and some have had their lives prolonged
by  them for many  years;  but in most of these
 cases I have found, upon inquiry,  that the disease
 recurred as soon as the patient left off the use of
his remedies, unless they were followed by neces-
 sary or voluntary exercise. 
        ON  PULMONARY  CONSUMPTION.    141

   It is truly surprising to observe how long some
persons have  lived who  have been affected by a
a consumptive diathesis, and by frequent attacks of
many  of  the most troublesome symptoms of this
disease. Van Sweiten mentions the case of a man,
who had lived thirty years in this state.  Morton
relates the  history of a man, in whom the  symp-
toms of consumption appeared with but little varia-
tion or abatement from his early youth till the 70th
year of his age.   The widow of the celebrated Se-
nac  lived  to be 84 years of age,  diirty of which
she passed in a pulmonary consumption. Dr. Ni-
cols was subject to occasional attacks of this dis-
ease during his whole life, and he lived to be above
eighty years of age.   Bennet says he knew an in-
stance in which  it continued above sixty years.  I
prescribed for my first pupil, Dr.  Edwards,  in a
consumption in  the year  1769.    He lived until
1802,  and seldom passed a year without spitting-
blood, nor a week without a cough, during that long
interval of time.  The fatal tendency of his disease
was constantly opposed by occasional blood-letting,
rural exercises,  a cordial, but temperate diet, the
Peruvian bark, two sea voyages, and travelling in
foreign countries.  There are besides these instan-
ces of long protracted  consumptions,  cases  of it
which appear in childhood, and continue for many
   VOL.  II.             T 
142    ON  PULMONARY  CONSUMPTION.
years.   I have seldom known them prove fatal un-
der puberty.

  I am led here to mention another instance of the
analogy betwreen  pneumony and the  pulmonary
consumption.   We often see the same frequency
of recurrence  of  both diseases in  habits which
are predisposed to them.   I have  attended a Ger-
man citizen of Philadelphia,  in several fits of the
pneumony, who has been confined  to his bed eight-
and-twenty times, by  the  same  disease, in the
course of the same number of years.   He  has, for
the most part, enjoyed good health in the inter-
vals  of those  attacks, and  always  appeared, till
lately, to possess a good constitution.  In the cases
of the  frequent recurrence  of pneumony, no one
has suspected the disease to have originated exclu-
sively in a morbid state of the lungs;  on  the con-
trary, it appears evidently to be produced by the
sudden influence of the same causes,  which, by
acting with less force,  and for a longer time, pro-
duce the pulmonary consumption.  The  name of
pneumony is taken from the principal symptom of
this disease, but it as certainly belongs to the whole
arterial system as  the consumption ;  and I add fur-
ther, that it is as certainly  produced by general
predisposing debility.  The hardness and fulness
of the pulse do not militate against  this assertion, 
       ON  PULMONARY  CONSUMPTION.     143

for they are altogether the effect of a morbid and
convulsive excitment of the sanguiferous system.
The strength manifested by the pulse is moreover
partial,  for every other part of the body discovers,
at the same time, signs of extreme debility.

  It would be easy, by  pursuing this subject a
little further, to mention  a number of facts which,
by  the  aid of principles  in physiology  and patho-
logy, which are universally admitted, would open
to us a new theory  of fevers, but this  would lead
us  too  far from the subject before us.  I shall
only remark,  that all that has been said of the
influence  of  general debilitating causes upon the
lungs, both in pneumony and consumption, and
of  the  alternation of the consumption with other
general diseases,  will receive great support from
considering the lungs only as a part of the whole
external surface of the body, upon which most of
the remote and exciting causes of both diseases
produce their first effects.  This extent of the sur-
face of the body,  not  only to the lungs, but to
the alimentary canal, was first taken notice of by
Dr. Boerhaave ;  but was unhappily neglected by
him in his theories of the diseases of the lungs and
bowels.   Dr.  Keil supposes that the lungs, from
the peculiar structure of the bronchial vessels,  and
air vesicles, expose a surface to the action of the 
144    ON PULMONARY CONSUMPTION.
air, equal to the extent of the whole external and
visible surface of the body.

  There are several distressing symptoms which
occur in pulmonary consumption that call for re-
lief.   These are chiefly a cough, night sweats,
and  a diarrhoea.   The medicines for the cough,
should be

  1. Demulcent teas, syrups, and lozenges.
These are  too common and too numerous to be
mentioned.  They should be more or less stimu-
lating according to the state of the pulse.

   2.  Opiates.   It  is a mistake in  practice,
founded upon a partial knowledge of the qualities
of opium to administer it only at nights, or to sup-
 pose that its effects in composing a cough depend
wholly upon its inducing sleep.  A dose of the
 same strength  should be given every morning,
 that is given at night, and small doses of it should
 be given during  the  day and night, when  the
 cough  is troublesome.  The  practice of giving
 laudanum in pulmonary consumption early in the
 morning is strongly recommended by Dr. Syden-
 ham.   It  is founded alike upon the nature of the
 disease, and a law in the animal economy men-
 tioned in the  Lectures upon animal life, that is, 
       on pulmonary consumption.    145

the system in its diurnal revolutions is always in a
state of the greatest debility immediately after wa-
king  in the  morning.  A great  advantage  will
arise from giving the dose of laudanum that is in-
tended to compose the cough at night, early in
the evening  before the system is excited by an
exacerbation  of fever. The quantity of this medi-
cine taken at all times should be proportioned to
the degrees of action  in the arterial system.  The
less this action  the more of it  may be taken with
safety and advantage.   It  does most service when
given in succession in the different forms of pills,
liquid laudanum, and  paregoric elixir.

   3.  Certain fumigations and vapours.   An
accidental cure  of a pulmonary consumption by the
smoke of rosin in a man who bottled liquors, raised
for'a while the credit of fumigations.  I have tried
them, but without much permanent effect.  A
vapour produced from pouring boiling water up-
on equal parts of tar and bran, received into the
lungs has sometimes given great relief.  The sul-
phurous and saline air of Lybia between mount
 Vesuvius, and  the Mediteranean sea, and the efflu-
via of the pine forests of Lybia were supposed in
ancient times to be powerful remedies in consump-
tive complaints ;  but it is probable the exercise
 used in travelling to those countries,  contributed 
146    o,n pulmonary consumption.
chiefly to the cures which were ascribed to foreign
matters acting upon the lungs.
                                              i
  4. Different positions of the body have been
found  to be more or less favourable to the  abate-
ment of the cough. These positions should be care-
fully sought for, and the body kept in that  which
procures the  most  freedom from  coughing.  I
have heard of an  instance in which a cough that
threatened a return of haemorrhage from the  lungs,
was perfectly  composed for two weeks by keeping
the patient nearly in one posture in bed, but relief
is more generally obtained from coughing, by an
erect posture  of the body.

   5.  Silence.  However much moderate speak-
ing,  reading,  and  singing may  contribute  to
strengthen the lungs,  there are cases in which a
cough is suspended by refraining from them to
such a degree,  as to employ speech only for the
most important purposes of life.

   II.  Night  sweats are to be checked  by the
elixir of vitriol; the nitric acid, drinking a  pint of
lime water daily, or instead of it, taking every
 night at bed  time a small tea spoonful of the fine
 powder  of calcined oyster shells,  and lastly  by
 eating water melons.    The last remedy acts as a 
        ON  PULMONARY CONSUMPTION.   147
 diarrectic, and thus  diverts the fluids from the
 skin  to  the kidnies.   The seeds of that pleasant
 fruit bruised and made into a tea, might be sub-
 stituted for it at every season of the year, and in
 ev^y country.

   III. A diarrhea  should be  restrained by the
 chalk julep, prepared with laudanum and the tinc-
 ture  of cinnamon, by injections of laudanum into
 the bowels,  and by astringent aliments and drinks.

   Thus have I mentioned the  usual palliative re-
 medies for the  consumption.   Many of these re-
 medies, under  certain circumstances, I  have said
 have cured the disease,  but  I suspect that most of
 these cures have taken place only when the disease
 lias partaken of an intermediate nature between a
 pneumony and  a true  pulmonary  consumption.
 Such connecting  shades, appear between the ex-
 treme points of many other  diseases.  In a former
 essay*, I endeavoured to account for the transmu-
 tation (if I may be allowed  the expression)  of the
 pneumony into the consumption, by  ascribing it to
 the increase of die debilitating refinements of civi-

  * Inquiry into the Diseases  and Remedies of the Indians
of North-America ; and acomparative view of their diseases
and remedies with those of civilized nations. Vol. I. 
 148   ON PULMONARY CONSUMPTION.
 lized life.  This opinion has derived constant sup-
 port from every observation I have made connected
 with this subject, since its first publication, in the
 year 1772.

   I come now to treat of the radical remedies
 for the pulmonary consumption.

   In a preceding inquiry*, I mentioned the effects
 of labour, and the hardships of a camp or naval life,
 upon this disease.   As there must frequently occur
 such objections  to each of  these remedies, as to
 forbid their being recommended or adopted, it will
 be necessary to seek for substitutes for them in the
 different species  of exercise.   These are, active,
passive, and mixed.   The active, includes walk-
 ing,  and the exercise of the hands and feet in work-
 ing or dancing.  The passive includes rocking in a
 cradle, swinging,  sailing, and riding in carriages
 of different kinds.   The mixed is confined chiefly
 to riding on horseback.

   I have mentioned all the different species of ex-
 ercise, not  because I think they all belong to the
 class of radical remedies for the consumption, but
 because it is often necessary to use those which are
* On the Pulmonary Consumption, 
ON  PULMONARY CONSUMPTION.
149
 passive, before we recommend those of a mixed or
 active nature.  That physician does not err more
 who advises a patient to take physic, without spe-
 cifying its qualities and doses, than the  physician
 does who advises a patient, in a consumption,  to
 use exercise, without specifying its species and de-
 grees.   From the  neglect  of this direction, we
 often find consumptive patients injured instead of
 being relieved by exercises, which, if used with
judgment, might have been attended with the hap-
piest effects.

   I have  before  suggested  that the stimulus  of
every medicine, which is intended to excite action
in the system, should always be in an exact ratio to
 its excitability.   The same rule should be  applied
to the stimulus of exercise.   I have heard a well-
attested case of a young lady, upon whose con-
sumption the first salutary impression was made by
rocking her in  a cradle ;  and I know another case
in which a young lady, in the lowest state of that
debility which precedes an affection of the lungs,
was prepared  for the use of the mixed and active
exercises, by being first moved gently backwards
and forwards  in a chariot without horses, for an
hour every day.  Swinging  appears to act in the
same gentle manner.  In the case of a gardener,
who was  far advanced in a consumption, in the
  VOL. II.            v 
150    ON  PULMONARY CONSUMPTION.
Pennsylvania hospital, I had the pleasure of observ-
ing its good effects, in an eminent degree.   It so
far restored him, as to enable him to complete his
recovery by working at his former occupation.

   In cases of extreme debility, the following or-
der should be recommended in the use of the dif-
ferent species of exercise.

   1. Rocking in  a cradle, or riding on  an elastic
 board, commonly called a chamber-horse.

   2.  Swinging.

   3.  Sailing.

   4.  Riding in a carriage.

   5.  Riding on horseback.

   6.  Walking.

    7. Running and dancing.

    In the use of each of those species of exercise
  great attention should be paid to the degree or force
  of action with which they are applied to the body.
  For example, in riding in a carriage, the exercise 
        ON  PULMONARY CONSUMPTION.    151
will be less in a four-wheel carriage than in a single
horse chair, and  less when the horses move  in a
walking, than a trotting gait.  In riding on horse-
back, the exercise will be less or greater according
as the horse walks, paces, canters, or trots,  in pas-
sing over the ground.

   I have good reason to believe, that an English
sea-captain, who  was on the  verge of the grave
with  the consumption, in the spring  of the year
1790, owed his perfect recovery to nothing but the
above gradual manner, in which, by my advice, he
made use of the exercises of riding in a carriage
and on horseback.   I have seen many other cases
of  the good effects of thus accommodating exer-
cise to debility; and I am sorry to add, that I have
seen many cases in which,  from the neglect of
this manner of using exercise, most of the species
and degrees of it, have either been useless, or done
harm.   However carelessly this observation may
be read by physicians, or attended to  by patients,
I conceive no direction to be more necessary in the
cure of consumptions.  I have  been thus particular
in detailing it, not only because I believe it to be
important,  but that I might atone to  society  for
that portion of evil which I might have prevented
by a more strict attention to it  in the first years of
my practice. 
152    ON  PULMONARY  CONSUMPTION.
  The  more  the arms are  used in exercise the
better.  One of the proprietary governors of Penn-
sylvania, who  laboured for many years  under  a
consumptive diathesis, derived great benefit from
frequently rowing himself in a small boat, a few
miles up and down the river Schuylkill.   Two
young men, who were predisposed to a consump-
tion, were perfectly cured by working steadily at a
printing press in this city.  A French physician in
Martinique cured this disease, by simply rubbing
the arms between the  shoulders and the elbows,
until they inflamed.  The remedy is strongly re-
commended, by the  recoveries  from pulmonary
consumption which have followed abscesses in the
arm-pits.   Perhaps the superior advantages of rid-
ing on horseback, in this disease, may arise in part
from the constant and gentle use of the arms in the
management of the bridle and the whip.

  Much has been said in favour of sea voyages in
consumptions. In the mild degrees of the disease
they certainly  have done service, but I suspect the
relief given, or the cures  performed by them,
should be confined chiefly to seafaring people, who
add to  the benefits of a constant change of pure
air, a share of the invigorating exercises of navigat-
ing the  ship. I have frequently heard of consump-
tive  patients reviving at sea, probably  from  the 
       ON  PULMONARY
transient effects of sea sickness upon the whole
system, and growing  worse as soon as they came
near the end of their voyage.  It would seem as if
the mixture of land and sea airs was hurtful to the
lungs, in every situation and condition in which it
Could be applied  to  them.  Nor are the peculiar
and morbid effects of the first operation of land and
sea airs upon the human body, in sea voyages, con-
fined only to consumptive people.   I  crossed the
Atlantic ocean, in the year 1766, with a sea captain,
who announced to his  passengers the  agreeable
news that we were  near the British coast, before
any discovery had been made of our situation by
sounding, or by a change in the colour of the wa-
ter.  Upon asking him upon what he  founded his
opinion, he said, that he had been sneezing, which,
he added,  was  the sign of an approaching cold,
and that, in the course of upwards of twenty years,
he had never made the land (to use the seaman's
phrase) without being affected in a similar manner.
I have visited  many  sick people  in  Philadelphia
soon after their arrival from sea, who have inform •
ed me, that they had enjoyed good health during
the greatest part of their voyage, and that they had
 contracted their indispositions after they came with-
 in sight of the land.   I mention these facts only to
 show the necessity of advising consumptive  pa-
 tients, who undertake a sea voyage for the recovery
CONSUMPTION.    15o 
 154    ON  PULMONARY CONSUMPTION.
 of their health, not to expose themselves upon deck
 in the morning and at night, after they arrive with-
 in the region in which the mixture of the land and
 sea airs may be supposed to take place.

  I subscribe, from what I have observed, to the
 bold declaration of Dr.  Sydenham, in  favour of
 the efficacy  of riding on horseback, in the cure of
 consumption.  I do not think the existence of an
 abscess,  when broken, or even tubercles in  the
 lungs, when recent, or of a moderate size, the least
objection to  the use of this excellent remedy.  An
abscess in the lungs is not necessarily  fatal, and
tubercles have no malignity in them which should
render their  removal impracticable by this species
of exercise.   The first question,  therefore,  to be
asked by a  physician who visits a patient in this
disease should be, not what is the state of his lungs,
but, is he able to ride on horseback.

  There are two methods  of riding for health in
this disease.    The first is by short excursions;
the  second is by long  journeys.   In slight  con-
sumptive affections, and after  a recovery from an
acute  illness, short excursions are sufficient to re-
move  the existing debility; but in the  more ad-
vanced stages of consumption, they are seldom ef-
fectual, and  frequently do  harm,  by exciting an 
ON  PULMONARY CONSUMPTION.
155
occasional appetite without adding to the digestive
powers.   They, moreover, keep the system con-
stantly vibrating by their unavoidable inconstancy,
between distant points of tone and debility*, and
they are unhappily accompanied at all times, from
the want of a succession of fresh objects to divert
the mind, by the melancholy  reflection that  they
are the sad, but necessary conditions of life.

    In a consumption of long continuance or of
great danger, long journeys on horseback are the
most effectual modes of exercise.   They afford a
constant succession of fresh objects and company,
which divert the mind from dwelling upon the dan-
 ger of the existing malady; they are moreover at-
 tended by a constant change of air, and they are
 not liable to be interrupted by company,  or transi-
 ent changes in the weather, by which means ap-
 petite and digestion, action and power, all  keep
 pace with each other.    It is to be lamented that
 the use of this excellent remedy is frequently op-
 posed by  indolence and narrow circumstances in
 both sexes, and by the peculiarity of situation and
 temper in the female sex.   Women are attached

   * The bad effects of inconstant exercise have been taken
 notice of in the gout.  Dr. Sydenham says, when it is used
 only by fits and starts in this disease, it does harm. 
 156     ON PULMONARY CONSUMPTION.
 to their families by stronger ties than men.  They
 cannot travel alone.   Their delicacy, which is in-
 creased by sickness, is liable to be offended at every
 stage;  and, lastly, they sooner relax in their ex-
 ertions to prolong their lives than men.   Of the
 truth of the last observation, sir William Hamil-
 ton has furnished us with a  striking illustration.
 He tells us, that  in digging  into the  ruins pro-
 duced by the late earthquake in Calabria, the wo-
 men who perished in it, were all found with their
 arms folded, as if they had abandoned themselves
 immediately to despair  and death;  whereas, the
 men were found with  their arms extended, as if
 they had resisted their fate to the last moment of
 their lives.   It would seem, from this fact, and
 many others of a similar nature which might be re-
 lated, that a capacity of bearing pain and distress
 with fortitude and  resignation, was the distinguish-
 ing characteristic of the female mind ; while a dis-
 position to resist and overcome evil, belonged in a
 more peculiar manner to the mind of man. I have
 mentioned this peculiarity of circumstances and
 temper in female patients,  only for the sake of con-
 vincing physicians that it will be necessary for them
to add all the force of eloquence to their advice,
when they recommed journeys to women in pre-
ference  to all other remedies,  for the recovery  of
their health. 
ON  PULMONARY
CONSUMPTION.
157
  Persons, moreover, who pursue active employ-
ments, frequently object to undertaking journeys,
from an  opinion that their daily occupations are
sufficient to produce all the salutary effects we ex-
pect from artificial exercise.  It will be highly ne-
cessary to correct  this mistake, by assuring such
persons that, however useful the habitual exercise
of an active,  or even a laborious employment may
be to preserve health, it must always be exchanged
for one which excites new impressions,  both upon
the mind and body, in every attempt to restore
the system from that debility which is  connected
with pulmonary consumption.

  As travelling is  often rendered useless, and even
hurtful in this disease,  from  being pursued in an
improper manner,   it will be necessary  to furnish
our patients with  such  directions as will enable
them to  derive the greatest benefit from their jour-
neys.  I shall, therefore, in this place, mention the
substance of  the directions which I have given  in
writing for many years to such consumptive pa-
tients as undertake journeys by my advice.

   1. To avoid fatigue.   Too much cannot be said
to enforce this direction.   It is the hinge on which
the recovery or death  of a consumptive patient
frequently turns.   I repeat it again, therefore, that
  VOL.  II.             x 
 158   ON PULMONARY CONSUMPTION.
 patients should be  charged over and over when
 they set off on a journey, as well as when they use
 exercise of any kind, to avoid fatigue.   For  this
 purpose they should begin by travelling only a few
 miles in a day, and increase the distance of their
 stages, as they increase their strengh. By neglect-
 ing this practice, many persons have returned from
journeys much worse than when they left home,
 and many have died in taverns, or at the houses of
 their friends on the road.   Travelling in stage-
 coaches is  seldom safe for a consumptive patient.
 They are often crowded; they give too much mo-
 tion ;  and they afford by their short delays and dis-
 tant stages, too little time for rest, or for taking the
 frequent refreshment which was formerly recom-
 mended.

  2. To avoid travelling too soon in the morning,
 and after the going down of the sun in the evening,
 and, if the  weather be hot, never to travel in the
middle of the day.  The sooner a patient break-
 fasts after he leaves his bed the better; and in no
 case  should he leave his morning stage with an
 empty stomach.

  3.  If it should be necessary for a patient to lie
 down, or to sleep in the day time, he should be
 advised to undress himself, and tg cover his body 
        ON PULMONARY  CONSUMPTION.    159
between sheets or blankets.   The usual ligatures
of garters,  stocks,  knee-bands, waistcoats,  and
shoes, are very unfriendly to sound sleep ;  hence
persons who lie down with their clothes on, often
awake from  an  afternoon's  nap in terror from
dreams, or in a profuse sweat, or with a head-ach
or sick stomach ; and generally  out of humour.
The surveyors are so sensible of the truth of this
remark,  that  they  always undress  themselves
when they  sleep  in the  woods.  An intelligent
gentleman of this profession informed me, that he
had  frequently seen young woodsmen,  who had
refused to conform to this practice,   so much in-
disposed in the morning,  that, after the experi
ence of a few nights, they were forced to adopt it.

   Great care should be tr.ken in sleeping, whe-
ther in the day time or at night, never to lie down
in damp sheets.   Dr. Sydenham excepts the dan-
ger from this quarter,  when he speaks of the ef-
ficacy of travelling on horseback in curing the con-
sumption.

   4.  Patients who travel  for health  in this disr
ease  should avoid all large companies, more espe-
cially evening and night  parties.   The air of a
contaminated room, phlogisticated by the breath
of fifteen or twenty persons,  and  by the  samp 
160    ON PULMONARY CONSUMPTION.
number of burning  candles, is poison to a con-
sumptive  patient.   To avoid  impure air from
every other source, he should likewise avoid sleep-
ing in a crowded  room, or with curtains around
his bed,  and ever? with a bed-fellow.

   5. Travelling,  to be effectual in this disease,
should be conducted in such a manner as that a
patient may escape the extremes of heat and cold.
For this  purpose  he should pass the winter,  and
part of the spring,  in Georgia or South-Carolina,
and the summer in  New-Hampshire,  Massachu-
setts, or Vermont, or,  if he pleases,  he may still
more effectually shun the summer heats, by cros-
sing the lakes,  and travelling along the shores of
the St. Laurence to the city of Quebec.   He will
thus escape the extremes of heat and cold, parti-
cularly the less avoidable one of heat; for I have
constantly found  the hot month of July to be as
unfriendly to consumptive patients in Pennsylva-
nia,  as the variable month  of March.  By these
means too he will enjoy nearly an equable tempe-
rature of air in  every month of the year ;   and his
system will be  free from the inconvenience of the
alternate action of heat and cold  upon it.   The
 autumnal months should be spent in New-Jersey
or Pennsylvania. 
        ON PULMONARY  CONSUMPTION.    161
   In these journeys from north to south, or from
 south to north, he should be careful, for reasons
 before mentioned, to keep at as great a distance
 as possible from the sea coast.   Should this inqui-
 ry fall into the hands of a British  physician, I
 would beg leave to suggest to him, whether more
 advantages would not accrue to his  consumptive
 patients from advising them to cross the Atlantic
 ocean,  and afterwards to pursue the tour which I
 have recommended, than by sending them to Por-
 tugal,  France,  or Italy.  Here they will  arrive
 with such a mitigation  of the violence of the di-
 sease,  in  consequence of the length of  their sea
 voyage, as will enable them immediately  to begin
 their journeys on horseback.  Here they will be
 exposed to fewer  temptations to intemperance, or
 to unhealthy amusements, than  in old European
 countries.  And,  lastly,  in the whole course of this
 tour, they will travel among a people related to
 them by a sameness of language and manners, and
 by ancient or modern ties of citizenship.   Long
journeys for the recovery of health, under circum-
 stances so agreeable, should certainly be perferred
to travelling among strangers of different nations,
languages,  and manners,  on  the continent of
 Europe. 
162     ON PULMONARY CONSUMPTION.
   6.  To render travelling on horseback effectual
in a consumption, if should be continued with mo-
derate  intervals from six to twelve months.   But
the cure should not be rested upon a single jour-
ney.    It should be  repeated every two or three
years, till our  patient has passed the consumptive
stages of life.  Nay, he must do more; he must
acquire a habit of riding constantly, both at home
and abroad ;  or, to use the  words of Dr. Fuller,
"  he must, like a Tartar, learn to live on horse-
"  back, by which means  he will acquire in time
"  the constitution of a Tartar*."

   Where benefit is expected from a change of cli-
mate,  as well as from travelling, patients should
reside at least two years in the place which is cho-
sen for that purpose.  I have seldom known a re-
sidence for a shorter time in a foreign  climate do
much service.

   To secure a perfect obedience to medical advice,
 it would be extremely useful if consumptive pa-
 tients could always 1** accompanied by a physician.
 Celsus says,  he  found it more  easy to cure the
 dropsy in  slaves than in freemen,  because they
 more readilv submitted  to the restraints he im*
*  Medicina Gymnastica, p. 116. 
        ON  PULMONARY  COSUMPTIONS.   163
posed upon their appetites.  Madness has become
a curable disease in England, since the physicians
of that country have  opened private mad-houses,
and have taken the entire and constant direction of
their  patients  into their  own hands.   The same
successful practice would probably follow the treat-
ment of consumptions, if patients were constantly
kept  under the eye and authority  of their physi-
cians.  The keenness of appetite, and great stock
of animal spirits, which those persons frequently
possess, hurry them into many excesses which de-
feat the best concerted plans of a recovery;  or, if
they escape these irregularities, they are frequently
seduced from our directions by every quack remc.
dy  which is recommended to  them.   Unfortu-
nately the cough becomes a signal of their disease,
at every stage of their journey,  and the easy or
pleasant prescriptions of even  hostlers and ferry-
men,  are often substituted to the self-denial and
exertion which have been imposed by physicians.
The love of life in these  cases  seems to  level all
capacities ; for I have  observed persons of the
most  cultivated understandings to  yield in  com-
mon with the vulgar, to the use of these  pre-
scriptions.

  In  a former volume I mentioned the  good ef-
fects  of accidental  labour  in pulmonary con- 
 164   ON PULMONARY CONSUMPTION.
 sumptions.   The reader will find a particular ac-
 count in the  first volume of Dr. Coxe's Medical
 Museum, of a clergyman and his wife,  in Virgi-
 nia, being cured  by the voluntary use of that
 remedy.

   The following circumstances and symptoms,
 indicate the longer or shorter duration of this di-
sease,  and its issue in life and death :

   The consumption from gout, rheumatism, and
 scrophula, is generally of long duration.    It  is
 more rapid in its progress to death, when it arises
 from  a half cured pleurisy, or neglected  colds,
 measles,  and influenza.   It is of shorter duration
 in persons under thirty,  than in those who are
 more advanced in lifev >

   It is always  dangerous in proportion  to the
 length of time,  in which the debilitating causes,
 that predisposed to it, have acted upon the  body.

   It is more dangerous when a predisposition to it
 has been derived from ancestors, than when it has
 been acquired.

  It is generally fatal when accompanied with a bad
 conformation of the breast. 
        ON PULMONARY  CONSUMPTION.      165

    Chilly fits occurring in the forenoon, are more
 favourable than when they occur in the evening.
 They indicate the disease to partake a little of the
 nature of an intermittent, and are a call for the use
 of the remedies proper in that disease.

   Rheumatic pains, attended with an abatement of
 the cough, or pains in the breast, are always favour-
 able ; so are

   Eruptions, or an abscess on the external parts of
 the body, if they occur before the last stage of the
 disease.

   A spitting of blood, in the early, or forming stage
 of the disease, is favourable, but after the lungs be-
 come  much  obstructed, or ulcerated, it is most
 commonly fatal.

   A pleurisy, occurring in the low state of the dis-
 ease, generally  kills,  but  I  have seen  a  case in
 which it suddenly removed the cough and hectic
 fever, and thus  became the means of prolonging
 the patient's life for several  years.       /

   The  discharge of calculi from the lungs by
coughing and spitting, and of a thin watery liquid,
with a small portion of pus swimming on its sur-
  VOL.  II.            y 
166    ON  PULMONARY  CONSUMPTION.
face, are commonly signs of an incurable consump-
tion.

  No prediction unfavourable to life can be drawn
from pus being discharged from the lungs.   We
see many recoveries after it has taken place,  and
many deaths where that,'symptom has been ab-
sent.  Large quantities of pus are discharged in
consumptions attended with abscesses, and yet few
die of them, 'where they have not been preceded
by   long continued debility of  the whole system.
No  pus is expectorated from tubercles, and how
generally fatal is the disease, after  they are formed
in the lungs!  It  is only  after  they  ulcerate that
they discharge pus, and it  is only after  ulcers
are  thus formed, that the consumption probably
becomes uniformly fatal.   I  suspect these ulcers
are  sometimes of a cancerous nature.

   A sudden cessation of the cough, without a su-
 pervening diarrhoea, indicates death to be at hand.

   A constant vomiting in a consumption,  is gene-
 arlly a bad sign.

   Feet obstinately cold, also a swelling of the feet
 during the day, and of the face in the night, com- 
        ON PULMONARY  CONSUMPTION.    167

 monly indicate a speedy and fatal issue of the dis-
 ease.

   Lice, andtheiallingoff of the hair, often precede
 death.

   A hoarseness, in the beginning of the disease, is
 always alarming, but it is more so in its last stage.

   A change of the eyes from a blue, or dark, to a
 light colour, similar to  that which takes place in
 very old people, is a sign of speedy dissolution.

   I  have never seen a recovery after an apthous
 sore throat took place.

   Death from the consumption comes on in some
 or more than one, of the following Avays :

   I. With a diarrhoea.   In its absence,

   2. With wasting night sweats.

   3. A rupture of an abscess.

  4.  A rupture of a large blood-vessel in the lungs,
attended with external or  internal haemorrhage. 
168    ON  PULMONARY  CONSUMPTION.
Sudden and unexpected death in a consumption is
generally induced by this, or the preceding cause.

  5. Madness.   The cough and expectoration
cease with this disease. It generally carries off the
patient in a week or ten days.

  6. A pleurisy, brought on by exposure to cold.

  7. A typhus fever, attended with tremors, twitch-
ings of the tendons, and a dry tongue.

   8, Swelled hands, feet, legs, thighs, and face.

   9. An apthous sore throat.

   10.  Great and tormenting pains, sometimes of a
spasmodic nature in the limbs.

   In a majority of the fatal cases of consumption,
 which I have seen,  the passage out of life has been
 attended with pain ;  but I have seen many persons
 die with it, in whom all the above symptoms were
 so lenient, or so completely  mitigated by opium,
 that death resembled a quit transition from a walk-
 ing, to a sleeping state. 
       ON PULMONARY CONSUMPTION.    169

  I cannot conclude this inquiry without adding,
that the author of it derived from his paternal an-
cestors a predisposition to the pulmonary consump-
tion, and that between the 18th and 43d years of
his age,  he has  occasionally been afflicted  with
many of the symptoms of that disease which he
has described.   By the constant and faithful  use
of many of the remdies which he has recommend-
ed, he now, at an advanced age, enjoys nearly an
uninterrupted  exemption from pulmonary com-
plaints.   In humble gratitude, therefore,  to that
Being, who  condescends to be called the pre-
server of men, he thus publicly devotes this result
of his experience and inquiries to the benefit of such
of his fellow-creatures as may be afflicted with die
same disease,  sincerely wishing that they may be
as useful to them, as they have been to the author. 
 
  OBSERVATIONS






        ON






THE CAUSE AND CURE






        OF






    DROPSIES. 
 
OBSERVATIONS,  &c.
       WHETHER we admit the exhaling  and
absorbing vessels to be affected in general dropsies
by preternatural debility, palsy, or rupture, or by
a retrograde motion of their fluids, it is certain that
their exhaling and absorbing power  is materially
affected by too much, or too little  action  in the
arterial system.  That too little action in the arte-
ries  should favour  dropsical effusions, has been
long observed;  but it has been less obvious, that
the same effusions  are sometimes promoted,  and
their absorption prevented, by too much action in
these vessels.  That this fact should have escaped
our notice isthe more remarkable, considering how
long we have been accustomed to  seeing  serous
swellings in the joints in the acute rheumatism,
and copious, but partial effusions of water in  the
  VOL. u.            z 
174
ON  DROPSIES.
form of sweat,  in every species of inflammatory
fever.

  It is nothing new that the healthy action of one
part, should  depend  upon  the  healthy action of
another part of the system.   We see it in many of
the diseases of the nerves and brain.  The tetanus
is cured by exciting a tone in the arterial system ;
madness is cured by lessening the action of the ar-
teries by copious blood-letting;  and epilepsy and
hysteria are often mitigated by the moderate use
of the same remedy.

  By  too  much action in the arterial system, I
mean a certain morbid excitement in the arteries,
accompanied by preternatural force, which is ob-
vious to  the sense of touch.   It differs from the
morbid excitement of the  arteries, which takes
place in common inflammatory fevers, in being at-
tended by less febrile heat, and with little  or no
pain in the head or limbs.    The  thirst  is nearly
the same in this state of dropsy, as in inflammatory
fevers.   I  include here those dropsies only  in
which the whole system is affected by what is called
a hydropic diathesis.

   That  debility should,  under certain circum-
stances, dispose to excessive action, and that exces- 
ON  DROPSIES.
175
 sive action should occur in one part of the body,
 at the same time that debility prevailed  in every
 other, are abundantly evident from the history and
 phenomena of many diseases.  Inflammatory fe-
 ver, active haemorrhages, tonic gout, asthma, apo-
 plexy, and palsy,  however much they are accom-
 panied by excessive action  in the  arterial system,
 are always preceded by original debility, and are
 always accompanied by obvious debility in every
 other part of the system.

   But it has been  less observed by physicians that
 an undue force or excess of action occurs in the
 arterial system in  certain dropsies, and that the
 same theory which explains the union of predis-
 posing and nearly  general debility,  with a partial
 excitement  and preternatural action in the arterial
 system, in the diseases before-mentioned, will ex-
 plain the symptoms and cure of certain dropsies.

   That  debility  predisposes to  every  state of
 dropsy, is evident from the history  of all  the re-
 mote and occasional causes  which produce them.
 It will be unnecessary to mention these causes, as
 they are  to be found in all our systems of physic.
 Nor will it be necessary to mention any proofs of
the existence of debility in nearly every part of the
body.  It is too plain to be denied.   I shall only 
176             ON  DROPSIES.
mention the symptoms which  indicate  a morbid
excitement and preternatural action of the arterial
system.  These are,

   1. A hard, full, and quick pulse.   This symp-
tom, I believe, is more common in dropsies than
is generally supposed,  for many physicians visit
and  examine patients in these diseases,  without
feeling the pulse.  Dr. Home  mentions  the fre-
quency of the pulse,  in the patients  whose cures
he has recorded*, but he takes no notice of  its
force except in two cases.  Dr. Zimmerman,  in
his account of the dropsy which terminated the
life  of Frederick II, of Prussia,  tells  us that he
found his pulse hard  and full.  I have repeatedly
found it full and hard  in every  form of dropsy,
and more especially in the first stage of the disease.
 Indeed I have seldom found  it otherwise in the
 beginning of the dropsy of the breast.

   2.  Sizy blood.   This has been taken notice of
 by many practical writers, and has very justly been
 ascribed, under  certain circumstances of  blood-
 letting, to an  excessive action  of the  vessels upon
 the blood.
* Medical Facts. 
ON  DROPSIES.
177
  3. Alternation of dropsies  with certain diseases
which were  evidently accompanied by excess of
action in the arterial system.   I have seen anasar-
ca alternate with  vertigo, and  both ascites and
anasarca alternate with tonic madness.  A case of
nearly  the  same  kind  is related by Dr.  Mead.
Dr.  Grimes, of Georgia, informed me that he had
seen a tertian fever,  in  which  the  intermissions
were attended with dropsical swellings all over the
body,  which suddenly  disappeared in every ac-
cession of a paroxysm of the fever.

  4.  The occasional connexion of certain dropsies
with diseases evidendy of an inflammatory nature,
particularly pneumony, rheumatism, and gout.

  5.  Spontaneous haemorrhages from the  lungs,
haemorrhodial vessels, and nose, cases of which
shall be mentioned hereafter, when we come to
treat of the cure of dropsies.

  6.  The appearance of dropsies in the winter and
spring,  in habits previously affected by the inter-
mitting fever.   The debility produced by this state
of fever, frequently disposes to inflammatory dia-
thesis, as soon as the body is exposed to the alter-
nate  action of heat and cold, nor is this inflamma-
tory  diathesis always laid  aside, by the transition 
178             ON  DROPSIES.
of the intermitting fever into a dropsy, in the suc-
ceeding cold weather.

  7. The injurious effects of stimulating medicines
in certain dropsies, prove diat there exists in them,
at times, too  much action in the blood-vessels.
Dr. Tissot, in a letter to Dr.  Haller, " De Vario-
" lis, apoplexia, cthydrope," condemns, in strong
terms, the use of opium in the dropsy.   Now the
bad effects of this medicine in dropsies, must have
arisen from its having been given in cases of too
much action in the arterial system;  for opium, we
know, increases, by its stimulating qualities, the
action and tone of the blood-vessels, and hence we
find, it has been prescribed with success  in drop-
sies of too little action in the system.

   8.  The termination of certain fevers in dropsies
in  which blood-letting wras not  used.   This has
been  ascertained by  many  observations.   Dr.
Wilkes relates*, that after " an epidemical fever,
which began in Kidderminster, in 1728, and soon
afterwards spread, not only over Great Britain, but
all Europe, more people  died dropsical  in  three
years, than did perhaps in twenty  or thirty years
*  Historical Essay on the Dropsy, p. 326. 
ON  DROPSIES.
179
before,"  probably from the neglect of bleeding in
the fever.

   But the existence  of  too much action in the
arterial system in certain dropsies, will appear more
fully from the history of the effects of the remedies
which have been employed either by design or ac-
cident in the cure of these diseases.  I shall  first
mention the remedies which have been used with
success in tonic  or inflammatory dropsies;  and
afterwards mention those  which have been given
with  success in dropsies  of a weak action in the
arteries.   I have constantly proposed to treat only
of the theory and cure of dropsies in general, with-
out specifying any of the numerous names it de-
rives from the different parts of the body in which
they may be seated; but in speaking of the reme-
dies which have been used with advantage in both
the tonic and atonic states, I shall occasionally men-
tion the name or  seat of the dropsy in which the
remedy has  done  service.

