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MEDICAL  & PHYSICAL
   C&ARLES CALDWELL, M. D.
Professor of the Institutes of Medicine and Clinical Practice;
     JJV TRANSYLVANIA UNIVERSITY.
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         LEXINGTON:
Jfyinfed a* «fcc office of the Kentucky Whig.
1826. 
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PREFACE.
   The following Memoirs contain several views and expositions, scien-
tific and professional, which, as far as the author is informed, are not to
be found in any other  work.  For  ought he  knows to the contrary,
therefore, they  may be  regarded as new.  Certainly  they originated
with himself, and were not derived from any written source.
  Most of these he embraces in his lectures, and delivers to a class, ma-
ny of whom, from want of experience and maturity of intellect, are not
competent judges of their truth.   He deems  it,  therefore, his duty to
publish them, and thus submit them to the  scrutiny and judgment of
those who are competent.
  If his opinions and principles be sound, they will sustain an examina-
tion by the professional and the enlightened, and prove worthy, to be in-
culcated on the minds of his pupils.  But if they be defective, they will
crumble under the touch of severe analysis, and ought to be do longer
propagated among the youth of the country.   In either case, the ordeal
of public opinion must decide.  Nor can a doubt be entertained,  that,
sooner or later, it will decide correctly.
  In no other way, as the author feels persuaded, can he do strict jus-
tice either to the public, his pupils, or himself.  If Ins opinions are true,
they must be useful;  and, therefore, the earlier they are made known,
the more auspicious will be the issue to  all whom they  may concern.
But if they are erroneous, they will produce mischief, and cannot be too
soon examined, and rejected.  In any event, then, to publish  must be
of good effect; because, in the march of knowledge, the subversion of
error, if not tantamount to the discovery of truth, is the usual harbinsrer
if it. 
TABLE Or CONTENTS,
                     MEMOIR I.
Jin Introductory Address, intended as a defence qf.tht
  Medical Profession against the charge c/irreligion
  and infidelity, with thoughts on  the truth and im-
  portance of natural religion.  Delivered, Novem-
  ber 2d, 1824.  p. 1.
                     MEMOIR II.
A  Dissertation in answer to certain prize questions, pro*
  posed by His Grace, the Duke of Holstein Oldenburg,
  respecting the "Origin,  contagion, and general philo-
  sophy of Yellow Fever, and the  practicability of that
  disease prevailing in  high northern latitudes" with
  thoughts on its prevention and treatment,  p. 76.
                     MEMOIR III.
    Thoughts on the analogies of disease,  p. 179.
» 
MEMOIR I.
        AN INTRODUCTORY ADDRESS,
                    INTENDED AS
d defence,of the Medical Profession against the charge
   Of IRRELIGION and INFIDELITY, With thoughts Oil the
   'truth and importance of natural religion.  Deliv-
   ered, November 2nd, 1824.