   The first remedy that I shall mention for drop-
sies is blood-letting. Dr. Hoffman and  Dr. Home
both cured dropsies accompanied by pulmonic con-
gestion by  means of this remedy.  Dr.  Monroe
quotes a case  of dropsy  from Sponius, in which
bleeding succeeded, but not till after it had been 
180
ON  DROPSIES.
used  twenty times*.   Mr. Cruikshank relates a
casef  of accidental bleeding, which confirms the
efficacy of blood-letting in these diseases.  He
tells us that he attended a patient with dropsical
swellings  in his legs, who had had  a hoarseness
for two years. One morning, in stooping to buckle
his shoes, he bursted a blood-vessel  in his  lungs,
from  which  he lost a  quart of blood; in  conse-
quence of which, both the swellings and the hoarse-
ness went off gradually, and he continued well two
years afterwards.  I have known one case, in which
spontaneous haemorrhages from the haemorrhodial
vessels, and from the nose, suddenly reduced uni-
versal dropsical swellings.   In this patient there
had been an uncommon tension and fulness in the
pulse.

   I could add the histories of many cures of ana-
sarca and  ascites,  performed by means of  blood-
letting, not only by myself, but by  a number of
respectable physicians  in the United States.  In-
deed I conceive this remedy to be as much indi-
cated by a tense and full pulse in those forms of
dropsy, as it is in a pleurisy, or in any other com-
mon inflammatory disease.

  * Treatise on the Dropsy.
* Treatise on the Lymphatics. 
ON  DROPSIES.
181
    In those deplorable cases of hydrothorax, which
 do not admit of a radical cure, I have given tem-
 porary relief, and thereby protracted life, by taking
 away occasionally a few ounces of blood.    Had
 Dr.  Zimmerman used this remedy in the case of
 the king of  Prussia, I cannot help thinking from
 the acconnt  which the doctor gives us of the diet
 and pulse of his royal patient, that he would have
 lessened his  sufferings much more than by plenti-
 ful doses of dandelion;  for I take it  for granted,
 from the candour and integrity which the doctor
 discovered in all his visits to the king, that he did
 not expect that dandelion, or any other medicine,
 would cure him.

   Although  a  full  and  tense pulse is always an
 indication of the necessity of bleeding; jet  I can
 easily conceive there may be such congestions, and
 such a degree of stimulus to the arterial system, as
 to produce a depressed,  or a low or weak pulse.
 Two cases of this kind are related by Dr. Monroe,
 one of which was cured  by bleeding.   The same
 symptom of a low and weak pulse is  often met
 with in the first stage of pneumony, and apoplexy,
and is only to be removed by the plentiful use of
the same remedy.
VOL.  II.
a a 
182             ON  DROPSIES.
  II.  Vomits  have often been given with advan-
tage in dropsies.    Dr. Home says, that squills
were useful in these diseases only when they pro-
duced a vomiting.  By abstracting excitement and
action from the arterial system, it disposes the lym-
phatics to absorb and discharge large quantities of
water.  The efficacy of vomits in promoting the
absorption of stagnating fluids  is not confined to
dropsies.  Mr.  Hunter was once called to visit a
patient in whom he found  a bubo in such a state
that he purposed to open it the next day.  In the
mean while, the patient went on board of a vessel,
where he was severely affected by sea-sickness and
vomiting; in consequence of which the bubo dis-
appeared, and the patient recovered without the use
of the knife.

   Mr. Cruikshank further mentions a case* of a
 swelling in the knee  being nearly  cured by a pa-
 tientvomitingeightand forty hours, in consequence
 of his taking a large dose of the salt of tartar instead
 of soluble tartar.

    III. Purges.   The efficacy of this  remedy, in
 the cure of  dropsies, has been acknowledged by
 physicians in all ages and countries.  Jalap, calo-
* Letter to Mr. Clare, p.  166. 
ON  DROPSIES.
183
mel, scammony, and gamboge, are often preferred
for this purpose; but I have heard  of two cases
of ascites being cured by a table spoonful of sweet
oil taken every day.  It probably acted only as a
gentle laxative.   The cream of tartar, so highly
commended by Dr.  Home, seems to act chiefly in
the same way.  Gherlius, from whom Dr. Home
learned the use of this medicine, says, that all the
persons whom he cured by it were in the vigour of
life, and that their diseases had been only of a few
months continuance.   From these two circum-
stances, it is most probable they were dropsies of
great  morbid action in the arterial system.    He
adds further, that the persons who were cured by
this medicine, wire  reduced very low by the use
of it.   Dr. Home says that it produced the same
effect  upon the patients whom he cured by  it, in
the infirmary of Edinburgh.  Dr. Sydenham pre-
fers gentle to drastic purges, and recommends the
exhibition of them every day.  Both drastic and
gentle purges act by diminishing the action of the
arterial system, and thereby promote die absorption
and discharge of water.   That purges promote ab-
sorption, we learn not only from their  effects in
dropsies, but from an experiment related by Mr.
Cruikshank*,  of a  man who  acquired several

   " Letter to Mr. Clare, p. 117. 
184
ON  DROPSIES.
 ounces of weight after the operation of a purge.
 The  absorption in this case was from the  atmo-
 sphere.   So great is the effect of purges in pro-
 moting absorption, that Mr. Hunter supposes the
 matter  of a gonorrhoea, or of topical venereal ul-
 cers to be conveyed  by them in some  instances
 into every part of the body.

   IV.  Certain medicines, which, by lessening the
 action of the arterial system, favour the absorption
 and evacuation of water.   The only medicines of
 this class which  I  shall name are nitre,  cream of
 tartar, and foxglove.

   1.  Two ounces of nitre dissolved in a pint of
 water, and a wine-glass full of it taken three times
 a-day have performed perfect cures, in two cases
 of ascites, which have  come under my notice.   I
 think I  have cured two  persons of anasarca, by
 giving  one  scruple of the same medicine  three
 times a-day for several weeks.  The two last cures
 were evidently dropsies of violent action in the ar-
 terial system.   Where nitre has been given in ato-
 nic dropsies it has generally been useless, and some-
 times done harm.  I have seen one instance of an
 incurable diarrhoea after tapping, which I suspected
arose  from the destruction of the tone of the sto-
mach and bowels,  by large and long continued 
ON  DROPSIES.
185
doses of nitre, which the patient had previously
taken by the advice of a person who had been cured
by that remedy.   To avoid this, or any other in-
convenience from the use of nitre in dropsies,  it
should be given at first in small doses, and should
always be laid aside,  if it should prove ineffectual
after having been given two or three weeks.

  2.  I  can say nothing of the efficacy of cream of
tartar in dropsies from my own experience, where
it has not acted as a purge.   Perhaps my want of
decision upon this subject has arisen only from my
not having persisted  in the  use  of it for the same
length of time which  is mentioned by Dr. Home.

   3.  There are different opinions cencerning the
efficacy of fox-glove in dropsies.  From the cases
related by Dr. Withering, it appears to have done
good;  but from those related by Dr. Lettsom* it
seems to have done harm.  I suspect the different
accounts of those two gentlemen have arisen from
their having given it  in different states of the sys-
tem,  or perhaps from a difference in the quality of
the plant from causes  mentioned in another placef.

  * Medical Memoirs, vol. II.
  f Inquiry into the Causes and Cure of Pulmonary Con-
sumption. 
186
ON  DROPSIES.
I am sorry to add further, that after many trials of
this medicine I have failed in most of the cases in
which I have given it.   I have discharged the wa-
ter in three instances by it, but the disease return-
ed, and my patients finally died.   I can ascribe
only one complete cure to its use, which was in
the year 1789, in a young man in  the Pennsylva-
nia hospital,  of  five and  thirty years of age, of a
robust habit, and plethoric pulse.

   Where medicines have once been in use, and
afterwards fall into disrepute, as was the case with
the foxglove, I  suspect the cases in which they
were useful, to have been either few or doubtful,
and that the cases in which they have done harm,
were so much more numerous and unequivocal,
as justly to banish them from the materia medica.

   V. Hard  labour,  or exercise in such a degree
as to produce fatigne, have, in several instances,
cured the dropsy.   A  dispensary patient, in this
citv, was cured of this disease by sawing  wood.
And a patient in an ascites under my care in the
Pennsylvania hospital, had his belly reduced seven
inches in  circumference in one day, by the labour
of carrying wood from the yard into the hospital.
A second patient  belonging to the Philadelphia
dispensary was cured by walking to Lancaster, 66 
ON  DROPSIES.
187
 miles from the city, in the middle of winter. The
 efficacy of travelling in this disease, in cold wea-
 ther, is taken notice of by Dr. Monroe, who quo-
 tes a case from Dr. Holler, of a French merchant,
 who was cured of dropsy by a journey from Paris
 to England, in the winter season. It would seem,
 that in  these two cases, the cold co-operated as a
 sedative with the fatigue produced by labour  or
 exercise, in reducing the tone of the arterial sys-
 tem.

   VI.  Low diet.   I have heard of a woman who
 was cured of a dropsy by eating nothing but boil-
 ed beans for three weeks, and drinking nothing
 but the water in which they had been boiled. Ma-
 ny other  cases  of the good effects of low diet in
 dropsies are to be found in the records of medicine.

   VII.  Thirst.   This cruel remedy acts by de-
 bilitating the system in two ways :  1st, by abstract-
 ing the  stimulus of distension ; and, 2dly, by pre-
 venting a supply  of fresh water to replace  that
 which is discharged by the ordinary emunctories
 of nature.

   VIII. Fasting.   An  accidental circumstance,
related  by  sir John Hawkins, in the life of Dr.
Johnson, first led me to observe the good effects 
188
ON  DROPSIES.
 of fasting in  the  dropsy.   If the fact alluded to
 stood alone under the present head of this essay, it
 would be sufficient to establish the existence of too
 much action, and the efficacy of debilitating reme-
 dies in certain dropsies.  I am the more disposed
 to lay a good deal of stress upon this fact, as it was
 the clue  which conducted me  out of the labyrinth
 of empirical practice, in which I had been bewilder-
 ed for many years, and finally led me to adopt  the
 principles and practice which I am now endeavour-
 ing to establish. The passage  which contains this
 interesting fact is as  follows:  "A few days  af-
 " ter (says sir John) he [meaning Dr. Johnson]
 " sent for me, and informed me, that he had dis-
 " covered  in himself the symptoms of a dropsy,
 " and, indeed, his very much increased bulk and
 " the swollen  appearance of his legs, seemed to
 " indicate  no  less.   It was on  Thursday that I
 " had this  conversation with him ; in the course
" thereof he declared, that he  intended to devote
" the whole of the next  day to fasting,  humilia-
" tion, and such other devotional exercises as be-
" came a man  in his situation.   On the Saturday
" following I made him a  visit,  and, upon entering
" his room, I observed in his countenance such a
" serenity as indicated, that some remarkable crisis
" of his  disease had produced  a change in  his
" feelings.  He told me that, pursuant to the rcso- 
ON  DROPSIES.
189
" lution he had mentioned to me, he had spent the
" preceding day in an abstraction from all worldly
" concerns; that to prevent interruption he had, in
" the morning ordered Frank [his servant] not to
" admit any one to him, and, the better to enforce
" the charge,  had added  these awful words, for
" your master is preparing  himself to die.   He
" then mentioned to  me, that in the course of this
" exercise  he found himself relieved from the dis-
" ease which had been growing upon him, and was
" becoming very oppressive, viz. the dropsy, by
" the gradual evacuation of water, to the amount
" of twenty pints, a like instance whereof he  had
" never before experienced."  Sir John Hawkins
ascribes this immense discharge water to the in-
fluence of Dr.  Johnson's prayers; but he  neglects
to take notice, that these prayers were answered,
in this intance, as they are  in many others,   in a
perfect consistence with the common and esta-
blished laws of nature.

   To satisfy myself  that this discharge of water,
in the case of Dr. Johnson, was produced by the
fasting only, I recommended it, soon after I read
the above account, to a gentlewoman whom I  was
then attending in an ascites.  I was delighted with
the effects of it.  Her urine, which for some time
before had notexceeded half a pint a-day, amounted
   vol.  n.            b b 
190
ON
DROPSIES.
to two  quarts on the day she fasted.   I repeated
the same  prescription once  a  week  for  several
weeks, and each time was informed of an increase
of urine, though it was considerably less in the last
experiments than in the first.  Two patients in an
ascites,  to whom I prescribed the same remedy, in
the Pennsylvania hospital,  the  one in the winter
of 1790, and the other in the winter of 1792, ex-
hibited  proofs in the presence of many of the stu-
dents of the university, equally satisfactory of the
efficacy of fasting in suddenly increasing the quan-
tity of urine.

   IX.  Fear.  This passion is  evidently of a de-
bilitating nature, and, therefore, it has frequently
afforded an accidental aid in the cure of dropsies,
of too much action.  I suspect, that the  fear of
death, which was so distinguishing a part of the
character  of Dr. Johnson, added a good deal to
the efficacy of fasting, in procuring the immense
discharge of water before-mentioned.   In  support
of the efficacy of fear simply applied,  in discharg-
ing water from the body in dropsies,  I shall men-
tion the following facts.

   In a letter which I  received  from Dr.  John
Pennington, dated Edinburgh,  August 3, 1790, I
was favoured with  the following  communication. 
ON  DROPSIES.
191
 " Since the conversation I had with you on the sub-
 " ject of the dropsy, I feel more and more inclined
 " to adopt your opinion.   I can furnish you with
 " a fact which I learned  from a Danish sailor, on
 " my passage to this country, which is much in fa-
 " vour of your doctrine.  A sailor in an ascites,
 " fell off the end of the yard into the sea;  the wea-
 " ther being calm, he was taken up unhurt, but,
 " to  use  the  sailor's words,  who told me the
 " story,  he was frightened half to death, and as
 " soon as he was taken out of the water, he dis-
 " charged a gallon of urine or more.   A doctor
 " on  board ascribed this large evacuation to sea
 " bathing, and accordingly ordered the man to be
 " dipped  in the sea every morning, much against
 " his will, for, my  informant adds,  that he had
 " not forgotten his fall, and that in four weeks he
 " was perfectly well.  I think  this fact can only
 " be explained on your principles.  The sedative
 " operation of fear was, no doubt, the cause of his
 " cure."

  There is an account of an ascite being cured by
 a fall from an open chaise,  recorded  in the  third
 volume of the Medical Memoirs, by M. Lowdell.
 I have heard of a complete recovery from dropsy,
having suddenly followed a fall from a horse.  In 
192
ON  DROPSIES.
both these cases,  the cures were probably the ef-
fects of fear.

  Dr. Hall,  of York-town, in Pennsylvania, in-
formed me, that he had been called to visit a young
woman of 19 years of age, who had taken all the
usual remedies for ascites without effect.   He at
once proposed to her the operation of tapping.
To this she objected, but so great was the fear of
this operation,  which the proposal of it suddenly
excited in her mind, that it brought on a plentiful
discharge of urine,  which in a few days perfectly
removed her disease.

  On the 27th of August, 1790,1 visited a gentle-
woman in this city with the late Dr. Jones, in an
ascites.   We told her for the first time, that she
could not be relieved without being tapped.   She
appeared to  be much terrified upon hearing our
opinion,  and said that she would consider of it. I
saw her two days afterwards, when she told me,
with a smile  on her countenance, that she hoped
she should get well without tapping, for that she
dad discharged two quarts of water in the course
of the day after we  had advised  her to submit to
that operation.  For  many days before, she had
not discharged more than two or three gills in
twenty-four hours.   The operation, notwithstand- 
ON  DROPSIES.
193
ing,  was still indicated, and she submitted to be
tapped a few days afterwards.

  I tapped the same gentlewoman a second time,
in January, 1791.  She was much terrified while
I was preparing for the operation, and fainted im-
mediately after the puncture was made.   The se-
cond time that I visited her after the operation was
performed, she told me (without being interroga-
ted on that subject), that she had discharged a pint
and a half of urine, within twenty minutes after I
left the room on the day I tapped her.  What
made this discharge the more remarkable was,  she
had not made more than a table spoonful of water
in a day, for several days before she was tapped.

  I have seen similar discharges of urine in two
other cases of tapping which have come under my
notice, but they resembled so nearly those which
have been mentioned, that it will be unnecessary
to record them.

  But the influence of fear upon the system, in the
dropsy, extends far  beyond the effects which I
have ascribed to it.   Dr.  Currie, of this city, in-
formed me that he called, some years ago,  by ap-
pointment, to tap a woman.  He no sooner enter-
ed the room than he observed her, as he thought, 
194
ON  DROPSIES.
to faint away.   He attempted to recover her, but
to no purpose.   She died of  a sudden paroxysm
of fear.

  It is a matter  of  surprise, that we  should have
remained so long ignorant of the influence of fear
upon the urinary organs in dropsies, after having
been so long familiar with the same effect of that
passion in the hysteria.

  X. A recumbent posture of  the  body.  It is
most useful when the dropsy is seated in the lower
limbs.   I have often seen, with great pleasure, the
happiest effects from this prescription in a few days.

  XI.  Punctures. These,  when made in the legs
and feet, often discharge in eight and forty hours
the water of the whole body.  I  have never seen a
mortification produced by them.   As they are not
followed by inflammation, they should be preferred
to blisters, which are sometimes used for the same
purpose.

  I cannot dismiss the remedies which discharge
water from the body dirough the urinary passages,
without taking notice, that they furnish  an addi-
tional argument in favour of blood-letting in drop-
sies, for they act, not by dbcharging the stagnating 
ON  DROPSIES.
195
 water, but by creating such a plentiful secretion
 in the kidneys from the serum of the circulating
 blood, as to make room for the absorption and con-
 veyance of the  stagnating water into the  blood-
 vessels.

   Now the same effect may be  produced in all
 tonic or inflammatory dropsies, with more certainty
 and safety, by means of blood-letting.

   In recommending the antiphlogistic treatment
 of certain dropsies,  I must here confine myself to
 the dropsies of such climates as dispose to diseases
 of great morbid action  in the system.   I am satis-
 fied that it will often be proper  in the middle  and
 eastern states of America; and I have lately met
 with  two  observations, which show  that it has
 been used with success at Vienna,  in Germany.
 Dr.  Stoll tells us, that, in the  month of January,
 1780, " Hydropic and asthmatic patients discover-
 " ed more or less marks of inflammatory diathesis,
 " and that blood was drawn from them with a spar.
 " ing hand  with advantage;"   and in  the month
 of November,  of the same year,  he says,  " The
 " stronger diuretics injured dropsical  patients in
" this season ; but an antiphlogistic drink, compos-
" ed of a quart of the decoction  of grass, with two
" ounces of simple  oxymel, and nitre and cream 
196
ON  DROPSIES.
" of tartar,  of each a drachm, did service*."  It
is probable that the same difference should be ob-
served between the treatment of dropsies in warm
and cold climates that is observed in the treatment
of fevers.  The tonic action probably exists in the
system in both countries.   In the former it resem-
bles the tides which are are suddenly produced by
a  shower  of rain, and as suddenly disappear;
whereas, in the latter, it may be compared to those
tides which are produced by the flow and gradual
addition  of water from  numerous streams, and
which continue for days and weeks together to ex-
hibit marks of violence in every part of their course.

  I come  now to say a few words upon atonic
dropsies, or such as are accompanied with a feeble
morbid action in the blood-vessels.  This morbid
action is essential to the  nature of  dropsies, for  we
never see them take place without it.   This is ob-
vious from the absence of swellings after famine,
marasmus, and in extreme old age,  in each of which
there exists the lowest degree of  debility, but no
morbid action in the blood-vessels.  These atonic
or typhus  dropsies  may easily be distinguished
from those which have been described, by  occur-

  * Ratio Medendi Nosocomio Practico Vindobonensi, vol.
iv. p. 56 and 99. 
ON  DROPSIES.
197
ring in habits naturally weak ;  by  being produced
by the operation of chronic causes; by a weak and
quick pulse ;  and by little or no preternatural heat
or thirst.

   The remedies  for atonic dropsies are all such
stimulating substances as increase the action of the
arterial system, or determine the fluids to the uri-
nary organs.   These are,

   I. Bitter and aromatic substances of all kinds,
exhibited in substance or in infusions of wine, spi-
rit, beer, or water.

   II. Certain acrid vegetables, such  as  scurvy.
grass, horse-radish, mustard, water-cresses,  and
garlic.   I knew  an old man who was perfectly
cured of an anasarca, by eating water-cresses, on
bread and  butter.

   III. Opium.  The efficacy of this medicine in
dropsies has been  attested by Dr. Willis, and se-
veral other practical writers.   It seems to possess
almost an exclusive power of acting alike upon the
arterial, the lymphatic, the glandular, and the ner-
vous systems.
VOL.  n.
c c 
198
ON
DROPSIES.
  IV.  Metallic tonics, such as chalybeate medi-
cines of all kinds, and the mild preparations of cop-
per and mercury.  I once cured an incipient ascites
and anasarca by large  doses of the rust of iron;
and I have cured many dropsies by giving mercury
in such quantities as to excite a plentiful salivation.
I have, it is true, often given it without effect, pro-
bably from my former  ignorance  of the violent
action  of the arteries, which so frequently occurs
in dropsies,  and in which cases mercury-must ne-
cessarily have done harm.

  V.  Diuretics, consisting of alkaline salts, nitre,
and the oxymels of squills and colchicum.   It is
difficult to determine how far these medicines pro-
duce their salutary effects by acting directly upon
the kidneys.   It  is remarkable that these organs
are seldom affected in dropsies, and that their dis-
eases are rarely followed by dropsical effusions in
any part  of the body.

  VI.  Generous diet, consisting  of animal food,
rendered cordial by spices; also sound old wine.

  VII.  Diluting  drinks taken  in such large quan-
tities as  to excite the action of the vessels by the
stimulus of distention.  This effect has been pro-
duced, sir George Baker informs us, by means of 
ON  DROPSIES.
199
large draughts of simple water, and of cyder and
water*.   The influence of distention in promoting
absorption is evident in the urinary and gall blad-
ders, which frequently return their contents to the
blood by  the  lymphatics, when  they are unable
to discharge them through their usual emunctories.
Is it not probable that the distention produced by
the large quantities of liquids which we are directed
to administer after giving the foxglove, may have
been the means of performing some of those cures
of dropsies, which have been ascribed to that  re-
medy?

   VIII. Pressure. Bandages bound tightly around
the belly  and  limbs,  sometimes  prevent the in-
crease or return  of dropsical swellings.   The in-
fluence of pressure upon the action of the lympha-
tics  appears in the absorption of bone which fre-
quently follows the pressure of contiguous tumours,
also in the absorption of flesh which follows the
long pressure of certain parts of the body upon a
sick bed.

  * The remark upon this fact by  sir  George, is worthy
of notice, and implies much more than was probably intend-
ed by it.  " When common means have failed, success has
" sometimes followed a method directly contrary to the es-
" tablished  practice."  Medical Transactions, vol. II. 
200
ON  DROPSIES.
  IX.  Frictions, either by means of a dry, or oiled
hand, or with linen or flannel impregnated with
volatine and other stimulating substances.   I have
found evident advantages from following the advice
of Dr.  Cullen, by rubbing the lower extremities
upwards, and that only in the morning.   I have
been at a loss to account for the manner in which
sweet oil acts, when applied to dropsical swellings.
If it act  by what is improperly called a sedative
power upon the blood-vessels, it will be more pro-
per in tonic than  atonic dropsies ;  but if it act by
closing the pores, and thereby preventing the ab-
sorption of moisture from the air, it will be very
proper  in the state of dropsy which is now under
consideration.  It is in this manner that Dr.  Cullen
supposes that sweet oil, when applied to the body,
cures that state of diabetes in which nothing but
insipid water is discharged from the bladder.

   X.  Heat, applied either separately or combined
with moisture in the form of warm or vapour baths,
has been often used with success in dropsies of too
little action.   Dampier,  in his voyage  round the
world, was cured of a dropsy by means of a copi-
ous sweat, excited by burying himself in a bed of
warm sand.   Warm fomentations to the legs, ren-
dered  moderately  stimulating by the addition of
saline or aromatic substances, have often done ser- 
                  ON DROPSIES.             201
 vice in the atonic dropsical swellings in the lower
 extremities.

    XI. The cold bath.  I can say nothing in favour
 of the efficacy of this remedy in dropsies, from my
 own experience.  Its good effects seem to depend
 wholy on  its increasing the excitability of the
 system to common stimuli, by the diminution of
 its excitement.   If this be the case, I would ask,
 whether fear might not be employed  for the same
 purpose,  and thus become as useful in atonic, as
 it was formerly  proved to be in tonic dropsies ?

   XII. Wounds, whether excited by cutting in-
 struments or by fire,  provided they excite inflam-
 mation and action in  the arteries, frequently cure
 atonic dropsies.   The good effects of inflammation
 and action in these  cases,  appear in die cure of
 hydrocele by means of the needle, or the caustic.

   XIII. Exercise. This is probably as necessary
 m the atonic dropsy  as it is in the consumption,
 and should never be omitted when a patient is able
 to take it.   The passive exercises  of swinging,
 and riding in  a  carriage,  are  most proper in the
 lowest stage of  the disease;  but as soon as the
patient's strength will  admit of it, he should ride 
202
ON  DROPSIES.
on horseback.  A journey  should  be preferred,
in this disease, to short excursions from  home.

  XIV. A recumbent posture of the body should
always be advised during the intervals of exercise,
when the swellings are seated in the lower extre-
meties.

  XV. Punctures in the legs and feet afford the
same relief in general dropsy, accompanied with a
weak action in the blood-vessels, that has been as-
cribed to them in dropsies of an opposite character.

  In the application of each of the remedies which
have  been mentioned, for the cure of both tonic
and atonic  dropsies, great care  should be taken to
use them in such a manner,  as to  accommodate
them to the strength and excitability of the pa-
tient's system.  The most powerful remedies have
often been  rendered hurtful,  by  being given in too
large doses in the beginning, and useless, by being
given in too small doses in the subsequent  stages
of the disease.

  I  have  avoided saying any  thing of the usual
operations  for  discharging  water from different
parts  of the body, as my design was to treat only
of the symptoms and cure of those dropsies which 
                  ON  DROPSIES.             203
 affect the whole system. I shall only remark, that
 if tapping and punctures have been more success-
 ful  in the early, than in the late stages of these dis-
 eases, it is probably because the sudden or gradual
 evacuation of water takes down that excessive ac-
 tion in the arterial system, which is most common
 in their early stage, and thereby favours the speedy
 restoration  of healthy action  in the exhaling  or
 lymphatic vessels.

  Thus have I endeavoured to prove, that two
 different  states of action  take place in dropsies,
 and have mentioned the remedies which are pro-
 per  for each  of them under separate heads.  But I
 suspect that dropsies are often connected with a
 certain intermediate or mixed action in  the arterial
 system, analogous to the  typhoid action  which
 takes place in certain fevers.   I am led to adopt
 this  opinion, not only from having observed mix-
 ed action to be so universal  in most  of the dis-
 eases of the  arterial and nervous system, but be-
 cause I have so frequently observed dropsical swel-
 lings to follow the scarlatina, and the puerperile fe-
 ver,  two diseases which appear to derive their pe-
 culiar character from a mixture of excessive and
 moderate force,  combined with irregularity of ac-
tion  in the arterial system.   In dropsies of mixed
action, where too much force prevails in  the action 
204
ON  DROPSIES.
of some, and too little in the action of other of the
arterial fibres, the remedies must be debilitating or
stimulating according to the greater or less predo-
minance of tonic or atonic diathesis in the arterial
system.

  I shall conclude this history of dropsies, and of
the different  and  opposite remedies  which have
cured them, by the following observations.

  1. We learn, in the  first place, from what has
been said, the impropriety and even danger of pre-
scribing stimulating medicines indiscriminately in
every case of dropsy.

 2. We  are taught, by the facts which have been
mentioned, the reason why physicians  have differ-
ed so much in their accounts of the same remedies,
and why the same remedies have operated so dif-
ferently in the hands of the same physicians.   It
is because they have been given without a refer-
ence to the  different states of the system, which
have been described.    Dr. Sydenham says,  that
he cured the first dropsical patient he was called
to, by frequent purges.   He began to  exult in the
discovery, as he  thought,  of a certain cure for
dropsies,  but his triumph was of short duration.
The same remedy failed in the next case in which
he prescribed it.   The reason probably was, the 
ON  DROPSIES.
205
 dropsy in the'first case was of a tonic, but in the
 second of an atonic nature;  for  the latter was an
 ascites from a quartan ague.   It is agreeable, how-
 ever,  to  discover, from the  theory of dropsies
 which has been laid down, that all the different re-
 medies for these diseases have been proper in then-
 nature, and  improper only in the state  of the sys-
 tem in which they have been given.  As the disco-
 very of truth in religion reconciles the principles
 of the most opposite sects, so the discovery of truth
 in medicine reconciles  the  most opposite modes
 of practice.  It would be happy if the inquirers af-
 ter truth  in  medicine should be taught,  by such
 discoveries,  to treat each other with tenderness and
 respect, and to wait with patience till accident, or
 time,  shall combine into one perfect and consistent
 system, all the contradictory facts and opinions,
 about which physicians have been so long divided.

   3.  If a state of great morbid action in  the arte-
 ries has been demonstrated in dropsies, both from
 its symptoms and remedies, and if these  dropsies
 are evidently produced by previous debility, who
 will deny the existence of a similar action in certain
 haemorrhages, in gout, palsy, apoplexy, and mad-
ness,  notwithstanding they are all the offspring of
predisposing'debility? And who will deny the  ef-
ficacy of bleeding, purges, and other debilitating   <
 VOL. II.              D d 
206
ON  DROPSIES.
medicines in certain states of those diseases, that
has seen the same medicines administered with
success in certain dropsies ?  To reject bleeding,
purging, and the other remedies for violent action
in the system, in any of the above diseases, be-
cause that action was preceded by general debility,
will lead us  to reject them in the most acute  in-
flammatory fevers,  for these are as much the off-
spring of  previous debility  as dropsies or palsy.
The previous debility of the former differs from
that of the latter diseases, only in being of a more
acute, or,  in other wrords, of a shorter duration.

   4.  From the symptoms of tonic dropsy which
have been mentioned, it follows,  that the distincr
tion of apoplexy into serous and sanguineous, af-
fords no rational indication  for a difference in the
mode of treating that disease.   If an effusion of
serum in the thorax, bowels, or limbs, produce a
hard and full pulse, it is reasonable to suppose that
the same symptom will be produced by the effusion
of serum  in the brain. But the dissections collect-
ed by Lieutaud* place this  opinion beyond all
controversy.  They prove  that the symptoms of
great and feeble morbid action,  as they appear  in
the  pulse, follow alike the effusion of serum and

         * Historia Anatomico Medica, vol. II. 
ON  DROPSIES.
207
 blood in the brain.  This fact will admit of an im-
 portant application to the disease, which is to be
 the subject of the next inquiry.

   5. From the influence which has been described,
 of the different states of action of the arterial sys-
 tem, upon the lymphatic vessels, in dropsies, we
 are led  to reject the indiscriminate use of bark,
 mercury, and salt water, in the scrophula.   When
 the action of the arteries is weak, those remedies
 are proper; but when an opposite state of the arte-
 rial system occurs, and, above all, when scrophu-
 lous tumours are attended with inflammatory ul-
 cers, stimulating medicines of all kinds are hurt-
 ful.  By alternating  the  above  remedies  with a
 milk and vegetable diet, according to the tonic, or
 atonic states of the arterial system, I have succeed-
 ed in the cure of a case of scrophula, attended by
 large ulcers in the inguinal glands, which had for
 several years resisted the constant use of the three
 stimulating remedies which have  been mentioned.

   6. Notwithstanding I have supposed dropsies to
 be connected with a peculiar state of force  in the
 blood-vessels, yet I have  not ventured to assert,
that dropsies may not  exist from an  exclusive af-
fection of the exhaling and absorbing vessels.  I
conceive this  to be as possible, as for a fever to 
208
ON  DROPSIES.
exist from an exclusive affection of the arteries, or
a hysteria from an exclusive affection of the  ner-
vous system.  Nothing, however, can be said up-
on  this subject, until physiology and pathology
have taught us more of the structure and diseases
of the lymphatic vessels.   Nor have I ventured
further  to assert,  that  there  are  not medicines
which may  act specifically upon the  lymphatics,
independently of the arteries.  This I conceive to
be as possible as for asafaetida to act chiefly upon
the nerves, or ipecacuanha and jalap upon the ali-
mentary canal, without affecting other parts of the
system.  Until such medicines are discovered,  it
becomes us to avail ourselves of the access to the
lymphatics,  which is furnished through the medi-
um of the arteries, by means of most of the reme-
dies which have been mentioned.

  7. If it should appear hereafter, that  we have
lessened the mortality of certain dropsies by the
theory and practice which have been proposed, yet
many cases of dropsy must still  occur in which
they will afford us no aid.   The cases I allude to
are  dropsies from enclosing cysts, from the ossifi-
cation of certain arteries, from schirri of certain
viscera  from large ruptures of exhaling or lym-
phatic vessels, from a peculiar and corrosive acri-
mony of the fluids, and, lastly, from an exhausted 
ON  DROPSIES.
209
state of the whole system.   The records of medi-
cine furnish us with instances of death from each
of the above causes.   But let us not despair.   It
becomes a physician to believe, that there is no
disease necessarily incurable;  and that there exist
in the womb of time, certain remedies for all those
morbid affections, which elude the present limits of
the healing art. 
 
AN INQUIRY
INTO THE
CAUSES AND CURE
OF THE
INTERNAL DROPSY OF THE BRAIN. 
 
AN INQUIRY, &c.
       HAVING, for many years,  been  unsuc-
cessful  in  all the cases,  except two, of internal
dropsy of the brain, which came under my care, I
began to entertain doubts of the common theory of
this disease, and to suspect that effusion of water
should be considered only as the effect of a primary
disease in the brain.

  I mentioned this opinion to my colleague, Dr.
Wistar, in the month of June, 1788, and delivered
it the winter following in my lectures.   The year
afterwards  I was confirmed in it,  by  hearing that
the same idea had occurred to Dr.  Quin.   I have
since read Dr. Quin's treatise on the dropsy of the
brain with great pleasure,  and consider it as the
first dawn of light which has been shed  upon it.
In pursuing this subject, therefore, I shall avail
  vol.  n.             e e 
214
ON  THE INTERNAL
myself of Dr. Quin's discoveries, and endeavour
to arrange the facts and observations I have col-
lected in such a manner, as to form  a connected
theory from them, which I hope will lead to a new
and more successful mode of treating this disease.

   I shall  begin  this inquiry by delivering a few
general propositions.

   1.  The internal dropsy of the brain is  a disease
confined chiefly to children.

 2. In children the brain is larger in proportion to
other parts of the body,  than it is in  adults;  and
of course a greater proportion of blood is sent to
it  in childhood, than in the subsequent periods of
life.   The effects of this determination of blood to
the brain appear in the mucous discharge from
the nose, and in the  sores on the head and behind
the ears, which are so common in childhood.

  3. In all febrile diseases, there is a preternatural
determination of blood to the brain.   This occurs
in a more especial manner in children; hence the
reason why they are so apt to be affected by con-
vulsions in the eruptive fever of the small-pox, in
dentition, in  the diseases from worms, and in die
first paroxysms of intermitting fevers. 
          DROPSY OF THE BRAIN.         Z1J
  4. In fevers of every kind, and in every stage of
life,  there is a disposition to effusion in that part
to which there is the greatest determination. Thus,
in inflammatory fever, effusions take place in the
lungs and in the joints.   In the bilious fever they
occur  in the liver, and in the gout in every part
pf the body.   The matter effused is always influ-
enced  by the structure  of the part  in which it
takes place.

  These propositions  being premised, I  should
have proceeded to  mention the remote causes of
this  disease;  but as this inquiry may possibly fall
into the hands of some gentlemen  who may not
have access  to the description of  it as given by
Dr.  Whytt,  Dr.  Fothergill, and Dr. Quin, I shall
introduce a  history of  its symptoms taken from
the last of those authors.  I prefer it to the histo-
ries by Dr. Whytt and  Dr. Fothergill, as it  ac-
cords most with the ordinary phenomena of this
disease in the United States.

   " In general, the patient is at first languid and
" inactive, often drowsy and peevish, but at inter-
" vals cheerful and apparently free from complaint.
" The appetite is weak, a nausea, and, in many
" cases, a vomiting, occurs once or twice in the
" day, and the skin is observed to be hot and dry 
216          ON THE  INTERNAL
" towards the evenings; soon after these symp-
" toms have appeared, the patient is affected with
" a sharp head-ach, chiefly in the fore-part, or, if
" not there,  generally  in the crown of the head:
u  it is sometimes, however, confined to one side
" of the head, and, in that case, when the posture
" of the body is erect,  the head often inclines to
" the side affected.   We  frequently  find, also,
" that the head-ach alternates with the affection of
" the stomach;  the  vomiting being less trouble-
" some when the pain is most violent,  and vice
" versa, other parts of the body are likewise sub-
" ject to temporary attacks of pain, viz. the extre-
" mities,  or the bowels, but more constantly  the
" back of the neck, and between the scapulae; in
" all such cases the  head is more free  from unea-
 " siness.

   " The patient dislikes the light at this period;
 " cries much, sleeps little, and when he does sleep,
 " he grinds his teeth,  picks his nose, appears to
 " be uneasy, and starts often, screaming as if he
 " were terrified; the bowels are in the majority of
 " cases very much confined, though it sometimes
 " happens that they are in an opposite state:  the
 " pulse  in  this early stage of the disorder, does
 " not  usually indicate any material derangement. 
DROPSY OF THE BRAIN.
217
   u When die symptoms above-mentioned have
 " continued for a few days, subject as they always
 " are in this disease to great fluctuation,  the axis
 " of one eye is generally found to be turned  in to-
 " wards the nose; the pupil on this side is rather
 " more dilated than on the other;  and when both
 " have the axes directed  inwards  (which some-
 " times  happens) both pupils  are larger than they
 " are observed  to be  in the eyes of healthy per-
 " sons: the vomiting becomes more constant, and
 " the head-ach  more excruciating;  every symp-
 " torn of fever then  makes  its appearance, the
 " pulse is frequent, and the breathing quick; ex-
 " acerbations of the fever  take place towards the
 "evening, and  the face is occasionally  flushed;
 " usually one cheek  is much more affected  than
 " the other ;  temporary  perspirations  likewise
 " break forth, which are not followed by any alle-
 ' viation of distress;  a  discharge of blood from
 " the nose, which sometimes appears about this
 " period, is equally inefficacious.

   " Delirium, and that of  the most violent kind,
 " particularly if  the patient has arrived at the age
 " of puberty,  now takes place, and with all the
" preceding symptoms of fever, continues for a
 ' while to increase, until about fourteen days, of-
" ten a much shorter space of time, shall  have 
218
ON THE INTERNAL
" elapsed since the appearance of the symptoms,
" which  were first mentioned in the above detail.

  " The disease then undergoes that remarkable
" change, which sometimes suddenly points out
" the commencement of what has been called its
" second stage:  the pulse becomes slow but une-v
" qual, both as  to its strength,  and the intervals
" between the pulsations; the pain of the head, or
" of  whatever part had previously been affected,
" seems to abate, or at least the patient becomes
" apparently less sensible of it;  the  interrupted
" slumbers,  or perpetual restlessness which pre-
" vailed during the earlier periods of the disorder,
" are  now succeeded by an almost lethargic tor-
" por, the strabismus,  and dilatation of the pupil
" increase, the patient lies with one, or both eyes
" half closed,  which,  when minutely examined,
" are  often  found to be completely insensible to
" light;  the vomiting ceases;  whatever  food  or
" medicine  is offered  is usually swallowed with
" apparent .voracity; the bowels at this period ge-
" nerally remain obstinately costive.

  " If every effort made by art fails to excite the
" sinking powers of life, the symptoms of what
" has been  called the second stage are soon suc-
" ceeded by  others,  which more  certainly an- 
IDR0PSY OF THE BRAIN.
219
 " nounce the  approach of death.    The  pulse
 " again becomes equal,  but so weak and quick,
 " that it is almost impossible to count it;  a diffi-
 " cuity of breathing, nearly resembling the stertor
 " apoplecticus, is often observed ; sometimes the
 " eyes are suffused with blood, the flushing of the
 " face is more frequent than before, but of shor-
 " ter duration, and followed by a deadly paleness;
 " red spots, or blotches, sometimes appear on the
 " body and limbs;  deglutition  becomes difficult,
 " and convulsions generally close the scene.   In
 " one case,  I may observe, the  jaws of a child of
 " four years of age were so firmly locked for more
 " than a day before death, that  it was impossible
 " to introduce  either food or medicine into  his
 " mouth;  and,  in another case,  a hemiplegia, at-
 " tended with  some  remarkable circumstances,
 " occurred during the two days preceding disso-
 " lution.

  " Having thus given as exact a history of apo-
 ' plexia hydrocephalica as I could compile from
" the writings of others, and from my own obser-
" vations, I should think myself guilty of imposi-
 14 tion on  my readers, if I did not caution them
 u that it must  be considered merely as a general
" outline:  the human brain seems  to be  so ex-
" tremely capricious (if the expression may be al- 
220
ON THE INTERNAL
" lowed) in the signals  it gives to other parts of
" the system,  of the injury it suffers throughout
" the course of this disease, that although every
" symptom above-mentioned does occasionally oc-
" cur, and indeed few cases of the disease are to
" be  met with, which do not exhibit many of
" them; yet it  does not appear  to me, that any
" one of them is constantly and inseparably con-
" nected with it."

  To this history I shall  add a few facts, which
are the result of observations made by myself, or
communicated to me by  my medical brethren.
These facts will serve to shew that there are ma-
ny deviations from the history of the disease which
has been given,  and that  it is indeed, as Dr.  Quin
has happily expressed it,  of " a truly proteiform"
nature.

  I have not found the dilated and insensible pu-
pil, the puking, the dilirium, or the strabismus, to
attend universally in this disease.

  I saw one case in which the appetite was unim-
paired from the first to the last stage of the dis-
ease. 
             DROPSY OF THE BRAIN.         -"I
  I have  met with one case in which  the disease
was attended by blindness, and another by double
vision.

  I have observed an uncommon acuteness in hear-
ing to attend two cases of this disease. In one of
them  the noise of the sparks which were discharged
from a hiccory fire, produced great pain and start-
ings which threatened convulsions.

  I have seen three cases in which the disease  ter-
minated in hemiplegia. In two of them it proved
fatal in a few days; it? a third it continued for near-
ly eighteen months.

  I have met with one case in which no preternatu-
ral slowness or intermission was ever perceived in
the pulse.

  I have seen the disease in children of nearly all
ages.  I once saw it in a child of six weeks old. It
was preceded by the cholera infantum. The sudden
deaths which we sometimes  observe in infancy, I
believe, are often produced  by  this disease.  Dr.
Stoll is of the same opinion. He calls it, when it ap-
pears  in this form, " apoplexia infantalis."*

             * Praelectiones, vol. I. p.  254.
  Vol. II.                           F f 
222
ON THE INTERNAL
  In the month of March,  1771, I obtained a gill
of water from the ventricles  of the brain of a negro
girl of nine  years of age, who died of this disease,
who complained in no stage of it of a pain in her
head or limbs, nor of a sick stomach. The disease
in this case was introduced suddenly by a pain  in
the breast, a fever, and the usual symptoms of a
catarrh.

  Dr.  Wistar informed me, that he  had likewise
met with  a  case  of internal dropsy of the brain,
in which there was a total absence of pain  in the
head.

  Dr.  Carson informed me, that he had attended a
child in this disease that discovered, for some days
before it died, the symptom  of hydrophobia.

  Dr.  Currie obtained, by dissection,  seven ounces
of water from the brain of  a child which died  of
this disease; in whom, he assured me, no dilatation
of the pupil, strabismus, sickness, or loss of appetite
had attended, and but very little head-ach.

  The causes which induce  this disease, act  either
directly on the brain, or indirectly upon it, through
the medium of the whole system. 
DROPSY OF THE BRAIN.
223
  The causes which act directly on the brain are
falls or bruises upon the head, certain positions of
the body, and childish plays,  which bring on con-
gestion or inflammation, and afterwards an  effusion
of water  in the brain. I have known it brought on
in a child by falling into a cellar upon its feet.

   The indirect  causes  of this disease  are more
numerous, and more frequent, though less  suspect-
«d, than those which have been  mentioned. The
following diseases of the whole system appear to
act indirectly in producing an internal dropsy of
the brain.

   1. Intermitting, remitting, and  continual fevers.
Of the effects of these fevers in inducing  this dis-
ease, many cases are recorded by Lieutaud.*

   My former pupil, Dr. Woodhouse, has furnish-
ed me with a dissection, in which the disease was
evidendy the effect  of the remitting  fever.  That
state of continual fever which has been distinguish-
ed  by the name  of  typhus,  is often the remote
cause  of this  disease.  The  languor  and  weak-
ness in all the muscles  of voluntary motion, the
head-ach,  the  inclination  to  rest and sleep,  and

          * Historia Anatomica-Medica, vol. II. 
2g4            ON THE INTERNAL
the disposition  to  be  disturbed, or terrified by
dreams,  which  are  said  to  be the  precursors of
water in  the brain,  I believe are frequently symp
toms of a typhus fever  which terminates in an in-
flammation, or effusion of water in the brain. The
history which is given of the typhus state of fever
in children by Dr. Butter,* seems to favour this
opinion.

   2. The rheumatism.  Of this  I have known two
instances.  Dr. Lettsom has recorded a case from
the same cause.f  The pains in the limbs, which
are supposed to be  the  effect, I suspect are fre-
quently the cause of the disease.

   3. The pulmonary consumption.  Of the  connec-
tion of this disease with an internal dropsy of the
brain, Dr.  Percival  has furnished us with the fol-
lowing communication:! " Mr. C-------'s daugh-
 " ter, aged nine years, after labouring under the
 " phthisis pulmonalis  four months, was  affected
 " with unusual pains in her head.  These rapidly
 " increased, so as to occasion frequent screamings.

   * Treatise on the Infantile Remitting Fever.
   t Medical Memoirs, vol. I. p. 174.
   \ Essays, Medical, Philosophical, and Experimental, vol. II.
 p. 339, 340. 
            DROPSY OF THE BRAIN.         *&>
"The cough,  which had  before  been extremely
" violent, and  was attended with stitches in the
" breast, now abated, and  in a few days ceased al-
" most entirely. The pupils of the eyes became di-
" lated, a strabismus ensued, and  in about a week
" death put an end to  her agonies. Whether this
" affection of the head  arose from the effusion of
" water or of blood, is  uncertain,  but its influence
" on the state  of the lungs is  worthy  of  notice."
Dr.  Quin likewise mentions a case from Dr. Cul-
len's private practice, in which an internal dropsy
of the brain followed  a pulmonary consumption.
Lieutaud mentions three cases of  the same kind,*
and two, in which it succeeded a catarrh.f

   4. Eruptive fevers*  Dr. Odier  informs us,J that
he had seen four cases in which it had followed
die small-pox,  measles, and scarlatina. Dr.  Lett-
som mentions a case in which it followed the'small-
pox,|| and I  have seen one  in which it was obvious-
ly the effects of debility induced  upon the system
by the measles.

  "Historia Anatomica-Medica, vol.  II.  lib. tertius, oba. 380,
394, 1121.
  tObs. 383,431.
  \ Medical Journal.
  |j Medical Memoirs, vol. I. p.  171. 
226            ON THE INTERNAL
  5.  Worms.  Notwithstanding  the discharge  of
worms gives no relief in this disease,  yet there is
good reason to believe, that it has, in some instan-
ces,  been produced  by them. The morbid action
continues in the brain, as in other cases of disease,
after the cause which induced it, has ceased to act
upon the body.

  6.  From the dissections of Lieutaud, Quin, and
others,  it appears  further, that the internal dropsy
of the brain has been observed to succeed each of
the following diseases, viz. the colic, palsy, melan-
choly, dysentery,  dentition,  insolation,  and  scro-
fula,  also the sudden healing of old sores.  I have
seen two cases  of it from the last cause, and one in
which it was produced by the action of the  vernal
sun alone upon the system.

  From the facts which have been  enumerated,
and  from dissections to be mentioned hereafter, it
appears, that the  disease in its first  stage  is  the
effect of causes which produce a less degree  of that
morbid action in the brain which  constitutes phre-
nitis, and that its second stage is the effect of a  less
degree of that effusion, which produces serous apo-
plexy in adults.  The former partakes  of  the na-
ture  of the chronic inflammation of  Dr.  Cullen,
and of  the asthenic inflammation  of Dr.  Brown.  I 
            DROPSY OF THE BRAIN.        *Zl
have taken the liberty to call it phrenicula, from its
being a diminutive species or state of phrenitis.  It
bears the same relation to phrenitis, when it arises
from  indirect causes, which pneumonicula does to
pneumony;  and it is  produced nearly in the same
manner as the  pulmonary consumption, by debili-
tating causes which act primarily on the whole sys-
tem.  The peculiar size  and texture of the brain
seem to invite the inflammation and effusions which
follow debility, to that organ in childhood, just as
the peculiar structure and  situation of the lungs
invite the same morbid phenomena to them, after
the body has acquired its growth, in  youth and
middle  life. In the latter stage which has been men-
tioned, the internal dropsy of the brain partakes
of some of the properties of apoplexy. It differs
from it in being the  effect  of a slow, instead of a
sudden  effusion of water or blood, and in being the
effect of causes which are of an acute instead of a
chronic  nature.  In  persons  advanced   beyond
middle life,  who are affected by this disease,  it
approaches to the nature  of  the common apo-
plexy,  by a speedy  termination  in  life or death.
Dr.  Cullen has  called it simply by the name  of
" apoplexia hydrocephalica." I have preferred  for
its last stage the term of chronic apoplexy; for I
believe with Dr. Quin,  that it has no connection
with a hydropic diathesis of the whole system. I 
228
ON THE IN1ERNAL
am forced to adopt this opinion,  from my having
rarely seen it accompanied by dropsical  effusions
in other parts of the body, nor a general dropsy
accompanied by an internal dropsy of the brain.
No more occurs in this disease  than takes  place
when hydrothorax  follows an inflammation of the
lungs, or when serous effusions follow an inflam-
mation  of the joints. I do not suppose that both
inflammation and effusion always attend in this dis-
ease;  on  the contrary, dissections  have shown
some cases of inflammation, with  little or no effu-
sion,  and some  of  effusion without inflammation.
Perhaps this variety may have been produced by
the different  stages of the  disease  in which death
and the  inspection  of  the  brain took  place.  Nei-
ther do I suppose, that the two stages which have
been mentioned, always succeed each  other in the
common order of  inflammation and effusion. In
every case where the full, tense, slow and intermit-
ting pulse  occurs, I believe there  is inflammation;
and as this state of  the pulse occurs in most cases
in the beginning of the disease, I suppose the in-
flammation, in most cases, to precede the effusion
of water. I have met with  only one case in which
the slow and  tense pulse was absent; and out of six
dissections of patients whom I have lost by this dis-
ease, the brains of four of them exhibited marks of
inflammation. 
DROPSY OF THE BRAIN.
229
   Mr. Davis discovered signs of inflammation, af-
 ter death from this disease, to be universal In eigh-
 teen or twenty dissections, he tells us, he found the
 pia  mater always distended  with blood.*  Where
 signs of inflammation have not occurred, the blood-
 vessels had probably relieved themselves by the ef-
 fusion of serum, or the morbid action of the blood-
 vessels had exceeded  that grade of excitement, in
 which  only  inflammation  can take place.  I  have
 seen one case of death from this disease, in which
 there was not more than a tea-spoonful of water in
 the  ventricles of the brain.  Dr. Quin mentions a
 similar case.  Here  death  was induced  by simple
 excess of excitement.  The water which is found in
 the ventricles of the brain refuses to coagulate by
 heat, and is always pale in those diseases, in which
 the serum of the blood, in every other part of the
 body, is of a yellow colour.

   In addition to these facts, in support of the inter-
 nal dropsy of the brain being the effect of inflamma-
 tion, I  shall  mention one more,  communicated to
 me in a letter, dated July 17th, 1795, by my former
pupil, Dr. Coxe, while he was prosecuting his stu-
dies  in London.  " It so happened (says my ingeni-
ous correspondent), that at the time of my receiving
           * Medical Journal, vol. VIII.
Vol. II.                          G g 
230
ON THE INTERNAL
your letter, Dr. Clark was at the hospital. I read to
him that part  which relates to your success in the
treatment of hydrocephalus internus. He was much
pleased with it, and mentioned to me a fact which
strongly corroborates your idea of its being a pri-
mary inflammation of the brain. This fact was, that
upon opening, not long since, the head of  a child
that had died of this  disease, he  found between
three and four ounces  of water in the ventricles of
the brain; also an inflammatory crust on the optic
nerves, as thick as he had ever observed it  on the
intestines in a state of inflammation.  The child lost
its sight before it died. The crust  accounted in a
Satisfactory manner for its blindness.  Perhaps some-
thing similar may always be noticed in the  dissec-
tions of such  as die in this  disease, in whom the
eyes are much affected."

  Having adopted the  theory of this disease, which
I have delivered, I resolved upon such a change in
my practice as should accord with  it. The  first
remedy indicated by it was

  I. Blood-letting.  I shall briefly mention  the ef-
fects of this remedy in a few of the first cases in
which  I prescribed it. 
            DROPSY Or THE  BRAIN.         231


                   CASE I.

  On the 15th of November,  1790, I was called
to visit the daughter of William Webb, aged four
years, who was indisposed with a cough, a pain in
her bowels, a coma, great sensibility of her eyes to
light, costiveness,  and a suppression of urine,  a
slow and irregular,  but tense  pulse, dilated pupils,
but no  head-ach. I found, upon inquiry, that she
had received a hurt on her head by a fall, about
seven weeks before I  saw her.  From this informa-
tion, as well as from her symptoms, I had no doubt
of the disease being the internal dropsy of the brain.
I advised the loss of five  ounces of blood, which
gave her some relief.  The blood  was sizy.  The
next day she  took a dose of  jalap and  calomel,
which operated twelve times.  On the  18th she lost
four ounces more  of blood, which was more sizy
than that drawn on the  15th.  From this time she
mended  rapidly. Her coma left her on  the 20th,
and her appetite returned; on the 21st she made a
large  quantity of turbid dark  coloured urine. On
the 22d  her pulse  became again a little tense, for
which she took a  gentle puke. On  the  23d she
had a natural stool.  On the 24th her pupils appear-
ed to be contracted to their natural size, and on the
30th I had the pleasure of seeing her seated at a 
232
ON THE INTERNAL
tea-table in  good health. Her pulse notwithstand-
ing, was a little more active and tense than natural.


                   CASE II.

  On the 24th of the same month,  I was called to
visit the son of John Cypher, in South-street, aged
four years, who had been hurt about a month be-
fore, by a wound on his forehead  with a brick-bat,
the mark of which still appeared. He had been ill
for near two  weeks  with coma, head-ach, colic,
vomiting, and frequent starlings in his sleep.  His
evacuations  by stool  and urine were  suppressed;
he had discharged three  worms, and had had two
convulsion fits just before I saw him. The pupil
of the right eye  was larger than that of the  left.
His pulse was full, tense, and slow, and intermitted
every fourth stroke.  The symptoms plainly indi-
cated  an internal  dropsy of the brain.  I ordered
him to lose four or five ounces of blood. But three
ounces  of blood  were drawn,  which  produced a
small  change in his pulse. It rendered the inter-
mission of  a pulsation perceptible only after every
tenth  stroke. On  the  25th he lost  five ounces of
blood, and took a purge of calomel  and jalap. On
the 26th he was better. On the 27th the vomiting 
             DROPSY OF THE BRAIN.         233
was troublesome, and his pulse was still full and
tense,  but  regular. I ordered  him  to lose  four
ounces of blood.  On  the 28th  his  puking and
head-ach  continued; his pulse was a little tense,
but regular; and his right pupil less  dilated.  On
the 29th his head-ach and puking ceased, and  he
played about the room.  On the  4th of December
he  grew worse;  his head-ach and puking returned,
with a hard pulse, for which I ordered him to lose
five ounces of blood.  On the 5th he was better,
but on the 6th his  head-ach and puking returned.
On the 7th I ordered his forehead to be bathed fre-
quently with vinegar, in which ice had been dis-
solved. On  the  8th he  was much  better.  On the
9th his pulse became soft, and he  complained but
little of head-ach. After appearing to be well for
near three weeks, except that he complained  of a
little head-ach, on the 29th his pulse became again
full and tense, for which I  ordered  him to lose six
ounces of blood, which for  the first time discovered
a buffy coat.  After this last bleeding, he discharged
a large quantity of water. From this time he recov-
ered slowly,  but his pulse was a little  fuller than
natural on the 19th of January following. He after-
wards enjoyed good health. 
234
ON THE INTERNAL
            CASES III. AND IV.

  In the month  of  March, 1792, I attended two
children of three  years of age, the one the daughter
of William King, the other the daughter of Wil-
liam Blake: each of whom  had  most of the symp-
toms of the inflammatory stage of the internal drop-
sy of the brain. I prescribed the  loss of four ounces
of blood,  and a smart purge in  both cases,  and in
the course of a few days had the  pleasure of observ-
ing all the symptoms of the disease perfectly sub-
dued in each of them.

                   CASE V.

  In the months of July and August, 1792, I at-
tended a female slave of Mrs. Oneal, of St.  Croix,
who had an obstinate head-ach, coma,  vomiting,
and a tense, full, and slow pulse. I believed it to
be the phrenicula, or internal dropsy of the  brain,
in its inflammatory  stage.  I bled her five times in
the course of two months,  and  each time with ob-
vious relief of  all the  symptoms of  the disease.
Finding  that her head-ach,  and  a  disposition to
vomit, continued after the tension of her pulse was
nearly reduced,  I gave her  as much calomel as ex- 
            DROPSY OF THE BRAIN.         235
cited  a  gentle salivation,  which in a few  weeks
completed her cure.

                  CASE VI.

   The  daughter of  Robert Moffat, aged eight
years, in consequence of the suppression of a ha*
bitual discharge  from sores on  her head,  in the
month of April, 1793, was affected  by  violent
head-ach, puking, great  pains and weakness in her
limbs, and a full, tense, and slow pulse.  I believed
these  symptoms to be produced  by an inflamma-
tion of the brain. I ordered  her  to lose six or se-
ven ounces of blood, and  gave her  two purges of
jalap and calomel, which operated very plentifully.
I afterwards applied a blister to her neck.  In one
week  from the time of my first visit to her she ap-
peared to be in perfect health.

                  CASE VII.

   A  young woman of eighteen  years  of  age,  a
hired servant in the family of Mrs.  Elizabeth
Smith, had been  subject to a head-ach every spring
for several years. The unusual warm days which
occurred in the beginning  of April,  1793,  pro- 
 236           ON  THE INTERNAL
 duced a return of this periodical  pain.  On the
 eighth of the month, it  was so severe as to confine
 her  to her  bed.  I  was  called to  visit  her on the
 ninth. I found her comatose, and, when awake,
 delirious. Her pupils were unusually dilated, and
 insensible to the light. She was constantly sick at
 her stomach, and vomited  frequently.  Her bowels
 were obstinately  costive, and her pulse was full,
 tense, and so slow as seldom to exceed, for several
 days, from 56 to 60 strokes in a minute. I ordered
 her to lose ten ounces of blood every day, for three
 days successively, and gave her, on each of those
 days, strong doses of  jalap and  aloes. The  last
 blood which was drawn from her was sizy.  The
 purges procured  from three to ten discharges eve-
 ry day from her bowels. On the  12th, she appeared
 to be much better. Her pulse was  less tense, and
 beat  80  strokes  in a minute.  On  the 14th,  she
 had a fainting fit.  On  the 15th,  she  sat  up,  and
 called for food. The pupils of her eyes now reco-
 vered their sensibility to light, as well as their na-
 tural size. Her head-ach left her, and, on the 17th,
 she  appeared  to be in good health.  Her pulse,
 however,  continued to beat between  50  and 60
 strokes  in a minute, and retained a small portion
 of irregular action  for several days  after she reco
vered. 
DROPSY OF THE BRAIN.
237
   I am the more disposed to pronounce  the cases
 which have  been described to have been internal
 dropsy of the brain, from  my  having never been
 deceived in a single case in which I have examined
 the  brains of patients whom I have suspected to
 have died of it.

   I could add many other cases to those which have
 been related,  but enough, I  hope, have been men-
 tioned to establish the safety and efficacy of the re-
 medies that have been recommended.

   I  believe,  with  Dr.  Quin, that this disease is
 much more frequent than is commonly supposed.
 I can recollect many cases of anomalous fever and
 head-ach in children, which have excited the most
 distressing apprehensions of an approaching inter-
 nal dropsy  of the  brain, but which have yielded
 in a few  days to bleeding, or to purges and blis-
 ters.  I think  it probable, that some,  or perhaps
 most of these  cases, might have terminated in an
 effusion of water in the brain, had  they  been left
 to themselves, or not been  treated with the above
 remedies. I believe further,  that it  is  often pre-
 vented by all  those physicians who  treat the first
 stage of  febrile diseases in  children with evacua-
tions, just as  the pulmonary consumption is pre-
  Vol. II.                         H h 
238           ON THE  INTERNAL
vented by bleeding, and low diet, in an inflamma-
tory  catarrh.

  Where blood-letting has failed  of curing this
disease, I am disposed to ascribe it to its being used
less copiously than the disease required. If its re-
lation to pneumonicula be the same in its cure, that
I have supposed  it to be in its cause,  then I am
persuaded, that the same excess in blood-letting is
indicated in it, above  what is  necessary  in phreni-
tis, that has been practised in pneumonicula, above
what is necessary in the cure of an acute inflamma-
tion  of the lungs. The  continuance, and, in some
instances, the increase  of the appetite in the inter-
nal dropsy  of the brain, would seem to favour this
opinion no less in this disease, than in  the  inflam-
matory state of pulmonary consumption. The ex-
treme  danger from the effusion of water into the
ventricles of the brain,  and the certainty of death
from its confinement there, is a reason likewise why
more blood should be drawn in this disease,  than
in diseases of the same force in other parts of the
body,  where the  products  of  inflammation  have a
prompt, or certain outlet from the body. Where
the internal dropsy is obviously the effect of a fall,
or of any  other cause which acts  directly  on the
brain,  there can be no doubt of the safety of very
plentiful bleeding; all practical writers upon surge* 
DROPSY OF THE BRAIN.
23i>
ry concur in advising it. The late Dr. Pennington
favoured me with an extract from Mr. Cline's ma-
nuscript lectures upon anatomy, delivered in  Lon-
don in the winter of 1792, which places the advan-
tage of blood-letting, in that species of inflammation
which follows a local injury of the brain, in a very
strong point of light.  " I know (says he)  that se-
" veral  practitioners object to the  use  of evacua-
" tions  as remedies for  concussions of the brain,
" because of the weakness of the pulse;  but  in
" these  cases the pulse is  depressed.  Besides, ex-
u perience shows, that evacuations are frequently
" attended with very  great  advantages. I remem-
" ber a remarkable case of a man in this [St. Tho-
" mas's] hospital, who was under the care of Mr.
u Baker.  He  lay  in a comatose  state  for  three
" weeks after an injury of the head.  During that
" time he was bled twenty times, that is to say, he
" was bled once  every day upon an  average. He
" was bled twice a day plentifully, but towards the
" conclusion he was bled more sparingly, and  only
" every  other day; but  at  each bleeding,  there
" were  taken,  upon  an average,  about  sixteen
" ounces of blood. In consequence of  this treat-
" ment, the man perfectly recovered his health and
" reason." 
240           ON THE INTERNAL
  Local bleeding by cups, leaches,  scarifications,
or arteriotomy, should be  combined  with venesec-
tion, or preferred to it, where the whole arterial sys-
tem  does not sympathize  with the disease  in the
brain.

  II. A second remedy to be used  in the second
stage of this disease is purges. I  have constantly
observed all the patients whose cases  have been re-
lated, to be relieved by plentiful and repeated eva-
cuations from the bowels. I was led to the  use of
frequent purges,  by having  long observed their
good effects in palsies, and other cases of conges-
tion  in  the brain, where blood-letting  was  unsafe,
and  where it had been used without  benefit. In
the Leipsic Commentaries,*  there is  an account
of a case of internal dropsy  of the  brain,  which
followed the measles, being cured by no other me-
dicines  than purges and  diuretics. I can say no-
thing in favour of the latter remedy, in this disease,
from my own experience. The foxglove has been
used in this city by several respectable practition-
ers,  but, I believe, in no instance with any advan-
tage.
* Vol. xxix. p. 139 
            DROPSY OF THE BRAIN.         -***
  III.  Blisters have been uniformly recommended
by all practical writers upon this disease. I have ap-
plied them to the head, neck, and temples, and gen-
erally with obvious relief  to the pain in the  head.
They should be omitted in no stage of the disease;
for even in its  inflammatory stage, the discharge
they occasion from the vessels of the head, greatly
overbalances their stimulating  effects  upon  the
whole system.

   IV. Mercury was long considered as the only
remedy,  which gave the least chance of a recovery
from a dropsy of the brain.  Out of all the cases in
which I gave it, before the year 1790, I succeeded
in  but two: one  of them  was  a child of three
years old, the other was a young woman of twenty-
six  years of age.  I am the more convinced that
the  latter  case  was internal dropsy of  the  brain,
from my patient having relapsed,  and died between
two or three years afterwards, of the same disease.
Since  I have adopted the  depleting remedies  which
have been mentioned,  I have declined giving mer-
cury altogether, except when combined with some
purging medicine,  and I have given it in this form
chiefly with a view of dislodging worms.  My rea-
sons for  not giving it  as a sialagogue are the un-
certainty of its operation, its frequent inefficacv
when  it excites a salivation, and, above  all, its dis- 
242
ON THE INTERNAL
 position to produce gangrene in the tender jaws of
 children.  Seven  instances of  its inducing  death
 from  that  cause,  in  children  between three and
 eight years of age, and with  circumstances of un-
 common distress,  have  occurred in Philadelphia
 since the year 1795.

   V. Linen cloths, wetted with  cold vinegar, or
 water, and applied to the forehead, contribute very
 much  to relieve the pain in the head. In the case
 of Mr. Cypher's  son,* the solution of ice in the
 vinegar appeared to afford the  most obvious  relief
 of this distressing symptom.

  A puncture in the brain has  been proposed by
 some writers  to discharge the water  from its ven-
 tricles. If the theory I have delivered be true, the
 operation promises nothing, even though it could
 always be performed with perfect safety. In  cases
 of local injuries, or of inflammation from any cause,
it must necessarily increase the disease; and in  cases
 of effusion only,  the debilitated  state of  the whole
 system forbids us to hope for any relief from  such
a local remedy.

  Bark, wine, and opium promise much more suc-
* Case II. 
DROPSY OF THE BRAIN.
243
cess in the last stage of the disease.  I can say no-
thing in their favour from my own experience;  but
from the aid they afford to mercury in other disea-
ses, I conceive they might be made to  accompany
it with advantage.

  Considering the nature of  the  indirect causes
which induce  the disease, and the case of a relapse,
which has been mentioned, after an interval of near
three years, as well as the symptoms of slow con-
valescence,  manifested  by the  pulse, which occur-
red in the first and seventh cases, I submit it to the
consideration of physicians, whether the use of mo-
derate exercise, and the  cold  bath,  should not be
recommended  to prevent a return of the disease in
every  case, where it has yielded to the power of
medicine.

  I have great pleasure in adding, that the theory
of this disease, which  I  have  delivered,  has been
adopted by many respectable  physicians  in Phila-
delphia, and  in other parts of the United States,
and that it has led to the practice that has been re-
commended, particularly to copious blood-letting;
in  consequence of which, death from a dropsy of
the  brain is not a more frequent occurrence, than
from any other of the acute febrile diseases of our
country. 
 
OBSERVATIONS
UPON
The Cause and Cure
OF THE
GOUT.
Vol. II. 
 
OBSERVATIONS, &c
       IN treating upon the gout, I shall deliver a
few preliminary propositions.

   1. The  gout is a disease of the whole  system.
It  affects  the  ligaments,  blood-vessels, stomach,
bowels, brain, liver, lymphatics,  nerves, muscles,
cartilages, bones, and skin.

   2.  The gout is a primary disease, only of the so-
lids.  Chalk-stones, abscesses, dropsical effusions
into cavities, and cellular membrane, and eruptions
on the skin, are all the effects of a morbid action in
the blood-vessels. The truth of this proposition
has been ably proved by Dr. Cullen  in his First
Lines. 
248
OBSERVATIONS ON
  3. It affects most frequently persons of a sangui-
neous temperament; but  sometimes  it affects per-
sons of  nervous  and phlegmatic temperaments.
The idle and luxurious are more subject to it, than
the labouring  and temperate  part  of mankind.
Women are said to be less subject to it than men.
I once believed, and taught this opinion, but I now
retract it.  From the  peculiar delicacy of  the  fe-
male constitution,  and from the thin covering they
wear on  their feet and limbs, the gout is less  apt
to fall upon those  parts than  in men, but they ex-
hibit all its other symptoms,  perhaps more  fre-
quently than men, in  other parts of the body. The
remote  causes  of gout moreover  to  be mentioned
presently, act with equal  force upon both sexes,
and more of them  I believe upon  women, than up-
on men.

   It generally attacks in those  periods of life, and
in those countries,  and seasons of the year, in which
inflammatory diseases are  most common.   It sel-
dom affects persons  before puberty, or in old age,
and yet I have heard of its appearing with all its
most characteristic symptoms in this city in a child
of  6, and in a man above 80 years of age.  Men of
active minds are said  to  be most subject to it,  but
I think I have  seen it as frequently  in persons of
slender  and torpid intellects, as  in  persons of an 
THE GOUT.
249
 opposite character.  I have heard of a case of gout
 in an Indian at Pittsburg, and I have  cured a fit of
 it in an Indian in this city.  They had both been
 intemperate  in the use of wine and  fermented li-
 quors.

   4. It is in one  respect a hereditary disease, de-
 pending upon the  propagation of a similar tempera-
 ment from father to son. When a predisposition
 to the gout  has been  derived from ancestors,  less
 force in exciting causes will induce it  than in those
 habits where this has not  been the case.  This
 predisposition sometimes passes by children,  and
 appears in grand-children. There are instances like-
 wise in which it has passed by the males, and ap-
 peared  only in  the  females  of a family.  It  even
 appears in the descendants of families who  have
 been reduced to poverty, but not often where they
 have been obliged to  labour  for a subsistence. It
 generally passes by those children who are born be-
 fore the gout makes its appearance in a father. It
 is curious to observe how extensively the predispo-
 sition pervades some families.  An English gentle-
 man, who had been afflicted  with  the gout, mar-
 ried a young woman  in  Philadelphia many years
ago, by whom  he had  one  daughter. His  wife
dying three weeks after the birth of this child, he
returned to England, where he married a second 
250
OBSERVATIONS ON
wife,  by whom he had six children, all of whom
except one died  with the gout before they attained
to the usual age  of matrimony in Great Britain.
One of them died in her 16th year. Finally the
father and grandfather died with the same disease.
The daughter whom this afflicted gentleman left in
this  city, passed her  life subject to the gout, and
finally died under my care in the year 1789, in the
68th  year of her  age. She left a  family of  chil-
dren, two of whom had the gout.  One of them, a
lady, has suffered exquisitely from it.

  •5.  The gout  is always induced  by general pre-
disposing debility.

  6. The remote causes of the gout which induce
this  debility, are,  indolence, great bodily labour,
long  protracted  bodily exercise, intemperance  in
eating,  and in venery, acid  aliments and  drinks,
strong tea and coffee, public and domestic vexation,
the violent, or long continued exercise of the un-
derstanding, imagination,  and  passions  in  study,
business, of pleasure, and  lasdy, the use of ardent
and  fermented  liquors.  The last  are absolutely
necessary to produce that form of  gout which ap-
pears in  the ligaments and muscles.  I assert this,
not only from my own observations, but from those
<jf Dr.  Cadogan,  and  Dr. Darwin, who say  they 
THE GOUT.
251
  ever saw a case of gout in the limbs in any per-
 son who  had not used spirits or  wine in a great-
 er  or less quantity. Perhaps  this  may be another
 reason why women, who drink less of those liquors
 than men, are so rarely affected with this disease in
 the extreme parts  of  their bodies.  Wines of  all
 kinds are more disposed to produce this form of
 gout than spirits. The reason of  this  must be re-
 solved into the less stimulus in the former, than in
 the latter liquors.  Wine  appears to resemble, in
 its action upon the body,  the moderate stimulus
 of  miasmata which produce  a common remitting
 fever,  or intermitting fever,  while  spirits resem-
 ble that violent action  induced by miasmata which
 passes by the blood-vessels, ligaments, and muscles,
 and invades  at once the liver, bowels, and brain.
 There is one symptom of the gout in the extremi-
 ties which seems to be produced exclusively by ar-
 dent spirits, and that is a burning in the palms of
 the hands, and soles of the feet. This is so uniform,
 that I have sometimes  been able to convict my pa-
 tients of intemperance in the use of spirits, when no
 other mark  of their having taken  them  in excess.
 appeared in the system.

   While I thus ascribe the gout  to the use  of
fermented and distilled liquors, let me repeat that
they are not its  exclusive  causes.  Dr. Harle  of 
252
OBSERVATIONS ON
 New-Castle died of  the  gout,  and yet he  never
 tasted wine nor spirits in the whole course of his
 life. He could not even  bear the taste of either of
 them in a piece of sweet  cake.  The Bramins who
 neither drink  wine nor spirits, nor eat animal food,
 are not exempted from this disease; and Sir James
 Jay has assured me that he has seen instances of it
 in persons who lived wholly upon vegetables.

   I have enumerated among the remote causes of
 the gout, the use of strong  tea.  I infer its predis-
 posing  quality to that disease, from its frequency
 at Japan, where tea is used  in large quantities, and
 from the gout being more common among that sex
 in our country who drink the most, and the strong-
 est tea.

   7. The exciting causes of the gout are frequently
 a greater degree, or a sudden application of its re-
 mote  and predisposing causes. They act upon the
 accumulated excitability of the system, and by de-
 stroying its equilibrium  of excitement, and regular
 order of actions, produce convulsion, or irregular
 morbid and local excitement. These exciting causes
 are either of  a stimulating, or  of a sedative  na-
 ture.  The former are violent exercise, of body or
mind,  night-watching, and even sitting up late at
 night,  a hearty meal, a fit of drunkenness,, a few 
                   THE GOUT.                ^3J
glasses of claret or a draught of cyder, where those
liquors have not been habitual to the patient, a sud-
den paroxysm of joy, anger, or terror, a dislocation
of a bone, straining of a joint, particularly of the
ankle, undue  pressure  upon the foot, or leg, from
a tight shoe or boot, an irritated corn, and the usual
remote  causes  of fever. The latter exciting causes
are sudden inanition from bleeding, purging, vo-
miting, fasting, cold, a  sudden stoppage of mois-
ture on the feet, fear, grief, excess in venery, and
the debility left upon the system by the crisis  of a
fever.  All these causes act more certainly when
they are aided  by  the additional debility induced
upon the  system in sleep. It is for this reason that
the  gout generally makes its  first attack  in the
night, and in  a part of the system most remote
from the  energy of the  brain, and most debilitated
by exercise, viz.  in the great toe, or in some part
of the foot. In ascribing a fit of the gout to a cause
which is  of a  sedative  nature, the reader will not
suppose that 1  have departed from  the simplicity
and uniformity of  a proposition I have elsewhere
delivered,  that  disease  is the  effect  of  stimulus.
The  abstraction of a natural and habitual  impres-
sion of any kind, by increasing the  force  of those
which remain,  renders  the production of morbid
and excessive  actions in the system as much the
effect of preternatural or disproportioned stimulus,
  Vol. II.                         K  k 
254
OBSERVATIONS ON
as if they were induced by causes that are exter-
nally and evidently stimulating. It is thus in many
other of the  operations of nature, opposite causes
produce the same effects.

  8. The gout consists simply in morbid excite-
ment, accompanied with irregular action, or the ab-
sence of all action from the force of stimulus. There
is nothing specific in the morbid excitement and ac-
tions  which take  place  in the gout different from
what  occur in fevers.  It is to be lamented that a
kind of metastasis of error has taken place in patho-
logy.  The rejection of a specific acrimony as the
cause of each disease, has unfortunately been fol-
lowed by a belief in as many specific actions as
there are different forms and grades of disease, and
thus perpetuated the evils of our ancient systems of
medicine.  However varied morbid  actions may
be  by their causes, seats, and effects, they are all
of the same nature, and the time will probably  come
when the  whole nomenclature of morbid actions
will be absorbed in the single name of disease.

  I shall now briefly enumerate the  symptoms of
the gout, as they appear in the ligaments, the blood-
vessels, the viscera, the nervous system, the alimen-
tary canal, the lymphatics, the skin, and  the bones 
                    THE GOUT.              255
 of the human body, and  here  we shall  find that
 it is an epitome of all diseases.