Gentlemen,
            Amidst the numerous manifestations of re-
spect, and the repeated  expressions of high commenda-
tion, which, by its dignity and usefulness, the  profes-
sion of medicine commands from the world, it experien-
ces, in relation  to one  subject of great importance,  a
want of charity and courtesy, not to term it wanton in-
justice, and sustains, on that ground, no inconsiderable
degree of unmerited reproach.   The subject alluded to
is  that of religion.
    While in talents and attainments, practical benevo-
lence and morality, and all the minor virtues and orna-
mental attributes that  belong to the character of the ed-
ucated gentleman, the accomplished physician  is univer-
sal^ acknowledged to have no superior, he is too gen-
erally charged, if not with infidelity, at  least with  ;t
marked  indifference  towards  religion, and a habitual
neglect of his duty to his God.   And the only plausible
ground on which the charge is erected, is his seeminu
disregard of public wnrfl-^).
                         B 
6
  If, in the language of the poet, this accusation "wert
true, it were a grievous fault, and grievously would the
accused  be destined to answer it."
   But if, on  the  contrary, it be radically unfounded.
originating with those who prefer it, in a spirit of illib-
erally, and an ignorance of the dirties belonging res-
pectively to the different walks of civil and social life,
justice requires that it be unequivocally revoked, by its
offending authors.  Nor should  the matter be suffered
to terminate here.   To prevent its revival,  it should bo
repelled and refuted, by the guiltless and the wronged.
   Having the honour  to occupy the station,  and to be
engaged in the functions, of a public teacher of medi-
cine, I hold it my duty to aid, with  such limited means
and powers as I may p'ossess, in defending the profession
with equal fidelity and zeal, against unintentional  mis-
representation, and premeditated calumny.
  Nor is this a-duty from the performance of which ei-
ther my feelings as a man, or my character as an officer,
permit me to shrink.    Could I,  for a moment, believe
medicine, either as a branch of  science, or a  practical
pursuit,  to be inimical to sound  and rational religion*
much as I am enamoured of it, and essentially as the cul-
tivation of it has contributed, and still contributes, t«
the highest and most durable enjoyments  of  my life, I
would abandon  it for  ever.  Indulge me, then,I pray
you, on the present occasion, in claiming for a  time,
your patient attention, while I engage in a humbleflRit
faithful effort, to wipe from it the defamatory  charge of
irreligion.
    That physicians who are engaged in a practice, at
once extensive, laborious  and engrossing, are less fre* 
3
 quently seen in the high places of religion, than mosi
 other characters of similar standing, is possibly true.
 Yet facts are wanting to convince me that it is so.  The
 examples are numerous which might be cited to prove,
 that, in the strict and technical meaning of the term, phy-
 sicians have been  among the most pious of men.  Nor
 is it less true, that, as a general rule, those individuals of
 them  most distinguished in the science of nature, have
 been most eminent  for practical piety, and active benev-
 olence. To say the least, in the regard it manifests for re-
 ligion, in  all its relations, the profession of medicine
 stands on an equality with the profession of law.
    But,for argument's sake, lam ready to admit, that
 practitioners of the healing art do  not so frequently  ex-
 hibit themselves at  church, in all  the studied formali-
 ties of devotion, as other respectable members  of the
.community.  Whatthenf   Are  all who thus appear in
 holy  places to  be ranked as holy,  and all  who  remain
-elsewhere  to be accounted impious?  To this interrog-
atory fanaticism itself will  not hazard  an  affirmative
reply.
    Are  physicians, then,  on account of their absence,
 <milty beyond others of neglecting the duties enjoined on
them by religion?  Are they alone to  be calumniated
and wantonly charged  with infidelity, because they do
not always  worship formally, to be seen of men?  Be-
cause, less solicitous about  the external glitter  of the
chalice,  they are more  attentive to its  purity within?
Because they prefer the silent bu*t substantial devotion
of the heart, faithfully engaged in high and indispensa-
ble duties,  to the loud and ostentatious  professions  of
the lips, when  the practice of such  professions would 
interfere most essentially with the performance of those
duties?   And because, as their practice demonstrates,
they discard the narrow considerations ofse//,and  give
the welfare of others a preference to their own?
   Is it, I repeat, on  account of conduct like  this, that
those who  are  often the ornaments, at once,  of human
nature, and the profession they pursue, are accused of a
want of  practical  piety?  Of a cold  disregard for the
author of that religion, whose divine precept, enjoining
mutual love, and the reciprocal exercise of the benevo-
lent affections, they spend their lives in endeavouring to
fulfil? With such  individuals let  me take my chance
of usefulness and true respectability here, and of happi-
ness  or misery hereafter, rather  than  with those  who,
themselves strict conformists to the usages of religion,
presumptuously  censure  and   heartlessly   condermi
them.
   Did physicians, from a sentiment of indifference, or a
spirit of active  hostility to religion, consume their time
in idleness or dissipation, rather than repair to places of
public worship, to join in offerings of gratitude and ado-
ration to the father of the universe, their example would
be pernicious  and their conduct reprehensible.   But,
when the c;iusc of their absence from the temple and
the altar, is active philanthropy, manifested  by a deep
and absorbing devotion to the duties of their profession!
When they are engaged alike in the services of the phy-
sician, and the  charities  of the man—ministering to
the sick, relieving those that  suffer pain, consoling the
affliccd,  pouring into the bosom of wretchedness the
healing  balm of sympathy and  friendship, wiping the
 tear from the cheek of sorrow, and,  where life  cannot be 
b
c>aved, soothing the agonies of the descent (o the tomb-
When  thus occupied  in  removing or  mitigating the
"thousand ills that flesh'  is heir to,"  they may,  with
hearts as pure, hopes as heavenly, and expectations as
rational,  that  their petitions will be granted, implore,
from a God of compassion and  benevolence, a blessing
on their labours, as if, with bended knees,  and uplifted
hands, they acted their'part in an assembly of worship-
pers.
    The position being  so incontcstible as to constitute a
truism, I need  scarcely state to you, that it is not to be
expected,  because, in the  nature  of things, it is not in-
tended,  that all men should do homage to their God in
the  same  way.  Every duty, of whatever  description,
provided it be performed from a laudable  motive, is an
act of worship  acceptable to the Mosr  High.   For he
4s no  more a respecter of forms tiian he is of persons.
He requires the incense of the heart, offered up under
(he  direction of the intellect,  enkindled  by zeal, and
fanned with  vestal fidelity and vigilance, and with that
he is satisfied.  To the  truth of these sentiments his own
declaration conclusively testifies.
   WThether, therefore,  the act of duty, which is but an-
other  name for an act  of worship, be performed by the
physician in the chamber  of the sick,  by the patriotic
senator  in the hall of legislation, or the conscientious
advocate within the walls of the forum; by the mariner
rocked on the tempest-shaken mast, the warrior fighting
the battles of his country,  or the professor of religion at
the foot of the altar; if  the heart be devoted and the mo-
tive correct, the offering will be alike meritorious and a-
like holy, in the estimation of that judge, who is at once 
                         6
 omniscient,  benevolent, and jusl.   Let no man dare to
 condemn the act, on account of its want of a prescribed
form.   Provided its spirit and  substance be right, it is
 all right, the mere  mode of performing it being but the
 external shadow of the substance which is within.  To
 contend for the reverse of this, and to make the Deity a
 stickler for a system of rituals, is to insult his majesty,
 and presumptuously degrade him to the level of man.
   He that most ably and faithfully performs his duty to
 his fellow men, acquits  himself most acceptably in his
 relation to his God.  In reason, this may be pronounced
 an incontrovertible  truth.   If it be not  also true in the-
 ology, then is that a branch of knowledge which reason
 condemns.
   That the truth and force of this position may the more
 fully appear, let us bring it to the test  of the following
 conjuncture.
   A city is  invested by a powerful enemy, resolved on
 conquest, rapine, and massacre.  The temples are open-
 ed, and in obedience to his  own  sense of duty, and the
 usages  of the place, the  commander in chief of the be-
 sieged party is engaged with  others in a public act of
 religious worship.
   With hurried step  and anxious eagerness, an officer
 <«pproaches  him, and  announces  that  the assault has
 already commenced, and  that the enemy, in numbers,
 are thundering at  the gate.
   In this emergency, what is the obvious duty of him to
 whose valour, vigilance, and skil\ in arms, the defence of
 the city and its  inhabitants is entrusted?   By which
 procedure will he manifest most acceptably his duty and
 nerfect devotion  to his God—retaining his position  in 
7
«.he house of worship, until the service is finished,  or
rushing  instantaneously to his companions in arms, to
animate them by his presence, direct them by 1  is genius,
mingle with them in battle, and lead them to victory by
his heroic example?    Let the question be propounded
even to the ecclesiastic who is ministering, at the mo-
ment, in holy things, and, with that promptitude and ea-
gerness which the occasion inspires, it will receive em-
phatically the proper reply.  That divine will not only,
from his  sacred  desk,  exhort his  commander to hurry
to his post, but, if his heart be manly, his temperament
enthusiastic, and  his soul  devoted to his  country's wel-
fare, he will himself accompany him.
   In a crisis like this, the duties of the assembled con-
gregation are  various, according to the services they are
fitted to render.  Let the brave and tire vigorous repair
to the  walls, to repel the foe, while the rites of devotion,
if they must be performed, belong only  to those, who,
from feeble arms  and feebler hearts, are eapableof noth-
ing more suitable to the occasion.
   Order is Heaven's first law.   A place for every thing,
and everything in its place.
   Nor is this less true in relation to the management of
 the affairs of  earth.  Sublunary concerns, of every dis*
 cription, are best conducted, when this law, in the regu-
 lation of them, is most strictly observed.
   Let the divine, then, the jurist, the civilian, the war-
 rior, the philanthropist, and the physician, labour, each
 in his own vocation, precisely as the nature of that vo-
 cation demands,  and the harmony and welfare of society
 will be the issue.  Let them usurp, in any measure, the
 functions of  each  ether, and  confusion  and disaste* 
f>
  will inevitably ensue.    Earth will  become  a scene of
  moral chaos and  wild  misrule.
     To thrs scheme of specific and exclusive duty, it will
  no doubt be objected, that there is a time for all things.
  That the sabbath is the time  for public worship, and
  that physicians ought devoutly to unite in it with others,
     To this  the reply is obvious  and satisfactory.   Of
  the physician, engaged in  extensive practice, it may be
  emphatically affirmed, in the  language of  the poet, that
              "Sunday shiDes no sabbath day to him."
  In the sufferings and ravages  of disease, no Sabbath is
  instituted either by divine or hum m authority.   Nor is
  he whose business  is  a  perpetual  warfare  with them,
  permitted to calculate on a day of rest.
     A physician in  the midst of  disease, is like an officer
  Stationed on the lines of an  enemy.  His  duty is at his
  post, where he must be  constantly on  the alert, suffi-
  ciently fortunate, if, by all  his  vigilance,  he can escape
  the disasters of circumvention  and  surprise.
   .  While others are ministering  in  heavenly  things, or
  partaking of the ministry,  he must  be engaged in res-
  cuing the sick, or protecting the healthy, from the ope*
  assaults ancl secret machinations of a dangerous foe.
     When the practitioner of melicineisthus, in the per-
  formance of the functions  of his profession,  rendering
  himself most useful to his fellow meu,  he is best dis
I  charging his duty to his God.   And  were he suddenly
  summoned from his abode  on  earth to the  judgment
I  seat on high,  he may approach  it  with a heart as
I  pure, a conscience as  tranqiiil, and   hopes as lively.
,  from the discharge of  his  professional  services  in the
,   the chamber of sickness, as if  he had been knoolinc in 
il
 the house of prayer.   If  any tenets of any religion be
 at war with this, they are  equally' at war with reason
 and benevolence, and ought to be rejected as heretical
 and dangerous.   Their source is in the blindness of the
 human mind, and the pride  and selfishness of the hu-
 man heart, not in the wisdom and moral perfections of
 God.
   Let me not, T entreat you,  from  any sentiment ex-
 pressed or implied by me, on this occasion, be pronoun-
 ced or considered an enemy to forms of religious wor-
 ship.  From none  of the  premises  here defended can
 such an inference be legitimately drawn.  Nor can any
 individual be further than myself from harbouring a hos-
 tility so  unreasonable and pernicious.   Such is the char-
 acter of  the human mind, that, for  the successful culti-
 vation of pious feelings, in mankind at large, forms of
 worship  are necessary in themselves.    They  are sanc-
 tioned, moreover, by divine authority, having been prac-
 tised by  the founder of the christian religion.  When
 nothing,  therefore,  of superior moment, intervenes to
 prevent it, a regular conformity to them becomes a duty.
 But it is not to be regarded  as a pammount duty.  It
 is not essential to the saving of the soul.  A fitness for
 Heaven can be attain/d without it.  It is not, therefore j
 of a nature so high  and holy, that the neglect of it, un-
 der the pressure of  weightier duties,  is to be  received
 as evidence  conclusive of infidelity or irrcligion.   The
 heart  may   be  as  piously and  ardently  engaged
 i:i religious exercises in the retirement of the closet, or
 when contemplating, in the silence of solitude under the
 wide arch of heaven,thc  beauty and  grandeur of sur-
rounding nature, as it can within the walls of t be solemn 
                          10
 temple, touched  by the influence of sacred music, and
 placed in the midst of adoring thousands.
   To affix on physicians, then, the slanderous imputa-
 tion of infidelity, merely on account of their constrain-
 ed neglect of public worship* argues,  in those who per-
 petrate the outrage, a heartless want of christian chari-
 ty, not to say of  a love of truth,  and is,  in its relation
 to those who suffer it, an act of wanton and flagrant in-
 justice When committed, as it usually is, by professors
 of religion, it is  an outrage  and  a crime, not  only a-
 gainst the  individual injured, and society in general, but
 in its immediate  relation to the Deity  himself, whose
 laws it violates, and prostitutes to the purposes of  slan-
 der his holiest institution.
   But we are told that it is not the mere neglect of 1110'
 ceremonials  of public worship that attaches to physi-
 cians the suspicion and charge  of infidelity and irreli-
 gion.   It is asserted that, in its  very nature, the  science
 of medicine is  unfavorable to  a belief  in the truths of
 theology.
   That that science, in common with every other which
 enlightens, expands and liberalizes the mind, (a)  is hos
 tile to theological  fanaticism and bigotry, to all unfound-
 ed sectarian dogmas, all  intolerant puritanical feelings.
 and all vindictive ecclesiastical denunciations—to ev-
 ery thing that tends to mislead the judgment, narrow the
 soul, and ruffianize the bosom of man, by tramelling his
intellect, and deracinating charity and benevolence  from.
 his heart—that  the  science of medicine is hostile to
 theology of this description, which, bearing  about it  no
 characteristics of celestial origin*, gives fearful manifes-
 tations of an opposite parentage, is Certainly true.  And 
n
 so unquestionably it ought to be. All nature is at war with
 theology like this; and Heaven itself indignantly disclaims
 it, as a foul misrepresentation of its canons of truth.
    Action and reaction are, in all things, equal and op-
 posite to each other.   That scheme of theology, then,
 which makes war on science, may be assured that science
 will return the assault.  But toue theology and science
 are not at war.   They no£ only harmonize with each
 other, they are one.
    Theology is the science of Deity, including the bound-
 less range of multifarious and reciprocal relations that
 exist between HIM  and the universe which he governs.
 When considered, then, on a catholic scale, the science
 of medicine may be  truly denominated a branch of the-
 ology; for,  taken, ir^its entire scope, it communicates
 very amply a knowledge of the Deity, his attributes and
 laws, through the medium of hisrworks.  Far from be-
 ing hostile, or in any degree  unfavourable to it,  when
 cultivated, in its  full extent,  it opens to its votaries an
 abundant source of religious .instruction—not embitter-
 ed by that militant spirit which breathes forth hatred in-
 stead of love; but that pure a)\d  heavenly kind of in-
struction, which  addressing itself to all  the fapulties of
 the mind, ameliorates the  whole  of them—illuminates
 and strengthens the  intellectual powers, and disclosing
 the wide spreading harmonies of nature,  improves the
 moral character of man, by fostering in his soul the spi-
 rit of benevolence, $e temper of forbearance, and the
 love of peace
   To such an extent  is this trjie, in relation  to the sci-
ence of medicine, that, m imitation  of the poet, when
 he exclaims. 
1"
            "Anundevout astronomer is mad.'
 i might here assertion firmer ground, and with a strong-?
 er emphasis^ that the physician who is destitute of reli-
 gion is deranged.
   There exist, by consent almost  universal, two sour-
 ces of religious knowledge; and, when considered in
 their relation to the  enlightened  and the philosophical,
 I presume not to decide which of them is richest in the
 treasures it contains, or the  measure of invaluable in-
 struction it imparts.   They  are  the  icord of God, as
 communicated in the  Scriptures, and the works of God,
 as exhibited in creation.   On the former is founded re-
 vealed religion; from the latter is derived the religion of
 nature-  Such, at least, are the terms by which these
 two  schemes of theological  science are denominated.
 But perhaps improperly; because, in their  fundamental
 principles, they are one.   In the genuine interpretation
 of the term, they are both revealed-, for the Deity speaks
 through  the  medium of his  other and more  general
 works, as audibly and intelligibly, as he does by the lips
 or the pens of his prophets.
  As far as nature  extends, natural and revealed religion
 are and must be the  same.  Miracles  alone excepted,
 whatever is true in religion is conformable to nature in
 her ordinary  course;  and whatever is contrary to nature-
 ie a departure from truth, whether it be denominated re-
 ligion or not.
  If any one  deny  tie  soundness of this  doctrine, he
 makes the Deity contradict himself.  Nor can my reason
for making this assertion  be  concealed, for a moment,
from the humblest inquirer.  God is as much the author
of nature as he is of  revelation.   Surely, then,  he car- 
                         13
not, without self-contradiction, make the latter speak one
language, and the former  another.   But he is not self-
contradictory.  They,  therefore, speak  the same lan-
guage; and, when, properly understood, inculcate neces-
sarily the same doctrines and the same practices, (b)
   All religious truth has the *jame origin.  It is a pure
and precious  stream, springing from the fountain of De-
ity himself.  But by the bounteous and  beneficent dis-
pensations of its author, it flows to man through sev-
eral channels,  because it is essential  that he should
have it with certainty and in abundance.
   Let us be careful, then, not to undervalue the truths
imparted, merely on account  of the medium through
which they may reach us.  Let  us not confound the
things with their sources or channels. They are equal-
ly valuable whether they come to us in words, from the
lips of inspired men, who are, at best, but the oracles of
God, on the occasion; or from the common works  of na-
ture, which are equally his oracles.  In the former case,
we receive the purposed of the Deity already interpre-
ted and clothed in language.  In the latter,  we receive
the same purposes, to be interpreted and  clothed in lan-
guage by ourselves.  In either case the process is reve-
lation.
   To the votaries of medicine, the Scriptures contain-
ing the word of  God, are as open as they  are to the cul-
tivators of other professions   To all physicians, there-
fore, revealed religion may be familiar, and to many of
them, it is  so.  But, in relation to the works of God, they
constitute, in a peculiar manner, the physician's domain.
Them he  must study—The  knowledge derived from
them he must appropriate, and render his own, else is 
                         11
 he unworthy alike of his vocation and his name.  With'
 natural religion,then, he can scarcely fail to be as famil-
 iar, as he is with the structure  of the human body, or
 the medicinal properties of the  articles  he uses in the,
 practice of his profession.
  Waiving entirely the  influence produced  on him by
 revealed religion, which, living and mingling as he does
 in a community of christians, must be necessarily con-
 siderable, his intimate acquaintance with  the  religion off
 nature, although  fortunately it can render him neither
 fanatical nor intolerant,must infuse into him sentiments
 of veneration and piety.  For the  student and lover of
 the beauties, beneficences, and sublimities of  nature, to
 be without such sentiments,  would seem to be impossi-
 ble.   Nothing but a heart of marble in a bosom of ada-
mant, could present such an anomaly of moral insensi-
 bility.
  To ascertain more satisfactorily the effects of natural
religion, on the minds of those who have attentively stu-
died it, it is only requisite to contemplate, for a moment,
 the extetxt and character of the information it imparts.
  For this purpose it is  sufficient to say,  that it teaches
the knowledge  of the  existence  of God, of his perfec-
 tions generally,  and of his  original  organization, and
 his moral  and physical  government, of the universe.  A
 few points connected with   the  immediate  scheme of
 christian salvation excepted,  it teaches whatever essen-
tial is contained in revealed religion, (c)  In its code of
 moral and social instruction, it may  be pronounced per-
fect  (d)  It shows, in a particular manner, and most im-
pressively, t^e dependence of all  things on the Great
 Supreme,  and his beneficent superintendence of all; and 
\6
thus implants and cherishes in the soul, the  celestial
seeds of gratitude and devotion.
   This it does by opening to us a view of the chain of
creation, the first link of which, being attached to the
footstool of Deity, the  others descend in regular grada-
tion, the inferior supported and retained in its place by
its immediate superior, connecting thus, by an indissolu-
ble tie, the lowest grade .of being with its creator, who
'Vimself sustains and  wields, at pleasure,  the stupen-
dous fabric.   It discloses, moreover, throughout this in-
terminable range of existence, that exquisite adaptation
of the parts to each other, and their perfect  subordina-
tion and fitness to the whole,  which nothing but infinite
wisdom could effect.
   In relation to  most of the attributes of the Deity,
there would seem to exist a vast disproportion between
the manifestations of them made by revealed and natural
religion.  To  the truly  intelligent  and  philosophical
mind, capable  of analysing the  fabric of creation, and
comprehending1 and  enjoying the spectacle  it  presents,
that manifestation effected by  the latter, is unspeakably
the most  magnificent, impressive, and  sublime.   The
reason of this  is obvious.  The one,  is made in ivords
invented by man, the other by ivorks in whMi Heaven
put forth both its wisdom and its  power.   But, waiving
the consideration of the  infinite distance between the
capabilities of the actors in the present instance,  who
does not know, that, in all cases, works can exhibit what
no powers of language can describe.
   Works are demonstration by appropriate  machinery.
Words are description, and nothing more.  In point of
perspicuity^ force, and impressiven^ss. the differer^p be* 
16
 tween these two  modes of communication is immense*.
 It is the same that exists  between  two lectures in phi-
 losophy, one of them simply recited in words, the other
 illustrated by suitable apparatus.
   When  the Deity is  represented  as riding  on the
 whirlwind,  as making  clouds  and thick darkness his
 pavilion and his covering, as holding the sea in the hol-
 low of his hand,  and  commanding  the  raging of the
 tempest to be still; or even as  organizing and governing
 the few heavenly bodies, which, glittering only as dimin-
 utive specks, are visible to the naked  eye—When thus
 depicted,by masters of description, his power and ma-
 jesty are forcibly felt.
   But, sublime and imposing as this description may be,
 in the abstract, it is nothing but a selection and colloca-
 tion of words, invented by man as  suitable representa-
 tives of his limited  conceptions,  most of  them bearing
 relation to our own little globe.  Faint and feeble, then,
 must it necessarily  appear, when contrasted  with the
 pageantry and unspeakable grandeur  of a systematized
 universe, in the construction of  which omnipotence has
 toiled!—a universe consisting of millions of orbs, some
of them millions  of times  larger than  this we inhabit,
 all of them individually, or arranged  in system?, with
 inconceivable velocity and power, moving aronnd each
 other, and the whole collectively around a common cen-
 tre, not only without  collision or  inconvenience, but
 with a harmony and order, produced  and  sustained by
the exquisite adaptation  and balance  of those Dowers
 and movements, that wouM seem to be destined'to cre-
 ate confusion!  Compared, I say, to the omnipotent and
 omnipresent Deity of a universe lifce  this, what is the 
                          17
God of a whirlwind, a tempest, a  limited ocean, an en-
tire globe, or even a circumscribed system of globes, con-
stituting collectively but  a single  group, lost in the
boundless gallery of creation!   But, I must not indulge
in the further pursuit of this  contrast, lest, in direct op-
position to  my intention  and feelings, the  language,
which the nature of the subject would compel me to use,
might be considered by  the feeble,  and represented by
the designing, as disrespectful  and injurious to revealed
religion.
   Physically speaking, then,  the  Deity, as exhibited in
the works of creation, is transcendent over all that lan-
guage can express.  And to this effect are the words of
revelation itself, where he is declared to be, in his char-
acter and perfections, "unspeakable." (c)
   Nor is his  moral  government,   as set forth in the
scheme of natural religion, in a less degree pre-eminent
over  that which is ascribed to him in revealed religion.
   In the latter system, without any positive reference to
other peopled  worlds, he is  represented as limiting his
moral government to the inhabitants of this.  For them
alone, has his bounty provided.  For them has he form-
ed the sun, the moon, and the  stars, and hung  them in
the heavens as lamps to direct them.
   According to this representation of his standing in cre-
ation, man would seem almost privileged  to exult with
the poet, in the following high-wrought effusion  of pride:
       "For me kind nature wakes her genial power,
       "Suckles each herb, and calls forth every flower;
       "Annual for me the grape, the rose renew
       "The juice n'ectarious and the balmy dew;
       "For me the mine a thousand treasures brings,
       "Forme health gushes from a thousand springs;
       "Seas roll to waft me, suns to light me rise;
       "My footstool the earth, my canopy the skies.'' 
                           18
    But, far different, in compass and magnificence, is the
  range of moral government, which the religion of nature
  bestows, on the creator, sutainer, and director of a uni-
  verse.  In this stupendous  scheme  of  things, millions
  of worlds,  peopled by millions  on   millions of inhabi-
  tants, swelling to a number  surpassed by nothing short
  of infinity, are necessarily  embraced,  and God is the
  father and governor of them  all.   These, like ourselves,
  are heirs  of  immortality, and candidates,  destined we
  hope to be successful ones, for endless, progressive, and
  indescribable felicity, (f)
    If my judgment  and feelings do not eminently deceive
  me, this view  of things, exhibited in creation, is much
  better calculated to give  elevation to the Deity, and hu-
  mility to man, than any that the powers of language can
  present.  But I need not add, that these are two  of the
  cardinal objects of religious instruction.
    From the sentiments here disclosed, let no one impute
  to me the demoralizing and  unchristian design, of ele-
  vating natural, to  the intentional degradation of reveal-
  ed religion.   The  charge would  be equally illiberal and
  false.
    But, while I venerate the  Scriptures as the oracles of
  Heaven, I cannot  do less in relation to the organized
  universe, which I  am compelled to  regard, if not as a
  kindred emanation from Deity himself, at least as a mir-
  ror reflecting the image  of his divine perfections.    Nor
  can I refiain from  speaking of those two sources of hea-
Ti venly knowledge, as  characterized by different kinds of
  excellency.    While the one is more explicit and abun-
  dant in practical instruction,  the other is more sublime
  in the truths  it reveals.  The  latter exalts and enno- 
19
 bles the soul,  while the former  conducts it more uner^
 ringly in the path of duty.
   Such is a brief and imperfect sketch  of the know-
 ledge which the religion of nature  imparts.  Poured as
 this knowledge is, in copious and uninterrupted streams,
 into the mind of the cultivated and observant physician,
 it is impossible for  irreligion  to  take  root  in his heart.
 Of the mere pretender and sciolist in medicine, I am not
 the defender.   To  his profession he is a dishonour. Of
 his character,   in a religious  point of view, let others
 judge.   I dismiss him, at once,  from further notice, in
 the terms of a well known passage in poetry, which is
 not more remarkable for the  harmony of its numbers,
 than the correctness of its sentiment.
           "A little learning is a dangerous thing,
           "Driuk deep, or taste not the Pierian spring—
           "Hereshallow draughts intoxicate the brain,
          "But drinking deeply sobers it  again."
   I know it will be said,  perhaps by  several, certainly
 by one individual who hears me, not only that  the rep-
 resentation I have  given  of the beauties and excellen-
 cies of natural religion is greatly exaggerated—not only
 that I have preternaturally  multiplied and magnified the
 advantages supposed to be deriveable  from  it, but, that,
 in reality, such advantages have  no existence—and, to
 finish the climax of this anomalous creed,  that natural
 religion is itself a fiction, all  religion  being necessarily
 derived from written revelation alone.
   The reason rendered for this opinion is, that by no ex-
 amination of material creation,  can  man  arrive at a
knowledge of the existence of God, who is exclusively
the object of religious  worship.   That,  had he not re-
vealed himself by  oral  communication,  the universe 
                         20
might have continued to exist, its arrangement and econ-
omy have been disclosed, and man  have cultivated, as
he has done, the science of nature, and still have remain-
ed ignorant of the very being of the  God of nature.
   In  relation to this subject, we are further told, that,
had not  the fact been specifically  revealed to us, we
could never have formed  a conception of  the production
or organization of the solar system,  or any part of it,
nor of the other systems  and orbs that revolve through
the heavens.   But,  that the entire  fabric  of  material
nature would have appeared to us to be either self-exis-
tent and eternal, or sdf-formed,  self-sustained, and self-
governed, itself at once the cause  and  the effect, and at
once the agent and  the  subject, the operator  and the
thing operated on,  in the  production of all the phe-
nomena of creation.   And again, that on the subject of
spiritual existence,  we should  have been utterly igno-
rant.  Of course, the existence  of the human mind, as
a spirit, and its destiny as an immortal  one, would have
been a secret to itself.
  Whatever may be the  sentiments of others with re-
gard to it, to me, this hypothesis, attempted to be main-
tained and propagated, at this  enlightened period, and
in this place  of science,  is  strikingly singular.  But
perhaps its singularity arises from its novelty.   For it
is not long since I  was first aware that it had a single
advocate.   And I must be permitted to add, that an at-
tempt to revive the Egyptian notion of metempsychosis,
or any of the transcendental visions of  Plato, would
not have more surprised me.
  If this hypothesis be true, it will prevail', for truth is
omnipotent and cannot be  resisted.  And if it prevail. 
2\
it will produce a  very signal  change, and constitute a
memorable epoch, in the science of theology.   It will
remove from the eyes of the theosophist the thick scales
that have dimmed his vision, and  introduce  him to a
view  of things entirely  new.  True or false, it is wor-
thy of examination.  If nothing else contributes to ele-
vate it, the subject to which it relates bestows on it im-
portance.  Suffer me again, then, to crave  your pa-
tience, while I proceed in my disquisition.
  Were  I, in the discussion of this  subject, to rely for
argument on the sacred Scriptures—and where is the
authority that is higher or holier—from that source of
divine and immaculate truth, evidence might be abun-
dantly adduced in my behalf.
  In maintaining the omnipotency  of God, Job, for tes-
timony confirmatory  of its existence,  thus  eloquently
refers to  the works of nature.
  "But ask now the beasts, and they shall  teach thee,
and the fowls of the air, and they shall teach thee;
  "Or speak to the earth,  and it shall teach thee; and
the fishes of the sea, and they shall declare unto  thee.
  "Who knoweth not, in all these, that the hand of the
Lord hath wrought this?"  Job. chap. xii. ver. 7,8,  9.
  "The  Heavens, says  the psalmist,  declare the glory
of  God; and the firmament showeth his handy work.
  "Day unto day uttereth  speech, and night unto night
sheweth knowledge.
  " There is no speech nor language where  their voice
is not heard.
  "Their line is gone out through  all the earth, and
their  words to the end of the world." Psalms, xix. ver:
1.2,3,4. 
                         22
   Again.   "And the Heavens shall declare his (God's)
 righteousness; for  God is Judge  himself." Psalms L.
 ver: 6.
   Speaking in reference  to unrighteous men, the apos-
 tle Paul thus expresses himself:
   "Because that which may be known of  God, is mani-
 fest in them; for God hath shewed it unto them.
   "For the  invisible things of him, from the creation of
 the  world  are clearly seen, being understood by  the
 things that are made, even his  eternal  power and God-
 head;  so that they are  without excuse."   Epistle to
 the Romans, chap. I. ver: 19, 20.                      j
   That these texts of Scripture  testify most explicitly I
 to the manifestation of God, through the medium of his ^
 works, cannot, in a spirit of candour, be denied.
   But knowing that a different  meaning is attached to
 them by cavillers, and  being unwilling to engage in a h
 war of mere construction, I shall waive all claim to the 1
 authority which they offer me,  and  endeavour to derive  3
 my evidence and argument,  from a  source which speaks
 a language that no sectarian interpretation can distort.    j
  To me it appears, that  the  doctrine  of  the absolute
 necessity of  oral revelation to  our knowledge of the   ■
 being,  attributes,  and government  of God, is  fraught  '*
 with considerations of no ordinary moment,  which its
 advocates, (if advocates it  has)  in the  ardour  of their   '■
 zeal to establish it, have entirely overlooked.
  If it be true, it argues,  or I deceive myself, a striking
defect in the high operations of creative wisdom.
  Admitting the infinity of the wisdom, goodness, and
power of God—and no one, I am sure,  will dare to de-   '
ny it—it follows of necessity that creation itself must 
23
be a system of optimism—a scheme of things as per-
fect as Deity can make it.  I speak under impressions of
reverence in declaring,  that to this effect the Deity is
bound by his own  perfections,  and  cannot violate the
laws which the* impose   That by the  Fate,  constitu-
ted by his infinite attributes, was the Creator constrain-
ed to  give birth to a universe, in its totality, as unexcep-
tionable  and perfect as  himself.   Nothing  short of a
creation  like this would be worthy of him, or could ac-
quit him at the bar of his own tribunal   If he requires
of his creatures that their works shall be as faultless as
their  capabilities can render them, he  cannot himself
have  failed to set them the example.
   To say less of him, or to  feel towards him  less
reverence than this sentiment conveys, would be, in a
spirit of rebellion, if not of blasphemy, to deny his per-
fections  and offend his majesty.  To pronounce the Dei-
ty, all-perfect  as he is, the author of imperfection,™ self-
contradictory.  If HE  is without defect, so must be his
creation.  He himself has told us that the tree is known
by its fruit.   If the parent be  spotless,  spotless must be
the offspring,  when viewed in relation to  universality
and ultimate design.
   But to make it, in its totality, perfect, there must
exist between the component  parts of the universe, and
between the parts and  the whole, a perfect adaptation.
They must be, in all respects,  as  exquisitely fitted to
each other, as infinite wisdom and power, actuated by
infinite goodness,  can render them.   By this test let u«
 examine the hypothesis under consideration.
   If this hypothesis be true, it involves a dilemma, be- 
                         24
 twcen the difficulties of which its advocates  are at lib-
 erty to choose for themselves.
   Either the  Deity has  constructed a universe  so de-
 fective in its organization,  and imperfect in its move-
 ments, that it  makes no manifestation of divine wisdom,
 in which the hand  of the architect may be discovered;
 or he has created man, as an  intelligent being, too dull
 of intellect to  make the discovery, to enjoy it, and to
 profit by it.  In either case there  exists a defect in the
 wisdom, power, or goodness, of the Creator, or in all
 of them.   That it would  best comport with these attri-
 butes, as well  as with divine justice, that  man, as an
 accountable being, should be able, wherever placed, to
 arrive, in some way, at the knowledge of Godvand of his
 own responsibilities, cannot be denied.  On no  other
 ground  can  he be charged with  guilt,  or  rendered
 accountable  for any  of his  actions.  For the Deity
to  hold  a  creature, formed  and  disposed of by him-
 self, responsible, under  the penalty of  fearful  pun-
ishment, for not knowing and worshipping him, and, at
the same time, to conceal from that creature his very
existence, would be worse than injustice.   It would be
the consummation of cruelty and tyranny united.  Were
 an earthly tyrant to act thus towards any of his subjects
 he would justly encounter the execration of the world.
 Surely, then, to such  a charge the Fountain of justice,
 benevolence, and goodness, cannot be liable.  To prefer
 it against him  would be unqualified blasphemy.
   That portion of mankind to which the word of God
 as contained in the Holy  Scriptures, has found its way^
 is exceedingly limited.   Throughout the lapse of sev-
 eral thousand years, this has been the case: nor is it 
25
 likely to be otherwise for thousands yet to come. What,
 in the mean time, is to be the destiny of those millions
 of mortals, who, never having been favoured with a sight
 of his written word, are forbidden to obtain a knowledge
 of God through the medium of his works?
   To this I am aware that an answer is attempted.
   We  are  told that  those unfortunate and benighted
 beings, who are thus deprived of all better resources,
 but whose salvation is  staked, notwithstanding, on the
 issue, must be content  with the  "dim green lights" of
 tradition.   Faint and miserable lights, indeed, contrast-
 ed  with the object to  which we are informed they are
 intended to lead!
   Under the most favourable circumstances, tradition
 is a medium entirely insufficient to convey and perpetu-
 ate, with an accuracy to be defended on, a knowledge
 even of ordinary affairs.   If not in the nature of things,
 at least in the issue of them, tradition and fiction pre so
 nearly  allied, that an age  of tradition  never fails to be
 an age  of fable.  To the truth of this, observation  and
 history abundantly testify.  Yet, in  the present  case,
 under circumstances as  inauspicious as can possibly be
 imagined,knowledge, essential to the everlasting welfare
 of an immense proportion of the human race, is entrust-
 ed exclusively to this narrow, uncertain, and perverting
 channel—A channel which never lias  remained free
 from pollution, during the period of a single generation;
 and, while man retains  his present character, never will.
  Thus the case is made to stand.   At the close of the
 deluge, Noah and his family possessed  a knowledge of
 the  true  God.   But, in a short time among their de-
scendants, who still  continued to  speak the same lan-
                          E 
                         26
 guage, this  knowledge was either lost, or in a high de-
 gree adulterated.
   In the plain of Shinar, the common language which
 they had hitherto spoken was taken from them, various
 others substituted in its place,  and they themselves, to
 meet no more, were widely scattered through different,
 remote, and dissimilar regions.   Under this revolution-
 izing and memorable dispensation, some of them sought
 the vicinity  of the sun, to pant in the shade beneath his
 tropical fires, others penetrated  into the climates of the
 north,  to buffet the polar blasts, and contend with  the
 rigours of a protracted winter,  while  a third portion of
 them selected, as their places  of  abode, countries fa-
voured with milder skies, and situated between the two
 extremes.
  To those  who understand the philosophy of language,
its  nature and influence as a medium of recollection,
and the effect which a sudden and  entire change  of it
must necessarily produce on the human  mind, in rela-
tion to knowledge previously acquired, all comment on
this event would be superfluous.
  A combination of causes better calculated to confound
knowledge of every description, if not entirely to erase
 it, no ingenuity  of man can devise.   Nothing can sur-
pass it short of an obliteration of memory itself.   Our
recollections through the familiar and delightful medium
of our mother  tongue, are the only clear and definite re-
collections we have.
  By those who were thus dealt with in  Shinar,  what
events  of their  lives  would be likely to impress'  them
most deeply  and  permanently,  to be  most vividly  re-
 membered and most'repeatedly talked of  by them, and
 