   1. The ligaments which connect the bones are
 the seats of  what  is  called  a legitimate or true
 gout.  They are affected with pain, swelling, and
 inflammation. The  pain is sometimes  so acute as
 to be compared to the knawing of a dog.  We per-
 ceive here the sameness of the gout with the rheu-
 matism.  Many pages, and indeed whole essays,
 have been composed by writers to distinguish them,
 but they are exactly the same disease while the mor-
 bid  actions are confined to this part of the body.
 They are, it is true, produced  by different remote
 causes, but this constitutes no more difference  in
 their nature than is produced in a coal of fire, whe-
 ther it be inflamed  by a candle, or by a  spark  of
 electricity.  The morbid actions  which are induced
 by the usual causes of rheumatism affect, though
 less  frequently,  the  lungs, the trachea, the head,
 the bowels,  and even the heart, as well as the gout.
 Those actions, moreover,  are  the  means of a fluid
 being  secreted which  is changed into  calcareous
 matter in the joints and other parts of the body, ex-
 actly like that which is produced by the gout. They
 likewise  twist and dislocate the  bones in common
 with the  gout, in a manner to be  described here-
after.  The only difference between what are called 
256
OBSERVATIONS ON
gouty, and rheumatic actions, consists in their seats
and in the degrees of their force. The debility which
predisposes to the  gout,  being greater,  and more
extensively diffused  through  the  body  than the
debility which precedes  rheumatism, the morbid
actions in the former case, pass more readily  from
external to internal parts, and produce in both more
acute and more dangerous effects. A simile derived
from the difference  in the  degrees of action  produ-
ced in the system by marsh miasmata, made use of
upon a former occasion, will serve me again  to il-
lustrate this part of our subject. A mild remittent,
and a yellow fever, are different grades of the same
disease. The former, like the  rheumatism, affects
the bones chiefly with pain, while the latter, like the
gout, affects not  only the bones, but the stomach,
bowels, brain, nerves, lymphatics, and all the inter-
nal parts of the body.

   II. In  the arterial system the gout produces fe-
ver.  This fever appears not  only in  the increased
force or frequency of the  pulse, but in morbid af-
fections of all the viscera. It puts on all the diffe-
rent  grades  of fever, from  the malignity of the
plague, to the mildness  of a common intermittent.
It has moreover  its regular exacerbations and re-
missions once in every four and twenty hours, and
its crisis  usually on the fourteenth  day, in  violent 
                    THE GOUT.               257
 cases.  In moderate attacks, it runs on from twenty
 to forty days in common with the typhus or slow
 chronic state of fever.  It is common for those per-
 sons who consider the gout as a specific disease,
 when it appears in the above forms, to say, that it
 is complicated  with fever; but this is an error, for
 there can exist  but one morbid action in the blood-
 vessels at once,  and the same laws are imposed upon
 the morbid actions excited in those parts of the
 body by the remote  causes  of  the gout, as by
 the  common  causes of fever. I have seen two in-
 stances of this  disease appearing in the form of a
 genuine hectic,  and one  in  which it appeared to
 yield to lunar influence, in the manner described by
 Dr.  Balfour.  In the  highly  inflammatory  state of
 the  gout, the sensibility of the  blood-vessels far
 exceeds what is seen in the same state of fever from
 more common causes.  I have known an instance
 in which a translation of the gouty action to the eye
 produced such  an  exquisite degree of  sensibility,
 that the patient  was unable to bear the feeble light
 which was emitted from a few coals of fire in his
 room, at a time  too when the coldness of the wea-
 ther would have  made a large fire agreeable to him.
 I once attended  a lady in this diseasein whom  the
 walking of her  attendants  across the floor of her
 chamber, and even the touch of a hand upon any
part of her body  in moving her in bed, excited con- 
258
OBSERVATIONS ON
 siderable pain.  It is  from the extreme sensibility
 which the gout imparts to the stomach, that the bark
 is so generally rejected by it. I knew a British officer
 who had nearly died from taking a spoonful of the
 infusion of that medicine, while his arterial system
 was in this state of morbid excitability, from a fit of
 the gout. It is remarkable that the gout is most dis-
 posed to assume a malignant character, during  the
 prevalence of an inflammatory constitution  of  the
 atmosphere.  This has been long ago remarked by
 Dr.  Huxham.  Several instances  of it have occur-
 red in this city since the year 1793.

   III.  The  gout  affects most of the viscera.  In
the brain it produces head-ach, vertigo, coma, apo-
plexy, and  palsy.  In  the lungs it produces pneu-
monia vera, notha, asthma, haemoptysis, pulmonary
consumption, and a short hecking cough,  first de-
scribed by Dr.  Sydenham.  In the throat it pro-
duces inflammatory angina.  In the uterus it pro-
duces hsemorrhagia uterina.  It affects the kidneys
with inflammation, strangury, diabetes, and calculi.
The position of the body  for weeks or months on
the back, by favouring the compression of the kid-
neys by the  bowels,  is the  principal reason why
those parts suffer so  much in  gouty people.  The
strangury appears to be produced by the same kind
of engorgement or choking of the  vessels of the 
                    THE GOUT.               259
 kidneys, which takes place in the small-pox  and
 yellow fever.  Four cases of it are described in the
 3d volume of the Physical and Literary Essays of
 Edinburgh, by Dr. David Clark.  I have seen one
 instance  of death in an old man from this cause.
 The catheter brought  no water from his  bladder.
 The late  Mr. John Penn, formerly  governor of
 Pennsylvania, I have been  informed by one of his
 physicians, died from a similar affection in his kid-
 neys from gout.  The catheter  was as ineffectual
 in  giving him relief, as it  was in  the case of my
 patient.  The  neck of the  bladder  sometimes be-
 comes the seat of the  gout.  It discovers itself by
 spasm, and a suppression cf urine in some cases,
 and occasionally by an habitual discharge of mucus
 through the urethra.  This disease has  been called,
 by Lieutaud,  "  a catarrh  of the  bladder."  Dr.
 Stoll describes it and calls it " haemorrhoids of the
 bladder."  But of all the viscera, the  liver suffers
 most from the gout. It produces  in it  inflamma-
 tion,  suppuration,  melena, schirrus, gall-stones,
jaundice, and an habitual increased secretion and ex-
 cretion of bile. These affections of the liver  ap-
pear most frequently in southern countries, and in
female habits. They are substitutes for a gout in
the ligaments, and in the extremities of the body.
They appear  likewise in drunkards from  ardent
spirits. It would seem that certain stimuli act spe- 
260           OBSERVATIONS ON
cifically upon the liver, probably for the wise pur-
pose  of discharging such parts of the blood from
the body, as are  vitiated by the rapidity of its cir-
culation.  I shall, in another  place,*  take  notice
of the action of marsh miasmata upon the livers of
men  and  beasts.  It has been observed that hogs
that live near brewhouses,  and feed upon the fer-
mented grains of barley, always discover  enlarged
or diseased livers. But a determination of the blood
to the liver, and an increased action of its vessels,
are produced by  other causes than marsh miasmata,
and fermented and distilled liquors. They appear in
the fever which accompanies madness and  the ma-
lignant sore-throat, also in contusions of the brain,
and in the excited state of the blood-vessels  which
is produced  by anger and  exercise. I have found
an attention to these facts useful in prescribing  for
diseases of the liver, inasmuch as they have led  me
from  considering them as idiopathic affections, -but
as the effects only of  morbid  actions excited in
other parts of the body.

  IV. The gout  sometimes  affects the arterial and
nervous systems jointly, producing in the  brain,
coma, vertigo, apoplexy, palsy, loss  of memory,
and madness, and in the nerves, hysteria, hypochon-
driasis and syncope. It  is common to say the gout
counterfeits all these diseases. But this is an  in-
                    * Vol. IV. 
THE GOUT.
261
 accurate  mode of speaking.  All those diseases
 have but one cause, and they are exactly the same,
 however different the stimulus may be, from which
 they are derived.  Sometimes the gout affects the
 brain and nerves  exclusively,  without producing
 the least morbid action in the blood-vessels. I once
 attended a gentleman from Barbadoes who suffered
 from this affeetion  of his brain and nerves, the most
 intolerable depression of spirits. It yielded to large
 doses of wine, but his relief was perfect, and more
 durable,  when a pain was excited by nature or art,
 in his hands or feet.

   The muscles  are sometimes affected by the gout
 with spasm, with general  and partial convulsions,
 and lastly with  great pain. Dr. Stoll describes a
 case of opisthotonos from it.  The angina pectoris,
 or a sudden inability to breath after climbing a hill,
 or a pair of stairs, and  after a  long walk, is  some-
 times a  symptom  of the  gout. There  is a pain
 which suddenly pervades  the  head,  breast,  and
 limbs, which resembles an electric  shock.  I have
 known two instances of it in gouty patients,  and
 have taken the liberty of calling it the " aura arthri-
 tica."  But the pain which affects  the muscles is
 often of a more  permanent nature. It is felt with
most severity in  the calves of  the legs. Sometimes
it  affects  the muscles of  the  head,  breast, and
  Vol. II.                          LI 
262           OBSERVATIONS ON
limbs, exciting in them large and distressing swel-
lings. But further;  the gout in  some  cases seizes
upon the tendons, and twists them in  such a man-
ner as to dislocate bones in the hands  and feet. It
even affects the cartilages. Of this  I  once saw an
instance in colonel Adams, of the state of Maryland.
The external parts  of both his ears  were so much
inflamed in a fit of  the gout,  that he was unable to
lie on either of his sides.

  V. The gout affects the alimentary canal, from
the stomach to  its termination in the rectum. Fla-
tulency, sickness, acidity, indigestion,  pain, or  vo-
miting,  usually  usher in a fit of the disease.  The
sick head-ach, also dyspepsia, with all its train of
distressing evils, are frequently the  effects of gout
concentrated in  the stomach.  I have  seen a case
in which the gout, by retreating to this viscus, pro-
duced the  same burning sensation which is felt in
the yellow fever. The patient who was the subject
of this symptom died two days afterwards with a
black vomiting.  It was Mr. Patterson,  formerly
collector of the port of Philadelphia,  under the Bri-
tish  government. I was not surprised  at these  two
uncommon symptoms in the  gout,  for I  had long
been familiar with its disposition to  affect the bili-
ary secretion, and the actions of the stomach. The
colic and dysentery are often produced by the gout 
THE GOUT.
263
in the bowels. In the southern states of America,
it sometimes produces a chronic diarrhcea, which is
known in some places by the name of the " down-
ward consumption."  The piles are a  common
symptom of gout, and where they pour forth blood
occasionally render it a harmless disease.  I have
known an instance in which  a gouty pain in the
rectum produced involuntary  stools in a gentleman
in this city, arid I have heard from a southern gen-
tleman,  who had been afflicted with gouty symp-
toms, that a similar pain was excited in the same
part to such a degree,  whenever he  went into a
crowded  room lighted by candles, as to oblige him
to leave it.  In considering the effects of the gout
upon this part, I am led to take notice of a trouble-
some itching in the anus which has been  described
by  Dr.  Lettsom, and justly attributed by him to
this  disease.*  I have known several cases  of it.
They always  occurred  in gouty  habits.  A dis-
tressing collection of air in the rectum, which ren-
ders frequent  retirement from company necessary
to discharge it, is  likewise a symptom of gout. It'
is accompanied with frequent, and small, but hard
stools.
* Medical Memoirs, vol. III. 
264
OBSERVATIONS ON
  Of the above morbid affections  of  the  nerves.
stomach, and bowels, the hysteria,  the sick head-
ach, and the colic, appear much oftener in  women
than in men.  I  have said that dyspepsia is a symp-
tom of gout. Out of more  than 500 persons who
were the patients  of the Liverpool  infirmary and
dispensary, in  one year, Dr.  Currie informs  us,
" a great majority  were females, "f

  VI. The gout affects the  glands and lymphatics.
It produced a salivation of a profuse nature in ma-
jor  Pearce Butler, which continued for two days.
It produced a bubo in the groin in a citizen of Phi-
ladelphia.  He  had never been infected with the
venereal disease, of course no suspicion was enter-
tained by me of its being derived from that cause.
I knew a lady who had periodical swellings in her
breasts, at the  same season of the year in which
she had before  been accustomed to have a regular
fit of the gout.  The scrofula and all the forms of
dropsy are the effects in many cases of the disposi-
tion of  the gout to  attack the lymphatic system.
There is a large hard swelling without pain, of one,
or both the legs and thighs, which has been called
a dropsy,  but is very different from the common
disease of  that name.  It comes on, and goes  off

  t Medical Reports on  the Effects of Hot and Cold Water,
p. 215. 
THE GOUT.
265
 suddenly.  It has lately been called in England the
 dumb  gout. In the spring of 1798 I attended co-
 lonel Innes,  of Virginia, in consultation  with my
 Edinburgh friend and fellow-student, Dr. Walter
 Jones, of  the same state. The colonel had large
 anasarcous swellings in his thighs and legs, which
 we had reason to believe were the effects  of an in-
 dolent gout. We made  several  punctures in his
 feet and  ancles, and  thereby  discharged a large
 quantity of water from his legs and thighs.  A day
 or two afterwards his ancles exhibited  in pain and
 inflammation, the usual form of gout in those parts.
 In the year 1794 I attended Mrs. Lloyd  Jones, who
 had a swelling of the same kind in her foot and leg.
 Her constitution, habits, and  the  sober  manners
 of her ancestors, gave me no reason to suspect it
 to arise  from the usual  remote  causes  of gout.
 She  was feverish, and her pulse was tense. I drew
 ten ounces of blood from her, and gave her a purge.
 The swelling subsided, but it was succeeded by an
 acute rheumatic pain in the part, which  was cured
 in a few days.  I mention these facts as an addition-
 al proof of the sameness  of the gout and rheuma-
 tism, and to show that the vessels in a simple dis-
 ease, as well as in malignant fevers, are often op-
 pressed beyond that point in which they  emit the
sensation of pain. 
266
OBSERVATIONS ON
  Under this head I shall include  an account of
the mucous  discharge  from  the  urethra,  which
sometimes takes place in an attack of the gout, and
which has ignorantly been ascribed to a  venereal
gonorrhaea. There is a description of this symptom
of the gout in the 3d volume of the Physical and
Literary Essays of Edinburgh, by Dr. Clark. It
was first taken notice of by  Sauvages by the name
of " gonorrhaea podagrica,"  in a work entitled Pa-
thologia Methodica, and afterwards  by Dr. Whytt.
Dr. Plaigne saw an instance of this  symptom alter-
nating with a pain in the great toe, and which was
removed by a blister to that part of the body. It oc-
curs most frequently in  old  people. I have known
three instances of it in this city. In the visits which
the gout pays to the genitals, it sometimes excites
great pain in the testicles.  Dr. Whytt mentions
three cases of this kind.  One of them was  attended
with a troublesome itching of the scrotum. I have
seen one case in which the  testicles were affected
with great pain,  and the penis with an obstinate pri-
apism. They succeeded a sudden translation of the
gout from the bowels.

  From the  occasional  disposition  of the gout to
produce a mucous discharge  from the urethra in
men, it is easy to conceive  that it  is the  frequent
cause of the fluor albus  in women, for  in them, the 
                  THE GOUT.               267
gout which is restrained from the feet, by a cause
formerly mentioned, is driven to other  parts, and
particularly to that part which, from its offices,  is
more disposed to  invite disease  to it,  than any
other.  The fluor  albus  sometimes occurs  in fe-
males, apparently of the most  robust  habits.  In
such  persons, more especially  if  they  have been
descended from gouty ancestors, and have led in-
dolent and luxurious lives, there can be no doubt
but the disease is derived from the gout, and should
be treated with remedies which act not only upon
the affected part, but the  whole system. It is known
by being accompanied with pains in the limbs, and
by being worst when in bed.  An itching similar  to
that I formerly mentioned in the anus,  sometimes
occurs in the vagina of women. Dr. Lettsom has
described it. In all the  cases I  have known of  it,
I believe it was derived  from the usual causes  of
the gout.

  VII. There are many records in  the annals  of
medicine of the gout affecting the skin. The ery-
sipelas, gangrene, and petechia; are its  acute, and
tetters, and running sores  are  its usual chronic
forms  when it appears in this part of the body.  I
attended a patient with the late  Dr. Hutchinson,  in
whom the  whole calf of one leg was destroyed by
a mortification which succeeded the  gout.  Dr. 
  f

268           OBSERVATIONS ON
Alexander, of Baltimore, informed me that pete-
chias were among the last symptoms of this disease
in the Rev.  Mr. Oliver, who  died in the town  of
Baltimore, about two years ago. In the  disposition
of the gout  to attack external parts, it  sometimes
affects the eyes and ears with the most acute and
distressing inflammation and  pain. I hesitate the
less in ascribing them  both to the gout, because
they not only occur in  gouty habits, but because
they now and then effuse a calcareous matter of the
same nature with that which  is found in the liga-
ments of the joints.

  VIII.  Even the bones are not exempted from the
ravages of this disease. I  have before mentioned
that the bones of the hands and feet are sometimes
dislocated by it.  I have heard of an  instance  in
which it dislocated the thigh bone.  It probably
produced this effect by the effusion of  that part of
the blood which constitutes chalk-stones, or by an
excrescence  of flesh in the cavity of the joint. Two
instances have occurred in this city of  its dislodg-
ing the teeth, after  having produced the most dis-
tressing  pains in the jaws. The  long  protracted,
and acute pain in the face, which has been so accu-
rately described by Dr. Fothergill, probably arises
wholly from the gout acting upon the bones of the
part affected. 
THE GOUT.
269
    1 have more than once hinted at the sameness of
- some of the states of the gout, and the yellow fever.
  Who can compare  the symptoms and seats of both
  diseases,  and-ribt admit the unity of the remote and
  immediate causes of fever?

    Thus I have enumerated proofs of the gout being
  a disease of the whole system.  I have only to add
  under this proposition, that it affects different parts
  of  the body in different people, according to the
  nature of their congenial or acquired predispositions,
  and that it often  passes from one part of the. body
  to another in the  twinkling of an eye.

  . The morbid excitement, and actions of the gout,
  when seated in the ligaments, the blood-vessels, and
  viscera, and left to  themselves,  produce effects dif-
  ferent in  their nature,  according to the  parts  in
  which  they take place.  In  the  viscera they  pro-
  duce congestions composed of all the component
  parts of the blood.  From the blood-vessels which
  terminate in  hollow cavities and in cellular mem-
  brane, they produce those effusions of serum which
  compose  dropsies.  From the same vessels proceed
  those effusions which produce on the skin erysipe-
  las, tetters, and all the different kinds  of eruptions.
  In the ligaments they produce an effusion of coagu-
  lablc lymph, which by  stagnation is  changed into
   Vol. II.                        M m 
270
OBSERVATIONS Oh>
what are called chalk-stones. In the urinary organs
they produce an effusion of particles of coagulable
lymph or red blood, which, under  certain circum-
stances, are changed into  sand, graVel, and stone.
All these observations are liable to some exceptions.
There are instances in which chalk-stones have been
found  in the lungs, mouth, on the eye-lids, and in
the passages of the ears, and a preternatural flux of
water and blood has taken place from the kidneys.
Pus has likewise been formed in the joints, and air
has been found in the cavity of the belly, instead of
water.

   Sometimes  the gout is  said to combine with the
fevers  which arise from cold and  miasmata. We
are not to  suppose from this circumstance, that the
system is under a twofold  stimulus. By no means.
The symptoms which are ascribed to the gout, arc
the effects of morbid excitement, excited by the
cold,  or miasmata acting upon parts previously de-
bilitated by the usual remote causes of that disease.
A bilious constitution of the air so often excites the
peculiar symptoms of gout in persons predisposed
to it, that it has sometimes been said to be epidemic.
This  was the case, Dr.  Stoll says, in Vienna, in
the years  1782 and  1784. The same mixture of
gouty  and bilious symptoms  was observed by Dr. 
THE GOUT.               271
Hillary,  in the fevers of Barbadoes.  It is because
gouty people have some parts of their bodies pre-
viously debilitated, that they often escape  epidemic
diseases. Those weak parts invite, and fix disease
to one or two places, and thus prevent its being dif-
fused throughout the whole  system.  Of this Sir
John Pringle relates a striking instance. While the
British  army was in die north of Scotland, in the
year 1746, the weather became suddenly very cold,
in consequence of which  catarrhs became general
among the soldiers, while  many of the officers were
affected only with gout. Here the obstructed perspi-
ration which fell upon the breast in the soldiers, was
translated to parts previously debilitated in the offi-
cers, and there excited the symptoms  of what is
called another disease.

  From a review of the symptoms of the  gout, the
impropriety of distinguishing  it  from  its various
seats, by specific  names,  must be  obvious to the
reader.  As well might we talk of a yellow fever in
the brain, in the  nerves, or in the  groin, when its
symptoms affect those parts, as talk of misplaced or
retrocedent gout.' The great toe,  and the  joints of
the hands and feet, are no more its exclusive seats,
than the " stomacHfcs the throne of the yellow fe-
ver " In short, th£*gout  may be compared to a 
272
OBSERVATIONS ON
 monarch whose empire is unlimited. The whole bo-
 dy crouches before it.

   It has been said as a reflection upon our profes-
 sion, that physicians  are  always  changing  their
 opinions respecting chronic diseases. For a long
 while they were all classed under the heads of ner-
 vous,  or bilious.  These  names  for many  years
 afforded a sanctuary for the protection  of  fraud
 and error in medicine. They have happily yielded
 of late  years to the name of gout. If we mean by
 this disease  a  primary affection of the joints, we
 have  gained nothing by assuming  that name;  but
 if we mean by  it a disease which  consists simply
 of morbid excitement,  invited by debility, and dis-
 posed  to  invade every part of the body, we con-
 form our ideas  to facts, and thus  simplify theory
 and practice in chronic diseases.

   I proceed now to treatof the method of cure.

  Let not the reader startle when I  mention curing
the gout.  It is not a sacred disease. There will
be no profanity in handling it freely. It has been
cured often, and I hope to  deliver such directions
under this head, as  will  reduwit as much under
the power of medicine, as a pleurisy or an intermit-
ting fever. Let not superstition say here, that the 
THE GOUT.
273
gout is the just punishment of folly and vice, and
that the justice of Heaven would be defeated by
curing it. The venereal disease is more  egregi-
ously  the effect of vice than the gout,  and yet
Heaven has  kindly directed human reason to the
discovery of a remedy which effectually eradicates
it from the  constitution. This opinion of the gout
being  a curable disease, is as humane as it is just.
It is calculated to prompt to early application for
medical aid, and to  prevent  that despair of relief
which has contributed so much to its duration, and
mortality.

  But does not the gout prevent other diseases, and
is it not improper upon this account to cure it? I
answer, that it prevents other diseases, as the daily
use  of drams prevents the intermitting fever.  In
doing  this, it brings on a  hundred more  incura-
ble  morbid  affections.  The yellow fever  carried
off many chronic diseases in the year  1793,  and
yet who would wish  for, or  admit such a remedy
for a similar  purpose?  The practice of  encourag-
ing, and inviting what has been called a  " friendly
fit" of the gout as a cure for other diseases, resem-
bles the practice of school boys  who  swallow the
stones  of cherries to assist their stomachs in digest-
ing that delicate fruit.  It is no more  necessary to
produce the gout in the feet, in  order to cure it, 
274           OBSERVATIONS ON
than it is to wait for, of encourage abscesses or na-
tural haemorrhages, to  cure a  fever.  The practice
originated at a time when morbific matter was sup-
posed to be the cause of the gout, but it has unfor-
tunately continued under the  influence of theories
which  have placed the seat of the disease  in the
solids.

   The remedies for the gout naturally divide them-
selves into the following heads.

   I. Such as  are  proper  in its approaching, or
forming state.

   II. Such as  are proper in violent morbid action
in the blood-vessels and viscera.

   III. Such as are proper in a feeble morbid action
in the same parts of the body.

   IV. Such as are proper to relieve certain local
symptoms which are not accompanied by general
morbid action. And

   V.  Such as  are proper to prevent its recurrence,
or, in other words, to eradicate it from the system.

   I.  The symptoms of an approaching fit of the 
                  THE GOUT.               275
gout are great languor and dulness of body and
mind,  doziness, giddiness, wakefulness, or sleep
disturbed by vivid dreams, a dryness, and some.
times a coldness, numbness,  and prickling, in the
feet  and legs, a disappearance  of pimples hi the
face, occasional  chills, acidity and flatulency in the
stomach, with an increased, a weak, or a defect of
appetite. The chemists  have discovered another
symptom of an approaching fit of the gout, and that
is, the presence of the phosphoric acid in the urine.
The very sweats they say of gouty patients tinge
the syrup of violets of a red colour from the pre-
dominance of this acid  in them. The symptoms
which have been mentioned  are not universal, but
more or less of them usher in nearly every fit of the
gout.  The reader will see at once  their sameness
with the premonitory symptoms of fever from cold
and miasmata, and assent, from this proof in addi-
tion to others formerly mentioned, to the propriety
of considering a fit  of the gout, as a paroxysm of
fever.

   The system, during the existence of these symp-
toms,  is in a state of morbid depression. The dis-
ease is as  yet unformed, and may easily be pre-
vented by the loss of a few ounces of blood, or, if
this remedy be objected to, by a  gentle dose of 
276
OBSERVATIONS ON
 physic, and afterwards by bathing the feet in warm
 water, by a few drops of the spirits of hartshorn in
 a little sage or camomile tea, by a draught  of wine
 whey, or a common dose of liquid laudanum,  and,
 according to a late Portuguese physician, by taking
 a few doses of bark.

  It is worthy of notice, that if these remedies are
 omitted, all the premonitory symptoms that have
 been  mentioned disappear as soon  as  the arthritic
 fever is formed, just as lassitude and chilliness yield
 to a paroxysm of fever from other causes.

  II.  Of the remedies that are  proper in cases of
 great morbid  action in the blood-vessels and vis-
 cera.

  I shall begin this head by repudiating the notion
of a specific cure for the gout existing in any sin-
gle  article  of  the materia  medica.  Every  attempt
to cure it by elixirs, diet-drinks, pills  or boluses,
which were intended  to act singly on  the  system,
has been as unsuccessful as the attempts to cure the
whooping cough by spells, or tricks of legerdemain.

  The first remedy that I  shall  mention for redu-
cing great  morbid action in the blood-vessels and
viscera  is blood-letting. I  was first taught the
safety of this  remedy  in the gout by  reading  the 
THE GOUT.
277
works of Dr. Lister, near forty years ago, and I
have used it ever since with great advantage. It has
the  sanction  of Dr. Hoffman,  Dr.  Cullen,  and
many others of  the  first names in  medicine in its
favour.

   The  usual  objections to  bleeding as a remedy,
nave been  urged with  more success  in the gout,
than in any othei disease. It has been forbidden,
because the gout is said to be a disease of debility.
This is an error.  Debility is not a disease.  It is
only its predisposing cause.  Disease is preternatu-
ral strength in the state of the system now under
consideration, occasioned by the abstraction of ex-
citement from one part,  and the accumulation of it
in another  part  of the  body.  Every argument in
favour of bleeding in a  pleurisy applies in the pre-
sent instance, for they both depend upon the same
kind of morbid action in the blood-vessels.  Bleed-
ing acts moreover alike in both cases by abstracting
the excess  of excitement from the blood-vessels,
and  restoring its natural  and healthy  equality to
every part of the system.

   It has been further said, that bleeding disposes
to more frequent returns of the  gout.  This objec-
tion  to  the lancet has been  urged by Dr. Syden-
  Vol. II.                         N n 
278
OBSERVATIONS on
ham, who  was misled in his opinion of it, by his
theory of the disease being the offspring of morbi-
fic matter.  The assertion is unfounded, for bleeding
in a fit of the gout has no such effect, provided the
remedies to be mentioned hereafter are used to pre-
vent it. But a fit of the gout is not singular in its
disposition to recur  after being once cured. The
rheumatism, the pleurisy, and the intermitting fever
are all equally disposed to return when persons are
exposed to their remote and exciting causes,  and
yet we  do not upon this account consider them as
incurable diseases, nor do we abstain from the usual
remedies which  cure them.

  The inflammatory or violent state  of the gout is
said most commonly to affect the limbs.  But this
is far from being the case. It  frequently makes
its first attack upon  the head, lungs, kidneys, sto-
mach, and  bowels. The remedies for expelling it
from the stomach and  bowels are generally of a
stimulating  nature. They are as improper in full
habits, and  in the recent  state of the disease, as
cordials are to drive the small-pox from the vitals
to the  skin. Hundreds  have been  destroyed  by
them. Bleeding  in these  cases affords  the same
speedy and certain relief that it  does in removing
pain from the stomach and bowels in  the first stage
of the yellow fever. Colonel Miles owes his life to 
FHE GOUT.               379
 the loss of 60 ounces of blood in an attack of the
 gout in his bowels, in the winter of 1795,  and ma-
 jor Butler derived the same benefit from the loss of
 near 30 ounces, in an attack of the gout in his sto-
 mach in the spring of 1798.

   I could add many more instances  of the efficacy
 of the lancet in the gout when it affects the viscera,
 from my  own experience, but I prefer mentioning
 one only from sir John Floyer, which is more strik-
 ing than any I have met with in its favour.  He tells
 us, sir Henry Coningsby was much disposed to the
 palsy from the gout when he was 30 years old. By
 frequent bleedings, and the use of the cold bath, he
 recovered, and lived  to be 88. During his old age,
 he was bled every three months.

  I have said, in the history of the symptoms of the
 gout, that it sometimes appeared in  the form  of a.
 hectic fever. I  have prescribed  occasional  bleed-
 ings in a case of this  kind accompanied with a tense
 pulse, with the  happiest effects.  It confined  the
disease for several years wholly  to the blood-ves-
 sels, and it bid fair in time to eradicate  it from the
 system.
The state of the pulse,  as described in another 
280
OBSERVATIONS ON
place,* should govern the use of the lancet in this
disease. Bleeding  is  required as much  in its  de-
pressed, as  in its  full and chorded  state. Colonel
Miles's pulse, at the time he suffered from the gout
in his bowels, was scarcely perceptible.  It did not
rise till after a second or third bleeding.

   Some advantage may be derived from examining
the blood. I have once  known  it to be  dissolved;
but for the  most part I have observed it, with  Dr.
Lister, to be covered with the buffy coat of com-
mon inflammation.

   The arguments made use of in favour of bleed-
ing in  the  diseases of old people in a former vo-
lume,  apply with equal force to its use in the gout.
The inflammatory state of this disease  frequently
occurs in the decline  of life, and  bleeding is as
much  indicated in such cases as in any other in-
flammatory fever.  The late Dr. Chovet died with
an inflammation in his liver from gout, in the 86th
year of his age. He  was twice bled, and his blood
each time was covered with a buffy coat.

   Where the gout affects  the head with obstinate
 pain, and appears to be seated in the muscles, cup-
* Defence of Blood-letting, vol. IV. 
THE COUT.
281
ping and leeches give great relief.  This mode of
bleeding should be trusted in those cases  only in
which the morbid action is confined chiefly to the
head, and appears in a feeble state in the rest of the
arterial system.

   The  advantages of bleeding  in the gout, when
performed under all  the circumstances that  have
been mentioned, are as follow:

   1. It removes or lessens pain.

   2.  It prevents those  congestions and effusions
which produce apoplexy, palsy, pneumonia notha,
calculi in the kidneys and bladder, and chalk-stones
in the hands and feet.  The gravel  and stone are
nine  times in ten, I believe, the effects of an effu-
sion of lymph or blood  from previous morbid ac-
tion in the kidneys.  If this disease  were narrowly
watched, and cured  as often as it occurs,  by the
loss of blood, we should have but  little gravel or
stone among gouty people. A  citizen of Philadel-
phia died a few years ago, in the 96th year of his
age,  who had  been subject to the strangury the
greatest part of his life. His  only  remedy for it
was bleeding. He lived  free from the  gravel  and
stone, and died, or rather appeared to fall asleep in
death, from old age. Dr. Haller mentions a  similar 
282
OBSERVATIONS ON
 case in his Bibliotheca Medicinse, in which bleed-
 ing had the same happy effects.

   3. It prevents the system from  wearing itself
 down  by  fruitless pain and  sickness, and thereby
 inducing a predisposition to frequent returns of the
 disease.

   4. It shortens the duration of a fit of gout, by
 throwing it, not into the feet, but out of the sys-
 tem, and thus prevents a patient's lying upon his
 back for two or three months with a writhing face,
 scolding, a  wife and  family of children, and some-
 times cursing every servant that comes near enough
 to endanger the touch of an inflamed limb.  Besides
 preventing all this parade of  pain and peevishness,
 it frequently, when assisted with other remedies to
 be mentioned presently, restores a man to his busi-
 ness and society  in  two or three days:  a circum-
stance  this of great importance  in  the  public as
 well as private pursuits of men; for who has not
 read of the most interesting affairs of nations being
 neglected or  protracted, by the principal agents in
 them  being  suddenly  confined to their beds, or
 chairs, for weeks or months, by a fit  of the gout?

  2. A second  remedy in the state of the gout
which  has  been mentioned,  is purging.  Sulphur 
THE GOUT.
283
is generally preferred for  this purpose, but castor
oil, cream  of tartar, sena,  jalap, rhubarb, and calo-
mel, may all be used with equal safety and advan-
tage. The stomach and habits of the patient should
determine  the choice of a suitable purge in every
case.  Salts are generally offensive to the stomach.
They once brought on a fit of the  gout  in  Dr.
Brown.

  3. Vomits may be given in all those cases where
bleeding is objected to, or where the pulse is only
moderately active.  Mr.  Small,  in  an excellent
paper upon the gout, in the 6th volume of the  Me-
dical Observations  and Inquiries,  p.  205, contain-
ing the history of his own  case, tells us that he
always  took  a vomit upon  the  first  attack of the
gout,' and  that it never failed of relieving all its
symptoms. The  matter discharged by this vomit
indicated a morbid  state of the liver,  for it was al-
ways a dark greenish bile, which was insoluble  in
water.  A  British  lieutenant,  whose misfortunes
reduced him to the necessity of accepting a bed in
the poor-house of this city, informed the late Dr.
Stuben, that he had once been much  afflicted  with
the gout, and  that he had  upon  many occasions
strangled a fit of it by the early use of an emetic.
Dr. Pye adds his testimony to  those which have
been given in favour of vomits, and  says  further,
that they do most service when they discharge an 
284
OBSERVATIONS ON
acid humour  from the stomach.  They  appear to
act in part by  equalizing the divided excitement of
the system, and in part by discharging the contents
of the gall-bladder and stomach, vitiated by the
previous debility of those organs. Care  should be
taken not to exhibit  this remedy where the gout
attacks the stomach with symptoms of inflammation,
or where it has a tendency to  fix itself upon the
brain.

  4. Nitre may be given with  advantage in  cases
of inflammatory action, where  the stomach is not
affected.

  5. A  fifth  remedy  is cool or cold air. This is
as safe and as useful  in the gout as  in  any  other
inflammatory  state of fever. The  affected limbs
should be kept out of bed, uncovered. In this way
Mr. Small says he moderated the pains of the gout
in his hands and feet.* I have directed the  same
practice with  great comfort, as well as advantage
to my patients.  Even cold water has been applied
with good effects to a limb inflamed by the  gout.
Mr. Blair M'Clenachan taught me the  safety and
benefit of this remedy, by using it  upon  himself
without the advice of a physician  It instantly re-
moved his pain, ny was the gout translated by it
to any other part of his body.  It was removed in
   ' Medical Observations and Inquiries, vol. VI. p. 201. 
THE GOUT.
235
the same manner, Dr. Heberden tells us, by the
celebrated Dr. Harvey,  from  his  own  feet.  Dr.
Kinlake has lately published a treatise in favour of
the application of cold water to the limbs of gouty
patients. To be effectual, he says it should be applied
by means of wet cloths for  eight and forty hours,
and that frictions should  be  used afterwards to the
parts affected.  This practice has had its advocates
and its opponents. Where no internal predisposition
exists from debility, it is I believe as safe  as in a
common rheumatism, but I would by no means ad-
vise it to persons who had been previously affected
with gout in the stomach, bowels, breast or brain.
Perhaps it would be best in most cases  to prefer
cool, or cold air, to cold water. The safety and ad-
vantages of both the modes of applying cold to the
the affected limbs which have been mentioned, show
the impropriety of the  common practice of wrap-
ping them in flannel.

   6.  Diluting  liquors, such  as are prescribed  in
common inflammatory fevers,  should  be given in
such quantities  as to dispose to a gentle  perspira-
tion.

   7. Abstinence from wine, spirits, and malt  liquors,
also from such  aliments as  afford much nourish-
ment or stimulus, should be carefully enjoined. Sa-v
  Vol. II.                          O o 
286
OBSERVATIONS ON
go, panada, tapioca, diluted milk with bread, and
the pulp of apples, summer fruits, tea, coffee, weak.
chocolate,  and  bread  soaked in chicken water  or
beef tea, should constitute the principal diet of pa-
tients in this state of the gout.

   8. Blisters are an invaluable remedy in this dis-
ease, when used at a proper time, that  is, after the
reduction  of the morbid actions in the system  by
evacuations.  They should be applied to the joints
of the feet and wrists in general gout, and to the
neck  and  sides, when it attacks the head or breast.
A strangury from the gout is no objection  to their
use. So far from  increasing  this complaint, Dr.
Clark  and Dr.  Whytt inform us, that they remove
it.* But the  principal advantage of blisters is de-
rived from their collecting and concentrating scat-
tered and  painful sensations, and  conveying them
out of the system, and thus becoming excellent
substitutes for a tedious fit of the gout.

   9.  Fear and  terror have in some instances cured
a paroxysm of this disease. A captain of a British
ship  of war, who  had  been  confined for several
weeks  to  his cabin by  a severe fit of the  gout in
his feet, was suddenly cured  by hearing the cry of

      * Physical and Literary Essays, vol. III. p. 469. 
                    THE GOUT.               287
 fire on board his ship. This fact was communicated
 to me by a gentleman who was a witness of it. Many
 similar cases are upon record in books of medicine.
 I shall in another place insert an account of one in
 which the cure effected  by a  fright, eradicated the
 disease from the system  so completely, as ever af-
 terwards to prevent its return.

   Thus have I enumerated the remedies which are
 proper in  the gout when  it affects the blood-vessels
 and viscera  with great morbid action.  Most of
 those remedies are alike proper when the morbid
 actions are seated in the muscular  fibres, whether
 of the bowels or  limbs, and whether  they produce
 local pain, or general convulsion, provided they are
 of a violent nature.

   There are some remedies under this head of a
 doubtful nature, on which I shall make a few ob-
 servations.

   Sweating has been recommended  in  this state
 of the gout.  All the objections to it in preference
 to other modes of depletion, mentioned in another
 place,* apply against its use in the inflammatory
state of the gout.  It is not only less safe than bleed-

             * Defence of Blood-letting. 
288           OBSERVATIONS ON
ing, purging, and abstinence, but it is often an im
practicable remedy.  The only sudorific medicine
to be trusted in this state of the disease is the Se-
neka  snake-root.  It promotes all the secretions and
excretions, and exerts  but a feeble stimulus upon
the arterial system.