21
handed down by  tradition to their immediate descend-
ants, and by them to tlieir descendants, from  generation
to generation, until remembrance should be lost in the
remoteness of futurity?—! answer, it would be the erec-
tion of the Tower  of Babel, with the object for which
it was intended,  the miraculous confounding of  their
tongues, and their dispersion and journeying thence to
their various places of destination.  These occurrences,
I say, would be as  likely—in my estimation  much more
so—to  be  held  in remembrance  by them, than the
knowledge possessed by them in relation to the being
or  attributes of a  God.  But, in the traditions of un-
lettered nations,  no remains of the description of such
occurrences are to  be found, (g)
   Much is said of the perpetuation, by tradition, of the
knowledge of the deluge of  Noah;  and an inference  is
hence deduced, that if that  event could be thus handed
down, so could a knowledge of God and of  his govern-
ment.
   But to those who rely on testimony like this, for the
establishment of their notions, it is important to recol-
lect, that the earth exhibits, in various places, incon-
testable evidence of sundry deluges, h) any one of which
may live in tradition as readily and  permanently, and
be as likely  to be spoken of, as that of Noah.  From
no fact of this kind, then, perpetuated in story, ean any
specific conclusion be drawn.
   As far as the knowledge  of  a God is  concerned, I
have no hesitation  in asserting, that to communicate it,
from so distant a  period as the  time of Noah, only
through the distorting tradition of ignorant and unlet-
 tered nations,  is worse than not to communicate it at 
                        28
all.   For, on a subject like  this, ignorance is  certainly
preferable to error,  (t)   And to preserve knowledge,
in this way, unpolluted by error of the grossest charac-
ter, may be pronounced impossible.
  But all nations heretofore discovered, however wretch-
ed, uncultivated, and ignorant, have some notion of the
being, as well as of the superintending providence of a
God.   They believe in the existence of one or more in-
visible and powerful agents, capable alike of  injuring
and benefitting them, and to which,  therefore, their hopes
and their fears  are  directed—which  they  invoke, and
endeavour to propitiate, when adversity assails  them,
and to which, in prosperity, they render up their thanks.
And  where  no revelation is concerned, their  concep-
tions  of  the disposition and character of these agents
bear a striking  affinity to tbe interpretations  they put
on the j henomenaand operations of nature around them.
Indeed it is  most obvious, that the  elements  of those
conceptions  are suggested by these  operations.
  In a boisterous and stormy region, the God of the igno-
rant is a  God of tempests, rides on the whirlwind  and
directs its career, and awakens the  hurricane, or bids
it be still.
  In  a volcanic region, his attributes are, in some way,
connected wiih fire; and, in a country of calmness, sun-
shine, and fertility, he is always invested  with a  cor-
responding character.  He is the  Ged of the seasons,
producing, protecting, fostering, and maturing, the boun-
ties of the earth.  Or he is a malevolent spirit, capable
of extinguishing the hopes of the year.
  These facts, resting on abundant and conclusive tes-
timony, demonstrate  satisfactorily, that, in unlettered 
29
nations, the views respecting a God, are derived from
the contemplation of the works of nature.
   Were tradition the only source of the knowledge of a
God, it would give  to him,  necessarily, his attributes
and his character.   In that case, the God of the north
would  resemble, in his disposition and qualities, the God
of the  south, the God of'the mountains would differ but
slightly from the God of the plains and the valleys; and
the God of the sea coast and of the  interior would be
the same.   In fact, the God  of every region and people
would  be alike, the attributes and general character be-
ing drawn from those of the God of Noah, their common
prototype.
   But so far is this from being the case, that the God of
every unlettered nation is nothing else than a Being pos-
sessing, in  the highest degree, those attributes and qual-
ities which the inhabitants are enabled to discover in
the works of creation.  He is the Beau ideal, formed
by a concentrated abstract of those attributes.   Nor is
it possible to communicate to them, by  language, the
knowledge of a God  of any other description.  Make
the attempt,  and you will find it to be fruitless.  You
will address  them in  sounds which are to them mean-
ingless, because they can form no conception of the
thing you would signify by them.   You  speak to them
literally in an unknown tongue.
   But describe to them  your God  by demonstrating his
attributes as they are manifested in nature around them,
and you render him intelligible to  them.  They know
something of a  storm, a  whirlwind, an  earthquake, a
thunder-cloud, of fire, of water, of the sun, and of the
moon.   Represent him  as the God of either of these, 
                         30
 and they will understand you.   You  furnish them with
 a solid tangible basis on which their minds can rest and
 act  But to construct such a basis out of words is not
 possible.
   Constituted as we are, words alone can teach us no-
 thing beyond what  we  may  derive from inarticulate
 sounds, or from the terms  of a foreign  tongue which
 we have never learnt.  To "render language, in the ab-
 stract, a medium  of  instruction, the Deity would have
 to change miraculously  the human intellect, if not the
 entire relation of things.
   Without such a change, with suitable  reverence do I
 make the assertion, he could not  communicate to man
 a knowledge of himself in mere words.  If not inter-
 preted by known objects, revelation would be unintelligi-
ble.  Hence, to such objects the  language  of revela-
 tion always  refers.   And  hence revelation  is uni-    ]
 formly made to man in  the language he understands.    )
 Were it made to him in any other, it would be made  in
 vain.   It would, indeed, be  no revelation,  because it
 would disclose nothing.   If made in the Arabic tongue,   ■!
 to an individual who understands only  the English, it    ,
 will not enlighten him.   Yet, as well might  it be made
 to him in a foreign and unknown  language, as in newly    \
fabricated words  purporting to belong  to his mother-
 tongue, but having no root in that tongue, nor any re-
 ference to objects already designated in it.  Such words    j
 would constitute essentially a language unknown.  To
 regard, them,  therefore,  as the medium  of revelation,   i
 manifests an entire ignorance of both the origin, object,
 and powers of language.
   To render theology,  then,  a rational science,  com- 
                        31
manding at once the approbation of the intellect and
the homage of the heart, the  lights  of nature and the
truths of revelation must be made to unite and fortify
each other.
   Inquire of our most intelligent missionaries who have
been engaged in the work  of propagating the gospel a-
mong the aborigines of our country.  They will confi-
dently tell you, that when they address the savage mind
in the  mere  language of written revelation, they are
not understood.   To render themselves intelligible, and
to produce an effect, they are compelled to have recourse
to the Book of ndure, and teach a knowledge of God
through the medium of his works, as interpreters of  the
Holy Scriptures.   So empty and unavailing—or, if I
may be permitted to quote  again my favourite poet, Msc
stale, flat, and unprofitable1' is mere nominalism.
   An  attempt is made to show, on metaphysical princi
pies, that,  from its nature and  capacities,  the human
mind cannot, without the aid of divine revelation, arrive
at a knowledge  of either the creation  ( j )  of the uni-
verse, or of the being of a God.   It  possesses,  we are
told, no knowledge of any  kind, except what it receives
through the external senses.   But it has never witness-
 ed the work of creation going forward, nor has it any
 sense  to take  immediate  cognizance of spiritual sab-
 stance.   Of such  substance, therefore, it can have no
 knowledge, except what it receives through the medium
of language.   But God is spiritual.   Of him, therefore^
 it can know nothing,  except by the language of revela-
 tion proceeding from himself.
   This is an effort to teach  science by means of a syl-
 logism.  Let us analyse it and see whether its element*
 be sound. 
                        -32
  The position we are about to examine is general.  If,
then, it be true, it is radically and universally so, and no
fact can be adduced in direct contradiction of it.   If, on
the contrary, not only one, but many such  facts can be
cited, then it  is unsound in its principles, and its advo-
cates must abandon it.
  In substance, this position  is, that the human mind
cannot be led to a belief in the  existence of any being
or event,  except immediately through the channel of
someone  of the external senses.   !t must either see,
or hear, or taste, or smell, or feel that being or event, or
else remain for ever ignorant of it.
  Tnis proposition must be received as a problem rath-
er than as a theorem.  And if 1 am not mistaken, it will
bcfonnd,on examination,  to be built on a view of intel
lectual philosophy  peculiarly  defective.  It takes from
man the exercise and the fruit of his reflective powers,
aiidreduces him to the  humble rank of a were being of
sense.  It denies  him at once the  power and the privi-
lege of adopting any  belief, as a mailer of  reason.   In
fact, it robs him of his reason altogether, making him a
mere m.-wad in intellect—a  creature of j)nmtive per-
ception and nothing more.
  That the elements, or raw materials of all our know-
ledge enter the mind through the channels of the exter-
nal senses cannot be denied.   But humble indeed would
be our intellectual  rank, if we had not the power of as-
sorting and combining  those  materials, and  weaving
tlictn into the web of science  or history, eloquence or
song.  Were this power denied  us, where would be our
philosophers, our statesmen, our orators, our mathemati-
cians, our painters, our  poets,,our sculptors, and our ar 
33
 chitects? Where, in fact, would be every monument of
 genius and intellect, which constitutes, at present, our
 glory  and our pride ?  I answer, that, in the case suppos-
 ed,  those monuments would have no  more existence
 among its, than they have among the herds of our pas-
 tures, or the flocks of our folds.  To a condition thus
 barren and degraded  would man be reduced, were the
 position I am examining founded in truth.
   But, thanks to him who formed us as we are, it is not
 thus founded.  Man  is not a being of sense alone, but
 of reason also, as  a higher power, to the operations of
 which our senses  are tributary.
   In the process of reasoning, by which I mean the dis-
 ciplined exercise of the reflecting faculties, we discover
 many things,  and  are led  to a belief in  the existence of
 many things, of which our senses are incapable of giv-
 ing  us primitive  information.  Such,  indeed,  are  the
 very object and end of our power to reason.
   Could sense alone communicate to us every thing re-
 quisite to be  known,  reason  would be useless.   The
 function of this power is to take up the process  of in-
 quiry  where sense leaves it, and cautiously proceed
 from the known to the unknown—from  simple  percep-
 tion, to the most splendid results of the united exertions
 of the reflecting faculties.
   In pursuing this course, the mind is oftentimes  led
 compulsively to a  belief in the existence and operation
 of beings or agents, not from any primitive perception
 of them,  but from  witnessing  their effects.  So true is
 this, and so irresistable is the propensity of the mind to
 endeavour to ascend from effects to causes, that perhaps
•mankind at large believe  in the existence  of as  manv
                         F 
34
agents not cognizable to their senses, as they do of those
that are.  The ignorant believe in'many more.   In  all
parts of the world, and in every state of society, a dread
of invisible agency haunts the uninformed.
   From a thorough investigation of this subject, it might
be made distinctly to appear, that, far from being disin-
clined to  a belief in the existence  of invisible beings,
man has a natural and most powerful propensity to that
effect—a  propensity which makes as really a part of
himself, as does a sentiment of hope, a taste for music,
or a love of colours.  From this source  arises, as  will
hereafter more conclusively appear, an immense propor-
tion of the superstition of the world.
   Of the sentiment here advanced, illustration and proof
may be abundantly adduced from various departments
of natural science.
   The medical world believes in the existence of a  pe-
culiar poison called marsh miasma.  Yet by none of
our senses is this substance perceived.  Its effects alone,
in the production of disease, testify to its existence.
   The same may be said  of the deleterious  agents pro-
ductive of influenza, measles, scarlatina, yellow fever,  '
pestis vera, and every other epidemic disease.   Physi-
cians believe in the existence  of them all,  and yet  are
they cognizable to none of our senses.  From their ef-
fects alone do we derive our knowledge of them.  Nor
do we ask for the aid of revelation on the subject.
   Through no other channel do we arrive at a knowl-   i
edge of the existence and  influence of gravitation, elec-   1
tricity, magnetism, caloric, and even the principle of   I
vitality itself.  We have no sense to take immediate cog-  ,
nizance of those subtle agents.   We simply witness, in 
35
nature around  us, their uniform effects.   That  these
effects must have causes, we are compelled by the con-
stitution of  our intellect to believe; for man is  essen-
tially inclined to researches in causality.  We inquire
after  those  causes,  but not being able to find  them
among visibly, agents, we conceive of them as invisibk6y
and attach to them for their designation the foregoing
names.
   Here is no revelation; nor is any requisite.  Here is
no primitive inventi/m  of names, to serve as means to
conduct us  to a knowledge of substances or things, to
which they  are to be afterwards  attached  as their  ap-
pellatives.
   A  system of nominalism like this, could the human
mind be led to the pursuit of such a fantasy, would be a
gross perversion  of the order of nature.  lb would be
first to conceive of and forma sign,  in the expectation
of finding  a suitable thing to be represented by it—ta
shape, in  imagination,  a shadow of a given figure  and
dimension,  and then look for a substance calculated to
produce it   It would  resemble  not a little the whimsi-
cal employment of the old batchelor, who amused him-
self by inventing names, and  imaginatively attaching
them, by  the baptismal ceremony,  to  the several chil-
dren  which he expectedjo be bom to him, after his mar-
riage.
   Nor is  revelation  necessary  to give us a knowledge
of any other invisible being, whose operations we wit-
ness    The same process of reasoning, united  to  the
same propeasity to inquire after causes, which leads us
to a belief in the being and agency of invisible material
things, can, with e$ual ease, conduct us to a belief m 
36
the existence of spiritual t* ings.   It is necessary lor us
to ascend but one  step  higher in the scale of inquiry,
and the object is effected, (k)
   In contemplating the  works of  nature, man  discovers
a phenomenon,  for  which,  by  the upmost stretch of
thought, he cannot account, through the influence of any
material agent.  He runs overall the properties of mat-
ter that are known  to him, and finds  them insufficient
for the solution of the difficulty.   Yet the phenomenon
is an effect, and as such, must have a cause.  At once,
llicrefore, he  fancies  a  cause, and immediately adopts it
as  an object of belief.   This cause is  something invisi-
ble—different from matter—possessing higher powers
than matter—placed even beyond the bourne of what its
discoverer means  by the term nature.   He,  therefore,
considers it supernatural, and denominates it spirit.
   In this process of investigation,  the number of spir-
itual beings supposed to be discovered,  will be in the in-
verse ratio of the intelligence of the discoverer.   The
philosopher will find but few,  and they will  be great.
Their  influence  will  be extensive and  their  action
powerful.  They  will be, according to circumstances.
Demigods or Gods.
   On the contrary, the  man  of civilization  who is bu-
ried in  ignorance, the  unlettered barbarian, and the
more uncultivated savage, will find many such beings;
andgthey will be small—limited in their spheres and fee-
ble in their powers.  They will constitute collectively
thatvast tr.be  of invisible  and  supernatural beings.
whose  existence is believed  in  by the ignorant of all
countries, but more especially  of those, in which  sci-
ence is but partially cultivated, or. altogether unknown. 
37
They will be the spirits of the fire, of the flood, of the
lir, of the tempest, of the thunder-cloud, of the water-
spout, of the earthquake,  of the  volcano,  and of such
:)ther phenomena as appear inexplicable to unenlighten-
ed man.   Or they will be the hovering shades of patri-
Dts and ancestors,  overlooking the concerns  of their
country and kindred.
   By pursuing this inquiry to the requisite  extent, wi-
dening progressively the  sphere  of his observations,
generalizing, as  he advances, on  an ampler scale, and
embracing in his view the unbroken uniformity that per-
vades creation, and  the boundless power  and wisdom
that mark tbe movements and economy of the universe—
by proceeding thus,  man arrives at length, at a belief in
the existence of one  Supreme, (I) all-powerful, and all-
wise, the God at once of the philosopher and the christian
If this great first cause  be not as clearly and accu-
rately depicted in all his attributes, as the God  of writ-
ten revelation,he will be much more sublimely and  suit-
ably represented in some of them.
   But I am told that in this chain of nature, which I am
attempting to construct, by which the philosopher is to
climb to the footstool of Deity—to mount "through na-
ture up to nature's God," a link is wanting,  which can
never be supplied, and without which the fabric is not
only defective, but useles.
   This link is the work of  creation.  We are told, Gen.
chap. I ver. 1,  that "In the beginning God created the
heavens and the earth," and it is asserted, that without
such information, we never could have known that they
were created—that  we could have  had no conception
of creation at all; but that  we should have considered 
38
the whole material  universe—the  earth,  the  sun, the
moon, the stars, and all they contain,  either as self-cre-
ated, or as uncreated and eternal.
   It must be acknowledged, that with all the aid revela-
tion affords us,  our views on the subject of creation are
exceedingly dim,  defective,  and  unsatisfactory.   To
conceive of the production of  a universe out of nothing,
is  to carry to its utmost limit  our  idea of omnipotence.
(w) Still, as there is no contradiction implied in the act,
we are compelled, perhaps, to acknowledge, that, in one
sense  of the term, omnipotence can achieve it.
   We are told that the material universe, as exhibited to
our scrutiny, presents us with  no phenomena calculated
to  convince us that creation, i. e.  existing nature, is an
effect, and that  we,  therefore, have  no ground  or in-
ducement to inquire after its cause.  That although we
see before us and around us, an existing, organized, and
well directed universe, we cannot, from the mere con-
templation of it, infer the existence of a producer, an
organizer and a director of that universe.
   When deliberately examined, and analysed with judg-
ment, this proposition has much  more the  appearance of
a puzzle or conundrum,  than of a solid, or even a seri-
ous argument.  While the superficial will deem it in-
genious, the philosopher will  pronounce it the fabrica-
tion of a sciolist.
   On a subject so obscure  and intricate as the present,
nothing  is more easy  than  to   construct  what may
appear like an  argument  in words, and prove exceed-
ingly  difficult to  answer, but which has no  influence,
in fact,  either in strengthening  conviction,  or al-
tering belief—which may captivate, forjjie moment* the 
39
unthinking and the superficial, but makes m impression
on the judicious and discerning.   A production like this
is a genuine sophism; and of this descript on do I con-
sider the position I am examining.   Whether I maybe
able, in the estimation of others, to refute it in words
or not, I feel, as  an  original  sentiment,  satisfactory to
myself, that it is fallacious.   And such sentiment being
in its character instinctive, will,  if I am not mistaken,
take possession of every  one who will dispassionately
and thoroughly investigate the subject.
   No sooner has the human mind, by the easy and  na-
tural process described, arrived at a belief in the  exist-
ence of spiritual beings, and of their superiority to ma-
terial ones, than every thing material, certainly  every
material phenomenon, will be considered by it  an effect.
 Spirit it will regard as occupying the primary and gov-
erning, matter the secondary  and governed rank  in ex-
istence. Whatever of matter, therefore, cannot be belie-
ved to be effected by matter, will be attributed to  spirit.
   That, from the principles which uniformly govern hu*
man inquiry, this will and must be the course of things,
no one can doubt who is at all versed  in the science of
mind.  No  one will  question it who  is observant of
Occurrences that daily  present  themselves.   Stronger
 still, no one will hold it dubitable who is attentive to
the operations of his own intellect.  Spiritual substance
 once conceived  of  and  believed in, becomes immedi-
 ately a source of reference for the solution of all diffi-
 cult problems arising out of the  phenomena exhibited
by matter.     ,
   In contemplating the scheme of the material universe,
even as far  as  it is unfolded to our view, a  belief in 
40
 the mere act of productive creation Tin simp'cr phrase-
 ology,) the calling of all things out of nothing, is not es-
 sential either to our perfect conviction of the being of a
 God, or to awaken in us a sentiment of piety and devo-
 tion.  It is not necessary, therefore, to the defence  and
 establishment of natural religion.
   To effect our purposes, in these respects, all we look
 or wish for is, the  attainment  of the knowledge of a
 Grlat Supreme, endowed  with attributes  worthy of
 adoration.   And this can  be much more  certainly  and
 suitably effected, by solemnly contemplating  the govern-
 ment of the Universe, than by curiously  and hypotkeli-
 cally speculating on the subject of its production.  I de-
 nominate this a matter of hypothesis, not from feelings
 of disrespect towards  the inquiry,  but  because it is
 known to be an unsettled opinion, even among  the most
 learned and pious divines.
   Creation, as interpreted by the followers of Maimoni-
 des,  (n) is exclusively an act or achievement of power;
 and might, therefore, have proceeded as well from  the
power of a malevolent being,  as of a beneficent one.
   But power is not the attribute of God,  which consti-
 tutes the object of acceptable  worship—which culti-
 vates and enkindles the best  affections, and  commands
 the unqualified homage of tbe heart.
   The omnipotence of the Deity, apart from  his other
 perfections, may deeply impress us with awe and admi-
 ration, astonishment and fear.   But these are not the
 elements of vital religion
   Fear alone is a low and ignominious motive of action.
 The offerings to Heaven which it extorts,  are fruitless__
 the forced  and heartless  adulation of a  slave, not  the 
41
 ameliorating and  endearing devotion of the child.   Of
 this latter and only valuable kind of worship, the gen-
 uine elements are  feelings of veneration, gratitude  and
 love.   But they are awakened, and held in  a  state of
 habitual excrtement, not  by  the omnipotence of the
 Deity, but'chiefly by  his wisdom,  goodness, mercy and
 truth..  But, with the mere production of the material
 universe, apart from its organization and  government,
 those attributes have no immediate connexion.  By their
instrumentality the Deity could not produce;  but, as
already stated, by his omnipotence alone.   It  is from
his moral attributes chiefly, that he is an object of wor-
ship—especially  of that worship, which improves our
nature, by cultivating the best affections of the heart
   Admit, if you please, that matter was  not produced,
but that it was coeternal with the director of the  Uni-
verse.   Whether true or false,  the supposition  neither
robs the Deity of a single  attribute, nor detracts from
him, in the  slightest degree, as  an object  of worship.
He still wields and governs and modifies matter  by his
own laws, and at his own pleasure, and,  therefore, re-
tains his omnipotence untouched.   He still  configurates
and endows  it, aud prescribes to it its destinies,  and is
still the benevolent parent and  the bounteous sustainer
of every thing that lives, and the wise and  beneficent
fashioner and controller  of all  that exists.   To  give to
matter its  properties,  and lay it in  subjection to'its
principles and laws, is as  truly the  work  of omnipo-
tence as to produce it.
  Man, therefore,  being dependent on the Deity for all-
he enjoys,  is  necessarily  accountable to him, on  the
ground of his  moral agency, for all he receives.   And
                         G 
42
■ji this accountability, the penalty,  if forfeited, can be
promptly inflicted; for the-puwerto compound, fashion,
and endow,-necessarily presupposes an equal power to
punish,decompound, and destroy.
  Under this  view of his relation  to  the  systematized
Universe, the Deity is as much  an object of  religious
worship, as if he were its  actual produce as well as
its omniscient constructor and beneficent governor.
  But were I  inclined to turn biblical critick, on the oc-
casion, and carry the war into the dominion of my ad-   j
versaries, I would be authorized in  assuring them, that,
on the score of the actual production of substance, there
is as much difficulty and uncertainty in revealed as there
is in natural religion.  On that subject the  Scriptures
iiive no information that can be held conclusive.   Here,
as in many other instances, different interpreters of those
Sacred Wriiirgs, not only construe them differently, but  1
affix to them meanings directly opposite.
   In the Hebrew text of the Old Testament, from which
 alone the true meaning of that  work is  to be derived,   \
the term Bura is used between sixty and seventy times.
(o) But in only one instance,  out of such  multiplied
repetitions,  is it made, either  in the Greek, Latin, or
English versions, to signify  the actual  production of
 substance.   On every other occasion, it  expresses, ac-
 cording to the best translators  and criticks, some modi-
fication of substance already  existing.  And the varie-
 'v of these modifications is not inconsiderable.
   When, according to the English translation,  Moses
 ells  us first, that  God  "created" the  Heaven and  the
 ^arth, he employs  the term Bura; and when  he after-
 r?rds tells  'is that he formed  certain living beings  out 
43
 the existing substance of the earth, the  word he uses is
 precisely the same.
    Wherefore, I beg leave to ask, are interpretation* so
 different, thus affixed to  the same word?   If there be
 for this change any  reason  except the mere opinion of
 the translator, I am altogether unable to discover it, and
 will feel obliged by anyone who will instruct me on the
 subject.
    When it suits one hypothesis, the word Bura signifies
 to produce out of nothing. . When it better suits anoth-
 er, it means to compound, fashion, or modify something
 already produced.   A third  hypothesis gives it a third
 meaning, until, by its  flexibility, ceasing  to have  any
 permanent meaning at all,  it becomes a mere "nose of
 wax,"obedient to the fancy of him who would mould it—
 a perfect cameleon, assuming  the  hue of every notion
 that may be concieved with regard to it.
   Let me entreat  the adversaries  of natural  religion,
 then, to be cautious how  they  attempt to disprove or in
 any way discredit the truth and importance of it, by op-
 posing to it an objection  to which revealed  religion is
 equally liable.
   But, in reality,  when  fairly  considered,  this uncer-
 tainty does not, in the slightest degree, detract from the
 value of any religion, either as a system of moral and
 divine instruction, or as  a  rule of enlightened and practi-
 cal piety.   Be the  question  settled as it may, the Holy
 Scriptures will still continue,  as they are  at  present,
 an unerring guide to Heaven and happiness.
   For I repeat, that, provide d our views and feelings, in
relation to the government of  the universe,  be correct,
our notions respecting its production cannot material- 
                          14
ly affect either our morality and  piety  here,  or felicity
and standing hereafter.  Nor is  this assertion at war   ,
with any fundamental principle or precept of either re-   -
vealed or natural religion.
   Subtle and intricate as this subject is, I indulge the
hope, that, by a fair analysis, it may be yet more clearly
and satisfactorily presented to the mind.
   That nothing can be  self-created, constitutes, in the
abstract, one of the first  and most indubitable points of
human belief—a point in which every one instinctively
acquiesces.
   Added to the force of  this general sentiment,  man
feels a perfect consciousness that he, at least, did not cre-
ate himself.  Besides, he  sees perpetually one genera-
tion proceeding from another, as effects from  their cau-
ses.  Persuaded that his ancestors resembled precisely «
himself and his contemporaries, he feels a conviction
that they also were equally incapable of creating them-.  !
selves.   Their production, then, he is compelled to  con- *
sider as really an effect,  as that  of  his contemporaries
and himself, which he knows to be such.   The cause of
this effect he is solicitous to ascertain, not only from his
constitutional propensity  to  inquire  into  causes, but
from the fact, that, in the present case, a knowledge of
the subject, involving, as  it  does, a correct acquaintance  '
with his own origin, is personally interesting to  him.     ^
   But no material agent  can he find capable of having    '
given existence to the  human race.   This  earth could
not have done it, for it has evidently but a limited and
secondary agency even in  the perpetuation of the race.
Nor could the effect  have  been  produced  by the more
remote and feebler influence of the sun, the moon, or 
46
any of the other celestial bodies.   To the agency, then,
of some invisible and more  powerful being, denomina-
ted  spirit,  . must  the   origin  of man  be  necessari
ly attributed—to the agency of something whose effects
are cognizable,but whose substance is concealed.
   By a similar process of inquiry and  reasoning, appli-
ed to various tribes  of inferior animals, arc we forced
to assign to them  a similar  origin.  Their  existence is
also an effect.   They could  not have  originally produ-
ced themselves.  Neither the earth nor the heavenly bo-
dies could have produced them.   To  invisible and spi-
ritual  agency, therefore, must their origin be lefered.
   Without  the least aid from revelation, then, a belief
in the creation of man  and   other animals can be easily
attained.  This rule applies  alike to. the inhabitants of
the air, the  ocean, and the land.
   Were we to consider this earth only in the light of a
mere insulated mass of brute  matter,  apart from its
structure, connexions, and dependencies, it would puz-
zle us, perhaps, to form any  rational and satisfactory o-
pinion on the  subject of its origin.  Thus viewed, it
would have no more character than a simple original parti
cle of matter, detached from all dependencies and allian-
ces;  and,  from its apparently  inert  and unchanging
condition, might  probably be supposed  to have existed
from eternity  in its present condition.
   But altogether different is the aspect it presents, when
we contemplate it as a component part of an organized
universe, its connexions,  dependencies,  and perfect a-
daptations in  full display before us.  It is then that we
discover in it, and the system to which  it belongs, mani-
festations of design, and evidences of infinite intelligence, 
4(3
  pCwer, and goodness.  It is then  that we recognize, In
  every feature of it,  the traces at once of a builder and
  governor, (p )
    It is a primitive truth, and must, therefore, command  '
  universal assent, that any structure or system of matter.
  which exhibits, in its arrangement, marks of design,  in-
  telligence, and power, is uecessarily an effect. It  is the ef-
  fect or production of the intelligence and power which
  it thus exhibits.  But intelligence and power are  nothing
 but attributes, and presuppose a subject  to  which they
 belong.   This subject,  then, is the creator of the system
 in which they appear.  To predicate of chance, either
 the  manifestations  of  design, or  the  arrangements
 of  system, would be self contradictory.
   By this test, which may be pronounced an infallible
 one, let  us briefly examine the  globe we inhabit,  and
 see whether it be the offspring of  creation or not.         i
   That immense power is concerned in  the economy  of  \
 this earth, is clearly demonstrated by the vastness  of  t
 its  size, multiplied into  the great velocity  of its motion,
 both on its own axis and around the sun; by the tern-   j
 pests that sweep and devastate its  surface; the  earth-
 quakes that convulse and  sometimes shatter its solid
 frame; and the volcanoes; that  burst  occasionally/rom
 its interior.   To these, as giving further manifestations    '
 to the same effect, may be added, the thunder storm and    ■
 the hurricane, the cataract ard  the raging of  the tem-
 pest-beaten  ocean.    These phenomena, I say, are  all
 declaratory of the existence and exercise of stupendous    ^
power.
  That marks of  consummate ivisdom are displayed in
the economy of the earth,  both  as a separate orb, and 
Vi
in its connections with the system to which it belongs,
every view that can be taken of it proclaims.
   When contemplating its exterior, the first thing that
strikes us is its globular form, which, for sundry reasons,
is thp best that infinite wisdom could  bestow on it, as
being most perfectly  suited to  its  present economy.
By giving to it greater compactness and strength, it fits
it better than  any  other  figure,  to  move swiftly and
equably through space, and to sustain, without derange-
ment, the stupendous velocity  of the motion it per-
forms.
   Were it bounded  by  any  other than  circular lines,
it would receive with much less uniformity,than it does,
the rays of the sun;  and, under  no other figure, would
all the parts of its  surface be equidistant from its cen-
tre.   In this  state  of things, the most projecting por-
tions would be subject to a much more intense  degree
of cold, and a  greater inequality in the density and pres-
sure of the atmosphere, than our loftiest  mountains, or
most frozen regions, at present  experience.  A  much
larger portion of it, therefore, would  be  uninhabitable
by man, than is the case under its existing condition and
figure.
   In the  compound motion of  our globe, on its own
axis, and around the sun, in the course of the ecliptic,
we behold  a further manifestation of consummate wis-
dom, in relation  to its reception  of heat and light, and
its retention of its place in  the  solar system.   For the
attainment of  these  ends, so essential  in the economy
of sublunary  things, no  other expedient  which omnis-
cience  could  devise, would be equal  to  that which it
has already instituted. 
                          48
   Check the diurnal motion of the earth  on its  own
  ixi?. and only half of  its surface will  be cheered  and
 warmed by the solar beams, the other half remaining
 in  endless  darkness, and  perpetual  winter.  In   this
 state of things, each portion would suffer,  perhaps,  in
 an equal degree,   While that  next the  sun would be
 scorched and dazzled by an  excess of eternal heat  and
 light, the opposite side would be  no less injuriously af-
 fected by a monotonous  duration of cheerless  gloom
 "ind pinching cold.
   Arrest the earth in  its ecliptic journey  around  the
 sun, and the vicissitudes  of the  seasons, with all  the
 pleasures and advantages resulting from them, will   im-
 mediately cease.   As respects  the present vegetable
 kingdom, there will be no longer either  winter or sum-
 mer, seed-time  or harvest,  but  a condition  of things
 equally nameless and lifeless will succeed.
  In relation to us, the  entire economy of  nature will
 be changed, and our globe must cither  be stocked with
 new races of inhabitants, both vegetable and animal
 adapted  in their constitutions to its  new  condition, or
 converted into a dreary, tenantless waste.
  Nor will the  disaster resulting from this altered state
 of sublunary creation terminate here.   The centrifugal
influence of the earth's motion in its orbit being destroy-
ed, we shall fall under the entire control of gravitation,
which will hurry us into the fiery vortex of the sun!
To what extent  this catastrophe  might affect the bal- .
ance and economy of the solar  system, or even of the
universe itself, I leave to mathematicians  and astrono-
mers to compute.
  A distinguished  favorite of the  Muses, whose pene- 
                            49
  (ration, extent of research, and varied attainments, as
 <i philosopher, were scarcely inferior to his  genius, as a
  poet, has thus expressed his sentiments on the subject.
     " From nature's chain whatever link you strike,
     " Tenth or ten-thousandth, breaks the chain alike
     " And if each system in gradation roll
     *' Alike essential to the amazing whole,
     " The least confusion but in one,not all
     " That system only, but the whole must fall.
     li Let earth unbalanced from her orbit fly,
     " Planets and suns rush lawless through the sky,
     " Let ruling angels from their spheres be hurl'd,
     " Being on being crlish'd, and world on world;
     " Heaven's whole foundations to their centre nod,
     " And Nature trembles to the throne of God."
    The division of the earth into dry land  and ocean,
 is another arrangement equally wise, and  suited to its
 general purposes  in creation.   Without this  it could not
 receive, in rains,  and  dews, and other modes of precipi-
 tation from the heavens, the amount  of waters,  which,
 as a residence for  animals  and vegetables, it requires.
   In contemplating the general  provisions of nature
 for  giving to  the various portions  of our  globe  the
 moisture they require,  we are impressed with sentiments
 of  admiration and delight, at  discovering one  of the
 most  exquisite  systems  of design  and  adaptation,
 that wisdom can frame,  or imagination conceive.
   In the fathomless ocean  we behold an inexhaustible
 reservoir  of supply; in the atmosphere, the electrical
 fluid, and the  sunbeams,  machinery for  elevating the
 waters  in a vaporous  condition;  in currents of wind,
 the  provision  for  waftinjg them to  distant regions; in
the  varied temperature of the  atmosphere in  different
places,  aided again  by the action of the electric fluid,
and  the attraction  of mountains and  hills, the means of
 -ondensing them into cloudy, and precipitating them to
                            H 
                         30
 the earth in rains,  nails,  and  snows; in springs and
 rivulets  and rivers, their escape from the earth after
 having ministered to the wants of the animal and vege-
 table kingdoms;  and in the great inclined plain extend-
 ing from the loftiest to  the lowest situations  on the
 earth's surface, the mechanism for conducting them back
 to the ocean.
   Remove but one of these requisites, and the  earth
 will be no longer properly  watered.  Take away the
 ocean, the supply will be cut off; the atmosphere, the
 waters will be elevated in vapour no more;  the winds,
 they will not be wafted to  remote  regions, that every
 place may receive them  in requisite abundance; the
"variety in the temperature of the atmosphere, the elec-
 tric fluid, and the attraction  of elevated points  of land,
 they will not be condensed  into clouds,  and precipita-
 ted in rain or any other form; the  elevation of the
 ground into hills and mountains, and they will not be re-
 conveyed to the the ocean, but, stagnating every where,
 will cover the earth with lakes and morasses, and ren-
 der it uninhabitable.
   Marks of wisdom, worthy of  a God, we also discov-
 er in the perfect and exclusive adaptation  of the inhab-
 itants of the earth to the different elements  in which
 they reside.
   Fish,  exquisitely fitted to respire, live, and  act in
 the waters, become immediately inefficient and  die  if
 removed  to the land.
   From their structure, powers, and modes of life
 quadrupeds are destined and peculiarly qualified, to re-
 side on dry land; while, from their configuration and
 lightness, the strength and durability of particular mus- 
51
cles, and their covering  and  enginery of feathers, the
adaptation of birds to be inhabitants of the atmosphere,
is equally perfect.
   Connected with the  feathered  race, are  other im-
portant and beautiful aptitudes,  according as  they are
aquatic or attached to dry land, swimmers or waders,
birds of prey,  or dependent on  other modes of sub-
sistence.
   The aptitudes, moreover, between the appetites, pro-
pensities, and different  structures  of  animals, whether
quadrupeds or birds, are striking and beautiful.
   From the swiftness of their movement, the  peculiar
form of their teeth and  claws,  and the power of the
muscles, that bring them into action, beasts  of prey,
that delight in  blood,  are admirably qualified for the
business of slaughter.   Of this  we have exemplifica?
tions sufficiently striking in the lion and the tiger.
   Animals  again  that crop the pasture, or  subsist on
any other description of vegetable food,  are equally fit-
ted, in structure and  intellect, for their destined modes
of life.  Examples of this we have in the horse, the ox,
the goat, and the sheep.
   Give to the ox the taste and propensities of the lion,
and he  will die of hunger, from a radical disqualifica-
tion, in form and action,  to  arrest other animals and
make them his food.   Transfer to the lion the taste and
other mental qualities of the ox,  and the issue to him
will be equally  fatal. Admit that he were even to crop
and swallow grass, his  digestive  organs would  prove
unfit to convert it into nourishment; in consequence of
which, it would prove deleterious in its action on his
system.  He would  die, therefore,  from the  effects of
flfisease, superadded  to a deficiency Of suitable aliment. 
                         52
   Implant in climbing quadrupeds  the  propensity  of
uirds to fly from tree to tree, without bestowing on them
also  the  form,  feathers,  and  muscular  powers, to  ftfc
them for the  light, and they will perish  in the attempt.
And give to land birds a disposition to trust themselves.
to the water, without confering on them the requisite
aptitudes for that element,  and they will inevitably be
drowned.
   In relation to  his capabilities to sustain himself, as
lord of creation on earth,  man also  exhibits  a  perfect
aptitude  between his corporeal and  intellectual qualifii
cations.   In confirmation  of this, change either of them,
and he is no longer fitted for his august situation.
   His intellect remaining as it now is, give to him the
corporeal fabric of the  horse, and, abundant  as ife  is in
animal vigour, he will be unable to accomplish any one
of his schemes calculated for the attainment of medita-
ted empire.   Or, his structure  of body  remaining un-
altered, exchange his intellect for that of the ox,  and-,
with all his corporeal powers to execute,  he will medi-
tate schemes of ambition  no more.
   But, with the intellect he now possesses to conceive,
and his hand and general  structure of body to carry
into effect his projects of rule, he is exquisitely fitted  to
.stand at the head of  sublunary creation.
   Had I  time and capability to analyse thus the organi-
zed universe, consisting as it does of matter and spirit
A could, satisfactorily demonstrate, that it is one unbro-
ken   system  of  aptitudes—that  it  is  characterised
throughout by marks of design, intelligence and power
—that each  of its parts is  specifically  adapted  to the
opndition of the  others, and that, in all their qualities. 
its numerous  subdivisions are  in  harmony with the
whole.
  Nor are goodness and benevolence less strikingly and
extensively manifested, in the arrangement and economj
of this mighty fabric  Examine it throughout,  compo-
sed as it is of suns  and systems, beyond the powers of
man to enumerate, with their myriads on myriads of in-
tellectual and immortal  inhabitants, swelling to the ve-
ry verge of infinity  itself, and, notwithstanding occa-
sional examples  of  suffering,  pleasure  and happiness
will be found to preponderate  over misery and  pain, in
a degree commensurate with the illimitable scheme of
things through  which they are diffused.  And  all this
appears conclusively,  to be the  effect  of provisions in-
tended for the purpose—Provisions, in  the preparation
of which we perceive as clearly the  presence and opera-
tion of intelligence, benevolence and power, and in the
contemplation of which we are led  as  irresistibly to a
belief in the existence and agency of an intelligent,
good, and powerful cause, as if the knowledge of it had
been revealed to us by a voice from Heaven.
  The unity of God we  satisfactorily infer from the
unity of design and harmony of movement in the organ-
ized  universe.  Nor is  a knowledge of his attribute of
mercy denied us.  To him we  naturally ascribe, in in-
finity, whatever of  good, amiable, or praiseworthy, we
feel in ourselves, or discover in  any of the productions
of nature.
  But our consciousness testifies to our own disposition
to clemency, our  conscience applauds  whatever act we
perform in  obedience to it, the manifestation  of it in
others commands our approbation, and we witness with 
                         51
abhorrence  acts  that proceed  from an  opposite sentf-
ment.  To the Deity, therefore,  we look  as  the foun-
tain  of mercy, whose  overflowing  and  innumerablft
streams, mingle and co-operate <vith those of his other
attributes, in carrying  healing and  happiness to every
portion of the universe he has formed.
  Such is the evidence, which, in the time allotted me
for this address, I have been able  to collect, from a  has-
ty survey of the globe we  inhabit, and the  system to
which it belongs, to establish thebelief, that they exhibit
themselves unequivocally, not as the offspring of acci-
dent, but design.                                     J
  Is it possible, then, for any one, lettered or unlette^l
ed, civilized or savage,  to look abroad  through nature
thus harmoniously  ordered, with an eye of intelligence,
and a disposition to observe,  and doubt that it ia the ef-
fect of a cause boundless in  the attributes it so irresi*- J
                                                    • i
tibly  manifests?   Can anyone do this, and still declare
that without the  aid of  a revelation in words, man is
unable to read and  understand the lessons of a God in
the volume of his works?
   Has the Deity, notwithstanding tbe infinity of all his
perfections, operated in a manner so  feeble and unskil-
ful, that he  is obliged to  label  the productions of his
hand, to render their origin and  intention intelligible?
   "This is the man, and this  the horse," appeared  over
the work of a sign-daubing painter,  to  distinguish his
representation of the  biped from the quadruped.   But
not so with the great and accomplished artist.   His pro-
ductions stand self-interpret ed.   Not so, in a particular
manner, with the divine artist, whose pencil has embla-
zoned the canvass of creation,  and whose works speak 
                         55
a language as audible, and intelligible, and impressive
as his words.
   I repeat, it is a primitive truth, which no one will ven-
ture to doubt or contradict, that whatever material stmc-
ture or system manifests in its combinations, design and
intelligence, is essentially an effect.  It is the work of
some intelligent agent, operating  to a foreseen and pre-
meditated end; and such is the decision of the common
sense of the  world.  A contrary decision, could such
be formed, would be preposterous.
   Let the  structure examined be a steam-engine or a
watch.   The adaptation of part to part being discover-
ed, the aptitude of each to accomplish some  design be-
ing recognized, and the effect of the whole combination
being perceived, in the  certain attainment of  the object
proposed, who  will  cherish even a  momentary doubt,
that the machine is an effect—the work  of an able and
disciplined mechanician?   Or who will venture to con-
tend, that a revealed account of it is necessary to make
known to the enlightened examiner of it, its origin and
uses?  He who, under these circumstances,  could at-
tempt to play the sceptic,  would subject himself to the
suspicion of a deranged intellect.
   But, in grandeur  of design, elegance  of workman-
ship, adaptation of  parts, and perfection of the whole,
what is the structure of any apparatus of human inven-
tion, compared to   that  of the  universe  of  the Most
High?—A machine so  magnificent and harmonious,
so perfect and durable,that without deterioration or error
in movement, repair of materials or  improvement of
plan, arid without the slightest interference of  the hand
that erected it, it will continae  in play, the admiration 
!>G
 and delight  of intelligent existence,  while being shall
 endure, unless its constructor shall otherwise direct.
    Shall man form a time-piece, then, and be recognized
 in his work, without revelation?   And  shall  the Deity
 construct the orrery of creation,  and still be concealed?!
 —still require an interpretation in words  to be  affixed
 to his labours?  Sh ill he mark with his  footsteps the
 dry-land and the  flood,  and  scepticism have the har-
 dihood to endeavour to efface them?   Or shall he write
 his name in  the  Heavens in stellar characters, and
 man  presumptuously deny it  a place there; or attempt ;
 to obscure it by the mist of sophistry?
   Let no one degrade himsilf or scandalize his God, by
 propagating  such sentiments,  or engaging in such ef-
 forts.   For he that cannot read  the existence and ope-
 rations of a Deity  in the fabric  of the universe, ani^
 in the  admirable structure of his own system, or feel
 them in the exercise of his own mind, proclaims himself <
 defective  either in body or in intellect.
   When all nature addresses man  in the same language
 —through the brightness of the day, the  glimmerings
 of the night, and the grateful vicissitudes from the one
 to the  other—through the  birds whose  home  is in the
 air, the beasts that  select  the forest for their dwelling,
 and the fishes that find their food  and their pastime in
 the flood—through  the waves that roll, the streams that J
 run, and the exhalations  that  rise and  mantle in the 1
 heavens—through the winds that blow, the clouds that
 threaten,  the lightnings  that  glare,  and  the rains
that fall—through the dry-land  and the morass, the val-
 ley, the champain and the  elevated ground, and even '4
through  his  own  form  and his  own feeling__wh^n 