   Many different preparations of opium have been
advised in this state of the gout. They are all hurt-
ful if given before the  morbid action of the system
is nearly reduced.  It should then be given in small
doses  accommodated  to the excitability  of the
system.

   Applications of various kinds to the affected limbs
have been  used  in a fit of the gout,  and some  of
them writh  success.  The late  Dr.  Chalmers  of
South-Carolina used to  meet the pain of the gout
as soon as it fixed in any of his limbs, with a blis-
ter, and generally removed it by that means in two
or three days. I have  imitated this practice in se-
varal cases, and  always  with success, nor have I
ever seen the gout thrown upon any of the viscera
by means of this remedy. Caustics have sometimes
been  applied to gouty limbs with advantage. The
moxa described and used by Sir William Temple,
which is nothing but  culinary fire,  has often not
only given relief to a  pained limb, but carried oft 
THE GOUT.
289
ix fit of the gout in a few hours. These powerful
applications may be used with equal  advantage in
those cases in which the gout by falling upon  the
head  produces coma,  or symptoms  of apoplexy.
A large caustic to the neck roused Mr. John  M.
Nesbit from a coma in which he had  lain for three
days, and thereby appeared to save his life. Blis-
ters and cataplasms of mustard, had been previ-
ously used to different parts of his body, but with-
out the least effect.  In cases of moderate  pain,
where a blister has been objected to, I have seen a
cabbage leaf afford considerable relief. It produces
a moisture upon the part affected, without exciting
any pain  An old sea captain  taught  me to apply
molasses to a limb inflamed or pained  by the gout.
I have frequently  advised  it,  and generally with
advantage.  All volatile and stimulating liniments
are improper, for they not only endanger a  transla-
tion of the morbid excitement to the viscera, but
where they have not this effect, they increase  the
pain and inflammation of the part affected.

  The sooner the patient exercises his lower limbs
by walking after a  fit of the gout, the better.  " I
made it a constant rule (says  Mr. Small) to walk
abroad as soon as  the  inflammatory  state of  the
gout  was past, and though by so doing,  I  often
suffered great pain, I am well convinced  that the 
290           OBSERVATIONS ON
free use I now enjoy of my limbs is chiefly owing
to my determined perseverance in the use of that
exercise; nor am I less persuaded that nine in ten
of gouty cripples owe their lameness more to in-
dolence  and fear of pain, than to  the  genuine
effects of the gout."* Sir William Temple  con-
firms the propriety of Mr. Small's opinion and
practice, by an account of an old man  who  obvi-
ated a fit of the  gout as  often as  he felt it coming
in his feet,  by walking in the open air, and after-
wards by going  into  a warm bed,  and  having the
parts well  rubbed where the pain began.  " By
following this course (he says) he  was never laid
up with the gout, and before his death recommend-
ed the same course to his  son if ever he should
fall  into  that accident." Under a conviction  of
the  safety of this  practice the same author con-
cludes the history of  his own case in the following
words:  " 1  favoured  it [viz.  the swelling in my
feet] all this while more than I  needed, upon the
common opinion,  that walking  too much  might
draw down the  humour, which  I  have since had
reason to conclude is a great mistake, and  that if I
had walked as much as  I could  from the  first day

     * Medical Observations and Inquiries,  vol. vi. p. 220 
THE GOUT.
291
the pain left  me, the swelling  might have left me
too in a much less time."*

   III. I come now to mention the remedies which
are proper in that state of the gout in which a feeble
morbid action takes place in the blood-vessels and
viscera.

   I shall begin  this head, by remarking,  that this
state  of the gout is often created, like  the typhus
state  of fever, by the  neglect,  or too scanty use of
evacuations in its first stage. When the prejudices
which now prevent the adoption of those remedies
in their proper  time,  are  removed, we shall hear
but little of the  low state of  the arthritic fever, nor
of the numerous diseases from obstruction which
are produced by the blood-vessels disorganizing the
viscera, by repeated  and  violent attacks of the
disease.

   To determine the  character  of a paroxysm  of
gout  and the remedies proper  to relieve it, the cli-
mate, the  season of  the year,  the  constitution  of
the atmosphere,  and the nature of the prevailing
epidemic, should be carefully attended to by a phy-

  * Essay upon the Cure of  the Gout by Moxa, vol. i Jblio
edition, p. 143 and 14J.                          ¥ 
292
OBSERVATIONS on
sician. But his principal  dependence should  be
placed upon die  state of the pulse. If it  do not
discover the marks which indicate bleeding formerly
referred to,  but is weak, quick, and soft, the reme-
dies should  be such as are calculated to produce a
more  vigorous and equable action in the blood-ves-
sels and viscera. They' are,

  1.  Opium.  It should  at first be  given in small
doses, and afterwards increased, as circumstances
may require.

  2. Madeira  or Sherry wine alone, or diluted with
water, or  in the form of whey, or rendered more
cordial by having any agreeable spice infused in it.
It may be  given  cold  or warm, according to the
taste  of the patient, or  the state of his stomach. If
this medicine be rejected in all the above forms,

  3. Porter should be given. It is  often retained
when no other liquor will lie upon the stomach.  I
think I once saved the life of Mr. Nesbit  by this
medicine.  It checked a vomiting, from the gout,
which seemed to be the last symptom of his depart-
ing life. If porter fail of giving relief,

  4^ Ardent spirits should be given, either alone,
or in  the form of grog  or toddy.  Cases have  oc- 
THE GOUT.
293
 curred in which a pint of brandy has been taken in
 the course of an hour with advantage. Great benefit
 has sometimes been found from Dr. Warner's tinc-
 ture, in this state of the gout. As these observations
 may  fall  into the h:mds  of persons who may not
 have access to Dr. Warner's book, I shall here in-
 sert the receipt for preparing it.

   Of raisins, sliced and stoned, half a pound.
   Rhubarb, one ounce.
   Sen;., two drachms.
   Coriander and fennel seeds, of each one drachm.
   Cochineal, saffron, and  liquorice root, each half a
     drachm.

   Infuse  them for ten days  in a quart of French
 brandy, then strain it, and add a pint more of bran-
 dy to the  ingredients, afterwards strain it,  and mix
 both  tinctures together. Four table spoons full of
 this cordial are to be taken every hour, mixed with
 an equal quantity of water, until relief be obtained.

   Ten drops of laudanum may be added to each
dose in those cases in  which the cordial does  not
produce its intended effects, in  two or three hours.
If all the different forms  of ardent spirits  which
have been mentioned fail of giving relief,
  Vol. II.                          P p 
294           OBSERVATIONS ON
  5. From 30 drops to a tea spoon full of ather
should be given in any agreeable vehicle. Also,

  6. Volatile alkali. From five to ten grains of this
medicine should be given every two hours.

  7. Aromatic substances, such as alspice, ginger,
Virginia snake-root, cloves, and mace in the form
of teas have all been useful in this state of the gout.
Dr. Heberden prefers  them  to  wine and spirits,
from their being more permanent in their effects.

   All  these remedies are indicated in a more espe
cial manner when the gout affects the  stomach.
They are likewise proper when it affects  the bow-
els. The  laudanum in this case should be given by
way of clyster.  After the vomiting was checked in
 Mr. Nesbit by means of porter,  he was afllicted
 with a dull and  distressing pain  in his bowels,
 which was finally removed by two anodyne clysters
 injected daily for two or three weeks.

    8. Where the gout produces spasmodic or con-
 vulsive motions,  the  oil of amber may be given
 with advantage.  I  once saw it remove for a while a
 convulsive cough from the gout.

    9. In cases where the stomach will bear the bark. 
THE GOUT.
295
 it should be given in large and frequent doses.  It
 does the same service in this  state of gout, that it
 does in the slow,  or low states of fever from any
 other cause. Where the  gout appears in the  form
 of an intermittent, the  bark affords the same  relief
 that it does in the same disease from autumnal ex-
 halations.  Mr. Small  found  great benefit from it
 after discharging  the contents of  his stomach and
 bowels by a dose  of tartar emetic. " I do not call
 (says this gentleman) a  fit of the gout a paroxysm,
 for there are  several paroxysms in  the fit, each of
 which  is ushered  in with a rigour, sickness at sto-
 mach, and subsequent heat.  In this the gout bears
 a resemblance to an irregular  intermittent, at  least
 to a remitting fever, and hence perhaps the efficacy
 of the bark in removing the gout."*

   10. The warm  bath is a powerful remedy in ex-
 citing a regular and healthy action in the sanguifer-
 ous system. Where the patient is too weak to  be
taken out of bed,  and put into a bathing tub, his
limbs and body should be wrapped in flannels  dip-
ped in warm water. In case of a failure  of all the
above remedies,

   11. A salivation should  be excited as speedily as

   * Medical Observations and Inquiries, vol. vi. p. 220. 
296
OBSERVATIONS ON
possible, by means of mercury. Dr.  Cheyne com
mends it in high terms. I have once used it with
success.  The mercury,  when used in this way,
brings into action an immense mass of latent ex-
citement, and afterwards diffuses it equally through
every part of the body.

   12.  Besides these internal  remedies,  frictions
with brandy, and volatile liniment, should be used
to the stomach and bowels. Blisters should be ap-
plied to parts in which congestion or pain is seated,
and  stimulating cataplasms should be applied  to
the lower limbs.  The flour of mustard has been
justly preferred for this purpose.  It should be ap-
plied to the upper part of the foot..

   The reader will perceive, in the account I have
given of the remedies proper in  the feeble state of
chronic fever, that they are  the  same which are
used in the common typhus, or what is called ner-
vous fever. There is no reason why they should not
r^e the  same, for  the supposed two morbid states
of the system are but one disease.

   It is agreeable in medical researches to be under
the  direction  of principles. They render  unneces-
sary, in many instances,  the  slow and expensive
operations of experience, and thus multiply know- 
THE  GOUT.
297
ledge,  by lessening labour. The science of navir
gation  has rested upon this basis, since the disco-
very of the loadstone. A  mariner who  has navi-
gated a ship to one  distant port,  is capable of
conducting her to every port  on the globe. In like
manner,  the physician who can cure  one disease
by a knowledge of its principles, may by the same
means  cure all the diseases of the human body, for
their causes are the same. Judgment  is required,
only in accommodating the force of remedies to the
force of  each  disease. The difference in diseases
which arises from their seats, from age, sex, habit,
season, and climate,  may be known  in a short
time, and is within the compass of very moderate
talents.

  IV.  Were I to enumerate all the local symptoms
of gout which occur without fever,  and the reme-
dies that are proper to relieve them,  I should be
led into a tedious digression. The reader must con-
sult practical books for an account of them. I shall
only mention the remedies for a few of them.

  The theory of the gout which has been deliver-
ed, will enable us to understand the reason why a
disease which properly belongs to the whole  sys-
tem should at  any time  be accompanied  only with
local morbid affection.  The whole body is a unit, 
298
OBSERVATIONS ON
and hence morbid impressions which are resisted by
sound parts are propagated to such  as are  weak,
where they excite those morbid actions we  call
disease.

   The head-ach is a distressing symptom of the
gout.  It yields to depleting or tonic  remedies, ac-
cording to the degree of morbid action which ac-
companies it. I have heard an instance of an old
man,  who was  cured of an obstinate head-ach by
throwing  aside his nightcap, and sleeping with his
bare head exposed to the night air. The disease in
this case was probably attended with great morbid
action. In this  state  of the vessels  of the brain,
cupping, cold applications to the head, purges,  a
temperate diet, and blisters behind the ears, are all
proper remedies, and should be used together, or
in succession, as the nature of the disease may re-
quire.  Many persons have been cured of  the same
complaint by sleeping in woollen nightcaps.  The
morbid action in these  cases is always of a feeble
nature. With this remedy,  tonics, particularly the
bark and  cold bath, will be proper.  I have once
known a chronic gouty pain in the head cured by
an  issue  in the  arm,  after pounds  of bark, and
many other tonic remedies, had been taken to no
purpose. 
THE GOUT.
299
  The  ophthalmia  from  gout should  be treated
with the usual remedies  for that disease when it
arises from other causes, with the addition of such
local applications to other and distant parts of the
body, as may abstract  the gouty action from the
eye.

   Dull but constant pains  in the limbs yield to fric-
tions, volatile liniments, muslin and woollen worn
next to the skin,  electricity,  a salivation, and the
warm and  cold bath. A gentleman who was afflic-
ted with a pain of  this kind for  three years and a
half in  one of his arms, informed me, that  he had
been cured by wearing a woollen stocking that had
been boiled with sulphur in water, for two weeks
upon the affected limb.  He had previously worn
flannel  upon it, but without  receiving any benefit
from it. I have known wool and cotton, finely card-
ed, and made into small mats, worn upon the hips,
when  affected by  gout with great advantage. A
cerecloth or taffety by touching  the flesh at more,
or at all points has been found to give great relief.
 Rubbing the limbs with castor  oil, and wrapping
them up in hot saRd have likewise been useful. In
obstinate sciatic pains,  with fever or inflammation,
 Dr. Pitcairn's remedy, published by Dr. Cheyne,
 has performed  many cures.  It  consists  in taking
from one to four tea spoons full of the fine spirit of 
300            OBSERVATIONS ON
turpentine  every morning, for a week or ten days,
in three times the quantity of honey, and afterwards
in drinking a large quantity of sack whey, to settle
it on the stomach, and carry it into  the  blood.  An
anodyne should be taken every night after taking
this medicine.

   A gouty diarrhoea  should be  treated  with  the
usual astringent medicines of the shops. Blisters to
the wrists and ankles, also a salivation, have often
cured  it. I have heard of its  being  checked, after
continuing for many  years, by the  patient eating
large quantities of alspice, which he carried loose
in his pocket for that purpose.

   The angina pectoris, which I have said is a symp-
tom of the gout, generally comes on with fulness
and tension in the pulse.  After these are reduced
by two  or three bleedings, mineral tonics seldom
 fail of giving relief.

   Spasms in the stomach, and pains in the bowels,
 often seize gouty people in the midst of business or
 pleasure,  or in the middle of  the night. My  con-
 stant prescription  for these complaints is ten drops
 of laudanum every half hour, till relief be obtained.
 If this medicine be taken in the forming state of
 these pains, a single dose generally removes the dis- 
                    THE GOUT.              301
 ease. It is preferable to spiced wine and spirits, in-
 asmuch as it acts quicker, and leaves no disposition
 to contract a love for it when it is not required to
 ease pain.

   The pain in the rectum, which has been descri-
 bed, yields to the common remedies for the  piles.
 Cold water applied to the part, generally gives im-
 mediate relief."

  For a preternatural secretion and  excretion  of
bile,  gentle laxatives,  and  abstinence  from  oily
food,  full meals, and all  violent exercises of the
body and mind,  are proper.

  The itching in the anus, which I have supposed
to be  a symptom of  gout, has yielded  in one
instance  that has come within my knowledge to
mercurial ointment applied to the part affected. Dr.
Lettsom recommends fomenting the part with a de-
coction of poppy heads and hemlock, and advises
lenient purges and a vegetable diet as a radical cure
for the disease.*

  For  the itching in the vagina I have found a so-
lution of the sugar of lead in water to be an excel-

            * Medical Memoirs, vol. III.
  Vol. II.                         q q 
302
OBSERVATIONS ON
lent palliative application. Dr. Lettsom recommends
as a cure for it, the use of bark in delicate habits,
and  occasional bleeding, with a light and moderate
diet if it occur about the time  of the cessation of
the menses.

   Obstinate  cutaneous eruptions, which  are the ef-
fects of  gout, have been cured by gentle physic, a
suitable  diet, issues,  and  applications of the un-
guentum citrinum to the parts affected.

   The arthritic gonorrhoea should be treated with
the same remedies as a gonorrhoea from any other
cause.

   In the treatment of all the local symptoms  that
have been enumerated, it  will  be of great conse-
quence to inquire, before we attempt to cure them,
whether  they have not succeeded general gout, and
thereby relieved the system from its  effects in parts
essential to life.  If this have been  the case, the
cure of them should  be undertaken  with caution,
and the danger of a local disease being exchanged
for a general  one, should be obviated by remedies
that  are  calculated to eradicate the gouty diathesis
altogether from  the system.  The means for  this
purpose, agreeably  to  our  order, come next under
our consideration. Before I enter upon this head. 
                   THE GOUT.               303
I shall premise, that I do not admit of the seeds of
the gout  remaining in  the body to be eliminated
by art after  a  complete termination  of one of  its
paroxysms, any more than I admit of the seeds of
a  pleurisy or intermitting fever remaining  in  the
body, after they have been cured by blood-letting
or  bark.  A predisposition  only  remains  in  the
system to  a return of the gout,  from its usual re-
mote and exciting causes. The  contrary idea took
its rise in those ages of  medicine in which morbific
matter was supposed to be the proximate cause of
the gout,  but it has unfortunately continued since
the rejection of that theory.  Thus in many cases
we see wrong habits continue long after the princi-
ples have been discarded, from which  they were
derived.

   I have known several  instances in which art, and
I have heard  and read of others in which acciden-
tal suffering from abstinence, pain, and terror have
been the  happy means of overcoming a predisposi-
tion to the gout.  A gentleman from one of the
West-India islands, who had been for many years
afflicted with the gout, was perfectly cured of it by
living a year or two upon the temperate  diet of the
jail in this city, into  which he was thrown for debt
by one of his creditors.  A large  haemorrhage from
the foot,  inflamed  and swelled by the gout,  acci- 
304            OBSERVATIONS ON
dentally produced by a penknife which fell upon
it, effected in an  Irish gentleman a lasting  cure  of
the disease.  Hildanus  mentions the history  of a
gentleman, whom he  knew intimately, who was
radically cured of a gout with which he had been
long afflicted, by the  extreme bodily pain he suf-
fered innocently  from  torture  in  the  canton  of
Berne.  He lived to be an old man, and ever after-
wards  enjoyed good health.*  The  following let-
ter from my brother contains the history of a case
in which terror suddenly eradicated the gout from
the system.

                      " Reading, July 27th, 1797.

U DEAR BROTHER,
        " WHEN I had the pleasure of seeing you
last week, I  mentioned  an extraordinary cure of
the  gout  in  this town, by  means of a fright.  In
compliance with  your request, I now send  an exact
narration of the facts.

   " Peter Fether, the person cured, is now alive,
a householder in Reading, seventy-three  years of
age, a native of Germany, and a very hearty man.
 The first fit  of the gout he ever had, was about  the
* Observat. Chirurg. 1. Cent. Obs. 79. 
THE GOUT.
305
year 1773; and from that time till 1785, he had a
regular attack in  the  spring  of  every year.  His
feet, hands, and  elbows were much swollen and
inflamed; the fits lasted long,  and were excruciat-
ing. In  particular, the last  fit in  1785 was  so
severe, as to induce  an apprehension, that it would
inevitably carry him  off, when he  was suddenly re-
lieved by the following accident.

   " As he lay in a small back room adjoining the
yard, it happened that one of his  sons, in turning
a  wagon  and horses, drove  the tongue  of  the
wagon with such force against the  window,  near
which the  old man lay stretched on a  bed, as to
beat in the sash of the window, and to scatter the
pieces of broken glass all about  him.  To such a
degree was he alarmed by the noise and violence,
that he instantly leaped out of bed,  forgot that he
had ever used crutches, and eagerly inquired what
was the matter.  His wife, hearing the uproar,  ran
into the room,  where, to her astonishment,   she
found her  husband on his feet, bawling against the
author of the mischief, with  the  most passionate
vehemence. From that moment, he has been  en-
tirely  exempt from  the gout, has never had the
slightest touch of it,  and now enjoys perfect health,
has a good appetite,  and says he was  never hear-
tier in his life. This  is probably the  more remark- 
306           OBSERVATIONS ON
able, when I add,  that he has  always been used to
the hard work of a  farm, and since the year 1785 has
frequently  mowed in  his  own  meadow, which  I
understand is low  and wet. I am well informed, in
his mode of living, he has been temperate, occa-
sionally indulging  in a glass of wine, after the man-
ner of the German farmers, but not to excess.

   " To  you, who have been long accustomed to
explore diseases, I leave the task of developing the
principles,  on which this mysterious  restoration
from the lowest decrepitude and bodily wretched-
ness, to a  state of perfect health, has been accom-
plished.  I well  know that tooth-achs,  head-achs,
hiccoughs,  &c.  are often  removed by  the  sudden
impression of fear,  and  that they return  again.
 But to  see a debilitated gouty frame instantly re-
 stored to vigour;  to see the whole system in a mo-
 ment, as it were, undergo  a  perfect  and entire
 change, and the most inveterate and incurable dis-
 ease radically expelled, is surely a different thing,
 and  must  be acknowledged a very singular and
 marvellous event. If an old man, languishing under
 disease  and infirmity, had died of mere fright, no-
 bodv would have been surprised at it;  but that he
 should be absolutely cured, and his constitution re-
 novated by it, is  a most extraordinary  fact, which, 
                   THE GOUT.              ou«
while I am compelled to  believe by unexception-
able evidence, I am totally at a loss to account for.
                  "  I am your sincerely
                       "  affectionate brother,
                           " JACOB RUSH."

   These facts, and many similar ones which might
be mentioned, afford ample  encouragement to pro-
ceed in enumerating the means which are proper to
prevent the recurrence of the gout, or,  in  other
words, to eradicate it  from the system. Besides
these cases of radical cures, it has often been sus-
pended, from two to thirty  years by the power of
medicine.

   V.  I shall first mention the means of preventing
the return of that  state of the disease  which is ac-
companied with violent action, and afterwards take
notice of the  means of preventing the return of
that state  of  it, in which a feeble morbid action
takes  place in the blood-vessels. The means for
this purpose consist in avoiding all the remote, ex-
citing, and predisposing causes  of the gout which
have been mentioned. I shall say a few words upon
the most important of them, in  the order that has
been proposed.

   I. The first remedy for obviating the violent state
of gout is, 
308           OBSERVATIONS ON
   1.  Temperance. This  should be regulated in its
degrees by the age, habits, and constitution of the
patient. A diet consisting wholly of milk, vegeta-
bles, and simple water, has been found necessary to
prevent the recurrence of the gout in some cases.
It was cured in lord Nelson by two years' absti-
nence from wine and animal  food,  during which
time he lived  wholly upon milk and vegetables.
But, in general, fish, eggs, the  white meats and
weak broths may be taken in small quantities once
a day, with milk  and vegetables at other times.
A little salted meat, which affords less nourishment
than fresh, may be eaten  occasionally. It imparts
vigour to the stomach, and prevents dyspepsia from
a diet consisting chiefly  of vegetables. The low
and acid  wines should be avoided, but weak  Ma-
deira or sherry wine and  water, or small beer,  may
be  drunken at meals. The latter  liquor was the
favourite drink of Dr. Sydenham in his fits of the
gout. Strong tea and coffee should not be tasted,
where there is reason to believe the habitual use of
them has contributed to bring on  the disease.

  From the disposition of the gout to return in the
spring and autumn,  greater degrees of abstinence
in eating and drinking will be necessary at  those
seasons than at any other time.  With this diminu-
tion of aliment, gentle purges should be taken, to 
THE GOUT.
309
obviate an attack of the gout. In persons above fifty
years of age, an abstemious  mode of living should
be commenced with great caution. It has sometimes,
when entered upon suddenly, and carried to its ut-
most extent, induced fits of the gout,  and precipi-
tated death.  In such persons, the abstractions from
their usual diet should be small, and  our depend-
ence should be placed upon other means to prevent
a return of the  disease.

   2.  Moderate labour and  gentle  exercise  have
frequently  removed that debility and  vibratility in
the blood-vessels, on which a predisposition to the
gout  depends.   Hundreds of persons who  have
been  reduced by misfortunes  to  the  necessity  of
working for their  daily bread, have thrown  off a
gouty diathesis derived from their parents, or ac-
quired by personal  acts of folly and  intemperance.
The employments  of  agriculture  afford the most
wholesome labour,  and walking, the most  salutary
exercise.  To be useful, they should be moderate.
The extremes of indolence  and bodily activity meet
in a point.  They both induce debility, which pre-
disposes to a recurrence of a fit of the gout.   Rid-
ing in a carriage, and  on horseback, are less  pro-
per as a means of preventing the disease than walk-
ing.  Their action upon the  body is partial.  The
lower limbs derive no benefit from it, and  on these
  Vol. II.                           R r 
310           OBSERVATIONS ON
the violent state of gout generally  makes its first
attack.  In  England,  many  domestic  exercises
have  been contrived for gouty people, such  as
shuttle-cock, bullets, the  chamber-horse, and  the
like, but they are all trifling in  their effects, com-
pared with labour, and exercise in the open  air.
The  efficacy of the former of those prophylactic
remedies will appear in a  strong  point of light,
when we consider, how much the operation of the
remote and exciting causes of the  gout which act
more or less upon persons in the humblest ranks of
society, are constantly counteracted in their  effects,
by the  daily  labour which is necessary for their
subsistence.

   3. To prevent the recurrence of the gout, cold
 should be carefully avoided,  more especially when
 it is combined  with moisture.  Flannel should be
 worn next the skin in winter, and muslin in sum-
 mer, in order to keep up a steady and uniform per-
 spiration.  Fleecy hosiery should be worn  in  cold
 weather upon the breast and knees, and the feet
 should be kept constantly warm and dry by means
 of socks and cork soaled shoes. It was by  wetting
 his feet, by standing two or  three hours upon the
 damp ground, that Colonel Miles produced the
 gout in his stomach and bowels which had nearly
 destroyed him in the year 1795. 
THE GOUT.
311
   4-. Great moderation should be used by persons
 who are subject to the gout in the exercise of their
 understandings  and passions.  Intense study, fear,
 terror, anger, and even joy, have often excited the
 disease into action. It has been observed, that the
 political and military passions act with more force
 upon the system, than those  which are of a social
 and domestic nature; hence generals and statesmen
 are so often afflicted with the gout,  and that too,
 as  was hinted in another place, in  moments the
 most critical and important to the welfare of a na-
 tion. The  combination of the exercises of the un-
 derstanding, and the passion of avarice in  gaming,
have often  produced an attack of this  disease.

  These facts show the  necessity of gouty people
 subjecting  their minds, with all their  operations, to
 the government of reason and religion.  The  un-
 derstanding should be exercised oily upon light and
pleasant subjects.  No study  should  ever  be pur-
 sued till it  brings on fatigue;  and above all things,
midnight, and even late  studies should be strictly
avoided. A gouty man should always be in bed at
an early hour. This advice has the sanction of Dr.
 Sydenham's name, and experience proves its effi-
cacy in all chronic diseases.

  5. The  venereal appetite  should  be  indulged
with moderation.  And, 
312
OBSERVATIONS ON
  6. Costiveness should be prevented by all per-
sons who wish to escape a return of violent fits of
the gout.  Sulphur is an excellent remedy for this
purpose. Dr. Cheyne commends it in high terms.
His words are, " Sulphur is one of the best reme-
dies in the intervals of the gout.  In the whole ex-
tent of the materia medica, I know not a more safe
and active medicine."*  Two cases have come with-
in my knowledge,  in which it has kept off fits of the
gout for several years, in persons who had been ac-
customed to have them  once or twice a year.  Rhu-
barb in small  quantities chewed, or in the form of
pills, may be taken to obviate costiveness, by per-
sons who object to the habitual use of sulphur. Dr.
Cheyne, who is lavish in his praises of that medi-
cine as a  gentle  laxative, says, he  " knew a noble
lord of great worth and  much gout, who, by taking
from  the  hands of a quack a drachm of rhubarb,
tinged with cochineal to disguise it, every morning
for six weeks, lived in health, for four years after,
without any symptom of it."f

   I have said that abstinence  should be enjoined

  * Ess; y on the Nature and True Method of Treating the
Gout, p. 36.
  t Page 30. 
                   THE GOUT.               J1J
with more strictness in the spring and autumn, than
at any other time, to prevent a return of the gout.
From the influence of the weather at those seasons
in exciting febrile actions in the system, the loss of
a pint of blood will be useful in some cases for the
same purpose. It will be the more necessary if
the gout has not paid its habitual visits to the sys-
tem. The late Dr.  Gregory had been accustomed
to an attack of the  gout  every  spring.  Two sea-
sons passed away without h s feeling any symptoms
of  it.  He began to flatter himself  with a  hope
that the predisposition to the disease had left  him.
Soon afterwards he  died suddenly of an apoplexy.
The loss of a few  ounces of blood at the  usual
time in which the gout affected him, would proba-
bly have protracted  his life for many years. In the
year 1796, in visiting a patient, I  was accidentally
introduced into a room where a gentleman from the
Delaware state had been lying on his back for near
six  weeks with an  acute fit of the gout. He gave
me a history of his sufferings. His pulse was full
and tense, and his  whole  body was covered with
sweat  from the intensity  of his pain.  He had not
had his bowels opened for ten days.  I advised pur-
 ging and bleeding in his case. The very names
of those remedies startled  him, for he had adopted
the opinion  of the salutary nature  of  a fit of  the
gout, and therefore hugged his chains.  After ex- 
314
OBSERVATIONS ON
plaining the reason of my prescriptions, he inform-
ed me, in support of them, that he had escaped the
gout, but two years  in  twenty, and  that in one of
these two years he had been bled for  a fall from
his horse, and, in the other, his body had been re-
duced by a chronic fever, previously to the time of
the annual visit of his gout.

  As a proof of the efficacy of active, or passive de-
pletion, in preventing the  gout, it has  been found
that  persons who sweat freely, either generally or
partially,  or  who  make a great deal of water, are
rarely affected by it.

  An epitome of all  that  has been  said upon the
means of preventing a return of the gout, may be
delivered in a few words. A man who has had
one fit of it, should consider himself in the same
state as a man who has  received the  seeds  of a
malignant fever  into  his blood.  He should  treat
his body  as if it were  a  Florence flask.  By this
means he will probably  prevent, during  his life, the
re-excitement of the disease.

  Are issues proper to prevent the  return of the
violent state of gout? I have heard of an instance
of an issue in the leg having  been effectual for this
purpose;  but if the remedies before-mentioned  be 
THE GOUT.
315
used in the manner that has  been directed, so un-
pleasant a remedy can seldom be necessary.

  Are bitters proper to prevent  a  return  of this
state of  gout? It will  be a sufficient answer  to
this  question  to  mention,  that the duke  of Port-
land's powder, which is composed of bitter ingre-
dients, excited a fatal  gout  in  many people who
used it for that purpose. I should as soon expect to
see gold produced by  the operations  of fire  upon
copper or lead, as expect to see the gout prevented
or cured by any medicine that acted upon  the sys-
tem, without the  aid of more or less of the reme-
dies that have been mentioned.

  II. We come  now, in the last place, to  mention
the remedies  which  are proper to prevent a return
of that state of gout which  is attended  with a feeble
morbid action in  the blood-vessels and viscera.

  This state of gout generally occurs in the even-
ing of life, and in persons of delicate habits, or in
such as have had their constitutions worn down by
repeated attacks of the disease.

   The remedies to prevent it are,

   1. A gently stimulating diet, consisting of animal 
316
OBSERVATIONS ON
food well cooked, with sound old Madeira or sherry
wine, or weak spirit and  water. Salted, and even
smoked  meat may be taken, in this state of the
system,  with advantage. It is an agreeable tonic,
and  is less disposed to  create plethora than fresh
meat. Pickles and vinegar  should seldom be tasted.
They dispose to gouty spasms in the stomach and
bowels.  Long  intervals  between meals should be
carefully avoided. The stomach, when over-stretch-
ed or empty, is always alike predisposed to disease.
There are  cases  in which  the evils of inanition in
the stomach will be prevented, by a gouty patient
eating in the middle of the night.

  2. The use  of chalybeate medicines.  These are
more safe  when used habitually,  than bitters.  I
have long been in the practice of giving the differ-
ent preparations of iron  in large doses, in chronic
diseases, and in that state of debility which disposes
to them. A lady of a weak  constitution informed
Dr.  Cheyne, that she once asked  Dr.  Sydenham
how long she might safely take steel.  His answer
was, that " she might take it for thirty years, and
then begin again if she continued ill."*

  Water impregnated with iron, either by nature

  * Essay on the  Nature and True Method of Treating the
Gout, p. 69. 
                    THE GOUT.              $17
or art, may be  taken instead of the  solid forms of
the metal. It will be more  useful if it be drunken
in a place where patients will have the benefit of
country air.

   3.  The  habitual use of the volatile  tincture of
gum guiacum,  and  of other cordial and gently sti-
mulating  medicines. A clove of garlic taken once
or twice a day, has been found useful in debilitated
habits predisposed to the gout. It possesses a won-
derful power  in bringing latent  excitement into
action. It moreover acts agreeably  upon the ner-
vous system.

  Mr. Small found great benefit from breakfasting
upon a tea made of half a drachm of  ginger cut
into small slices, in preventing occasional attacks
of the gout in  his stomach.  Sir Joseph Banks was
much relieved by a diet of milk, with ginger boiled
in it.  The  root of the sassafras of our country
might probably be  used with  advantage for th$
same purpose.  Aurelian speaks  of certain  reme-
dies for the gout which he  calls " annalia."*  The
above medicines belong to this class. To be effec-
tual, they  should be persisted in, not for one  year
only, but for many years.

       * Morborum Chronicorum. Lib. v. Cap. 2.
  Vol. II.                          S s 
318
OBSERVATIONS ON
  4. Warmth, uniformly applied, by means of suit-
able dresses, and sitting rooms, to every part of the
body.

  5. The warm bath in winter, and the temperate
or cold bath in summer.

  6. Exercise. This may be in a  carriage, or  on
horseback. The viscera being  debilitated  in this
state of predisposition to the gout, are strengthened
in a peculiar manner by the gentle motion of a
horse.  Where  this or other modes of passive ex-
ercise  cannot be had, frictions to  the limbs and
body should  be used every day.

   7. Costiveness should be avoided by taking occa-
sionally one or two table spoons full of Dr. Warner's
purging tincture  prepared by infusing  rhubarb,
orange  peel, and caraway seeds, of each an ounce,
for three days in a quart of Madeira, or any other
white  wine.   If  this  medicine be  ineffectual  for
opening the  bowels, rhubarb may be taken in the
manner formerly mentioned.

   8.  The understanding and passions  should  be
constantly employed in agreeable studies and pur-
suits.  Fatigue of mind and  body should be care-
fully avoided. 
THE GOUT.
319
  9. A warm climate often protracts life in persons
subject  to this state  of  gout.  The  citizens of
Rome who had worn down their constitutions by
intemperance,  added many years to their  lives, by
migrating to Naples, and enjoying there, in a warm-
er sun, the pure air of the Mediterranean, and sir
William Temple says the Portuguese obtain the
same benefit  by transporting  themselves to the
Brazils, after medicine and diet cease to impart vi-
gour to their constitutions in their native country.

  Thus have I enumerated the principal remedies
for curing and preventing the gout. Most of them
are to be met  with in books of medicine,  but they
have been administered by physicians, or  taken by
patients with so little regard to the different  states
of the  system, that they have in many instances
done more  harm  than good. Solomon places all
wisdom, in the management of human affairs,  in
finding out the proper times for performing certain
actions.  Skill  in medicine consists in an eminent
degree  in  timing  remedies. There is  a time  to
bleed, and a time to withhold the lancet. There is a
time to give physic, and a time to trust to the ope-
rations of nature.  There is a time to eat meat, and
there is a time to abstain from it. There is a time
to give tonic medicines, and a time to refrain from
them. In a word,  the cure of the gout depends 
320           OBSERVATIONS ON
wholly upon two things, viz. proper  remedies, in
their proper times, and places.

  I shall take leave of  this disease, by comparing
it to a deep and dreary cave in a new  country, in
which ferocious  beasts and venomous  reptiles, with
numerous ghosts  and hobgoblins,  are  said to  re-
side. The neighbours point at the entrance of this
cave with horror, and tell of the many ravages that
have been committed upon their domestic animals,
by  the  cruel tenants which inhabit it.  At length
a school-boy, careless of his safety, ventures to en-
ter this subterraneous  cavern,  when! to his great
delight, he finds nothing in it but the  same kind of
stones and water he  left behind him upon the sur-
face of the earth. In like  manner, I  have  found
no  other principles necessary to explain the  cause
of  the  gout, and no other remedies  necessary to
cure it, than such as are admitted in explaining the
causes, and in prescribing for the most  simple and
common diseases.

   The following is an epitome of the opinions upon
the cause and cure of the gout, which are contained
in  the  preceding  observations, most  of which are
opposed by modern systems of medicine.

   1.  The gout does not depend upon a specific ac- 
THE GOUT.
321
Hon in the blood-vessels, any more than it does up-
on a specific morbid matter.

  2. It is not seated exclusively in the joints, nor
in the limbs.

  3. It is not induced exclusively by ardent nor fer-
mented liquors, nor by intemperance in eating, but
by every other cause that induces chronic debility
from  action or abstraction;  also by the causes that
induce nearly all other diseases.

  4. It is more common in the female than in the
male sex, and that in the ratio of ten  to one.

  5. It differs from the rheumatism, only in its seats
and grades.

  6. There  is no specific remedy for it. The nu-
merous and pompous specifics that  have been re-
commended for its cure, are melancholy records of
the imperfection and obliquity of the human under-
standing.

  7. It is, notwithstanding, subject to the power of
medicine; and may be cured  by the application of
the  same principles and remedies to it, which cure
other acute and chronic diseases. 
322         OBSERVATIONS ON, &.C.
  8. It is not necessary, in order to prevent or cure
the gout, to translate or to fix it  in the  limbs.  It
should be chased out of the system.

  9. It is not a healthy, nor a friendly disease.

  10.  It does not cure other diseases. It  suspends
weak  diseases  only,  when  it attacks with great
force.  But while it suspends  weak diseases, it ag-
gravates all such as are of a violent nature. 
  OBSERVATIONS




      UPON





The Cause and Cure





      OF THE





 HYDROPHOBIA. 
/' 
OBSERVATIONS, &c.
       IN entering upon the consideration of this
formidable disease, I feel myself under an involun-
tary  impression,  somewhat like that  which was
produced by the order the king of Syria gave to
his captains when he was conducting them to bat-
tle: " Fight not with small  or great, save only with
the king of Israel."*  In whatever light we  con-
template the hydrophobia, it may be considered as
pre-eminent  in power and mortality, over all other
diseases.

   It is now many years since the distress and hor-
ror excited by it, both  in patients and their friends,
led me with great solicitude to investigate its na-
ture. I have at length satisfied myself with a the-

                * II. Chron.  xviii. 30.
   Vol. II.                          T t 
326           OBSERVATIONS ON
ory of it, which, I hope, will lead to a rational and
successful mode of treating it.