to each of these objects nature has given a tongue, and
proclaimed with them all the  existence, the attributes,
and the operations of a God, it is monstrous that  man,
whom she thus addresses,  should doubt or deny—that
he should insultingly demand  a  revelation  in wo-ds, to
make amends for the insufficiency of the works of cre-
ation—that he should virtually say to his divine creator,
" The universe you have formed  is so obscure, in design,
and so defective in execution, that it furnishes no knowl«
edge of its author; make yourself known, therefore, in
articulate sounds, or I shall nota be able to recognize
your existence."
   Conduct, I say, like this, is in its nature  monstrous,
and in its tendency offensive to the Majesty of Heaven,
beyond what any language of mine can express.   Nor
is it much less so to allege, that although the Deity has
thus deeply and iixtelibly imprinted on the tablet of the
universe himself and his attributes, he  has done  it  in
vain, in consequence of having  formed  man, his  chef
d? oeuvre on earth, with such defects and unfitnesses, that
he is unable to perceive them, and to  profit by the dis-
covery.
  Such, gentlemen, are my views of the general  char-
acter of the religion of nature, and  such the foundation
on which to me it appears to rest—a foundation, as  wide
as the limits, and as stable  as the everlasting  fabric of
creation, and whose soundness  neither the demurs  of
the sceptic,  the denunciations of the fanatick, nor the
trick of the sophist can ever affect.
  A comparison between the aggregate  merits of natu-
ral and revealed  religion, it is neither my province nor
my purpose to institute.  That they are both excellent. 
both necessary, and, as far as the former extends, per-
fectly coincident  with  each  other, in  the views they
disclose, and the rules of practice they inculcate, cannot
be denied, because they are equally of divine authority.
Let them  both, therefore, be cultivated, as sending forth
reciprocally the lights that are  required, and operating \
as salutary checks on each other.
   When the everlasting  welfare of  man is at  stake,
there can  be neither  too many lamps  to direct his foot-
Steps, too many correctives of  his  erring propensities,
nor too many incentives to  urge  him to his duty.  If
he attain  his end by all the aids which the books of na-
ture and of written  revelation  conjointly  afford, he is
amply rewarded for his trouble  and toil  in the examina-
tion of both.   I  shall only add, that  if revealed reli-
gion be most abundant in practical precepts, the religion j
of nature is  the most 'sublime, arid  by far the richest in
philosophical truths.   The former, being never inten-il
ded by its divine  author  as a  fountain of science, sim-
ply instructs us in the road to  Heaven, while the latter
enlightens and enchants us by the way.  Hence the one !
is better adapted  to mankind at  large,  while the other
has been  denominated the religion of philosophers.
   In closing this address, which the extent of my sub-
ject has inordinately protracted,  permit me earnestly to
recommend toyou, while you  cultivate  with assiduity
the religion of nature, not to  jeopardize your own wel-
fare, nor give cause of offence  to pious  worshippers, by a
wilful  neglect  of the rites  and ceremonies of the relfc
gion of the Bible.
END OF  MEMOIR  I 
NOTES TO  MEMOIR I.
                  Note (a) page  10.
   The  truly  enlightened  and  liberal, who  always
 prefer the substance to the shadow, the thing done to the
 manner of doing it, are friendly, in the abstract, both to
 religion and religious worship.   But they are neither in-
 tolerant sectarians, nor stickling formalists.  Provided
 offerings of devotion  be the incense  of the litart, they
 consider them likely to be  accepted, attaching but little
 weight to the  circumstances of time, place, or form.
   Hence physicians professing no very decided prefer-
 ence for any one of those sects in religion, whose tenets
 accord with the word  and  will of God, as made known
 in the Holy Scriptures and the  Book of creation, all
 sects are inclined to disown and often to denounce them.
 For it is to  be lamented, that "he who is not  in all
 things with us is against us" is too generally the disor-
 ganizing language of sectarianism.
   Physicians  thoroughly  educated and extensively ver-
 sed in the science of nature, being liberal and catholic,
 in reference to religion, friendly to every denomination
 of christians,  but particularly  wedded, perhaps* to none,
 are too frequently slandered by all denominations, and
pronounced abettors of. irreligion and  infidelity.
   Such is the iniquitous character of party spirit, whe-
 ther it relate to the affairs of this world, or those of the
next.   Neutrality  being its  detestation is always de*
nounced by it.
                 Note (b)  page 13.
  Those who, in the sickening  cant  of the times, de-
claim against nature, as the  author of crime, are  not on-
ly violators of truth, but slanderers of the Deity. 
                         60