  For a history of the symptoms of the disease, and
many interesting  facts connected with  it, I beg
leave to refer the reader to Dr. Mease's learned
and ingenious inaugural dissertation,  published  in
the year 1792.

  The remote and exciting causes of the hydropho-
bia are as follow:

   1.  The bite of a  rabid animal. Wolves, foxes,
cats, as  well as  dogs, impart the disease. It has
been said  that blood  must be  drawn in  order to
produce it, but I have heard of  a case in Lancaster
county, in Pennsylvania, in which a  severe contu-
sion, by the  teeth of the rabid animal,*without the
effusion of a single drop of red blood, excited the dis-
ease. Happily for mankind, it cannot be  commu-
nicated by blood or saliva falling upon sound parts
of  the  body. In Maryland, the negroes  eat with
safety the flesh of hogs that have perished from the
bite of mad dogs; and I have heard of the milk of
a cow, at  Chestertown, in the same state, having
 been used without any inconvenience by a whole
 family, on the very day in  which she was affected
 by this disease, and which killed her in a few hours. 
               THE HYDROPHOBIA.          327
Dr.  Baumgarten confirms these facts by saying,
that  " the flesh and milk of rabid animals have been
eaten with perfect impunity."*

   In the following observations I shall confine my-
self  chiefly to the. treatment of the  hydrophobia
which arises from the bite of a rabid animal, but I
shall add in this place a short account of all  its
other causes.

   2. Cold night air. Dr.  Arthaud, late president
of the  society  of Philadelphians in St. Domingo,
has published several cases in which it was produ-
ced in negroes  by sleeping all night in  the open air.

   3. A wound in a tendinous part.

   4. Putrid and impure animal food.

   5.  Worms.

   6.  Eating beech nuts.

   7.  Great thirst.

■  Medical Commentaries, Philadelphia edition, vol. 7. p. 409 
328           OBSERVATIONS ON
  8. Exposure to intense heat.

  9. Drinking cold water  when the  body  was
very much heated.

  10. A fall.

  11. Fear.

  12. Hysteria.

  13. Epilepsy.

  14. Tetanus.

  15.  Hydrocephalus. Of the presence of hydro-
 phobia in the hydrocephalic state of fever, there1
 have been several instances in Philadelphia.

   16.  An inflammation of the stomach.

   17.  The dysentery.

   18.  The  typhus fever.  Dr.  Trotter  mentions
 the hydrophobia as a symptom which frequently
 occurred in the typhus state of fever in the British
 navy.*
* Medicina Nautica, p. 301. 
              THE HYDROPHOBIA.           329
   19. It is taken notice of likewise in a  putrid fe-
ver by Dr. Costej* and Dr. Griffitts observed it in
a high degree in a young lady who died of the yel-
low fever, in 1793.

   20.  The  bite  of an  angry, but  not a diseased
animal.

   21. An involuntary association of ideas.

   Cases of spontaneous hydrophobia from  all the
above causes are to be met with in practical wri-
ters, and of most  of them in  M. Audry's learned
Work, entitled, u Recherches sur la Rage."

   The dread of water, from which this disease de-
rives its name, has five distinct grades.  1. It can-
not be  drunken. 2. It cannot be touched. 3. The
sound of it pouring from one  vessel to another, 4.
the sight of it, and 5.  even the  naming of it, can-
not be  borne, without  exciting convulsions. But
this  symptom is not  a universal  one. Dr.  Mead
mentions three cases in which there was no dread
of water, in persons who received the disease from
the bite of a rabid animal. It is unfortunate for

  * Medical Commentaries, Dobson's edition, vol. II. p. 476* 
330
OBSERVATIONS ON
this disease, as well as many others, that a single
symptom should  impose names upon them.  In the
present instance it has done  great harm,  by fixing
the attention of physicians so exclusively upon the
dread of water which occurs in it,  that they have
in a great measure overlooked every other circum-
stance which  belongs to the disease. The  theory
of the hydrophobia,  which  an examination of its
causes, symptoms, and  accidental cures, with all
the industry I was capable of, has led me to adopt,
is, that it is a malignant state of fever. My reasons
for this opinion are as follow:

   1. The disease in  all  rabid animals is a fever.
This is obvious in dogs who  are most subject to it.
It is induced in them by the  usual causes of fever,
such  as  scanty or putrid aliment,* extreme cold,
and the  sudden  action of heat upon their bodies.
Proofs of its being derived from each of  the above
causes are to  be met with in most of the authors
who have  written upon it.   The  animal  matters
which are  rendered morbid  by the action  of the

  * " Animal food, in a state of putridity, is amongst the most
frequent causes of canine madness."
  " Canine madness chiefly arises  from the excessive number
•fill-kept and ill-fed dogs."
                   Young's Annals, vol. XVII. p. 561. 
THE  HYDROPHOBIA.
331
above causes upon them, are determined to the sa-
liva, in which a change seems to be  induced, simi-
lar  to  that  which takes place in the perspirable
matter of the human species from the operation of
similar  causes  upon  it.  This matter it is well
known, is  the  remote cause of the jail fever.  No
wonder the saliiva of a dog should produce a disease
of the same kind, after being vitiated by the same
causes,  and thereby disposed to produce  the same
effects.

  2. The disease  called canine madness, prevails
occasionally among dogs at those times  in which
malignant fevers are epidemic. This will not sur-
prise those persons who have  been  accustomed to
observe the prevalence of the influenza and bilious
fevers among other domestic animals at a time
when they  are epidemic among the  human species.

  3. Dogs,  when they are said to be mad, exhibit
the usual symptoms of fever, such as a want of ap-
petite, great heat, a dull, fierce, red, or watery eye,
indisposition to motion, sleepiness, delirium,  and
madness. The symptom  of madness is  far from
being universal, and hence many dogs are diseased
and die with this malignant fever, that are inoffen-
sive, and instead of biting, continue to fawn upon
their masters.  Nor  is the disposition of  the fever 
332
OBSERVATIONS ON
 to communicate itself by infection universal among
 dogs any more than the same fever in the human
 species, and this I suppose to be one reason why
 many people are  bitten by what  are  called mad
 dogs, who never suffer  any inconvenience from it.

   4.  A dissection of a dog,  by Dr. Cooper, that
 died  with this fever,  exhibited all the usual marks
 of inflammation and effusion  which takes place in
 common malignant fevers.  I shall in another place
 mention a fifth argument in favour of the disease
 in dogs being a malignant fever, from the efficacy
 of one of the most powerful remedies  in that  6tate
 of fever, having cured it in two instances.

  II.  The disease  produced in  the human species
 by the bite of a rabid animal,  is a malignant fever.
 This  appears first from its symptoms. These,  as
 recorded by Aurelian, Mead, Fothergill, Plummer,
 Arnold,  Baumgarten,  and  Morgagni,  are chills,
 great  heat, thirst, nausea, a burning sensation in the
 stomach,  vomiting,  costiveness; a  small,  quick,
 tense, irregular, intermitting, natural, or slow pulse;
 a cool skin, great sensibility to cold air, partial cold
and clammy sweats on the hands, or sweats accom-
panied with a warm skin diffused all over the body,
difficulty of breathing, sighing, restlessness, hiccup,
giddiness, head-ach, delirium,  coma,  false vision, 
THE HYDROPHOBIA.
333
dilatation of the pupils, dulness of sight, blindness,
glandular swellings, heat of urine, priapism, palpi-
tation of the heart, and convulsions. I know that
there are cases of  hydrophobia upon record,  in
which there is  said  to be a total absence of fever.
The same thing has been  said of the plague. In
both cases the supposed absence of fever is the effect
of stimulus acting upon the blood-vessels with so
much force  as to suspend morbid action in them.
By abstracting a part of this  stimulus, a fever is
excited,  which soon discovers itself in the pulse
and on  the  skin, and frequently in pains in every
part of the  body.  The dread of water,  and  the
great sensibility of  the system to cold air, are  said
to give a specific  character to the  hydrophobia;
but the former  symptom, it  has been often seen, oc-
curs in  diseases from other causes,  and the latter
has been  frequently observed in the  yellow fever.
It is no more extraordinary  that a fever excited by
the bite of a rabid animal should excite a dread of
water,  than that fevers from odier  causes should
produce aversion from certain aliments, from light,
and from sounds of all kinds; nor is  it any more a
departure from  the  known laws of stimulants,  that
the saliva of a  mad dog should affect the fauces,
than that mercury should affect the salivary glands
Both stimuli appear to act in a specific manner.
  Vol. II.                         U u 
334           OBSERVATIONS ON
  2. The hydrophobia partakes of the character of
a malignant fever, in appearing at different intervals
from the time in which the infection is received
into the body.  These  intervals  are from one day
to five or  six  months. The  small-pox  shows it-
self in intervals from eight to twenty days,  and the
plague and yellow fever from the moment in which
the miasmata are inhaled, to nearly the  same dis-
tance of time.  This  latitude in  the  periods  at
which infectious and contagious matters are brought
into action in the body, must be resolved  into the
influence which the  season  of the year,  the habits
of the patients,  and the passion of  fear have upon
them.

   Where the interval between the time of being
bitten, and the  appearance of a dread  of water,
exceeds five or six months,  it is probable  it may
be occasioned by a disease  derived from another
cause. Such a person is  predisposed  in common
with other people to all the  diseases of  which the
hydrophobia is  a  symptom. The  recollection  of
the poisonous wound he has received, and its usual
consequences, is seldom absent  from his mind for
months or years.  A fever, or an  affection of his
nerves from their most common causes,  cannot fail
of exciting in  him apprehensions  of the  disease
which usually follows the  accident to which he has 
              THE HYDROPHOBIA.           335
been exposed. His  fears are then let loose upon
his system, and produce in a short time a dread of
water which appears to be wholly unconnected with
the bite of a rabid animal. Similar instances of  the
effects of fear upon the  human body are to be met
with in books of medicine. The  pains produced by
fear acting upon the  imagination  in supposed vene-
real infections, are as real and severe as they are in
the worst state of that disease.

   3. Blood  drawn in the  hydrophobia exhibits  the
same appearances which  have been remarked  in
malignant fevers. In Mr. Bellamy, the gentleman
whose case  is so minutely related by Dr. Fother-
gill, the  blood discovered with  " slight  traces  of
size,  serum remarkably  yellow." It was  uncom-
monly sizy in  a boy  of Mr. George Oakley whom
I saw, and bled for the first time, on the fourth day
of his disease,  in  the beginning  of the year 1797.
His pulse imparted to the fingers the same kind of
quick and tense stroke,  which is common in  an
acute  inflammatory  fever. He  died  in  convul-
sions the  next  day. He had been bitten by a mad
dog on one of his temples,  three weeks before
he  discovered any signs  of  indisposition. There
are several other cases upon  record, of the blood
exhibiting,  in  this disease, the same appearances
as in common  malignant and inflammatory fevers. 
336
OBSERVATIONS ON
  4. The hydrophobia accords exactly with malig-
nant fevers in its duration.  It generally terminates
in death, according to its violence, and the habit of
the patient,  in the  first, second, third, fourth, or
fifth day, from the time of its attack, and  with the
same symptoms which  attend the last stage of ma-
lignant fevers.

  5. The body, after death from the hydrophobia,
putrefies with  the  same rapidity that it does after
death from a malignant fever in which no  depletion
has been used.

  6. Dissections of bodies which have died of the
hydrophobia,  exhibit the same appearances  which
are observed  on the bodies of  persons who have
perished of malignant  fevers.  These appearances,
according to Morgagni and Tauvry,* are marks of
inflammation  in the throat,  oesophagus,  trachea,
brain,  stomach, liver,  and  bowels. Effusions of
water, and congestions of blood in the brain,  large
quantities of dark-coloured or  black bile in  the
gall-bladder  and  stomach,  mortifications  in  the
bowels and bladder,  livid spots on the  surface of
the  body, and, above all,  the arteries filled  with
fluid blood  and the  veins  nearly  empty.  I  am

   * Bibliotheque Choisie de Medecine, tome XV. p. 210. 
THE HYDROPHOBIA.
337
aware, that two cases of  death from hydrophobia
are related by Dr.  Vaughan,  in which no appear-
ance of di ease was discovered by  dissection in any
part of the body. Similar appearances have occa-
sionally been met with in persons who have died of
malignant  fevers.  In  another place  I  hope  to
prove, that we err in placing  disease in inflamma-
tion, for it is  one of its primary effects only,  and
hence, as was before  remarked, it does  not  take
place in many instances  in malignant fevers, until
the  arteries are  so far  relaxed by two  or three
bleedings,  as  to be able  to  relieve themselves by
effusing red blood into serous  vessels, and thus to
produce that error  loci which  I shall say  hereafter
is  essential  to inflammation.*  The existence of
this  grade of  action in the arteries may always be
known by the presence  of sizy blood,  and  by the
more obvious and common symptoms of fever.

  * In the 6th volume  of the Medical Observations  and In-
quiries, there is an account of the dissection of a person  who
had been destroyed by taking opium.   "  No morbid ap-
pearance  (says  Mr.  Whateley, the surgeon who opened
" the body) was found  in any part of the body, except  that
" the villous coat of the stomach was very slightly  inflamed."
The  stimulus of  the opium in  this  case  either produced an
action which transcended inflammation, or destroyed action
altogether by its  immense force, by which means the more
common morbid  appearances which follow disease in a dead
body could not take place. 
338           OBSERVATIONS ON
  The remedies for hydrophobia, according to the
principles I have endeavoured to establish,  divide
themselves naturally into two kinds.

  I. Such as are proper to prevent the disease, after
the infection  of the rabid animal is received  into
the body.

  II. Such as are proper to  cure  it when formed.

  I. The first remedy under the first general head is,
abstracting or destroying the  virus, by cutting or
burning out the wounded part, or by long and fre-
quent effusions of water upon it,  agreeably to the
advice of Dr. Haygarth, in order to wash the saliva
from it.   The  small-pox has been prevented, by
cutting out the part in which  the puncture was
made in the  arm with variolous matter.  There is
no  reason  why the  same practice should not suc-
ceed, if used in time,  in the hydrophobia. Where
it has failed of  success, it has probably been used
after the poison has contaminated the blood. The
wound should be kept open and running for seve-
ral  months. In this way  a  servant girl, who was
bitten by  the  same cat that bit Mr.  Bellamy, is
supposed  by Dr.  Fothergill  to  have  escaped the
disease.  Dr.  Weston of Jamaica believes that he
prevented the disease  by the  same means,  in two 
THE HYDROPHOBIA.
339
instances. Perhaps an advantage would arise from
exciting a good deal of inflammation in the wound.
We observe after inoculation, that the more inflam-
ed the puncture becomes, and the greater the dis-
charge from it, the less  fever and eruption follow
in the small-pox.  The inflammation  in both cases
prevents the absorption of the poison, by abstracting
the usual excitement  or  capacity of  action in the
lymphatics, and concentrating it in the blood-vessels.

  A second preventive is a  low diet,  such as  has
been often used with success to mitigate the plague
and yellow fever.  The system,  in this case,  bends
beneath the stimulus of the morbid saliva, and thus
obviates or lessens its effects  at a future day.

  During  the use of these  means to prevent the
disease, the utmost care should be taken to keep
up our patient's spirits, by inspiring confidence in
the remedies prescribed for him.

  Mercury has been used in order to prevent the
disease. There are many well-attested cases upon
record,  of persons who have been salivated after
being bitten by mad animals, in whom the disease
did not show itself, but there are  an equal number
of cases to be  met  with, in  which a  salivation did
not prevent it.  From this it  would seem probable, 
340            OBSERVATIONS ON
that the saliva did not infect in the  cases in which
the disease was supposed to  have been prevented
by the  mercury.  At  the time calomel was used
to prepare the body for the small-pox, a salivation
was often induced by it. The affection of the sali-
vary glands in many instances lessened the number
of pock, but I believe in no instance prevented the
eruptive fever.

  I shall say nothing here of the many other medi-
cines which have been used to prevent the disease.
No one of them  has, I believe,  done  any more
good than the  boasted specifics which have been
used to eradicate the gout, or to procure old age.
They appear to  have derived  their  credit from
some of the following circumstances accompanying
the bite of the animal.

   1. The animal may have  been  angry, but not
diseased with a malignant fever such as I have de-
scribed.

   2. He may have been  diseased, but not  to such
a degree as to have rendered his saliva infectious.

   3. The saliva, when infectious, may have been
so  washed  off in  passing  through  the  patient's 
               THE HYDROPHOBIA.          341
 clothes,  as not to have entered the wound made in
 the flesh. And

   4. There may have been no predisposition in the
 patient to receive the fever.  This is often observed
 in persons  exposed to the plague, yellow  fever,
 small-pox, and to the infection of the itch, and the
 venereal disease.

   II. The hydrophobia, like the small-pox, generally
 comes on with some pain, and inflammation  in the
 part in which the infection was infused into the
 body, but to this remark,  as in the small-pox, there
 are  some  exceptions. As  soon  as  the disease
 discovers itself, whether by pain or  inflammation in
 the wounded part, or by any of the symptoms for-
 merly mentioned, the first  remedy indicated is blood-
letting.  All the  facts which have been mentioned,
relative to its cause, symptoms, and the appearances
of the  body after death, concur to enforce the use
of the  lancet  in  this  disease. Its affinity  to the
plague and yellow fever in its force, is  an addition-
al argument in favour  of  that remedy. To be ef-
fectual, it should  be used in the most liberal man-
ner.  The loss of 100 to 200 ounces of blood will
probably be necessary  in  most  cases  to effect a
cure.   The  pulse  should  govern the  use of the
lancet as in other states of  fever, taking care not to
  Vol. II.                         X x 
342           OBSERVATIONS ON
be imposed upon by the absence of frequency in it,
in the supposed absence of fever, and of tension in
affections of the stomach, bowels, and brain. This
practice, in the extent I  have recommended it, is
justified not only by the theory of the disease, but
by its having been used with  success in the follow-
ing cases.

   Dr. Nugent cured  a woman by two copious
bleedings, and afterwards by the use of sweating
and cordial medicines.

   Mr.  Wrightson was  encouraged by Dr. Nu-
gent's success to  use  the same remedies with the
same happy issue in a  boy of 15 years of age.*

   Mr.  Falconer cured a young woman of the name
of Hannah Moore, by " a copious bleeding,"  and
another depleting remedy to be mentioned here-
after.!

   Mr.  Poupart cured a woman by bleeding until
 she fainted, and Mr. Berger  gives an account of a
 number of persons being bitten by a rabid animal.,

   * Medical Transactions, vol. ii. p. 192.
t.Ditto, p. 222. 
THE HYDROPHOBIA.
343
all of whom died, except two who were saved by
bleeding.*

  In the 40th volume of the Transactions of the
Royal Society of London, there is an account of a
man being cured of hydrophobia by Dr. Hartley,
by the loss of 120 ounces of blood.

  Dr. Tilton cured this disease in a woman in the
Delaware state  by very copious bleeding.  The
remedy  was suggested to the doctor by an account
taken from a London  magazine of a dreadful hy-
drophobia being cured by an accidental and profuse
hemorrhage from the temporal artery.f

  A case is  related by Dr. Innes,^  of the loss  of
116  ounces of blood  in seven days having cured
this disease.  In  the patient who was the  subject of
this cure, the bleeding was used in  the most de-
pressed, and apparently weak state of the pulse.  It
rose constantly with the loss of blood.

  The cases related by  Dr.  Tilton and  Dr. Innes
were said to be of a  spontaneous nature, but the

  * Bibliotheque Choisie de Medecine, tome xv. p. 212.
  t Medical Essays of Edinburgh, vol. i. p. 226.
  t Medical Commentaries, vol. iii. p. 496. 
344
OBSERVATIONS ON
morbid actions were exactly the same in both pa-
tients with those which are derived from the bite of
a rabid animal. There is but one remote cause of
disease, and that is stimulus, and it is of no conse-
quence in the disease  now under consideration,
whether the dread of water be the effect of the sali-
va of a rabid animal acting upon the fauces, or of a
morbid excitement determined to those parts by
any other stimulus.  The  inflammation of the  sto-
mach depends upon  the same kind of morbid ac-
tion,  whether  it be produced by the miasmata of
the yellow fever, or the usual remote and exciting
causes of the  gout.  An apoplexy is the same dis-
ease  when it arises from  a  contusion  by external
violence,  that  it  is  when it arises Spontaneously
from  the congestion of blood or water in the brain.
A dropsy from obstructions in the liver induced by
strong drink, does not differ in its proximate cause
from  the  dropsy brought on by the obstructions in
the same  viscus which are  left by a neglected, or
half cured bilious fever. These remarks are of ex-
tensive application, and, if duly attended to, would
deliver us from a mass of error which has been ac-
cumulating  for ages in medicine:  I mean  the no-
menclature of diseases from their remote causes. It
is the most offensive  and injurious part of the rub-
bish  of our science. 
THE HYDROPHOBIA.
345
   I grant that bleeding has been used in some in-
stances in hydrophobia  without effect,  but  in all
such cases it was  probably used out of time, or in
too sparing a manner. The credit  of this remedy
has suffered in many other diseases from the same
causes. I beg it may not be tried  in this disease,
by any physician who has not renounced our mo-
dern systems of nosology, and adopted, in their ut-
most extent, the principles and practice of Botallus
and Sydenham in the treatment of malignant fe-
vers.

   Before I quit  the subject of blood-letting in hy-
drophobia, I have to add, that  it  has been used
with success in two instances in dogs that had ex-
hibited all the usual symptoms  of  what has been
called  madness.  In one case, blood was  drawn by
cutting off the tail, in the other,  by cutting off the
ears of the diseased animal. I mention these facts
with pleasure, not  only because  they serve to sup-
port the  theory and practice which I have endea-
voured to establish in this disease, but because they
will render it unnecessary to destroy the life of a
useful  and affectionate animal  in order to  prevent
his spreading it. By curing it in a  dog  by means
of bleeding, we moreover beget confidence in the
same  remedy in  persons who have  been  bitten by 
346
OBSERVATIONS ON
him, and thus lessen the  force of the disease,  by
preventing the operation of fear upon the system.

  2. Purges and clysters  have  been found useful
in the  hydrophobia.  They  discharge  bile which
is frequently vitiated, and  reduce morbid action in
the stomach and blood-vessels.  Dr. Coste ascribes
the cure of a young woman in a convent wholly to
clysters given five or six times every day.

  3. Sweating after  bleeding completed the  cure
of the boy whose case is mentioned by Mr. Wright-
son. Dr. Baumgarten speaks highly of this mode
of depleting,  and  says  further,  that it has never
been cured " but by evacuations of some kind."

  4. All the advantages which attend  a salivation
in common malignant fevers,  are to be expected
from it in the hydrophobia. It aided blood-letting
in two persons who were cured by Mr. Falconer
and Dr. Le Compt.

  There are  several cases upon record in which
musk and opium have afforded evident relief in this
disease.

  A physician in Virginia cured it by large doses
of bark and wine.  I have  no doubt of  the efficacy 
              THE HYDROPHOBIA.          347
of these remedies when the disease is attended with
a moderate or feeble morbid action in the system,
for I take it for granted, it resembles malignant fe-
vers from other causes in appearing in different
grades of force. In its more violent and common
form, stimulants of all kinds must do harm, unless
they are of such a nature,  and exhibited in  such
quantities, as to exceed in their force the stimulus
of the disease; but this is not to be expected, more
especially as the stomach is for the most  part so ir-
ritable as sometimes to reject the mildest aliments
as well as the most gentle medicines.

   After the morbid actions in the system have been
weakened, tonic remedies  would probably be use-
ful in accelerating the cure.

   Blisters and stimulating  cataplasms, applied to
the feet, might probably  be used  with  the same
advantage in the declining state of the disease, that
they have been used in the same stage of other ma-
lignant fevers.

   The cold bath,  also long immersion in cold wa-
ter, have been frequently used in this disease.  The
former aided the lancet, in the cure  of the  man
whose case is related by  Dr. Hartley* There  can
be no objection to the cold water in either of the 
348
OBSERVATIONS ON
*bove forms, provided no dread is excited by it in
the mind of the patient.

   The reader will perceive here that I have desert-
ed an opinion which I formerly held upon the cause
and cure of the tetanus.  I supposed the hydropho-
bia to depend upon  debility. This debility I have
since been led to consider as partial, depending up-
on abstraction of excitement from some, and a mor-
bid accumulation of it in other parts of the body.
The preternatural excitement  predominates so far,
in most cases of hydrophobia, over debility, that
depleting remedies promise more speedily and safe-
ly to equalize, and render it natural, than medicines
of an opposite character.

  In the treatment of those cases of hydrophobia
which are not derived from the bite of a rabid ani-
mal, regard should always be had to its remote and
exciting  causes, so as to  accommodate the reme-
dies to them.

  The imperfection of the present nomenclature of
medicine has  become the subject of general com-
plaint. The mortality of the disease from the bite
of a rabid animal has been increased by its name.
The terms  hydrophobia and canine madness con-
vey  ideas of the symptoms of  the disease only, 
THE  HYDROPHOBIA.
349
and of such of them too as are by no means uni-
versal.  If  the  theory  I have  delivered,  and  the
practice  I have recommended,  be just, it ought to
be called the hydrophobic state of fever.  This
name associates it at once  with all the other states
of fever, and leads us to treat it with the remedies
which are  proper in its kindred diseases, and to
vary them  constantly with  the  varying state of the
system.

  In reviewing what has been  said of this disease,
I dare not  say that I have not  been misled  by th?
principles of fever which  I  have adopted;  but if
I have, I hope  the reader  will  not be discouraged
by my errors, from using  his reason in medicine.
By contemplating those errors,  he  may perhaps
avoid the shoals upon which I have been wrecked.
In all his researches, let him ever remember that
there is the same  difference between the knowledge
of a physician who prescribes for diseases as limited
by genera and species,  and of  one who prescribes
under the direction of just principles, that there is
between the  knowledge we obtain  of the  nature
and extent of the sky,  by viewing a few feet of it
from the bottom  of a well, and viewing from  the
top of a mountain the whole canopy of heaven.
  Vol. II.                          Yy 
350
OBSERVATIONS ©N
  Since the first edition of the foregoing  observa-
tions, I have seen a communication to  the editors
of the  Medical  Repository,*  by  Dr.  Physick,
which has thrown new light upon this obscure dis-
ease, and which, I hope, will aid the remedies that
have been proposed, in rendering them  more effec-
tual for its cure. The doctor supposes death from
hydrophobia to be the effect of a sudden and spas-
modic constriction of the glottis, inducing suffoca-
tion, and that it  might be prevented by creating an
artificial passage for air into the lungs, whereby life
might  be continued long enough  to admit  of the
disease  being cured by other remedies.  The fol-
lowing account of a dissection is intended to show
the probability of the doctor's proposal being attend-
ed with success.

  On the  13th of September,  1802, I  was  called,
with Dr.  Physick,  to  visit, in consultation with
Dr. Griffitts, the son of William Todd, Esq. aged
five years, who  was ill  with the disease called hy-
drophobia, brought on  by the  bite of a mad dog,
on the  6th of the preceding month. The wound
was small,  and  on his cheek, near  his mouth, tw«
circumstances which are said at all times to increase
* Volume V>. 
THE HYDROPHOBIA.
351
the danger of wounds from rabid animals.  From
the time he was bitten, he used the cold bath daily,
and took the infusion, powder, and  seeds  of the
anagallis, in succession, until the 9th of September,
when he  was seized with a fever  which at first re-
sembled  the  remittent of the season. Bleeding,
purging, blisters, and the warm bath were prescrib-
ed for him, but without  success.  The last named
remedy appeared to afford him some relief,  "which
he manifested by paddling and playing in the water.
At the time I saw him he was  much  agitated, had
frequent twitchings, laughed often; but, with this
uncommon excitement in his muscles and nerves,
his mind was unusually correct in all its operations.

   He discovered no dread of  water, except  in one
instance, when he turned from it  with horror. He
swallowed occasionally about a spoon full of it at a
time, holding the cup in his own hand, as if to pre-
vent too great a quantity  being poured at once into
his throat.  The  quick manner of his  swallowing,
and the intervals between each time  of doing so,
were  such as  we sometimes  observe in persons hi
the act of dying of acute  diseases.  Immediately af-
ter swallowing water, he looked pale, and panted for
breath. He spoke rapidly, and with much difficulty.
This was more  remarkably the case  when  he at-
tempted  to pronounce the words  carriaget water. 
3,52           OBSERVATIONS ON
and river.  After  speaking  he panted for breath in
the same manner that he did after  drinking.  He
coughed and breathed as patients do in the mode-
rate grade of the cynanche trachealis. The dog that
had bitten  him, Mr. Todd informed me, made a
similar  noise in attempting to bark, a day or two
before he  was killed.  We  proposed making an
opening into his  windpipe. To this his parents
readily  consented;  but while we were  preparing
for the operation,  such a change  for  the worse
took place, that we concluded not to perform it. A
cold  sweat,  with a feeble and quick pulse,  came
on; and he died  suddenly,  at 12 o'clock at night,
about six hours after I first saw him. He retained
his reason, and  a playful  humour, till the  last
minute of  his life.  An  instance of the  latter ap-
peared  in his throwing his handkerchief at his fa-
ther just before he expired.  The parents consented
to our  united request to examine  his body.  Dr.
Grimtts being obliged to go into the country, and
Dr.  Physick being indisposed,  I  undertook  this
business the next  morning; and, in the presence
of Dr. John Dorsey (to whom I gave the dissecting
knife),  and my pupil  Mr. Murduck, I discovered
the following appearances. All the muscles of the
neck had a livid colour, such as we  sometimes ob-
serve, after death, in persons who have died of the
sore  throat.  The muscles employed in deglutition 
THE HYDROPHOBIA.
353
-and  speech were suffused with  blood.  The  epi-
glottis was inflamed, and the glottis so  thickened
and  contracted, as  barely to  admit a probe of the
common size.  The trachea below it was likewise
inflamed and thickened, and contained a quantity
of mucus in it, such as we observe, now and then,
after death from cynanche trachealis.  The oeso-
phagus exhibited no marks of disease; but the sto-
mach had  several inflamed spots upon it, and con-
tained a matter of a brown appearance, and which
emitted an offensive odour.

  From the history of this dissection, and of many
others,  in  which much fewer  marks  appeared of
violent disease, in parts whose  actions are essential
to life, it is highly probable death is not induced in
the ordinary manner in which malignant fevers pro-
duce it, but by a sudden or gradual suffocation. It
is the temporary closure of this  aperture which pro-
duces the  dread of swallowing liquids: hence  the
reason why they are swallowed  suddenly, and with
intervals, in the manner that has been described;
for,  should the glottis be closed during the time of
two swallows, in the highly  diseased  state of the
system  which takes place  in this disease,  suffoca-
tion would be the immediate  and certain conse-
quence. The same  difficulty and  danger attend the
swallowing saliva, and hence the  symptom of spit 
'354           OBSERVATIONS ON
ting,  which has been  so  often taken notice of in
hydrophobia.  Solids are swallowed more easily than
fluids, only because they descend by intervals, and
because a less closure  of  the glottis is sufficient to
favour their passage  into the stomach. This remark
is confirmed by the frequent occurrence of death in
the very act of swallowing, and that too with the
common symptoms  of suffocation.  To account for
death from this cause, and in the manner that has
been  described, it will be necessary to recollect,
that fresh air is more necessary to the action of the
lungs in a fever than in  health, and much more so in
a fever of a malignant character, such as the hydro-
phobia appears to be, than in fevers of a milder na-
ture.  An aversion from swallowing liquids is not
peculiar to this disease. It occurs occasionally in the
yellow fever.  It  occurs  likewise  in  the disease
which has prevailed among the cats, both in Eu-
rope and America, and probably, in both instances,
from  a dread  of suffocation in  consequence of the
closure of the glottis, and sudden  abstraction of
fresh air.

  The seat of the disease, and the cause of death,
being, I hope, thus ascertained, the  means of pre-
venting death come  next  under our consideration.
Tonic remedies,  in  all their forms, have been  ad-
ministered to  no  purpose. The theory of the dis 
THE HYDROPHOBIA.
355
ease would lead us to expect a remedy for it  in
blood-letting.  But this, though now and then used
with success, is not its cure, owing,  as we now see,
to the mortal seat  of the  disease being so  far re-
moved  from the circulation,  as  not to  be affected
by  the  loss of blood  in the most  liberal quantity.
As well might we expect  the  inflammation and
pain of a paronychia, or what is called a felon  on
the finger,  to  be removed by the same  remedy.
Purging and  sweating, though occasionally  suc-
cessful,  have failed in many instances; and even
a  salivation,  when  excited  (which is rarely  the
case), has not cured  it. An artificial aperture into
the windpipe alone  bids fair to arrest its tendency
to  death, by removing the symptom  which gene-
rally  induces it, and thereby giving time for other
remedies,  which have hitherto been unsuccessful,
to  produce their usual salutary effects in  similar
diseases.*  In  removing faintness,  in  drawing  off
the water  in  ischuria, in  composing convulsions,
and in  stopping hemorrhages in malignant  fever,
we do  not  cure the disease, but we prevent death,
and thereby gain time for the use  of the remedies
which  are  proper to cure  it.  Laryngotomy ac--

   * The hoarse barking, or the total inability of mad dogs te
bark, favours still further the idea that the  mortal seat of the
disease is in the glottis, and that the remedy which has been
proposed rs a rational one. 
356
OBSERVATIONS ON
cording  to  Fourcroy's advice,  in  diseases of the
throat which  obstruct respiration,  should be  pre-
ferred to tracheotomy, and  the  incision should be
made  in the triangular space between the thyroid
and cricoid  cartilages.  Should  this operation be
adopted, in order to save life, it will not offer  near
so  much violence to humanity as many other  ope-
rations.  We cut through a large mass of flesh in-
to the bladder in  extracting a stone. We cut  into
the cavity  of the thorax in the operation for the
empyema.  We perforate the  bones of  the  head
in trepanning; and we cut  through the uterus, in
performing the Caesarian operation, in order to  save
life. The operation of laryngotomy is much  less
painful and dangerous  than any of them; and be-
sides permitting the patient  to breathe and to swal-
low, it is calculated to serve the inferior purpose of
lessening the  disease of  the glottis by  means of
local  depletion. After  an aperture has been  thus
made through the larynx,  the remedies should be
such as are indicated by the state of the system,
particularly  by the state  of the pulse.  In hot cli-
mates  it is, I believe, generally a disease of feeble
re-action, and requires tonic remedies;  but in the
middle and northern states  of America it is more
commonly attended with so  much activity and ex-
citement of the blood-vessels, as to require copious
blood-letting and other depleting remedies. 
THE HYDROPHOBIA.
357
  Should this new method of attacking this furious
disease be adopted, and  become generally success-
ful, the discovery  will place the ingenious gentle-
man who suggested it in the first rank of the medi-
cal benefactors of mankind.

  I have only to add a fact upon this subject which
may tend to increase confidence in a mode of pre-
venting the  disease, which has been recommend-
ed by Dr. Haygarth, and used with success in se-
veral instances. The same dog which bit  Mr.
Todd's son,  bit at the same time, a  cow, a pig,  a
dog, and a  black  servant of Mr. Todd's.  The
cow and pig died; the dog became mad, and was
killed  by his master. The black man, who was
bitten on one of his fingers, exposed the wound for
some time,  immediately after  he received t, to  a
stream  of pump   water, washed it likewise  with
soap and water. He  happily escaped the  disease,
and is now  in  good  health. That his  wound was
poisoned is  highly probable, from its having  been
made eight  hours  after  the  last  of the above ani-
mals was bitten, in which time  there  can be but
little doubt  of such a fresh secretion of saliva hav-
ing taken place as  would have produced the hydro-
phobia, had it not been prevented by the above
simple remedy. I am not, however, so much en-
couraged by its happy issue in this case  as to advise
  V©l. II.                         Z  7. 
358           OBSERVATIONS, &C.
it in preference  to  cutting out  the wounded part.
It should only be resorted to where the fears of a
patient, or his distance  from a surgeon render it
impossible to use the knife. 
     AN INQUIRY




       INTO THK





    Cause and Cure





        OF THE





CHOLERA INFANTUM. 
 
AN INQUIRY
             INTO THE

       Cause  and Cure

             OF THK

CHOLERA INFANTUM.
      BY this name  I mean to designate a dis-
ease, called in Philadelphia,  the " vomiting and
purging of children."  From the regularity of  its
appearance  in the summer months, it is likewise
known by the name of " the disease of the season."
It prevails in most of the large towns of the United
States. It is distinguished in  Charleston, in South
Carolina, by the name of " the April  and May
disease," from making  its first appearance in those
two months. It seldom appears in Philadelphia till
the middle  of June, or the beginning of July, and
generally continues till  near the middle of Septem- 
362
THE CAUSE AND CURE  OF
ber. Its frequency and danger are always in pro-
portion to the heat of the weather. It affects chil-
dren from the first or second week after their birth,
till they  are  two years old.  It sometimes begins
with a diarrhoea,  which continues for several days
without any  other symptom  of indisposition; but
it more frequendy comes  on  with a violent vomit-
ing and purging, and a high fever.   The matter
discharged from the stomach and bowels is gene-
rally yellow  or green,  but the stools are  some-
times slimy  and  bloody,  without any tincture of
bile. In some instances they are nearly as limpid as
water.  Worms are frequently discharged in each
kind of the  stools that has been described. The
children, in  this  stage  of the  disease, appear to
suffer a good deal  of pain.  They draw  up their
feet, and  are never  easy in one  posture.  The
pulse is quick and weak.  The head is unusually
warm,  while the extremities retain their natural
heat, or incline to  be cold.  The fever  is of the
remitting  kind, and discovers evident exacerba-
tions, especially  in  the  evenings. The disease  af-
fects the head so much, as  in some instances to
produce symptoms not only of  delirium, but of
mania, insomuch  that  the  children  throw  their
heads  backwards  and forwards,   and sometimes
make attempts to scratch, and to bite their parents,
nurses,  and  even  themselves.  A  swelling  fre- 
THE CHOLERA INFANTUM.
363
qUently occurs in the abdomen, and in the face and
limbs.  An intense thirst attends every stage of
the disease.  The eyes appear languid and hollow,
and  the  children  generally  sleep  with  them  half
closed.  Such is  the insensibility of the system in
some instances  in this disease,  that flies have been
seen to alight upon the eyes  when open, without
exciting a motion in  the eyelids  to remove  them.
Sometimes the  vomiting  continues  without the
purging, but more generally the purging continues
without the vomiting, through  the whole course of
the disease. The  stools  are frequendy  large, and
extremely fetid,  but  in  some  instances they are
without smell, and resemble drinks and aliments
which  have been taken into the body. The disease
is sometimes  fatal in  a few days. I once  saw it
carry off a child in  four  and twenty  hours.  Its
duration is varied by the season of the year, and
by the changes  in the temperature of the weather.
A cool day frequently abates its violence, and dis-
poses it to a favourable termination. It often con-
tinues, with occasional variations in its appearance,
for six weeks or two  months.  Where  the disease
has  been of long continuance,  the  approach of
death is gradual, and attended by a number of dis-
tressing symptoms.  An emaciation of  the  body
to such a degree, as that the bones come through
the  skin, livid  spots, a  singultus, convulsions, i< 
364
THE CAUSE AND CURE OF
strongly marked hippocratic  countenance, and  a
sore mouth, generally precede the fatal termination
of this  disease.  Few children ever recover,  after
the  last symptoms  which  have  been mentioned
make their appearance.

  This disease has been ascribed to several causes;
of each of which I shall take notice in order.

  L It has been attributed to dentition. To refute
this  opinion, it will  be necessary to observe, that
it appears  only  in one season of the  year.  Den-
tition,  I acknowledge, sometimes  aggravates it;
hence we find it is  most severe in that period of
life,  when the greatest number of teeth make their
appearance, which   is  generally about  the  10th
month.  I think  I observed  more  children to die
of this disease at that age, than at any other.

  II. Worms  have likewise  been suspected of
being the  cause of this disease.  To this opinion,
I object the uncertainty of worms ever producing
an idiopathic fever,  and the  improbability of their
combining  in such a  manner  as to  produce an
annual  epidemic disease of  any kind. But  fur-
ther, we often  see  the  disease in all its  force,
before that age, in which worms usually produce
diseases; we likewise  often see it resist the  most 
           THE CHOLERA INFANTUM-        365
powerful  anthelmintic  medicines; and,  lastly,  it
appears from  dissection,  where  the  disease  has
proved fatal,  that not a single worm has been dis-
covered in the bowels. It is  true, worms, are in
some  instances discharged  in  this disease,  but
they are frequently discharged in greater numbers
in the hydrocephalus  internus, and in  the small-
pox, and  yet who will assert either of those  dis-
eases to be produced by worms.

  III.  The summer fruits have been  accused of
producing this disease. To this opinion I  object,
that  the   disease is but  little  known  in country
places, where  children eat much more fruit than
in cities.  As far as I have observed,  I  am dispos-
ed to believe, that the moderate use of ripe fruits,
rather tends to prevent, than to induce the disease.

  From   the discharge of bile  which  generally
introduces the  disease, from  the remissions  and
exacerbations of the fever which accompanies it,
and from  its  occurring nearly in the same season
with the  cholera  and  remitting  fever  in  adults,
I am disposed to consider  it as a modification of
the same diseases.  Its appearance  earlier in the
season than  the cholera  and  remitting fever in
adults, must be ascribed  to  the constitutions of
children  being more predisposed from weakness
  Vol. II.                       3 A 
366
THE  CAUSE AND CURE OF
to be acted upon,  by the  remote causes which
produce those diseases.

  I  shall now mention  the remedies  which arc
proper and useful in this disease.

  I. The first indication of cure  is to evacuate
the bile  from  the  stomach and  bowels.   This
should be done by gentle doses of ipecacuanha, or
tartar emetic.   The  vomits  should  be repeated
occasionally,  if indicated,  in every stage  of the
disease.   The bowels should be  opened by means
of calomel, manna, castor oil, or magnesia. I have
generally found rhubarb improper for this purpose,
while the stomach  was  in  a very  irritable state.
In  those cases, where there is reason  to believe
that the  offending  contents of  the  primae  viae
have been discharged  by nature (which  is  often
the case), the  emetics and  purges should by no
means be given;  but,  instead  of them, recourse
must be  had to

  II. Opiates.  A few  drops of liquid  laudanum,
combined in a testaceous julep, with peppermint
or cinnamon-water, seldom  fail of  composing the
stomach  and bowels.  In  some instances, this me-
dicine alone subdues the disease in two or  three
days; but where  it does not prove so  successful, 
           THE CHOLERA INFANTUM.        367
it produces a remission of pain, and  of other dis-
tressing symptoms, in every stage of the disease.

  III. Demulcent  and diluting drinks  have  an
agreeable effect in this disease.  Mint and  mallow
teas,  or a tea made of blackberry  roots  infused
in  cold  water, together  with a decoction of the
shavings of hartshorn and gum arabic with cinna-
mon, should  all  be given in their turns  for this
purpose.

  IV. Clysters made of flaxseed tea,  or of  mut-
ton broth, or of  starch dissolved  in water,  with
a few drops of liquid laudanum in them, give ease,
and produce other useful effects.

  V. Plasters of Venice treacle  applied to  the re-
gion of the stomach, and flannels  dipped in  infu-
sions of bitter and aromatic herbs in  warm  spirits,
or Madeira wine,  and applied to the region of the
abdomen, often afford considerable relief.

  VI. As soon as the  more violent  symptoms of
the disease are composed,  tonic and cordial medi-
cines should  be  given. The bark in decoction,
or  in substance (where it can be retained in that
form), mixed with a  little nutmeg, often produces
the  most  salutary effects.  Port wine  or claret 
568        THE CAUSE AND  CURE OF
mixed with water are likewise proper in this stage
of the disease.  After  the  disease  has continued
for some time, we  often  see an  appetite suddenly
awakened for articles of diet of a stimulating na-
ture.  I have  seen   many  children recover from
being gratified in an inclination to  eat salted fish,
and the different kinds of salted  meat.  In some in-
stances  they discover an  appetite for  butter, and
the richest gravies of roasted meats, and eat them
with obvious relief to all their symptoms.  I once
saw a  child  of sixteen months old perfectly re-
stored,  from the lowest stage of this  disease,  by
eating large quantities of rancid English  cheese,
and drinking  two or three glasses of port wine
every day.  She  would in  no  instance eat bread
with the cheese, nor  taste the wine,  if  it was mix-
ed with water.

   We sometimes see relief given  by  the  use  of
the warm  bath,  in   cases of obstinate pain. The
bath is  more effectual, if warm  wine is used,  in-
stead of water.

   I have had  but few opportunities of trying the
effects  of  cold water applied  to the body  in this
disease; but from  the benefit  which  attended  its
use in the cases in which it was prescribed, I am
disposed to believe that it would do great  service^ 
THE  CHOLERA  INFANTUM.       369
 could we overcome the prejudices which subsist in
 the minds of parents against it.

   After all that has been said in favour of the re-
 medies that have been mentioned, I am sorry to add,
 that I have very often seen them all administered
 without effect. My principal dependence, therefore,
 for many years, has been placed upon

   VII.  Country air.  Out  of many  hundred  chil-
 dren whom  I have  sent  into the country, in every
 stage  of this disease, I have lost but three;  two
 of whom  were sent,  contrary to my advice,  into
 that unhealthy part of the neighbourhood of Phila-
 delphia  called the Neck, which lies between the
 city and the conflux  of the rivers  Delaware and
 Schuylkill.  I  have seen one cure   performed by
 this remedy,  after convulsions had taken place.
 To derive the utmost benefit from the country air,
 children should be carried out  on horseback, or in
 a carriage, every day; and they  should be exposed
 to the open air as much  as possible in fair weather,
 in the day time. Where the convenience  of the
 constant benefit of country air  cannot be obtained,
 I have  seen evident advantages from taking  chil-
• dren out of the city once or twice a  day. It is ex-
 tremely agreeable to see the little sufferers revive 
370
THE CAUSE AND CURE OF
as soon  as they  escape  from the city air, and in-
spire the pure air of the country.

   I  shall conclude this inquiry, by recommending
the following methods of preventing this disease,
all of which  have been found, by experience to be
useful.

   1. The daily use of the cold bath.

   2. A faithful and attentive accommodation of the
dresses of children to the state and changes of the
air.

   3. A  moderate  quantity of salted  meat taken
occasionally in those months  in which the disease
usually prevails.  It is perhaps in part from the dai-
ly use  of salted meat  in  diet, that the children of
country people escape this disease.

  4. The use  of sound  old  wine in the summer
months.  From a tea  spoon  full,  to  half a wine
glass full, according to the age of the child, may
be  given every  day.  It is  remarkable,  that the
children  of persons in easy circumstances, who sip
occasionally  with their parents the  remains of a
glass of wine after dinner, are much less subject  to 
           THE CHOLERA INFANTUM.        371
this disease, than the children of poor people, who
are without the benefit of that article of diet.

  5. Cleanliness, both  with  respect  to the skin
and  clothing of children. Perhaps the  neglect of
this direction may be another reason why the chil-
dren of the poor are most subject to this disease.

  6.  The removal  of children into the  country
before the approach of warm weather. This ad-
vice is peculiarly necessary during the whole pe-
riod of dentition.  I have  never known  but one
instance of a child  being affected by this disease,
who had  been  carried into the country in order to
avoid it.

   I  have only to add  to the  above observations,
that since the prevalence of the yellow  fever in
Philadelphia after the year  1793, the cholera infan-
tum has assumed symptoms of such malignity, as to
require bleeding to cure it.  In some cases, two and
three  bleedings were necessary for  that purpose. 
 
OBSERVATIONS
        ON THE





Cynanche Tracliealis.
Vor.. II.                   3 B 
 
    OBSERVATIONS

           ON THE

Cynanche Tracliealis.
       THE vulgar name of this disease in Penn-
sylvania  is hives.  It is  a corruption of the word
heaves, which took  its  rise from the  manner in
which the lungs heave in  breathing. The worst de-
gree of the disease  is called  the  bowel  hives,
from the great motion of  the abdominal muscles in
respiration.

  It has been called suffocatio  stridula  by Dr.
Home, and  cynanche trachealis by Dr.   Cullen.
Professor Frank  calls it trachitis, and Dr. Darwin
considers it as a pleurisy of the windpipe.  By the
two latter names, the authors  mean to convey the
correct idea, that the disease is the same in its na-
ture with the common diseases of other internal
parts of the body. 
376
OBSERVATIONS on the
  It is brought on by the same causes which in-
duce  fever, particularly  by  cold.  I have seen it
accompany as  well as succeed,  the  small-pox,
measles,  scarlet-fever, and apthous sore  throat.  In
the late Dr.  Foulke it succeeded acute rheuma-
tism.  The late Dr. Sayre informed me, he had
seen it occur in a case of yellow fever,  in the year
1798.

  It sometimes comes on suddenly, but it more
frequently creeps on in the form of a common cold.
Its  symptoms are  sometimes constant,  but they
more generally remit, particularly during the day.
It attacks children of  all  ages, from three months
to five years old. But  it occasionally attacks adults.
It generally runs its course in three or four days,
but we now and then see it protracted in a chronic
and feeble form, for eight and ten days.

  Dissections show the  following appearances in
the trachea.  1 A  slight degree  of inflammation.
2. A thick matter resembling mucus. 3. A mem-
brane similar to that which succeeds inflammation
in the pleura and  bowels, formed from the coagu-
lating  lymph of the blood. 4. In some  cases the
trachea exhibits no marks of disease of any kind.
These cases  are  generally violent, and  terminate
suddenly. The morbid excitement here transcends 
           CYNANCHE TRACHEALIS.        377
inflammation.  Similar instances  of the absence  of
the common  signs of disease after death, occur in
other parts of the body. Where the cynanche tra-
chealis has appeared in the high  grade which has
been last mentioned, it has been called spasmodic.
Where the serous vessels of the trachea have been
tinged with red blood, it has been considered  as
inflammatory.  Where a  liquid matter  has been
found in the trachea, it has been  called  humoral;
and where a membrane  has  been seen adhering to
the trachea, it has received from Dr. Michaelis the
name of angina  polyposa.  But all  these different
issues of the cynanche trachealis  are the effects of
a  difference  only in its force, or in its  duration:
they all depend, upon one remote,  and one proxi-
mate cause.

   In the forming state of this disease, which may
be easily known by a hoarseness, and a  slight de-
gree  of stertorous cough,  a puke of antimonial
wine,  tartar  emetic, ipecacuanha,  or oxymei of
squills,  is for the most part an immediate  cure. To
be effectual,  it should  operate  four or five times.
Happily children are seldom injured by a little ex-
cess in  the operation of this class  of medicines. I
have prevented the formation  of this disease many
hundred times, and frequently  in my own  family,
by means of this remedy. 
 378         OBSERVATIONS ON THE
   After the disease is completely formed, and ap-
 pears  with the  usual  symptoms described  by au-
 thors, the remedies should be

   1.  Blood-letting. The late Dr. Bailie of New-
 York used to bleed until fainting was induced. His
 practice has been followed by Dr. Dick of Alex-
 andria, and with great success. I have generally
 preferred small, but frequent, to copious bleedings.
 I once drew twelve ounces of blood, at four bleed-
 ings,  in one day, from a son of Mr. John  Carrol,
 then in the fourth year of his. age.  Dr. Physick
 bled a child, of but three months old, three times
 in one  day.  Life was saved in both  these  cases.
 Powerful as  the lancet is, in this, disease, its vio-
 lence and danger require that it should be aided by

  2. Vomits. These  should  be given every day,
 or oftener, during the continuance of the disease.
 Their  good  effects are  much more  obvious and
 certain  in  a  disease of the  trachea, than  of the
 lungs, and hence their  greater utility, as I shall say
 hereafter, in a consumption  from a catarrh, than
 from any other of its causes.

  3.  Purges.  These  should  consist  of calomel
and jalap,  or  rhubarb, and should always  follow 
CYNANCHE TRACHEALIS.
319
the use of  emetics, if they  fail  of opening  the
bowels.

   4. Calomel  should  likewise be given in large
doses.  Dr.  Physick gave half  a drachm of  this
medicine, in one day, to the infant whose case has
been mentioned. I  have never  known  it excite
a salivation when given  to  children  whose ages
render them subjects  of it,  probably  because it
has been given in such large  quantities as to pass
rapidly through the bowels.  Its good effects seem
to depend upon its exciting a counter-action  in the
whole  intestinal canal, and  thereby lessening  the
disposition of  the  tracheal  blood-vessels to dis-
charge the mucus,  or  form  the membrane, which
have been described.

   5. Blisters  should  be applied  to  the throat,
breast, and neck, and even to the limbs.

   6. Dr. Archer of Maryland commends, in high
terms,  the  use of polygola,  or Seneca snake-root,
in this  disease. I can  say nothing in favour  of its
exclusive use, from my  own experience, having
never given it, but as an auxiliary to other remedies.

   1: I  have seen great relief given by the use of
the warm bath, especially when it has been follow-
ed by a gentle perspiration. 
380         OBSERVATIONS ON THE
  8. Towards the close of the disease, after the
symptoms of great morbid action begin to decline,
a few drops  of liquid laudanum,  by quieting the
cough which generally succeeds it,  often produce
the most salutary effects. They should be gi en in
flaxseed, or bran, or onion tea, of which drinks the
patient  should  drink  freely in  every stage  of the
disease.

   The  cynanche trachealis is attended with most
danger, when the patient labours  under a constant
and audible  stertorous breathing.  The danger is
less, when a dry stertorous cough attends,  with
easy respiration  in  its  intervals.  The  danger  is
nearly over  when the  cough, though stertorous,
is loose, and accompanied with a discharge of mucus
from the trachea.

   An  eruption  of little red blotches, which fre-
 quently appears and disappears two or three times
 in the course of this disease, is always a favourable
 symptom.

   I once  attended a man  from  Virginia,  of the
 name of Bampfield,  who,  after an attack  of this
 disease, was much distressed  with the stertorous
 breathing and  cough  which belong to it. I sus-
 pected both to arise from a membrane formed by 
CYNANCHE TRACHEALIS.
381
inflammation in  his  trachea.   This membrane I
supposed to  be in part detached from the trachea,
from the rattling noise which  attended his breath-
ing.  He had  used many remedies for it to no pur-
pose.  I advised  a  salivation,  which  in  less than
three weeks perfectly cured him.

  Since  the  general  adoption of the  remedies
which have been enumerated, for the cynanche tra-
chealis, instances of its mortality have become very
uncommon in the city of Philadelphia.
Vol. II.                         .3 C 
 
        AN ACCOUNT





             OF THE






   Bilious Remitting Fever,





          AS IT APPEARED





        IN PHILADELPHIA,





In the Summer and Autumn of the Year 1780. 
 
          AN ACCOUNT

               or THE

Bilious Remitting Fever, &c.
       BEFORE I proceed to describe this fever,
it will be necessary to give a short account of the
weather, and of the diseases which preceded its ap-
pearance.

  The spring of 1780 was dry and cool. A catarrh
appeared among children  between  one year and
seven years of age. It was accompanied by a de-
fluxion from the eyes and nose, and by a cough and
dyspnoea, resembling, in some instances, the cynan-
che trachealis, and in others a peripneumony. In
some cases it was complicated with the symptoms
of a bilious remitting and intermitting  fever.  The
exacerbations of this fever were  always  attended
with dyspnoea and cough. A  few patients expecto-
rated blood.  Some had swellings behind their ears. 
•386
ACCOUNT OF THE
and others were affected with small ulcers in the
throat. I met with only one case of this fever in
which the pulse indicated bleeding. The rest yield-
ed in a few days to emetics, blisters, and the bark,
assisted by the usual more simple remedies in such
diseases.

  An intermittent prevailed among adults  in the
month of May.

  July and August were uncommonly warm.  The
mercury stood on the 6th of August at 94|, on the
15th of the same month at 95\ and for several days
afterwards at 90\ Many labouring people perished
during this month by  the heat, and by drinking,
not only cold water but  cold  liquors of  several
kinds,  while they were under the violent impres-
sions of the heat.

  The vomiting and purging prevailed universally,
during  these two warm months, among  the  chil-
dren, and  with uncommon  degrees of mortality.
Children from one year to eight and nine years old
were likewise very generally affected by blotches
and little boils,  especially in their faces. An erup-
tion on  the skin, called by the  common people the
prickly  heat, was very  common at this time among
persons of all  ages.  The  winds  during  these 
BILIOUS REMITTING FEVER.
>387
months blew chiefly from  the south, and  south-
west. Of course they passed over the land which
lies between  the city,  and the conflux of the ri-
vers Delaware  and Schuylkill, the peculiar situa-
tion of which, at that  time, has been already de-
scribed.

  The dock,  and the streets of Philadelphia,  sup,
plied the winds at this season, likewise, with a por-
tion of their unwholesome exhalations.

  The moschetoes were  uncommonly numerous
during the autumn.  A certain  sign  (says Dr.
Lind) of an unwholesome atmosphere.

  The remitting fever made its first appearance in
July and August, but its symptoms were so mild,
and its extent so confined, that  it excited no ap-
prehensions of its subsequent more general preva-
lence throughout the city.

  On the 19th of August the air became  suddenly
very cool.  Many hundred people in the  city com-
plained, the next day, of different degrees of in-
disposition, from a sense of lassitude to a fever of
the remitting type.  This was the  signal  of the
epidemic.   The weather continued  cool during
the remaining part  of  the month,  and during the 
388
ACCOUNT OF THE
whole month of September.  From  the  exposure
of the district of Southwark (which is often distin-
guished by the name of the Hill J to tjie south-west
winds, the fever  made its  first appearance in that
appendage of the city. Scarcely a family, and, in
many families, scarcely a member of them, escaped
it. From  the  Hill it gradually travelled along the
second street  from  the Delaware, improperly call-
ed Front-street.  For a  while it was confined to
this street only, after it entered the city,  and hence
it was called by some people the Front-street fever.
It gradually spread through other parts of the city,
but  with  very different degrees  of  violence.  It
prevailed  but little   in the Northern  Liberties. It
was scarcely known  beyond Fourth-street from the
Delaware. Intemperance  in  eating  or drinking,
riding in  the sun or rain, watching,  fatigue,  or
even a fright,  but more frequently cold,  all served
to excite the seeds of this fever into action, where -
ever they  existed.

  All  ages  and both sexes were affected by this
fever.  Seven  of  the practitioners of physic were
confined by it nearly at the same time.  The city,
during the prevalence of the fever, was filled with
an unusual number  of strangers,  many  of whom,
particularly  the  Friends   (whose yearly  meeting
was held in the month of September), were affected 
BILIOUS REMITTING FEVER.
389
by  it.  No other febrile disease was observed du-
ring this time in the city.

  This fever generally came  on with rigour, but
seldom with a regular chilly fit, and often without
any sensation of cold.  In  some persons  it was in-
troduced by a slight sore throat, and  in others by
a hoarseness which was mistaken  for a common
cold. A giddiness  in the  head was the forerunner
of the  disease in some people. This giddiness at-
tacked so suddenly, as to produce, in several in-
stances,  a faintness, and even symptoms of apo-
plexy.  It was remarkable that all those  persons
who were affected in this violent maimer, recover-
ed in two or three days.

  I met  with one  instance of  this  fever attacking
with coma, and another with convulsions, and with
many  instances, in which it was introduced by a
delirium.

  The pains which accompanied this fever were
exquisitely severe  in the  head, back, and limbs.
The pains in the head  were sometimes in the back
parts of it, and at  other times  they occupied only
the eyeballs. In some people, the pains were so
acute in their backs and hips,  that they  could not
lie in bed.  In others, the pains affected  the neck
  Voi. II.                         3 D 
39U
ACCOUNT OF THE
and arms, so as to produce  in one  instance a diffi-
culty of moving the fingers  of the right hand.
They all complained more or less  of a soreness in
the seats of these pains, particularly when they  oc-
cupied the head and eyeballs.  A  few complained
of their flesh being sore to the  touch, in every part
of the body. From  these  circumstances, the dis-
ease was sometimes believed to be a rheumatism;
but  its more  general name among all  classes of
people was, the break-bone fever.

   I met  with  one case  of pain in the  back, and
another of an  acute ear-ach,   both  of  which  re-
turned periodically every night, and without any
fever.

   A nausea universally,  and in some instances  a
vomiting,  accompanied by a disagreeable taste in
the mouth,  attended this fever. The bowels  were,
in most  cases, regular, except where the disease
fell with its whole force upon them, producing a
dysentery.

   The tongue was generally moist,  and  tinctured
of a yellow colour.

   The urine was high  coloured,  and in its  usual
quantity in fevers. 
           BILIOUS REMITTING FEVER.      391
   The  skin was generally moist, especially where
the disease terminated on the third or fourth day.

   The pulse was quick and full, but never hard, in
a single patient  that came  under my care, till  the
28th of September.

   It was remarkable, that  little, and, in some  in-
stances, no thirst attended this fever.

   A screatus,  or constant hawking and spitting,
attended in many cases  through the  whole disease,
and was a favourable symptom.

   There were  generally remissions  in  this fever
every morning,  and  sometimes  in the evening.
The exacerbations  were more severe every other
day, and two exacerbations were often observed in
one day.

   A rash  often  appeared on the  third and  fourth
days,  which  proved  favourable.   This  rash was
accompanied, in some cases, by a-burning  in the
palms of the hands  and soles  of  the feet.  Many
people at this time, who were not confined to their
beds, and some, who  had no fever, had an efflores-
cence on their skins. 
392            ACCOUNT OF THE
  In several persons the force of the disease seem-
ed to fall upon the face, producing swellings under
the jaw and  in the ears, which in  some instances
terminated in abscesses.

  When the fever did not terminate on the third
or fourth day, it  frequently ran on to the eleventh,
fourteenth, and even twentieth days,  assuming in
its  progress, according  to  its duration, the usual
symptoms of  the typhus  gravior, or  mitior, of
Doctor Cullen.  In some cases, the discharge of a
few spoons-full of blood from the nose accompanied
a solution of the  fever on the  third or fourth day;
 while in  others,  a profuse hemorrhage from the
 nose, mouth, and bowels, on the tenth and eleventh
 days, preceded a fatal issue of the disease.

    Several cases came under my care, in which the
 fever was succeeded by a jaundice.

    The disease terminated in some cases  without
  sweating or sediment  in  the  urine;  nor did  I
  observe such patients more disposed to relapse than
  others provided  they took a  sufficient quantity of
  the bark.

    About the beginning of October  the  weather
  became cool, accompanied by rain and an easterly 
          BILIOUS REMITTING FEVER.      393
wind.  This cool and wet  weather continued for
four days. The mercury in the thermometer fell
to 60°, and  fires became  agreeable.  From this
time the fever evidently declined,  or was accom-
panied by  inflammatory symptoms.  On  the  16th
of October, I met with a case of inflammatory an-
gina;  and on the next day  I visited a patient who
had a complication of the bilious fever with a pleu-
risy, and whose blood discovered strong  marks of
the presence of  the inflammatory diathesis. His
stools were of  a  green  and black  colour. On the
third  day of his disease a rash appeared on his
skin,  and on the  fourth, in consequence of a se-
cond bleeding,  his fever terminated with the com-
mon symptoms of a crisis.

   During the latter end of October, and the first
weeks in November,  the  mercury  in the  ther-
mometer fluctuated  between  50  and 60°.  Pleu-
risies and inflammatory  diseases of all kinds now
made their  appearance. They were  more nu-
merous and more acute, than  in this stage of the
autumn,  in former years. I met with one case of
pleurisy in November, which did not yield to less
than four plentiful bleedings.

   I shall now add a short account of the  method
I pursued in the treatment of this fever. 
394
A.CC0UNT OF  1 HE
  I  generally began by giving a  gentle  vomit  of
tartar  emetic.   This medicine, if given  while the
fever was in its forming state, frequently  produced
an immediate  cure; and  if given after its forma-
tion, on the first day, seldom failed of producing a
crisis  on  the   third or  fourth  day.  The  vomit
always discharged  more  or  less bile.  If  a nausea,
or an  ineffectual  attempt to vomit continued after
the exhibition  of the tartar emetic, I gave a second
dose of it with the happiest effects.

  If  the  vomit failed  of  opening  the  bowels, I
gave  gentle doses  of  salts and  cream of tartar,*
or of  the  butter-nut pill,f so as to procure two or
three  plentiful  stools.   The matter  discharged
from  the bowels was   of a  highly bilious nature.
It was sometimes so acrid as to  excoriate the rec-
tum, and so offensive, as to occasion, in some cases,

  * I have found that cream of tartar renders the purging
neutral salts less  disagreeable  to the taste and stomach;  but
accident has lately taught me, that the juice of two limes or
of one lemon, with about half an ounce of loaf sugar, added
to six drachms of Glauber's or Epsom salt,  in half a pint of
boiling water,  form  a  mixture that is nearly as pleasant as
strong beverage.

  t This pill is made from  an extract of a strong decoction
of the inner bark  of the white walnut-tree. 
          BILIOUS REMITTING EEVER.      395
sickness and faintness both in the patients and in
their  attendants. In  every instance, the  patients
found relief by these evacuations, especially  from
the pains in the head and limbs.

   In  those  cases,  where  the  prejudices  of the
patients against an emetic, or where an advanced
state of pregnancy, or a habitual predisposition to
a  vomiting  of  blood  occurred, I  disharged the
bile entirely  by means of the lenient purges that
have been mentioned.  In  this practice  I  had the
example  of  Doctor  Cleghorn,   who  prescribed
purges with great success in a fever of the same
kind in Minorca, with that which has been de-
scribed.*  Doctor Lining prescribed purges  with
equal success  in an  autumnal pleurisy in South
Carolina,  which I take to have been a form of a
bilious remittent, accompanied by an inflammatory
affection of the breast.

   After evacuating the contents of the stomach
and bowels, I  gave small  doses of tartar  emetic,
mixed with Glauber's salt.  This medicine excited
a general perspiration.  It likewise kept the bowels
gendy open,  by which means  the bile was dis-
charged as fast  as it was accumulated.
* The tertiana interposita remissione tantum of Dr. Cullen. 
396            ACCOUNT OF THE
  I constantly recommended to my patients, in this
stage of the  disorder, to lie in  bed.  This favoured
the eruption of the rash,  and the solution of the
disease by  perspiration.  Persons  who struggled
against the fever by sitting up, or who attempted
to shake it off by labour or exercise, either sunk
under it, or had a slow recovery.

   A  clergyman  of a respectable  character from
the  country, who was attacked by  the disease in
the  city,  returned  home,  from a desire of being
attended by his own family,  and died  in a  few
days afterwards. This  is only one, of many cases,
in which I have observed  travelling, even in the
easiest carriages, to prove  fatal in fevers after they
were  formed,  or  after  the  first  symptoms  had
shown themselves.  The quickest and most effec-
tual way of conquering a fever, in most cases, is,
by an early submission to it.

   The drinks  I recommended to my patients were
 sage and balm teas,  weak  punch, lemonade,  wine
 whey, tamarind and apple  water.

   The apple  water  should be made  by pouring
 boiling water upon slices of raw apples.  It  is
 more lively than that which is made by pouring
 the water on roasted apples. 
           BILIOUS REMITTING FEVER.      397
   I found obvious advantages, in many cases, from
 the use of pediluvia every night.

   In every case, I found the patients refreshed and
 relieved by frequent changes 6f their linen.

   On the third or fourth day, in  the  forenoon,
 the pains  in  the head  and back generally abated,
 with  a sweat which was diffused  over the whole
 body. The pulse at this time remained quick and
 weak.  This  was,  however,  no  objection to the
 use of the bark, a few doses of which immediately
 abated its quickness, and prevented a return of the
 fever.

   If the fever continued beyond the third or fourth
 day without an intermission, I always had recourse
 to  blisters.  Those which were  applied  to  the
 neck, and  behind  the  ears,  produced  the  most
 immediate good  effects. They  seldom  failed of
 producing an intermission  in the  fever,  the  day
 after  they were  applied. Where delirium or coma
 attended, I applied  the  blister to the neck on the
first day of the disease, A worthy family in this
 city will always  ascribe the life of a promising boy,
 of ten years old, to the early  application  of a blis-
 ter to the neck,  in this fever.
  Vol. II.                         3 E 
398
ACCOUNT OF THE
  Where the fever  did not yield to blisters, and
assumed malignant,  or typhus  symptoms, I  gave
the medicines usually exhibited  in  both those
states of fever.

  I took notice, in the history of this fever, that it
was  sometimes accompanied  with  symptoms of
a dysentery. Where this disease appeared, I pre-
scribed lenient purges and opiates.  Where  these
failed  of success, I  gave the bark  in the inter-
missions of  the pain  in  the bowels, and  applied
blisters to the wrists.  The good  effects of  these
remedies led me  to  conclude, that the dysentery
was the febris introversa of Dr. Sydenham.

  I am  happy in having  an opportunity,  in this
place,  of bearing a testimony in favour of the use-
fulness of  opium in this disease, after the neces-
sary evacuations   had been made.  I  yielded, in
prescribing it at first, to the earnest solicitations of
my patients  for   something  to  give  them  relief
from  their  insupportable pains, particularly when
they  were  seated in the eyeballs  and head.  Its
salutary effects in  procuring sweat, and  a remission
of the fever, led  me to prescribe  it afterwards in
almost every case,  and always with the  happiest
effects.  Those physicians enjoy but little pleasure
in practising physic, who know not  how much 
BILIOUS REMITTING FEVER.
399
of the pain  and anguish  of fevers, of  a certain
kind, may  be lessened by  the  judicious  use of
opium.

  In treating of the  remedies used in this disease,
I have  taken no  notice  of blood-letting. Out of
several  hundred patients whom I visited  in  this
fever, I did not meet with a single case,  before the
27th of September, in which the state of the pulse
indicated  this evacuation.  It is true,   the pulse
was full,  but never hard.  I acknowledge that  I
was called to several patients who had  been bled
without the advice of a physician,  who  recovered
afterwards on the  usual days  of the solution of
the fever. This  only can be ascribed to that dis-
position which Doctor Cleghorn attributes to fevers,
to preserve their types under every variety of treat-
ment, as  well as constitution. But I am bound to
declare  further,  that  I heard of several cases in
which bleeding was followed by a fatal termination
of the disease.

  In this  fever relapses were very  frequent,  from
exposure  to the  rain, sun, or night air, and from
an excess in eating or drinking.

  The convalescence from this disease was marked
by a  number of extraordinary symptoms, which 
400
ACCOUNT OF THE
rendered patients the subjects of medical attention
for many  days after the  pulse  became perfectly
regular, and after the crisis of the disease.

   A bitter taste in  the mouth, accompanied by a
yellow colour on the tongue, continued for near a
week.

   Most  of those  who recovered  complained of
nausea, and a total want of appetite. A faintness,
especially upon sitting  up in bed, or  in  a chair,
followed this fever.  A weakness in the knees was
universal.  I met with two patients,  who were most
sensible of this weakness in the right knee. An
inflammation in one eye,  and in  some instances in
both  eyes, occurred in several patients after their
recovery.

   But the  most remarkable  symptom of the con-
valescence from this fever, was  an  uncommon de-
jection of the spirits. I attended two young ladies,
who shed tears while they vented their complaints
of their sickness and weakness. One of them very
aptly proposed  to me to change  the  name of the
disease, and to  call it, in its  present stage,  instead
of the break-bone, the break-heart fever. 
          BILIOUS REMITTING FEVER.       401
  To remove these symptoms, I gave the tincture
of bark and elixir of vitriol in frequent doses. I like-
wise recommended the plentiful use of ripe fruits;
but I saw the best effects from temperate meals of
oysters, and a liberal use of porter.  To these  was
added, gentle exercise in the open air, which  gra-
dually completed the cure. 
 
        AN ACCOUNT





            OF THE






SCARLATINA ANGINOSA,





             AS IT





    APPEARED IN PHILADELPHIA,




      In the Years 1783 and 1784. 
 
AN ACCOUNT
                OF THE

SCARLATINA ANGINOSA.
      THE beginning of the month of July was
unusually cool; insomuch that the mercury in Fah-
renheit's thermometer stood at 61 in the day time,
and fires were very comfortable, especially in the
evening. In  the last week but one of this month,
the weather  suddenly became so warm, that the
mercury rose to 94i,  at  which it  remained for
three days. As this heat was accompanied by no
breeze from any quarter, the sense of it was ex-
tremely  distressing to many people.  Upwards of
twenty persons died in the course of those three
days, from the excess of the heat, and from drink-
ing cold water.  Three old people died suddenly
within this space of time.  This extreme heat was
succeeded by cool  weather, the mercury having
  Vol. II.                        3 F 
406
ACCOUNT OF THE
 fallen to 60°, and the month closed with producing
 a  few intermitting and remitting  fevers,  together
 with several cases of inflammatory angina.

   The  weather  in the month of August  was ex-
 tremely variable. The mercury, after standing for
 several days at 92\ suddenly fell so low, as not on-
 ly to render fires necessary, but in  many places to
 produce frost.

   Every form of fever made its appearance in this
 month.  The  synocha was so  acute,  in  several
 cases, as to require  from three  to four bleedings.
 The remitting fever was accompanied by an un-
 common degree of nausea and  faintness.  Several
 people died, after a few days' illness,  of  the malig-
 nant bilious fever, or typhus gravior, of Dr. Cullen.
 The intermittent s  had nothing peculiar in them, in
 their symptoms or method of cure.

   Towards the  close of the month,  the scarlatina
anginosa made its  appearance, chiefly among chil-
 dren.

   The month of September was cool and dry, and
the scarlatina anginosa became epidemic among
adults as well as young people. In most of the
patients  who were affected by it, it came  on with 
            SCARLATINA ANGINOSA.        407
a chilliness  and a sickness at the stomach, or a vo-
miting; which  last  was so invariably present, that
it  was with me a pathognomonic  sign of the dis-
ease.  The matter discharged from  the stomach was
always  bile. The  swelling of the throat was  in
some instances so  great, as to produce a difficulty
of speaking, swallowing, and breathing. In a few
instances, the speech was accompanied by a squeak-
ing voice, resembling that which  attends the cy-
nanche  trachealis.  The ulcers on  the tonsils were
deep, and covered with white, and, in some instan-
ces,  with black sloughs. In  several cases,  there
was a discharge of  a  thick mucus from the  nose,
from  the beginning, but it oftener  occurred in the
decline  of the disease, which most frequently hap-
pened on the fifth day. Sometimes  the subsiding  of
the swelling of the  throat was followed by a swel-
ling behind  the ears.

   An eruption on  the skin generally attended the
symptoms which have been described. But  this
symptom appeared with considerable variety.  In
some people it preceded, and in others it followed
the ulcers and swelling of the throat. In some,  it
appeared only on the outside  of the throat, and on
the breast;  in  others, it appeared chiefly on the
limbs. In a  few it appeared on the  second or  third
day of the disease, and never returned afterwards. 
408            ACCOUNT OF THE
I saw two cases of eruption without a single symp-
tom of sore throat. The face of one of those pa-
tients  was swelled, as  in  the erisypelas.  In the
other, a young girl of seven years old,  there was
only a slight redness on the skin. She was seized
with  a vomiting,  and died delirious  in fifty-four
hours. Soon after her death, a livid colour appeared
on the outside of her  throat.

   The bowels, in this degree of the disease, were
in general  regular.  I can recollect but few cases
which were attended  by a diarrhcea.

   The fever which  accompanied the disease was
 generally  the typhus  mitior  of Dr.  Cullen.  In
 a few cases it assumed symptoms of great malig-
 nity.

   The disease frequently went off with a swelling
 of the hands and feet. I saw one instance in a gen-
 tlewoman, in whom this swelling was absent, who
 complained of very  acute  pains  in her limbs,  re-
 sembling those of the rheumatism.

    In two cases which terminated fatally, there were
  large  abscesses;  the one on the outside, and  the
  other on  the inside of  the throat.  The first of
  these cases was accompanied by troublesome sores 
            SCARLATINA ANGINOSA.        409
on the ends of the lingers. One of these  patients
lived twenty-eight, and the other above thirty days,
and both appeared to die from the discharge which
followed the opening of their abscesses.

  Between the degrees of the disease which I have
described, there were many  intermediate degrees
of indisposition which belonged to this disease.

   I  saw in  several cases a discharge  from behind
the ears, and from the nose, with a slight eruption,
and no sore  throat. All  these patients were able to
sit up, and  walk about.

   I saw one instance of a discharge from the inside
 of one of the ears in a child,  who had ulcers in his
throat, and  the squeaking voice.

   In some, a pain in the  jaw, with swellings  be-
 hind the ears, and a  slight fever, constituted  the
 whole of the disease.

   In  one case  the disease came on with  a coma,
 and in several patients it  went off with this symp-
 tom.

    A few instances occurred of adults, who walked
 about and  even  transacted  business, until a  few
 hours before they died. 
410
ACCOUNT OF THE
   The intermitting fever, which made its appear-
ance in August, was not lost during the month of
September. It continued to prevail, but with seve-
ral peculiar symptoms.  In many persons it  was
accompanied by an  eruption on  the  skin,  and a
swelling of the hands and feet.  In  some, it  was
attended by a sore  throat and pains behind the ears.
Indeed, such was  the predominance  of the scarla-
tina anginosa, that many hundred people complained
of sore throats, without any other  symptom of in-
disposition. The   slightest occasional  or  exciting
cause, particularly  cold, seldom failed of producing
the disease.