   Nature perverted, corrupted,  and abused, leads to the
 perpetration of crime.  But  the same  thing is true of   :
 the abuses  of religion.  Nature, in her purity, is the
 only  true representative of  her  immaculate Author.. 1
 Whatever accusations, therefore, are preferred against   ■
 the former, are, at the same time, virtually preferred
 against the latter.
                  Note (c) page 14
   I know it is contended that  the offering of expiatory   ;
 sacrifices is a mode of worship necessarily  of divine or-   :
 igin, and that it could  not have  been instituted, on any
 views of the Deity derived from nature.
   That this opinion is fallacious,  might  be clearly de-   J
 monstrated, were time  afforded me to subject it to analy-
 sis.                                                   '*
   The practice of men, in  all  countries  and ages, in
 their relations both to Heaven and to each  other, satis-
 factorily evinces, that  a belief in the fitness and efficacy
 of oblations to avert resentment, and secure an exemp-
 tion from dreaded punishment,  is an original sentiment  j
 of the human mind.  It would seem to be rather  an in-
 stinctive feeling, than an impression  derived from ex?. i
ternal sources,                                         "
   On the termination of a deadly feud, the native chiefs
 of Scotland, as  well as those  of other nations, have
been in the uniform habit of exchanging presents.
   On the close of a sanguinary struggle  in arms, the
Indian presents to him who was lately his  adversary,
the pipe of peace, or bestows on him some more valua-
ble present.
   By civilised and polished individuals, conciliatory en-
tertainments  are  often  given, and,  on  sheathing  the
sword, the courts or leaders  of powerful  nations, do
homage to each other by mutual and  costly largesses.
Nor is,it uncommon for the weaker party to purchase a
peace by valuable concessions.
   From these practices, so universal among  men, the
 attempt to propitiate the Deity by precious offerings, k> 
bl
   a transition as natural as it is  slight.   Mankind juugt
   of him as they do of each  other;  and attempt to propi-
   tiate him, as they would themselves be propitiated.
     Nor does this  consideration lessen, in  the  smallest
   degree, the  worth of sacrifices.  On the  contrary, it
   represents them as the more  estimable  and important.
   When the precepts which we receive,  as  the  written
   commands of God, harmonize with the constitution and
( ^native feelings of our minds, the evidence of their truth
  "i& the stronger, and a  punctual obedience  to them  the
.   better secured.  It is not  true that divine injunctions
   are valuable in proportion as they run counter to native
   feeling.