   The  month of  October was much  cooler than
September, and the disease continued, but with less
alarming symptoms.  In several adults, who were
seized with it, the hardness of the pulse indicated
blood-letting. The blood, in one case, was covered
with a buffy coat, but beneath its surface it  was
dissolved.

  In the month of November, the disease assumed
several  inflammatory symptoms, and  was attended
with  much less danger than formerly.  I  visited
one patient whose symptoms were so inflammatory
as to require  two bleedings. During  the decline
of the disease, many people complained of trouble- 
SCARLATINA ANGINOSA.
411
 some sores on the ends of their fingers. A number
 of children  likewise  had sore  throats and  fevers,
 with eruptions on their  skin, which resembled the
 chicken-pox.  I  am  disposed to suspect  that this
 eruption was the effect of a spice of the scarlatina
 anginosa, as several instances occurred of patients
' who had all  the symptoms of this disease,  in whom
 an eruption of white  blisters succeeded  their re-
 covery. This form of the disease has been called by
 Sauvage, the scarlatina variolosa.

   I  saw one case of sore  throat, which was suc-
 ceeded  not  only  by swelling, in the abdomen and
 limbs, but by a catarrh, which brought on  a fatal
 consumption.

   A considerable  shock of an earthquake was felt
 on the 29th of this month, at ten o'clock  at  night,
 in the city of Philadelphia; but no change  was per-
 ceived in the disease,-in consequence of it.

   In December,  January, and  February,  the wea-
 ther was intensely cold. There was a thaw for  a
 few  days in January,  which broke  the ice  of the
 Delaware, but it was followed by cold so excessive,
 as to close  the river  till the beginning of March.
 The mercury, on the 28th  and 29th of February,
 stood below 0 in Fahrenheit's thermometer.
♦ 
412
ACCOUNT OF THE
  For a few weeks in the beginning of December,
the disease disappeared in the circle of my patients,
but it broke out with great violence  the  latter end
of that month, and in the January following. Some
of the worst cases that I met with  (three of which
proved fatal) were in those two months.

  The  disease disappeared in the spring,  but it
spread afterwards through the neighbouring states
of New-Jersey, Delaware, and Maryland.

  I shall now add an account of the remedies which
I administered in this disease.

  In every case that I was called to, I  began the
cure by giving a vomit joined with calomel.  The
vomit was either tartar emetic or  ipecacuanha, ac-
cording to the  prejudices,  habits,  or constitutions
of my patients. A quantity of bile  was generally
discharged by  this medicine. Besides evacuating
the contents of the stomach, it cleansed  the throat
in its passage  downwards.  To insure this effect
from the calomel, I  always  directed it to be given
mixed  with syrup  or sugar and  water,  so as to
diffuse it  generally over every part  of  the throat.
The calomel  seldom failed to  produce  two  or
three  stools.  In  several  cases I was obliged, by
the continuance of nausea,  to repeat the emetics, 
            SCARLATINA  ANGINOSA.        413
and always with immediate and obvious advantage.
I gave the calomel in  moderate doses  in  every
stage of the disease.  To restrain its  purgative ef-
fects, when necessary, I added to it a small  quan-
tity of opium.

  During the whole course  of the disease, where
the calomel failed of opening the bowels, I  gave
lenient  purges, when a disposition to  costiveness
required them.

  The throat  was kept clean by detergent gargles.
In several  instances I saw evident advantages from
adding a few  grains of calomel to them.  In cases
of great difficulty of swallowing or breathing, the
patients found relief from receiving the steams of
warm water mixed with a little  vinegar, through a
funnel into the throat.

   A perspiration kept  up  by gentle doses of anti-
monials,  and  diluting  drinks,  impregnated with
 wine, always gave relief.

   In every case which did  not yield to the above
 remedies on the third  day,  I applied a blister be-
 hind each ear, or one  to the neck, and, I  think,
 always with good effects.
   Vol. II.                          n c; 
  414         ACCOUNT OF  THE, &C
    I met with no cases in  which the bark appeared
  to  be indicated,  except  the three in  which the
  disease proved fatal. Where the sore throat  was
  blended with the  intermitting fever, the bark  was
  given with advantage. But  in  common  cases  it
  was  unnecessary.  Subsequent  observations  have
  led me  to believe, with  Doctor Withering,  that
  it is sometimes hurtful in this disease.

    It  proved fatal  in many  parts of the country,
'  upon  its first appearance; but wherever the mode
  of treatment here delivered  was adopted, its morta-
  lity was soon checked.  The  calomel  was  used
  very  generally in New-Jersey and New-York. In
  the Delaware state, a physician of character made
  it a practice not only to give calomel, but to anoint
  the outside of the throat with mercurial ointment. 
ADDITIONAL OBSERVATIONS

              UPON THE

     Scarlatina Anginosa.
       1 HIS disease has prevailed in Philadelphia,
at different seasons, ever since the year 1783. It
has blended itself occasionally with all our epidem-
ics. Many cases have come under my notice since
its  first appearance, in which dropsical swellings
have succeeded the fever. In some instances there
appeared to be effusions of water not only in the
limbs and abdomen, but in the thorax. They yield.
ed, in every case that I attended, to purges of calo-
mel and jalap. Where these swellings were neglect-
ed, they sometimes proved fatal.

  In the winter of 1786-7, the scarlatina anginosa
was blended with the cynanche parotidea,  and in
one instance with a typhus mitior. The last was in 
416      ADDITIONAL OBSERVATIONS
a young girl of nine years of age.  She was seiz-
ed with a vomiting of bile and an efflorescence on
her breast, but discovered no other symptoms of
the scarlatina anginosa till the sixteenth day of her
fever, when a swelling appeared on  the  outside of
her throat, and after her recovery, a pain and swel-
ling in one of her knees.

   In the month of July, 1787, a number of people
were affected by sudden swellings of their lips and
eyelids.  These swellings generally came on in the
night,  were  attended  with  little or no pain, and
went off in two or three days. I met with only one
case in  which  there  was a different issue to  these
symptoms.  It was in a patient in the Pennsylvania
hospital, in whom a swelling in the lips ended in a
suppuration, which, notwithstanding the liberal use
of bark and wine,  proved  fatal in  the  course of
twelve days.

   In the months of June and July, 1788, a num-
ber of people  were affected by sudden swellings,
not only of the lips, but of the cheeks and throat.
 At the  same time  many persons were affected by
 an inflammation of the eyes. The swellings  were
 attended with  more  pain than they were the year
 before,  and some  of them required  one or  two 
       UPON THE SCARLATINA ANGINOSA.   417
purges to remove  them; but in general they went
oft without medicine, in two or three days.

  Is  it proper  to  refer these complaints to  the
same cause  which produces  the scarlatina  an-
ginosa?

  The  prevalence of  the  scarlatina  anginosa at
the same  time in this city; its disposition to pro-
duce swellings in different  parts of the body; and
the analogy of the intermitting fever, which often
 conceals  itself  under  symptoms that  are  foreign
 to its usual type;  all seem  to render  this con-
jecture probable.  In one  of the cases  of  an  in-
 flammation of  the eye,  which came under my
 notice, the  patient  was affected  by vomiting a
 few  hours  before  the  inflammation appeared, and
 complained of a  sickness  at his stomach for two
 or three days  afterwards.  Now a  vomiting and
 nausea appear  to  be very generally symptoms  of
 the scarlatina anginosa.

    In the autumn  of 1788, the  scarlatina anginosa
 appeared with different  degrees  of  violence  in
 many  parts of the  city.   In two instances  it ap-
 peared with an obstinate  diarrhoea; but it  was in
 young subjects, and not in adults, as described by
  Doctor  Withering.   In  both  cases, the  disease 
418      ADDITIONAL OBSERVATIONS
proved  fatal; the one on the third,  the other  on
the fifth day.

  In the month of  December of the  same year,
I saw  one  case  in  which a running from one  of
the ears, and a deafness came  on,  on the  fifth
day, immediately after the discharge of mucus from
the nose had ceased. This case terminated  fa-
vourably on the ninth day,  but was  succeeded,
for several  days afterwards,  by a  troublesome
cough.

  I shall conclude  this  essay  by  the following
remarks:

   1. Camphor has  often  been  suspended  in  a
bag from the neck,  as a  preservative against this
disease.  Repeated  observations  have taught me,
that it possesses little or no efficacy for this pur-
pose.  I have had reason to entertain  a more fa-
vourable opinion  of the benefit of washing the
hands  and  face with vinegar,  and  of  rinsing the
mouth  and  throat with vinegar and water  every
morning, as means of preventing this disease.

   2.  Whenever I have been  called to a  patient
 where the  scarlatina appeared  to be in a forming
 state,  a vomit  of ipecacuanha  or  tartar emetic, 
      UPON THE SCARLATINA  ANGINOSA.   419
mixed with a  few grains of calomel, has  never
failed of completely checking the disease, or of so
far  mitigating  its violence,  as  to  dispose it to a
favourable issue  in a few days;  and if these obser-
vations  should  serve  no  other purpose  than  to
awaken the early attention of patients and physi-
cians to this speedy and effectual remedy, they will
not have been recorded in vain.

  3.  When the  matter which  produces  this dis-
ease has been received into  the body, a purge has
prevented its being excited into action, or rendered
it  mild,  throughout  a whole  family.  For this
practice I am indebted to  some observations on the
scarlatina,  published by Dr.  Sims in the  first vo-
lume of the Medical Memoirs.

  4.  During  the prevalence of the  inflammatory
constitution of the  atmosphere, between the years
1793 and  1800, this disease occurred occasionally
in  Philadelphia,  and yielded, like the other epide-
mics of those years,  to copious blood-letting, and
other depleting remedies. 
 
           AN ACCOUNT




                OF





        THE MEASLES,





               AS THET




     APPEARED IN PHILADELPHIA,




          In the Spring of 1789.











Vol. II.                    3 H 
 
AN ACCOUNT, &c.
       THE  weather in December, 1788, and in
January,  1789, was variable, but seldom very cold.
On the first of February,  1789, at six o'clock in
the morning, the mercury in Fahrenheit's thermo-
meter fell 5' below 0, in the city of Philadelphia.
At twenty miles  from the  city, on the Schuylkill,
it fell 12  below 0, at  the same hour. On the 19th
and  20th of this  month,  there fell a  quantity of
snow, the depth of which, upon  an  average, was
supposed to be about eight or ten inches.  On the
23d, 24th, 25th,  and 27th the weather was  very
cold. The mercury fluctuated  during  these  days
between 4° and 10° above 0.

   In the intervals between these cold days, the
weather  frequently moderated, so that the Dela-
ware was  frozen  and thawed not less than four 
424
An  account of the
times.  It was not navigable till the  8th of March.
There  were in all, during the  winter and month of
March, sixteen distinct falls of snow.

  In April and May there were a few warm days;
but upon the whole, it was a very cold and  back-
ward spring.  The  peaches  failed almost  univer-
sally.  There were no strawberries or cherries on
the 24th of May,  and every other vegetable pro-
duct was equally backward.  A country woman  of
84 years of  age informed me, that it  was the cold-
est spring she had ever known.  It was uncomforta-
ble to sit without fire till the first of June.

  The measles appeared first in the Northern Li-
berties, in December. They spread slowly in Janu-
ary, and  were not  universal in  the city till Febru-
ary and March.

  This disease, like many others, had its precursor.
It was either a gum-boil, or a sore  on the tongue.
They were both very common, but not universal.
They occurred, in some  instances, several  days
before  the  fever, but  in general they made their
appearance during the eruptive fever, and were a
sure mark  of the  approaching  eruption  of the
measles. I  was first led to observe  this fact, from
having read Dr. Quin's accurate account of the 
MEASLES IN 1789.
425
measles in Jamaica.  I  shall  now proceed to men-
tion the symptoms of the measles as  they appeare
in the different parts of the body.

   1. In the head, they produced great pain, swel-
ling of the eye-lids, so as to obstruct the eye-sight,
tooth-ach, bleeding  at  the  nose, tinnitus aurium,
and deafness;  also coma for two days, and  convul-
sions.  I saw the last symptom only in one instance.
It was brought on by a stoppage'of a running from
the ear.

   2.  In the  throat and  lungs,  they  produced a
soreness and hoarseness, acute or dull pains in the
breast and sides, and a painful or distressing cough.
In one case  this cough  continued  for two hours
without any intermission, attended by a copious ex-
 pectoration. In two cases,  I saw a constant invo-
 luntary discharge of phlegm and mucus from the
 mouth,  without  any cough.  One of  them  ter-
 minated  fatally.  Spitting  of blood  occurred  in
 several instances.   The  symptoms of pneumonia
 vera notha and typhoides  were very common. I
 saw two  fatal cases from pneumonia notha, in both
 of which the patients died with the  trunk of the
 body in an erect posture. I met with two cases in
 which there  was no cough till the eruption made
 its appearance on  the fourth  day,  and  one which 
426
AN  ACCOUNT  OF THE
 was accompanied by all the usual symptoms of the
 cynanche trachealis.

*•  3. In the stomach the measles  produced, in ma-
 ny instances, sickness and vomiting. And

   4.  In  the  bowels,  griping,  diarrhoea,  and in
 some instances,  bloody stools.  The diarrhoea  oc-
 curred  in every stage  of the disease, but it was
 bloody and most painful in its decline. I  attended
 a black girl who discharged a great many worms,
 but without the least relief oi" any of her symptoms.

   There was a  great variety in this disease.  1. In
 the time of the attack of the fever, from  the time
 of  the reception of the contagion.  In  general  the
 interval was fourteen days, but it frequently appear-
 ed  before, and sometimes later than that period.

   2. In the time of the eruption,  from the begin-
 ning of the fever.  It  generally appeared  on  the
 third and fourth days.  In  one  case,  Dr.  Waters
 informed  me, it did not appear till the eighth day.

   3. In the abatement or continuance of the fever
 after the eruption. 
MEASLES IN 1789.
427
  4. In the colour and figure of the eruption. In
some it put on a pale red, in others a deep, and in
a few a livid colour, resembling an incipient morti-
fication.  In some there appeared red blotches, in
others an equally diffused redness,  and  in a few,
eruptions like the small-pox, called by Dr. Cullen,
rubiola varioloides.

  5.  In the duration of the eruption on the skin.  It
remained in most cases only three or four days; but
in one, which came under my care, it remained nine
days.

  6.  In the manner of its retrocession. I saw  very
few cases of  its leaving the branny appearance  so
generally spoken of by authors on the skin.

   7.  In not affecting  many persons, and even fami-
lies who were exposed to it.

   The symptoms which continued in many  after
the retrocession of the measles, were cough, hoarse-
ness, or complete aphonia, which continued in two
cases for two weeks; also diarrhoea, ophthalmy, a
bad taste in the mouth, a defect or excess of appe-
tite,  and a fever, which in some instances was of
the intermitting kind, but which in more assumed
 the more dangerous  form of the  typhus mitior. 
428
AN ACCOUNT OF THE
Two cases of internal dropsy of the brain followed
them. One was evidently excited by a fall. They
both ended fatally.

  During the prevalence of the disease I observed
several persons  (who had had the measles, and who
were closely  confined to the rooms of persons ill
with them) to be affected with a slight cough, sore
throat, and even sores in the mouth. I find  a simi-
lar fact taken notice of by Dr. Quier.

  But I observed further,  many children to be af-
fected by a fever, cough, and all the other  symp-
toms of the measles which have been mentioned,
except a general eruption, for in some there was a
trifling efflorescence about the neck and breast. I
observed  the same thing in 1773  and 1783.  In
my note  book I find the following account of the
appearance of this disease in children in the year
1773. " The measles appeared in.March; a  catarrh
" (for by that name I then called it) appeared at the
" same time,  and was often mistaken for them, the
" symptoms being nearly the same in both. In the
" catarrh  there was in some instances a  trifling
" eruption. A lax  often attended it, and some who
" had it had an extremely sore mouth." 
              MEASLES IN 1789.           429
  I was  the more struck with this disease, from
finding it was  taken  notice of by Dr. Sydenham.
He calls it a morbillous fever.  I  likewise find an
account of it in the 2d article of the 5th volume of
the Edinburgh  Medical  Essays.  The  words of
the author, who is  anonymous,  are  as follow.
"During this  measly  season,  several  persons,
"who never  had the measles, had all the symp-
" toms of measles, which went off in a few days
"without any eruptions.  The same persons had
"the   measles  months  or years  afterwards."  Is
this disease a common fever, marked by the reign-
ing epidemic,  and produced in the same  manner,
and by the same causes, as the variolous  fever de-
scribed by Dr. Sydenham, which he says prevailed
at the same time with the small-pox? I think it is
not. My reasons for this opinion are as follow.

   1. I never saw it  affect any but children, in the
degree that has  been mentioned, and such only as
 had never had the measles.

   2  It  affected whole  families at the  same  time.
 It proved  fatal  to one  of three children  whom  it
 affected on the same day.

   3   It terminated in  a pulmonary  consumption
 in a  boy of ten years old, with  all the symptoms
                                   3 I
   Vol. II. 
430           AN ACCOUNT OF THE
which attend that disease when it follows  the regu-
lar measles.

  4. It affected a child in one family, on the same
day that two other members of the  same family-
were affected by the genuine measles.

  5. It appeared on the  usual days of the genuine
measles, from  the  time the persons affected by it
were exposed to its contagion. And,

  6. It  communicated the disease  in  one family,
in the  usual time in which  the disease  is taken
from the genuine measles.

  The measles, then, appear  to follow the analogy
of the small-pox, which affects so superficially as to
be taken a second time, and which produce on per-
sons who have had  them what are called  the nurse
pock. They follow  likewise the analogy of another
disease,  viz.  the scarlatina  anginosa. In  the  ac-
count of the epidemic for 1773, published in  the
third volume  of the Edinburgh Medical  Essays,
we are told, that such patients as had previously had
the scarlet fever without sore throats, took the sore
throat,  and  had no eruption, while those who had
previously had the sore throat had  a  scarlet  erup- 
               MEASLES. IN 1789.           431
tion, but the throat remained free from the distem-
per.  All other persons who were affected had both.

  From these facts, I have  taken the liberty of
calling it the internal measles, to distinguish it from
those which are  external. I think the discovery of
this new state of this disease of some application to
practice.

  1. It will lead us to be cautious in declaring any
disease  to  be the external  measles, in which there
is not a general  eruption. From my ignorance of
this, I have been led to commit several mistakes,
which were dishonourable to the profession. I  vvas
called, during the prevalence of the measles in. the
above-named season, to visit a girl  of twelve years
old,  with an eruption  on the skin.  I called it the
measles. The  motheir told me  it was  impossible,
for  that I had  in  1783 attended her for the same
disease.  I  suspect the anonymous  author  before-
mentioned has fallen into the same  error. He adds
to the account before quoted  the following words.
" Others who had undergone  the measles formerly,
" had at this time a fever of the erysipelatous kind,
" with  eruptions like  to  which nettles cause,  and
" all the previous and  concomitant symptoms of
" the measles,  from the beginning to the end of the
" disease." 
432
AN  ACCOUNT OF THE
  2. If inoculation, or any other mode of lessening
the violence of the disease, should be adopted, it
will be of consequence  to  know what  persons are
secure from the attacks  of it, and who  are still ex-
posed to it.

  I shall now add a short account of my method of
treating this disease.

  Many hundred families came through the disease
without the help of a physician. But in many cases
it was attended with peculiar danger, and  in some
with death. I think it was much more fatal than in
the years 1773 and 1783,  probably owing to the
variable weather in the winter, and the  coldness
and dampness of the succeeding spring. Dr.  Hux-
ham says, he once saw  the measles attended with
peculiar  mortality,  during a late  cold and  damp
spring in England. It was much more fatal (caete-
ris paribus) to adults than to young people.

  The remedies I used  were,

   1. Bleeding,  in  all  cases where great pain and
cough,  with  a hard  pulse attended.  In some I
found it necessary to repeat this  remedy. But I
met with many cases in which it was forbidden by- 
               MEASLES IN 1789.            433
the weakness of the pulse, and by other marks of a
feeble action in the blood-vessels.

  2. Vomits. These were  very useful  in remov-
ing a nausea;  they likewise favoured the eruption
of the measles.

   3. Demulcent and diluting  drinks. These were
barley water,  bran, and  flaxseed tea, dried cherry
and raw apple water, also  beverage, and cider and
water.  The  last drink  I  found to  be the most
agreeable to my  patients  of any that  have been
mentioned.

   4. Blisters to the neck, sides, and extremities,
according to the symptoms.  They were  useful in
every stage of the disease.

   5. Opiates. These were given not only at night,
but in small doses during the day, when a trouble-
some cough or diarrhoea attended.

   6. Where a catarrhal fever ensued, I used bleed-
ing and blisters.  In those cases  in  which this  fe-
ver terminated in an intermittent, or in a mild  ty-
phus fever, I gave the bark with evident advantage.
In that case of measles, formerly mentioned, which
was accompanied by symptoms of cynanche trache- 
434           AN ACCOUNT OF  THE
alis, I gave calomel with the happiest effects. In the
admission of fresh  air I observed a medium as to
its temperature, and accommodated  it to the de-
grees of action in the  system. In different parts of
the country, in Pennsylvania and New-Jersey,  I
heard with great pleasure of the  cold air being used
as freely and as successfully in this disease,  as in
the inflammatory small-pox. The same people who
were so much benefited by cool air, I  was inform-
ed, drank  plentifully of cold water during every
stage of the fever. One thingilm favour of this coun-
try practice deserves to be mentioned, and  that is,
evident advantages  arose  in  all  the cases which I
attended, from patients leaving their beds in the fe-
brile state of this disease.  But  this was practised
only  by those  in  whom inflammatory diathesis
prevailed, for  these alone had strength  enough to
bear it.

   The  convalescent state of this disease required
particular attention.

   1. A diarrhoea often continued to be troublesome
after other symptoms had abated. I relieved  it  by
opiates and demulcent drinks. Bleeding has been
recommended for it, but I did  not find it  neces-
sary in a single case. 
               MEASLES IN 1789.            435
  2.  An  ophthalmia  which  sometimes  attended,
yielded to astringent collyria and blisters.

  3.. Where a cough or fever followed so slight as
not to require bleeding, I advised a milk and vege-
table  diet, country air, and  moderate warmth; for
whatever might have been the relation of the lungs
in the  beginning of the disease  to  cold  air,  they
were  now evidently too much debilitated to bear it.

  4. It is a common  practice to  prescribe purges
after  the measles. After the asthenic state of this
disease they certainly do harm.  In  all cases, the
effects of them may be better obviated by diet, full
or low, suitable clothing, and  gentle exercise, or
country air. I  omitted them in  several cases, and
no  eruption or  disease of any kind  followed  their
disuse.

  I shall  only add to this account of the measles,
that in several  families, I saw  evident advantages
from  preparing the  body for the reception of the
contagion, by means of a vegetable diet. 
 
AN ACCOUNT
                  OF


       THE INFLUENZA,

             AS IT APPEARED

           IN PHILADELPHIA,

In the Autumn of 1789, in the Spring of 1790, and in the
              Winter of 1791.
Vol. II.                    3 K 
 
AN ACCOUNT, &c.
       THE latter end of the month of August,
in the summer of 1789, was so very cool that fires
became agreeable. The month of September was
cool, dry, and pleasant. During the whole of this
month, and for some days before it began, and af-
ter it ended, there had been no rain. In  the begin-
ning of October, a number of the members of the
first  congress, that had assembled in  New-York,
under the present national government,  arrived in
Philadelphia, much indisposed with  colds. They
ascribed them to the fatigue and night air to which
they had  been exposed in travelling in  the public
stages; but from the number of persons who were
affected, from the uniformity of their complaints,
and from the rapidity with which it spread through
eur city, it  soon became  evident that it was the 
440
OF THE INFLUENZA
disease so well known of late years by the name of
the influenza.

  The  symptoms which ushered  in  the disease
were generally a hoarseness, a sore  throat, a sense
of weariness, chills, and a fever. After the disease
was formed, it affected more  or less the following
parts  of the body.  Many  complained  of acute
pains  in the head. These pains were frequently
fixed  between the eye-balls, and,  in  three cases
which came under my notice, they were terminated
by abscesses in the frontal sinus, which discharged
themselves through the nose. The  pain in one of
these cases, before the rupture of the abscess,  was
so exquisite that my patient  informed  me that he
felt as if he should lose his reason.  Many com-
plained of a great itching in the eye-lids. In some,
the eye-lids were swelled. In others, a copious ef-
fusion of water took place from the eyes; and in a
few, there was  a true  ophthalmia.  Many com-
plained of great pains in one ear, and some of pains
in both ears. In  some, these pains terminated in
abscesses, which discharged for some days a bloody
or  purulent matter.  In others, there was a swel-
ling behind each ear,  without a  suppuration.—
Sneezing  was a universal  symptom.  In  some, it
occurred not less than fifty times in a day.   The
matter discharged from the nose was so acrid as to 
           in 1789, 1790, and 1791.        441
inflame  the nostrils and the upper lip,  in such  a
manner as to  bring  on swellings, sores, and scabs
m many people. In  some,  the nose  discharged
drops, and  in a few,  streams of blood,  to the
amount in  one  case,  of twenty ounces. In many
cases it was so much  obstructed, as  to render
breathing through it  difficult. In some,  there was
a total defect of taste. In others, there  was a bad
taste  in  the  mouth,  which  frequently  continued
through the whole course  of the disease. In some,
there was  a  want  of appetite. In  others, it was
perfectly natural. Some complained of a soreness
in their mouths, as if they had been inflamed by
holding  pepper in  them. Some had swelled jaws,
and many complained of the tooth-ach.  I saw  only
one case in which the disease produced a coma.

   Many were affected with pains in the breast and
sides.  A difficulty  of breathing attended in some,
and a cough  was universal.  Sometimes this cough
alternated with  a pain  in the  head. Sometimes it
preceded this pain, and  sometimes it followed it.
It was  at all times  distressing.  In some instances,
it resembled the chin-cough. One  person  expired
in a fit of coughing,  and many persons spat blood
in  consequence of  its violence. I saw  several pa-
tients in whom the  disease  affected  the  trachea
 chiefly,  producing great difficulty  of  breathing, 
442
OF THE INFLUENZA
 and,  in one case,  a suppression of the voice, and
 I heard of another in which the disease, by falling
 on the trachea, produced a  cynanche trachealis.
 In  most of the cases which terminated fatally, the
 patients died of pneumonia notha.

   The stomach  was  sometimes  affected  by nau-
 sea and vomiting;  but  this was far from being a
 universal symptom.

   I met with four  cases in which  the whole force
 of the disease fell upon the bowels,  and went off in
 a diarrhoea; but in general the  bowels were regu-
 lar or costive.

  The limbs were affected with such acute pains
 as to  be  mistaken for the rheumatism,  or for the
 break-bone fever of 1780. The pains were  most
 acute  in the back and thighs.

  Profuse sweats appeared in many over the whole
body in the  beginning,  but without  affording any
relief. It  was  in some  instances  accompanied by
erysipelatous, and in four* cases which came to my
knowledge, it was followed by miliary eruptions.

  The pulse was sometimes tense  and quick,  but
seldom full.  In a great majority of those  whom I
visited it was quick, weak, and  soft. 
            in 1789, 1790, and 1791.        443
   There was no appearance in the urine  different
 from what is common in all fevers.

   The disease had evident remissions, and the  fe-
 ver  seldom continued  above three or four days;
 but the cough, and some  other  troublesome symp-
 toms, sometimes continued two or three weeks.

   In a few persons, the fever terminated in a tedi-
 ous and dangerous typhus.

   In several pregnant women  it produced uterine
 hemorrhages and abortions.

   It  affected adults of both sexes  alike. A few
 old people escaped it.  It passed by children un-
 der eight years old with a few exceptions. Out
 of five and thirty maniacs in the Pennsylvania hos-
 pital,  but  three  were  affected by  it.  No profes-
 sion or occupation escaped it. The smell of  tar
 and  tobacco did  not preserve the  persons  who
 worked in them from the  disease, nor did the use
 of tobacco,  in  snuff, smoking,  or chewing, afford
a security against it.*

  * Mr. Howard  informs us that the use of tobacco is  not
a preservative against the plague, as has formerly been sup-
posed;  of  course that apology for the use  of an offensive
weed should not be admitted. 
 444          OF THE INFLUENZA
   Even previous and existing diseases did not pro-
 tect patients  from it. It insinuated into sick cham-
 bers, and blended itself with every species of chro-
 nic complaint.

   It was  remarkable that persons who worked in
 the open air,  such as sailors, and 'long-shore-men,
 (to use a mercantile epithet) had it  much worse
 than  tradesmen  who   worked  within doors.  A
 body of surveyors, in the eastern woods of Penn-
 sylvania,  suffered  extremely  from it. Even  the
 vigour of constitution which is imparted by the sa-
 vage  life  did not mitigate  its  violence. Mr.  An-
drew Ellicott, the geographer of the United States,
informed me  that he was a witness of  its  affecting
the Indians in the neighbourhood of Niagara with
peculiar  force.  The  cough which attended  this
disease  was so new and so irritating  a complaint
among them, that they ascribed it to witchcraft.

  It proved  most  fatal on the  sea-shore of  the
United  States.

  Many people who had recovered, were affected
a second time with all the symptoms of the disease.
I met with a  woman, who after recovering from it
in Philadelphia, took it a second time in New-York,
and a third time upon her return to Philadelphia. 
           in 1789, 1790, and 1791.        445
  Many thousand people had the disease, who were
not confined to their houses,  but transacted busi-
ness as usual out of doors. A perpetual coughing
was heard in every  street of the city. Buying and
selling were  rendered tedious by the coughing of
the farmer  and the citizen  who  met in market
places. It even rendered divine service scarcely in-
telligible in the churches.

  A few  persons who were exposed to the disease
escaped it, and some had it so lightly as scarcely to
be sensible of it. Of the  persons who were confined
to their houses, not a fourth part of them kept their
beds.

  It proved fatal (with few exceptions) only to old
people, and  to persons  who  had been previously
debilitated by consumptive complaints.  It  likewise
carried off several hard drinkers. It terminated in
asthma in three persons whose cases came under
my notice, and in pulmonary consumption, in many
more.  I  met with an instance in a lady,  who was
much relieved of a chronic complaint in her liver;
and I  heard of another instance of a clergyman
whose general health was much improved by a se-
vere attack of this disease.

  It was not wholly confined to the  human species.
  Vol. II.                         3 L 
446
ON THE INFLUENZA
It affected two cats, two house-dogs, and one horse.
within the sphere of my observations.  One of the
dogs  disturbed his mistress so much by coughing
at night, that she gave him ten  drops of  laudanum
for  several nights,  which perfectly  composed him.
One of the  cats had a  vomiting with her cough.
The horse breathed as if he  had been affected by
the cynanche trachealis.

  The scarlatina anginosa, which prevailed during
the summer, disappeared after the first  of October;
but appeared again after the influenza left the  city.
Nor was the remitting fever seen during the preva-
lence of the  reigning epidemic.

  I inoculated about twenty children for the small-
pox during this prevalence of the influenza, and ne-
ver saw that disease exhibit a more favourable ap-
pearance.

  In the treatment of the influenza  I was governed
by the  state of the system.  Where inflammatory
diathesis discovered itself by a full or  tense pulse,
or where great  difficulty of breathing  occurred,
and the pulse was  low  and weak in the  beginning
of the disease, I ordered moderate  bleeding.  In  a 
            in 1789, 1790, and 1791.       447
 few cases  in  which the symptoms of pneumony
 attended, I bled a second time  with advantage. In
 all these instances of inflammatory affection, I gave
 the  usual  antiphlogistic medicines. I  found that
 vomits did not terminate the disease, as they often
 do a common catarrh, in the course of a day, or of
 a few hours.

   In cases  where no inflammatory action appeared
 in the  system, I prescribed cordial drinks and diet,
 and  forbade every kind of evacuation.  I saw seve-
 ral instances of persons who had  languished for a
 week or two with the disease,  who were suddenly
 cured  by eating a hearty meal, or by drinking half
 a pint of  wine, or a pint  of warm punch. In all
 these cases of  weak  action in the blood-vessels,
 liquid  laudanum gave great relief, not only by sus-
 pending the cough, but by easing the  pains in  the
 bones.

   I met with  a case of an  old  lady who was sud-
 denly and perfectly cured of her cough by a fright.

  The duration of this epidemic in our city was
about six  weeks.  It  spread from New-York and
Philadelphia in all directions, and  in the course of
a few  months pervaded  every  state in the union.
 It was  carried  from the United  States to several of 
448
ON THE INFLUENZA
the West-India islands. It prevailed in the  island
of Grenada in the month of November, 1789, and
it was heard of in the course of the ensuing winter
in the Spanish settlements in South-America.

  The following  winter was unusually mild, inso-
much that the navigation of the Delaware was not
interrupted during  the  whole  season,  only  from
the 7th to the 24th of February.  The  weather on
the 3d and 4th days of March  was very cold, and
on the 8th and 9th davs of the same  month, the
mercury in Fahrenheit's  thermometer  stood at 4°
at 7 o'clock  in  the morning.  On the 10th and
11th, there  fell a deep  snow.  The weather du-
ring the remaining part of the month  was  cold,
rainy, and variable.  It continued to  be  variable
during the month of April.  About  the middle of
the month there fell an unusual quantity of rain.
The showers  which fell  on the night of the 17th
will long be connected in the memories of the citi-
zens of Philadelphia with the time of the death of
the celebrated Dr. Franklin. Several pleurisies ap-
peared during this month; also a few cases of mea-
sles. In  the last week of the month the influenza
made its appearance. It was brought to the city from
New-England, and affected, in its course, all the in-
termediate states. Its symptoms were nearly the same
as they were in the preceding autumn, but in many
people it put  on  some new appearances. Several 
           in 1789, 1790, and 1791.       449
persons who were affected by it had symptoms of
madness, one of whom destroyed himself by jump-
ing out of a window. Some had no cough, but very
acute pains in the back and head. It was remarked
that those who had the disease  chiefly in the breast
the last year, complained now chiefly of their heads,
while those  whose  heads were affected formerly,
now complained chiefly of their breasts. In many
it  put on the  type  of an intermitting fever.  Seve-
ral complained  of  constant  chills,  or constant
sweats; and  some  were much alarmed by an un-
common  blue and dark  colour in their hands. I
saw one case of ischuria, another of an acute pain
in the rectum, a third of anasarca, and a fourth of a
palsy in the  tongue and arms; all of which appear-
ed  to  be  anomalous symptoms of the influenza.
Sneezing, and pains in  the ears and frontal sinus,
were less common now  than they were in the fall;
but a pain in the eye-balls was a universal symptom.
Some had a  pain in the one eye  only, and a few
had  sore eyes, and  swellings in  the face.  Many
women who had it,  were affected  by an irregular
appearance of the catamenia.  In two persons whom
I saw, the cough was  incessant  for  three  days,
nor could it  be composed by any other remedy
than plentiful  bleeding. A patient of Dr. Samuel
Duffield  informed  me,  after  his recovery,  that
he  had had no other symptom of the disease than 
450           OF THE  INFLUENZA
an efflorescence on his skin, and a large swelling
in his groin, which terminated in a tedious abscess.

  The prisoners in the jail who had it in the au-
tumn, escaped it this spring.

  During the prevalence of this  disease, I saw no
sign of any other epidemic.

  It declined sensibly about the first week in June,
and after the  12th day of this month  I  was  not
called to a single patient in it.

  The remedies for it  were the same as were used
in the fall.

  I used bleeding in  several cases on the second,
third, and fourth days  of the disease, where it had
appeared to  be improper  in  its first stage. The
cases which required bleeding were far  from being
general. I saw two instances of syncope of an alarm-
ing nature, after the loss of ten  ounces of blood;
and  I heard of one instance of a  boy who died in
half an hour after this evacuation.

  I remarked that purges of all kinds worked more
violently than usual in  this disease. 
           in 1789, 1790, and 1791.       451
  The convalescence from it was very slow, and a
general languor appeared to pervade the citizens for
several weeks after it left the city.

  The month of December, 1790, was extremely
and uniformly cold. In the beginning of the month
of  January,  1791,  the  weather moderated, and
continued to be pleasant  till the 17th,  on  which
day  the  navigation of  the  Delaware, which had
been completely obstructed by the ice, was opened
so as to admit  of  the  arrival  of several vessels.
During the month of December many people com-
plained of colds;  but  they  were  ascribed wholly to
the weather.  In  January four or  five  persons in a
family were affected by colds  at the same time;
which created a suspicion of a return  of the influ-
enza. This  suspicion was soon confirmed by ac-
counts of its prevailing in the neighbouring coun-
ties of Chester and  Montgomery, in Pennsylvania,
and in the distant states of Virginia  and Rhode-
Island. It did not  affect  near  so generally as in
the two  former  times of  appearance. There was
no difference in  the  method of treating it. While
the common inflammatory diseases of  the winter
bore the  lancet  as usual,  it was remarked that pa-
tients who were attacked by the influenza, did not
bear bleeding in  a greater proportion, or in a larger 
452          OF THE INFLUENZA
quantity, than in the two former times of its appear-
ance in the city.

  I shall conclude this account of the influenza by
the following observations:

  1. It exists independently of the sensible quali-
ties of the air, and  in all kinds  of weather.   Dr.
Patrick Russel has proved the plague to be equally
independent of the influence of the sensible quali-
ties of the atmosphere, to a certain degree.

  2. The influenza passes with the utmost rapidity
through a country, and affects the greatest number
of people, in a given time, of any disease in the
world.

  3. It appears from the histories of it which are
upon record, that neither climate, nor the different
states of  society,  have  produced  any material
change in the disease. This  will appear from com-
paring the account I have given, with the histories
of it which have  lately been given by Dr. Grey,
Dr. Hamilton, Dr.  A.  Fothergill,  Mr. Chisholm,
and other modern physicians.  It appears  further,
that even time itself has not been able materially to
change  the  type  of this disease. This is evident,
from comparing modern accounts of it with those 
           in 1789, 1790, and 1791.        453
which  have been handed down to us  by ancient
physicians.

  I have hinted in a former essay at the diminutives
of certain  diseases.  There is a state of influenza,
which is less violent and more local, than that which
has  been described.  It generally prevails  in the
winter season.  It seems  to originate from  a mor-
bid  matter,  generated  in  crowded  and  heated
churches, and  other  assemblies  of the people.  I
have seen a cold, or  influenza, frequently  universal
in Philadelphia, which 1 have  distinctly traced to
this  source.  It would seem  as if the same  species
of diseases resembled pictures, and that while some
of them partook of the deep and  vivid  nature of
mosaic work, others  appeared  like the feeble and
transient impressions of water colours.
Vol. II.
3 M 
 
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