                     Note (d) page  14.
     The morality of nature, when correctly understood,
   and faithfully interpreted,  is as pure  and  practical as
   that of  revelation.  If  pagan nations have not fully
   profited by it, neither have they by physical knowledge.
     The defect, then, is nqt in nature, but in themselves.
   They  have misinterpreted nature and  committed  ex-
   cesses on her.  And so do christians misinterpret written
   revelation, extorting from it moral and theological dog-
   mas, which it does not authorize.  They,  moreover, push
   it to points of great extravagance,  and  by that means,
   vitiate certain practices  which are in themselves right;
   and which,  when  duly regulated,  revelation  counte-
   nances.
     In these respects, nature and revelation  are  equally
   abused.   But, from the  abuse of an institution, let no
   one decry and undervalue  its use.   On  this principle,
   revealed religion would suffer more than  any human es-
   tablishment.  For the abuses it  has sustained and is
   daily sustaining, are beyond  those presented  to man
   from any other quarter.
     All the author contends for is, that, as far as she goes.
   nature, correctly interpreted,  leads  to truth, to virtue,
   to piety, and to happiness.   To deny this, is to slander 
  the Deity.   It is to call his works imperfect, and virtu-
  ally assert, that he has hung out,in nature, artful decoys
  to allure men to vice.
                   Note (e) page 17.
   " Unspeakable'' because the Deity is, in every thing,
 infinite, and language, which  is of hum tn  invention,
 finite in its powers.  Had he  formed a language infi-
 nite in expression, by which to communicate a  knowl-
 edge of himself,  it would have been unintelligible to
 the limited capacity of  man.
   He has, therefore, condescended to speak to man in
 his own language, as  the  only medium through which
 he could be understood.
  •To represent  human language as equal in compass
 and force of  expression to the works of nature, would
 foe to  place  man  on a  level with the Deity.   Let the
 fanatickwho can neither  read  nor prize the volume of
 creation^ beware of such presumption.

                  Note (f) page 18.
   To realize this view of things, in all the sublimity  li
 and grandeur that belong to it, let any  one, capable of  ■
 reflection and accustomed to analysis,  contemplate the   ]
 starry  heavens, when the atmosphere is serene, and no
 clonds interpose  to obstruct  his vision, or  limit hi«
 ^t'ospect.
   Having numbered  the  magnificent array of  fixed
 stars, that present themselves to the naked eye, let  him
 remember, that each of  them is a central  sun, with a
 system of secondary orbs, and sub-systems of satellites,
 revolving around it; many, perhaps most, of them, im-
 measurably larger  than this  earth; and  that the whole
 of them are inhabited by rational, accountable, and im-
 mortal beings.
   Let him further  recollect, that all he beholds, vast and
 over a helming as the scope of it may  appear to  him,
 occupies but a speck in the organized universe—a mere
point in the vestibule of  the temple of creation.   That   . 
63
the  telescope,  even with  its present limited  powers*,
brings to view millions of other central suns, surrounded
by their systems of peopled worlds, and that there still
exist in the immensity of space, undescried by the eye
of astronomy, millions on millions of other similar suns
and systems, whose very light, with all the inconceiva-
ble velocity of its motion, has not,  since the period of
their location in the spheres where  they revolve, had
time to reach this distant planet   Add to this, that from
the centre to the boundaries of peopled space, unbroken
order, harmony, and happiness every where prevail.
   Having exhausted his powers, in thus attempting to
compass the physical  and  moral  magnificence of the
universe, let the  individual  declare, whether  human
language can express, or  imagination  conceive, one
millionth part of  the  power, wisdom, and goodness
of Him, who organized and sustains and governs the
whole I!
   If they cannot, then am I  indubitably privileged to
allege, that the manifestations of some of the attributes
of God, through the revelation of his works,  is more
magnificent  and  impressive than that by written  reve-
lation.
   There is yet another point of view, in which the re-
ligion of nature presents us  with a scheme  of things
unspeakably magnificent.   Not  confined  to  any  pari
of peopled space, it  is  the  common inheritance of the
whole of it.
   The  universe of matter, denominated by  the pious
and  eloquent Dr. Young  "The elder Scripture"  con-
stitutes a volume intended to be read by the universe of
mind.
   To the erring  inhabitants  of this earth, a  written
revelation was necessary.  But to us alone it is proba-
bly confined.
   To the intelligent beings attached  to the innumerable
millions  of orbs, that  roll  through space, from  its  cen
tre to its confines, the  book of  creation, presented in 
                         d4

 the hand-writing of Deity himself, which nothing can -
 interpolate, counterfeit^ or change, may be alone suffi-
 cient to communicate to them the requisite knowledge
 of its divine author, and  to  instruct them in their wor-
 ship of him.
   A  peculiar written revelation  is suited only to a pe-
 culiar state of things.  That state is  probably limited
 to this earth.   But the revelation of nature,  possessed
 of universal aptitudes, is  calculated for the instruction
 and amelioration of intellect wherever it exists.
   This catholic, delightful, and magnificent conception
 of things, is calculated to render us not only more en-
 lightened  and  liberal philosophers,  but  more pious,
 grateful,  and  adoring  worshippers—more  intelligent
 men, and better christians.

                  Note (g)  page 21.
   It has been alleged by many writers,  that the disper-
 sion of the Jews has  been the  means  of diffusing the
 knowledge  of a God  among the inhabitants of  our
 globe.
„  That that people communicated to  the nations in
 which they found asylums, some information respecting
 the God of Israel,  is no doubt  true.   But it is equally
 so, that, in all their  wanderings, they did not  find a
 community or tribe of the human family,  which did not
 believe in a God of its own before their arrival.
   On the subject, therefore,  of  a belief in the existence
 of a Deity, the dispersion of the Jews  had no  bearing
 To modify the o inions of nations as to his character,^
 all that that event could effect.  *

                 Note (/i) page 21.
   The various families of fos-il  remains found by geol-
 ogists, at different depths below the surface of the  earth
 and evidently deposited in  their respective  strata  at dif-
 ferent periods, cannot be accounted  for in any other
 way, than through the agency of as many deluges; not,
 we presume, universal ones, but sufficiently extensive to 
65
constitute memorable epochs  in the history of certain
parts of our globe.
   These circumscribed inundations are neither  to be
confounded with the universal deluge, recorded by Mo-
ses, nor offered as reasons for  discrediting its existence.
A belief in the existence of all of them may be honest-
ly entertained.
                  Note (i) page 28.
   " It Were better, says Bacon, to have no opinion of God,
at all, than  such an  opinion as is unworthy of him;
for the one is  unbelief, the other is contumely;  and cer-
tainly superstition is the reproach of the  Deity." Es-
say  17th.
                  Note {j)page 31.
   When  the author  employs the term " creation" as
expressive of his own views, he  means formation out
of substance  already existing.  In  relation to no other
meaning, as affixed to that term, is he to be considered
as expressing positively either his assent or dissent.
   By the term " Creator," he, in like manner, means the
constructor of the universe, not the actual producer of
substance.  But he repeats, that he is not to oe charged
with the denial of such production.
                 Note (k) page 36.
   The very names  we bestow on spirit and  its  opera-
tions, afford  conclusive  proof that we attain all  the
knowledge of them  we possess,  by  the process of in-
quiry, which is here described.
   By the exercise of  our reflecting powers, we form a
conception of the "substance, and then express it by a
suitable term.  In a process the reverse of this—to form
names first, and then search for things to  be signified
by them, the  human mind has never yet engaged.  Nor
can  it seriously engage in it, until  its nature shall have
been changed.
   The better to realize  the  absurdity of such a mea-
sure, let any one  deliberately make  the attempt, and 
66
he will find  himself foiled  in every effort.  He  will
perceive that he is  working  as directly against nature,
as if he were attempting to  make gravitation act from
the earth's centre, instead of  towards it.
                  Note  (I) page 37.
   It is not  true,~as certain  declaimers  confidently as-
sert, that the religion of nature 'necessarily leads to a
belief in polytheism.   That  effect arises from the abuse
of it; and that abuse, from ignorance, and a defective
examination  of the material universe.
   The  ancients  were polythefsts, because they  were
unacquainted with the science of nature,  particularly
astronomy, natural history, and chemistry.  They were ig-
norant of that exquisite harmony, and unity of design,  J
which pervade creation, and,  when correctly understood,  \
testify as clearly to the unity of its author, as revelation  j
itself.  To assert the contrary of this, is to pass a slan-  I
der on the Deity, by  presumptuously maintaining  that j
he has contradicted himself—that  he  has  spoken onc»
language in his word,  and a different one in his works—1
that  in the former, he has declared himself one, and in J
the latter many.  In bofh,h\s de laration of his unity 1
is alike explicit, and alike emphatical.                  1
   Examine,  with  attention, the organization of  the  |
heavens.   The bodies  that compose  them, being all
spheres,  are  one  in figure.   In organization they are  ]
also  One, being all assorted  and arranged in systems  i
on the saine  principles.   In relation to  their scheme of  j
giving and receiving light, entire unity  prevails among*!
them, the central orbs  being  the sources of  that emana-
tion, and the exterior ones its recipients.   Revolving, as
they do, on  their own axes,  and around  common  cen-  ti
ters, the movements they perform are likewise one.  And,
as far  as, from our knowledge, w3 are privileged to
speak of them, they are one in their aptitudes as places
of abode for living beings.   We rationally, therefore,  ]
infer, that they are one in being peopled.
   Descend  from the heavens to the ^globe where we 
/*
                         67

 dwell, and contemplate the  uniformity  of design  and
 workmanship, which characterizes,  so strikingly, its
 living inhabitants.   When  considered in their  rise,
 their progress, and their end, their structure, their en-
 dowments, their action, and  the  materials which com-
 pose them, they present the aspect of one great family,
 descended from a common parent, directed by a common
 governor, and flourishing under the bounties  of a  com-
 mon benefactor.
   Let any one of intelligence, take this simple view of/
 things, and, without prejudice, speak  in obedience to*
 the impressions it will produce, and  if he does not de-
 clare that it is hostile to the puerilities and corruptions
 of polytheism, and that it leads.directly and irresistil^y
 to a belief in one creation and one God, then will  Ire-
 sign the controversy, and agree that the religion </ na-
 ture shall be expunged forever from the circle.jf the
 sciences, and denounced as a demoralizing-s^tem of
 infidelity.
   But  if,  on the  contrary, such  should be tIe issue of •
 the examination proposed, then  shall I e^ect to hear
 no more of empty declamation  and malgnant misre-
 presentation, directed,against those wjtf honestly and
 conscientiously believe in the truth o7 the  religion of
 nature—who feel a  conviction whix** they cannot  re-
 sist, and which their conscience  it?" forbids them to
 resist, that God can speak and  hapspoken, not only by
 the prophets whom he has inspirp*? but by the universe
 which he has constructed.
   Nothing but ignorance or d/honesty can induce  any
 one to draw from  the  polyfrteism of  the uninformed,
 whether they be ancients C* moderns, arguments against
 the natural religion of & enlightened and  the  philo-
sophical  As well may narrow minded  declaimers  in-
veigh against the astronomy and chemistry of the pre-
sent day, on account of the corruptions which degraded
those sciences in former times.
  Let the world become more  enlighto.net .and  preju- 
                         (*8

dice pass  awav, and then will it be universally  ac-
knowledged, that natural and revealed religion are alike
true, and that they go hand in  hand, with that harmo-
nious march, which characterizes all the institutions of
God, in conducting man to heaven and happiness.
  Notwithstanding any  seeming admission to the  con-
trary  in this note, the ancients were not polylheisls, in
that gross and unqualified meaning of  the  term, which
is generally affixed to it.
  Although they were believers in flip  being and minis-
try  of many inferior divinities, they admitted the exist-
ence and superintendence of one  Supreme,  the great
arbiter of the Heavens, as well as of the earth, whom all
he  others were compelled, to obey.
  In their gradations of rank, the offices they  perform-
ed, ^nd the worship they received, the  minor Deities of
the ancients were*in no  small degree, analagous to the
angelsof the moderns.  Nor is saint-worship less com- j
mon nov, than was the worship  of household  gods in
former lixies.                                       m
   Let caviiers beware, then, of denouncing the religion
of  nature, 0\ account of  a charge, from which that ofl
revelation, as^ractised  by  many christians,, is  not ex,- '
empt.

                 Note (m) page 38.
   The term "omn^otence" is differently understood by
different interpreter^0f it.
   Some understand Ly it a power equal to the organi- ;
zing, sustaining, and governing of the present universe,
exactly as it is, withou being necessarily adequate to
any thing greater.  Othei, again contend,  that, by the J
omnipotence of the Deity, ^.understood a power capa- 1
blc of constructing, supportiag, and  directing, innu-
n.erable universes of the  same description, or even of a
character infinitely superior.
   Without entering into the disquisition himself, or ex-
pressing any decided  opinion in  relation to it, the au-
thor will only observe, that, as far  as he has attended ta 
u"9
the subject, the weight of authority appears to counte*
nance the former interpretation.  That the omnijiotence
of the Deity means, the amount of power put forth in
tlie establishment  of the universe,  and  nothing  more.
We can judge of power only by its effects
   The works of God  would  seem to be the best com
ment, not merely on his power, but on most of his oth-
er perfections.   It is neither unreasonable nor irrever-
ent, to allege, that his wisdom and goodness operating
on his power, induced or rather compelled him, to make
things on a scale  as grand and sublime, as beautiful
and perfect, as he was able.
                 Note (n) page 40.
   "The Hebrew word Bura (Gen: I.  1.) rendered "crea-
ted? has, chiefly on the authority of Maimonides, been
considered as implying what theologians call an abso-
lute creation out of nothing.   But this,  it has been al-
leged, is not the appropriate meaning.   It rather means
to fashion, form, and decorate, a matter already exis-
ting; and in this  connexion especially,  it means to re-
trieve from a state  of desolation,  and to embellish this
little spot of earth, so as to render it fit for its inhabi-
tants.  In this limited sense  God  is afterwards (Chap:
II. 7.) said to have created man, not out of nothing, but
out of the  dust of the ground." Vid-  Rees's Cyclop.
Art. Creation.
   Again, under the same article,  "Upon the  whole,
we may observe, that it seems to have been  the current
opinion among the ancient Jews and earliest christians,
that the. world was created by God of  pre-existing un-
fashioned matter.   The matter of which the earth was
created, or  rendered a habitable  world, was "without
form and void," or a desolate waste, or in a state of des-
olation ; that is, as some   have supposed, a pre-existing
earth, reduced by  some  awful  calamity to a  chaotic
state."
   Again.  "The word Bura  appears to have the same
 meaning, and,  if etymology be regarded, to be the self 
                         70

 same word with the Latin jparo,(to prepare;) and it is
 so rendered by Theodotian in Greek, etoimasai, Ezek.
 xxi. 19; and by the Chaldee Paraphrast. Josh: xvh. 15.

                 Note (o) page 42.
   As far as the author has looked into the subject, the
 following are the onlv places, in the Old Testament, in
 which the word Bura is found.
   Gen; 1.  1.27.27—2. 3. Deut. 4. 32. Isai; 40. 26—
 Jer: 31. 22—Isai: 4. 5—Mai: 2. 10—Isai: 41. 20-45.
 18—Gen: 5. 2-Psal; 89. 47. Gen: 6, 7.—Isai: 45  12
 —54.  16.  16.   Isai:  43.  7.-45.  8—42. 5—45.
 18—40. 28—43. 15—57.  19—65.  17. 18. 18—45. 7.
 7.  Amos 4. 13.  Isai: 43. 1.  Eccles; 12. 1.  Gen: 5.
 1. Psalm:  51. 10.   Numb:  16. 30.  Gen:  1.21. 27.
 Ezek: 21. 30. 35.   Exod: 34. 10.  Isai: 48. 7.   Psal:
 148.5.—102.  18.  Ezek:  28. 13..  Gen: 5.  2.—2. 4.
 Psal: 104. 30-.  Numb  16. 3a.
   1  Sam: 2. 29.  Judg; 3. 17. Psal: 73. 4.  1 Kings
 4, 23;  Dan: 1. 15,  Hab;  1.  16.  Ezek: 34. 20—34.
 3.  Gen; 41. 5. 18—41 2. 7.20—41. 4.
   By a strict examination of the  passages  in the Old
 Testament here refered to, the biblical critic will find,
 thatm Gen: LI. only, is the word Bura translated, to
 create  or   produce  from  nothing.    In every   other
 place it indicates some modification of substance alrea*
 dy existing.
   Hence the belief,  honestly entertained and boldly as*.
 serted, by some of the most enlightened and pious di-
 vines, that the translation "created," affixed to the term,
 Bura, in the chapter  and  verse of Genesis already de-
 signated, is  calculated and  intended  rather  to accord
 with the particular hypothesis of the translators, than to
 render, with accuracy, the meaning of the original.

                Note (p) page 46.
   It is not contended, that, from the premises here laid
down, every  individual of the human  family, however 
71
ignorant, is able to infer the being, attributes, and gov-
ernment of a God. Such inference is the work of an in-
tellect somewhat cultivated.  But the  requisite degree
of cultivation may be derived from the study of nature,
no less certainly than from  the study of  the Holy Scrip-
tures.
  As an objection to the doctrine we are endeavouring
to establish, we are told that the deaf and dumb have
no knowledge of a God, until they  derive it from their
instructors.
   The reason of this is   obvious.  Until they are in-
structed, they are so ignorant as scarcely to occupy the
rank of rational beings.
   The first effort of their teachers is to communicate
to them the  knowledge of God. Instead  of  this, let
these unfortunate beings be taught first to  observe na-
ture, and to  reason on it,  and, without any  direct infof-
mationon the subject, they will soon  infer the existence
of a primary constructing  and governing Cause, which
is tantamount to a belief in  the  existence and superin-
tendence of  a God.
  As the author thinks it not improbable, that dishon-
est attempts,  formerly made, will be renewed, to cover
with odium, in the minds of the uninformed and the
prejudiced, his sentiments on the subject of the religion
of natural revelation, especially his belief in its equali-
ty, in some respects, with the religion of  written revela-
tion, and its superiority to it iii others, he deems it expe-
dient to fortify his views,  on that topic, with the senti-
ments, corresponding  precisely with his own, of some
of the most^iotts, enlightened and orthodox divines, that
have ever done honour to the  christian church.
  He will begin with Calvin, who, by the strength of his
talents, the severity of his  morals, the purity of his vir-
tues,  and the fervour  and  intensity of his piety and de-
votion, gave rise tn an epoch in Tgctical theology. 
12
   Out of very entensive  quotations  to the same effect,
which might be easily  made  from the writings of that    \
distinguished reformer, the  few following sentences are
selected as sufficient for the author's purpose.
   k4The  knowledge of God,  is naturally  implanted in
the minds of men."
   "We hold it out  of  controversy, that  there is in the    j
mind of man, even by natural inslinction, a certain feel-
ing of the Godhead.  For, to the end that no man should
flee  to the pretence of ignorance,  God  himself hath
planted in all men,  a  certain understanding of his di-
vine majesty; that they all, not one excepted, may know
that there is a God.
   "Therefore God  hath  not only'planted in the minds    ,
of men that seed of religion, which we have spoken of,
but also hath so disclosed himself in the whole  work-
manship  of the world,  that men  cannot open  their
eyes but they must needs behold him." Again.   "He
hath, in all his works, graven certain marks of his glory, '^
and those so plain  and notably discernable, that the ex*   m
cuse of ignorance is taken away from men, be  they nev-    1
cr so gross and dull ivitted"                             1
   To the same effect are the sentiments of Bishop But-    J
ler, whose'analogy  between Natural  and Revealed reli-    j
gion has been long made a text-book, in most of the col-
leges of the United States.   That  distinguished theolo-    1
gian in one  place  pronounces Christianity "a republi-    1
cation and external institution of naturat  and essential
reVgion? and, in  another, declares  natural religion to
be "the foundation and  principal part" of Christiani-
ty.  Again. ''-Christianity teaches natural religiomn its    ■
genmne simplicity.
   "Reason can and ought to judge, not  only  of the   1
meaning, but also of the   morality  and the evidence of * 8
revelation.                                             '
   "La reason  be kept to," and if any part of the Scrip -
ture account of the redemption of the world by Christ,    '
can be shown to be really contrary to it. let the Scripture^
in the nrnne of God. be given up" 
73
    The writings  of Archbishop  Tillotson,  one  of the
  ablest and most pious diviues that England has  pro-
  duced, abound with .matter in favor of the truth and
  importance of natural religion.  In  a sermon on  that
  subject, one of the most profound and excellent he  ever
  delivered, he declares  that God makes known to us our
  duty, by " A kind of natural instinct—By natural rea-
  son—and, by the general vote and consent of mankind."
    In his celebrated work on  the  Apostolic Epistles,
  Dr.  Macknight, a divine of great  learning  and  piety,
  and perfectly orthodox in his belief, has the following
  passage.  " Thus,  in the  compass of two  verses,  the
  apostle has explained what  the light of nature is,  and
  demonstrated that there is such a light existing.  It  is a
  revelation from God,  written on the heart or mind of
  man; consequently is a revelation  common  to all  na-
  tions, and, so far as it goes, agrees with tfc things writ-
  ten in the  external revelation which ^od  hath  made
  to some nations; for the mind of men, as made by God,
 harmonizes with the mind of God "
   The pious and enlightened Poddridge thus  expresses
 himself;
   " Those rules of action which a  man  may discover,
 by the use of his reason, to be agreeable to  the nature
 of things, and  on which his  happiness will   appear to
 him to  depend,  may  be called the  law of nature; and
 when these are considered as  intimations  of  the divine
 will and purpose, they may be called the natural laws of
 God."                                            J
   Again.  " It is highly for the interest of states,  that
 the great principles of natural religion should be be-
 lieved, viz:  the  being and providence of  God, and the
 certainty of an  exact retribution either here  or hereaf-
 ter"—" For any  one  to  pour contempt upon  this natu-
 ral law  of God, under  pretence of extolling any  sup-
 posed divine revelation, or intimation of God's will  in
 an extraordinary  manner, will appear very absurd"__
"No discovery (meaning revelation) can be supposed so
                         L 
71
particnlar, as not to need the use of reasoning upon Hie
principles of the law of nature,  in  explaining and  ap-
plying it to particular cases.
  Bishop Stillin^fleet—" I shall, therefore, attempt to
prove, that the christian religion not only supposes,  but
improves, refines, establishes, and enforces,  the  general
and most  allowed principles of natural religion, as to
the being of God  and providence, the  most agreeable
way of worship, the  nature and kind  of moral duties,
and the rewards and punishments of another world."
  Dr. Barrow,a divine distinguished alike for eloquence
anC piety.
   " l^e first  excellency, peculiar to the christian doc-
trine, is,that it  gives us a true, proper, and complete   !
character o- notion of God,  such  as perfectly agrees   ;
with what th\ best reason dictates, the works of  na-
ture DECLARE,\qncient tradition  doth attest, and com-
mon  experience tWify."                               j
   Vattel, although \qt a divine, is a writer of great   j
soundness and acknowledged authority.   In his works   |
we find the following sentence.                          J
   " Every religion that should, in this case,  clash with   1
the  law of nature, would  beur upon it the marks of
reprobation, and it could not come fyom  the  author of
 nature, who is always constant, always faithful."
   A well known citizen of the state of Kentucky,  dis-
 tinguished alike as a civilian, a jurist, and an advocate,  j
 when lately pleading in a very important trial, express-
 ed himself to the jury, in the following  words.   " The   I
 character of God may be as truly  read in the works of
Nature, as  in  the Scripture.   They are equally  inva-  I
 riable, and  point out their divine  author."—(See trial   1
 of I. B.Desha, p. 190.)
   Were the author inclined to  pursue this subject, he
 might, for further testimony to the truth  and excellen-   ]
 cy of the religion of natural revelation, refer to the
 works of Derham, Paley, Harvey,  Young,  St*rrm, and  '
 several other writers of equal  distinctions   But his 
75
memoir is already protracted  greatly beyond the limits.
he  had originally assigned to it   He  will  only add,
that, in preparing this note,  his  intention has been, not
to make himself responsible for the correctness  of the
sentiments of the several authors  he has quoted  and
named, (although he deems them correct,) but merely
to show, that many individuals, of the highest  reputa-
tion, for talents,  piety,  and christian orthodoxy, have
been firm believers and decided advocates of the truth-
and practical value of Natural Religion. 
 
MEMOIR II.
                  PREFATORY NOTE.

  THAT the author might render to each of the questions, thatconsti
tutethe basis of this Dissertation, an answer as precise and specific as
possible, he has replied to them severally in the order in which they
are propounded in the series.
  Although they all differ from each other in their principal and imme-
diate objects, most  of them embrace some points  that  are common to
the rest.   This circumstance has necessarily led, in the replies, to oc-
casional repetitions of facts and  opinions that had been previously sta-
ted.
  In whatever degree such repetitions may detract from the symme-
try and merits of his Dissertation, as a literary performance, they will
not the author trusts, in any measure impair its practical u tility, nor de-
tract from its aptness as an answer to the queries.
  He will  regret exceedingly to  be found deficient, in any instance, in
the details that may be deemed  requisite for the satisfactory illustra-
tion of the topic under consideration.  Should such an event occur, he
hopes it will be attributed to its  true cause, a solicitude to avoid prolix-
ity in discussion, and not to the want of illustrative materials.
  The only difficulty he haB experienced, in preparing  his Disertation,
has been, not in procuring facts, but in selecting the most suitable from
jj£e  abundance  that  presented itself.   Tbe  mechanical  exercise
of the pen excepted, a volume could  have been written with more fa-
cility than this production.
      Transylvania University,     )
        Lexington, Ky,  Oct. 23d, 1823. $ 
                   ADVERTISEMENT.

   THAT the reader may  understand the cause of the peculiar shape
 »n which  this  memoir appears, he  is informed, that, according to a
 scheme concerted and made public, the best Dissertation that might   )
 be written in answer to  the questions to which it  relates,  and which
 were proposed by His Grace, the Duke of Holstein Oldenburg, with
 the view of informing himself how  best to protect his realm from sup-
 posed contagion, was to be entitled to a prize of a specified value.  An
 invitation to contend for this prize was  liberally given to medical phi-
 losophers of every country.  On  the merits of the Dissertations that
 might be received, pursuant to this  arrangement, the College of Pby»
 liciansof Berlin was appointed to decide.
  Although, when the author prepared this memoir, it was his purpose
 uvsubmit it to the tribunal designated, as a prize-dissertation, lie relin-
 quished his intention, on a  twofold ground.  He was deterred, in part,
 iy the difficulty of transmitting the manuscript to its place of destina-
 tion; but, more particularly, by what he believed to  be the dis-qualifica-
 tisns.of those who were authorised to sit in judgment on it.
  The College of Physicians of Berlin, although an able, enlightened,
.ami very respectable  society,  possesses,  as a body,  no experimental
Jm&aledgc of yellow fever.  Probably not an individual member of it,   1
 lias ever witnessed a case of that disease.                               I
  Nor is this all.  It is,  perhaps, equally probable, that, from the pre-  ||
 jjudiices of Education, the influence  of books, and the prevailing opin-
 ion of the North of Europe, the college consists entirely of contagion-   '
 ids.  Or if not  entirely, at least with the exception of but a very few
 members.  However pure and upright may be its intentions, then—and
 t3»e author, does not permit himself for a moment to doubt them—it can-
 Btttbe an impartial and a competent tribunal.  Its feelings being pre-
 occupied, its judgmentmust be in chains.
  Henoje, to submit the Dissertation to  its decision, was not deemed
 expedient.  It was, therefore, withheld from the Faculty of Berlin,   '
 and awaits the judgment of  an enlightened, public.
  As originally prepared, the Memoir contained no directions as  to the,
 treatment of the disease to which it relates.  To render it more useful,.
 because more practical, these were subsequently added.
    Lexington, Kg, January \$t, 1826. 
A  DISSERTATION,
                   IN ANSWER TO

Certain prize questions, proposed by His Grace,  the
  Duke of Holstein Oldenburg, respecting the " origin,
  contagion, and general philosophy of yellow fever^
  and  the practicability of that  disease prevailing in
  high northern latitudes," with thoughts on its preven-
  tion and treatment.
              PRIZE  QUESTIONS.
  1. What are the causes  of Yellow Fever in tropicai
climates ?
  I. Quae sunt causae febris flavae in terris tropicis?
  II. Is the Yellow Fever of the South of Europe, and
that of  the  United  States of America, similar to the
Yellow Fever of tropical climates, and does it arise
from the same causes?
  II. Num febris flava Europae  austral is,  civitatum-
que Americae septentrionalis consociatarum, febri flavae
terrarum tropicarum similis est  iisdemque causis ori-
tur?
  III. Is yellow fever a specific disease, or only a high-
er grade of intermitting and remitting fever,  endemical
in hot climates?
  HI. Morbus peculiaris, seu,  ut vulgo dicunt, speci- 
                                                      i
                         80
 ficus, an nihil nisi vehcmcntior  febris biliosa intermit*
 tens et remittens,  climatibusque fcrvidioribus endemica
 est?                                                  ,
   IV.  Does it prevail as an endemic in the low grounds  *
 of the sea-coast only, where it has heretofore appeared,  i
 leaving the more elevated places untouched?
   IV.  Utrum ubicunque  hucusque  exorta est  in oris
 maritimis inferioribus solummodo  endemice  grassatur,   ;
 et locos editiores intactos relinquit?
   V. Does Yellow Fever appear more frequently as a
 sporadic complaint,  and  only  occasionally as an epi-
 demic during the hottest seasons of the year?
   V. Num saepius sporadice tantum, et nonnumquam
 solummodo flagrantissimo anni tempore,  ut  epidemia
 apparet.                                               ,
   VI. Tn the most violent and malignant form of Yel- j
 low Fever, is any  thing  secreted and thrown out from J
 the body, which can  communicate the disease,  eitherfl
 directly or indirectly, from the sick to the well?
  VI. Num in ea fortasse, vehementissima facta, quod-  fl
 dam secerni segregarique potest, quod contagione, vel
 proxima vel remota, aliis corporibus communicatur?
  VII. Vv hat degree  of  temperature is necessary to
 produce the disease and render it epidemic, and to what  • *
 degree of north latitude has it heretofore extended?      m
  VII. Quantus caloris  gradus  requiritur, ut epidemise  1
 naturam induat,  slcque divulgetur, et ad quem gradum   '■
 latitudinis septentrionalis hucusque pervenit.
  VIIT. May not the disease arise and prevail as an ep-
idemic on the  scacoast of Northern Europe, especially
on the northwpstern  borders of Germany, during the 
81
hottest months of summer, or is it peculiar to warm
and tropical climates.
  VIII. Nonne etiam haec  febris mensibus aestivis fer-
vidioribus, in  oris  Europae *q»ilonaris, et  praesertim
Germaniae ad  caurum sitae maritimis oriri et epidemice
divulgari poterit, an potins  morbus tropicis et omnibus
terris calidioribus proprius e*st?
  IX. Should question VI. respecting  the contagious
nature of Yellow Fever, be answered in the affirmative,
must we not conclude, that the disease, although not ca-
pable of arising and spreading as an  endemic or epi-
demic, on the seacoasts of the  north,  on  account of
the low summer temperature  of  those regions, miy yet
be introduced and propagated  there, in a contagious and
sporadic form, by vessels arriving from its native climate,
having on board  infected merchandise,  individuals, or
ch-athing?
   IX. Quod si quaestio VI. de contagiosa hujus febris in-
dole afnrmetur, nonne statuendum est etiamsi in regioni-
bus septentnonalibus et  prope oram maritimam jacenti-
bus propter minorem caloris  gradum,  oriri  febris ista
endemice, divulgarique epidemice nonpossit; fervidiori-
bus tamen mensibus periculum contagionis imminere his
regionibus et  quidem navibus e patria hujus morbi veni-
entibus, sive mercibus venenum   recipientibus  onustae
sint, sive  socii infecti et lue jam correpti, eisque, si non
propagationem epidemicam, sporadicam tamen, ut di-
cunt, contagionem effici  posse?
   X. Although incapable  of  generating the same com-
plaint, can the contagion  of Yellow Fever, in northern
latitudes give  rise to any other destructive disease?
   X. Num febris flavae. contagium, etiamsi in terris sep-
                          M 
 teutrionem versus sitis, hujus ipsius morbi naturam indu- "
 ere non possit, alios morbos exitiosos gignere potest?
   XI.  Should the answer to question IX, being affirma-
 tive, admit that Yellow Fever may be translated to the
 climates of the north, and  there prevail, if not epidemi-
 cally, at least in a sporadic form,                       ^
   a.  What means should  be adopted to prevent its in-
troduction, especially if the contagion can be conveyed
 in merchandise brought from infected ports?
   b Should the answer be negative, ought the institu-
 tion of quarantine to be abolished?
   XI. Quaestione IX. affirmatur, febrim flavam utique
 in loca frigidiora  transferri, et ibi,  se non epidemice
 grassari, attamen sporad:cam  contagionem  efficere pos-   j
 se, quaeretur,
   a. Quae consilia ad earn repellendam  ineunda sint,  '
praesertim si  contagio  per raerces e portis infectis alia-  ;
tas esse potest, et,
   b. Num, si hoc negetur, institutum morae  quadragen- "'\
 ariae sit rejiciendum? 
             INTRODUCTORY REMARKS.

       That he may  give to the  Medical Faculty of the
    University of Berlin, the least possible trouble in read-
    ing this dissertation, and every practicable facility in judg-
    ing of its merits, it is  the  intention  of the author to
    compress it within as narrow limits, as a due regard to
    perspicuity of expression, and the requisite explanatory
    details, will admit   To  communicate truth, and to be
    clearly understood, are the  points that claim his atten?
5   tion, and awaken his solicitude.
       Having derived his knowledge of yellow fever, much
    more from observation and experience, than from books,
    he will affect in the following pages no parade of medi-
    cal learning.  Content  with a brief recital of facts, and
    such inferences from them as  he may deem most impor-
    tant, for the views he may  present, and the principles
    he means to  advocate,  his  reliance will be, in  a great
    measure, on his own resources.  Although he will often
    refer, for authority and illustration, to events  that are
    ■well known, and many of which have  been long on re-
    cord,  yet, of most of them, he  was himself a witness,.
    and in not a few of them an interested actor.
      In the year 1793, so memorable in the American an-
il*   nals of medicine,  during the summer and autumn of
    which, yellow fever swept so destructively through the
    city of Philadelphia, he commenced his professional
    studies, in the  university of that  place,  and saw, as a
    pupil, no inconsiderable portion of the disease.
      From that time, until the year 1805 inclusively, eve 
                         84
ly summer was  more or  less pestilential.   Six times
within that  period, viz:  in  1797,  1798,  1799,1.02,
1803, and 1805, did yellow fever prevail  cjndtmically
in the city of Philadelphia.   During this protracted se-
ries of calamities, he was a resident of that metropolis,
and a spectator of events.
   In the spring  of 1797, he entered  on  the practical
duties of his profession,  and was extensively conver-
sant with the disease, and he hopes  he  may add, with-
out either presumption or vanity, faithfully observant of
it, on each  occasion when  it subsequently  prevailed.
During the  prevalence  of the fever in 1803, he was a
member of the Board of Health, and one of the physi-
cians of the city Hospital.  A better opportunity to ac-
quire an  intimate knowledge of the complaint, in its
entire character, and in all its relations, he could not
have enjoyed.  In his own person he experienced three
attacks of it, the first  exceedingly malignant and dan-
gerous, but the two latter  less severe than a common
intermittent.
   The earliest impressions which he received from his
preceptors, and from books  which were placed in his
hands for the purpose,  respecting yellow  fever, were,
that it was  highly contagious.   Confident, perhaps, to
excess, in this persuasion, he  zealously commenced his
observations on it in person.  But experience soon con-
vinced him  of his error.
  Even before it had closed its epidemic career in 1793,
he perceived, with surprise,  that in an uncontaminated
atmosphere, it was not  communicable from the sick to
the well.   From that moment his  ardour  as a conta-
gionist began to subside, and even to yield to doubts as 
85-
to the truth of the Doctrine he had imbibed.  Nor was ii
long, until by subsequent observation, these doubts ter-
minated in a conviction that his views had been erroneous.
The principal facts which led to that conviction, will be
faithfully recited in this Dissertation.
   Thus far has the author deemed it expedient to speak
of himself;  not, as he trusts, from motives of  egotism,
but to show, by an honest representation  of  events, that
his opportunities to acquire some knowledge of yellow
fever have not been inconsiderable.
   As further introductory, he will  only add,  that, al-
though very young at the time, he was one of the earli-
est defenders of the non-contagion  of this disease in
the United States, and that his  writings, some of which
he shall have occasion  to  quote in the  following pa-
ges, were believed,  at the time,  to  have  contribute d
their share  to the change of public sentiment which
gradually ensued.
   A belief very generally prevails, even  among those
who ought to  be  better informed  on the subject,  that
the doctrine of  the  non-contagion of yellow fever, at
least in  the United States, is ascribable to the genius of
the late Dr. Rush.  To prove the  fallacy of this belief,
testimony ample and conclusive can be adduced.
   That that distinguished physician was the founder of
the doctrine of  the domestic origin of yel ow  fever, in
the United States, cannot be denied.   But when  the
disease appeared in Philadelphia, in 1793, his  writings
evince  that he  was a confirmed contagionist.  He be-
lieved that the complaint originated from the putrefaction
of animal  and  vegetable  substances;  but  that, when
thus generated,  it was communicable, by contagion, from 
86
the sick to the well.   Nor was it until about  the yeap
1805-6 or 7, (the precise date is  not recollected,) that
he abandoned this opinion, and published, in the New
York Medical Repository,  his recantation of it.   All
this appears on record, under the sanction of his own
name. 
 REPLIES  TO THE  QUESTIONS PROPOSED.

   I.  What are the causes of Yellow Fever in  tropical
 climates?
   To this question the  correct  reply, expressed suc-
 cinctly and without detail, would be, that in tropical
 climates, yellow fever is produced by a malana or poi-
 sonous exhalation, arising from the decomposition and
 recomposition of the matter of organic substances.
   But,to render the answer as clear and satisfactory as
 the subject merits and the occasion requires, a  brief'ex-
 position  of it,-by way of illustration, appears to be re-
 quisite.
   In furnishing this, it is important to observe, that sev-
 eral causes act as auxiliaries to that on which  the dis-
 ease essentially depends.
   For the production of the febrile poison, a tempera-
 ture of the atmosphere high and long continued, is found
 to be requisite.  Nor is  it without  reason  that that
 temperature is believed to be influential in rendering
 the system more  susceptible than it  would be  under a
 lower one, of the action of. the exhalation it  has been
 instrumental in generating.   Under any  temperature,
 this poison, if introduced into  the stomach, the organ
 on which it seems  primarily  to  act, would  doubtless
produce fever, but its action can scarcely fail to be great-
ly facilitated by that state of debility and enfeebled re-
 sistance,  into which the system is necessarily thrown,
by the influence of long continued tropical heats, Those
heats act  primarily and immediately on the skin, and 
                          88
 sympathetically on the abdominal viscera, thus exhaust-
 ing and debilitating the organs both externally and in-
 ternally.
   In the production of the disease, the operation  of ma-
 laria and heat, is powerfully aided by frequent and  sud-
 den  vicissitudes in the sensible qualities of the atmos-
 phere, especially those from dryness  to humidity, and
 from a higher- to a lower temperature—such,  for exam-
 ple,  as usually occur in the passage of time  from day  j
 to night.   Changes in the iveight  of the  atmosphere  ,
 are not known to have any appreciable effect in relation
 to the  disease.   If they have, it is secondarily, through
 the medium of other atmospheric  mutations which they  j
 produce.                                              J
   These  causes  united  are  sufficient of  themselves to J
 produce yellow fever sporadically, and perhaps as an en- J
 demic. But to render it epidemic, a pestilential constit&W
 Hon  of the atmosphere must concur.                   ^
   It is contended by some, that a  very high  and long 1
 continued temperature of the weather, accompanied by ■
 frequent vicissitudes in the sensible qualities of the air,
 is alone sufficient for the  production of the disease.       1
   The fallacy of this  opinion  appears from the well
 known fact, that where none but those two  causes  ex- I
 ist, the complaint never prevails.   By arguments to be m
 adduced hereafter, this point will be  more  fully illus- f
 trated.                                                4
   By the following considerations,  does this reply to the 1
 question proposed,  appear to be supported, in the sev- M
 eral  elements of which it is composed                 %
   In three respects chiefly do tropical differ  materially I
from other climates, viz. temperature, the average of rain 1 
                         89
that falls, and the luxuriancy and general amount of vege*
tation.  To these may be added, as a  matter of minor
consideration, the superabundance of insects and rep-
tiles, which increases as you advance towards the heats
of the equator; and, as a consequence  of the whole,
the greater extent, activity, and constancy of the putre-
factive process, (a)
   To the influence of some of these causes, then, or to
the combined operation of two or more of them, must
we  attribute the indigenous  growth of yellow  fever.
But that neither of them  singly can generate that dis-
ease, may be demonstrated by a brief analysis of the
subject.
   The mean temperature of tropical climates  is from
80 to 83deg. of Fahrenheit's thermometer.
   That this cause is not alone competent  to  the pro-
duction of yellow fever,  appears from facts of general
notoriety.
   In tropical seas, the crews of vessels that are clean-
ly in themselves, and free from damaged cargoes,  are
never attacked by it.  The same is true of vessels of
this description lying in harbour, beyond  the reach  of
exhalations from the shore.   Even  the inhabitants  of
tropical plains, hills, and other situations,  themselves
dry, and remote from bodies of stagnant water, are ex-
empt from this disease.   From many parts of Africa
and  South  America, conclusive evidence of this is de-
rived.  But were the fever the product of temperature
alone, this  would not be the case, the places just desig-
nated being subject to  as intense  heats  as those are
where it prevails.  Nor, in extra-tropical regions, does
the complaint ever occur during the most intemperate 
90
summers, unless in places where the temperature is aicT-
ed by other causes.
   In no climate have rains alone been ever suspected as
the source of malignant fever.  Nor do they  possess
qualities calculated to render them so.  Were they thus
deleterious between the tropics, then would the disease
we are considering prevail wherever they fall in  suffi-
cient abundance.   But they fall at sea, in harbours at a
distance from shore, and on hills and plains remote from
marshes'and stagnant waters, as copiously as elsewhere.
Hence, the fact, that those  places are exempt from fe-
ver,  is evidence satisfactory that rains do not produce
it.                                                    1
  That neither  the mere luxuriance  of vegetation,  a
superabundance of insects and reptiles, nor sudden vi-
cissitudes of atmospherical temperature, are alone the
source of this disease, may be proved by  a similar course
of reasoning.   Each of these, singly,  exists in as high
a degree,  in places free from fever, as  in those where  !
it prevails.
  But,  respecting the  combined influence  of some of
these causes, a different opinion commands our belief.
To prove that, in tropical climates, that influence is the
genuine source of yellow fever, evidence which we hold  I
to be sufficient may be adduced.                        ■
  As an endemic,  the  disease  prevails chiefly, if not
only, during the hottest months of the year.  And, oth-
er things being alike, the  more intense and protracted  \
the heats, the more certainly does it appear, the more
malignant is  its character, the more extensive its preva-
lence, and tlie more destructive its ravages.
  But,  to give it existence, stagnant water and  dead 
91
 vegetable, mingled  perhaps,  with animal' matter, mus?
 unite their agency to  that of high  and long continued
 heats.   In whatever inhabited part  of the torrid zone
 these three causes co-operate sufficiently to excite in
 (he organic matter concerned, a vigorous and protracted
 putrefactive process, and to  evolve  an abundance  of
 pestiferous exhalation, there, yellow fever  is inevitably
 generated.  And where they do not thus co-operate, it
 never occurs.
   That this is true, the medical history  of the West
 India Islands,  of  many continental  parts   of tropi-
 pical America, and of sundry trading establishments in
 Africa  conclusively testify.    Hence the  disease  ap-
 pears only in large populous  cities, where, from artifi-
 cial causes, moisture andputrifiable matter are necessa-
 rily accumulated, in flat maritime situations,  and in the
 low grounds  of water  courses,  where nature herself
 makes  similar  depositions, or within  the range of ex-
 halations from marshes, or other depositories of stag-
 nant water and organic filth.   And in situations of thi$
 description, placed beneath the influence of  a  tropical
 sun, especially during the hottest  season of  the year,
 the effluvia productive  of yellow fever are never wanting.
 In proof of this,  strangers from temperate  and high
 latitudes, visiting such places,  are constantly liable to  be
 attacked by it,  either sporadically, or in the  character
 of an endemic.   To render it  epidemic,  a malignant  or
pestilential constitution of the atmosphere must, as al-
 ready stated, concur  with the other  causes that have
 been specified.
  Strictly speaking, then, in the production of epidemic
yellow fever, four  agents  must co-operate, viz.  a high 
yg
temperature of considerable duration, stagnant moisture,
dead organic matter, and a deleterious constitution  of
the atmosphere. •
  To produce the effect, the latter agent  is as  essential
as either of the former.
  To attempt to  account for this fact, is not my present
intention.  Nor, to any of the purposes I have in view,
is it essential that I should.  To establish it, as the re-
sult of observation, is  sufficient.
  Were I, however, to hazard  an opinion on the sub-
ject, 1 might allege, that the deleterious  constitution of
the atmosphere acts in one or  both of the following
modes.
  It aids in the production of the pre-disposition to yel-
low fever, or, by its  influence,  prevents  the poisonous I
gas, which chiefly engenders that pre disposition, from m
being so readily diluted, dissipated, or  neutralized,  by j
the atmosphere, as it would be, if the constitution  did I
not prevail   In either way, singly, it may contribute to I
the spread of the disease.   By acting in both ways, it 1
will be doubly powerful.
  To cite, in confirmation  of these several positions,
instances which must be familiar  to every one versed in I
medical literature, would be superfluous.   They are to J
be found in  the works of most  authors  of reputation, 1
who have written, from observation, historically or phil-j
osophically, on the bilious endemic of tropical climates. ■
Nor can any one  fail to have  a  lively  recollection of
them, who has enjoyed opportunities  of personal obser-
vation.
   I know it is contended by a few medical writers, one
or two  of them  of no ordinary  standing,  that  yellow \ 
                         93
fever is not an endemic of the West India Islands, nor
of the tropical section of the American continent, but
was imported into them from distant regions, and prop-
agated by means of a specific  contagion.
  By father Labat, a Dominican friar, we are assured,
that, about the year 1686, this disease was introduced
into Martinique, from Siam in India, by  the Oriflamme
ship of war, and spread rapidly by contagion, producing
among strangers the most frightful mortality.  Hence it
received the denomination of " Mai de Siam," and must,
according to  this view of the  subject, have maintained
itself in the West Indies ever since, by its specific ca-
pacity of self-propagation.
   It is unfortunate for the ecclesiastic  who  has trans-
mitted this report to us, that,  in support of his opinion,
he  adduces no evidence superior in weight to his  own
assertion.  Yet he was not in Martinique when the  Ori-
flamme arrived, nor did he visit  that  island  until eight
years afterwards.   These facts being recorded by him-
self, need no  further proof.
   To attempt a refutation, or even an analysis of such
a statement, would be a humiliating condescension and
a waste of time. A more imbecile story has rarely been
propagated.  Yet has it been made the foundation  of
an obstinate  controversy, respecting the origin of yellow
fever.   It is  here  referred to,  only to  show, on  what
feeble  and frivolous evidence  medical  writers too often
rely,  when  treating of  subjects, of vital importance.
.Nor does this observation apply to any topic with more
pertinency or force, than to the usual mode of discussing
the point of  doctrine we are now considering.
  It is sufficient to add, that, as  far  as authentic facts 
                          91
 enable us to judge, the fever described by father Labar
 did not spread by contagion.   Tbe correct history of
 its  appearance, progress, and termination, refutes such
 a belief. (6)   ~Sor, from our knowledge of Siam, are we
 authorised to believe, that that  seaport has ever been
 infested by such a disease.  The  plgec is sickly; but, as
 far as I am informed, no author has pronounced it sub-
 ject to  yellow fever.   Indeed the  whole narrative de-
 serves to be regarded  as  one of the  numerous fictions
 in medicine,  by which we have so  credulously suffer-
 ed ourselves to be deluded, in relation to the subject of
 febrile contagion.
   By Dr. Chisholm, Inspector General of the British
 ordnance medical  department in the West  Indies, an
 elaborate work, in  two volumes octavo, was  written to
 prove, that, in Febroary 1793, yellow fever was impor-
 ted from Bulnma in Africa, in the ship Hankey, propa-
 gated by contagion in the town of St. George  in Grena-
 da, and thence commumoated, not only  to  many other-
 West India Islandss but to  the United  States, South
 America, Ireland, and  various seaports in the South of
 Spain.  •
   An effort more visionary and unsuccessful than this,
 has rarely been made  by a respectable inquirer.  The
pursuit after the philosophers stone might ba  cited as a
counterpart to it, both in principle and issue*
   For talent and knowledge, Dr. Chisholm  maintains
 a reputable standing among his cotemporaries;  and, as
a controversial writer,  few men have ever possessed a
superior amount of zeal and perseverance.   His experi-
ence, moreover, is sufficiently ample.  Yet, with all his
resources, he has utterly failed in  his attempt to prove 
                         95
that yellow  fever  is  contagious.  Even from  his own
statements, as far as he  has given  us a specification of
facts,  the  contrary opinion is necessarily  deducible.
Were it admissible, on the present occasion, to intro-
duce an  analytical, view  of his work, this assertion
could be  fully substantiated  by it.   To the production
itself, then, I might safely refer for its own  refutation.
   In relation to the contagious nature of this  complaint,
and its importation  from foreign places, all writers of
high authority,  on West India diseases, who have ad-
verted to the subject, are  opposed to Dr  Chisholm in
sentiment.  Of these, it is  sufficient  to  particularize
Mosely, McClean, Lempriere, Pinkard, Boreland, Jack-
son, and Bancroft.  The latter, more especially, has,
with great minuteness and accuracy, examined in detail,
and successfully overthrown,  the hypothesis which Dr.
Chisholm had so laboriously erected.
   At a much earlier period,  when  too  youthful, per-
haps, both in medicine and  years, to encounter,without
temerity, an antagonist  so disciplined  and  full of re-
sources, I myself attempted an analysis and refutation of
the opinions of that writer on the same  subject.  Of
the manner of this  attempt, and the success that atten-
ded it, some judgment may be formed, from a perusal of
No. IX, of the second memoir of my  work  published
in 1801, entitled "Medical and Physical Memoirs."
   Although Dr.  Bancroft's publication, which  appear-
ed long afterwards, is by far more voluminous, I am not
confident,  that it contains, in detail, any thing that mine
does not  exhibit, in principle.   In some  respects,  it
might serve as a commentary  on mine.   It is to be dis-
tinctly understood, that nothing here stated is intended 
                          96
as a charge  of plagiarism against Dr. Bancroft.  Al-
though he quotes some of my writings of that period, I
am prepared to believe,  that my '-Medical and Physical
Memoirs," had never been read  by him.    Had they
been, there exists no  sufficient reason  why he should
not have also referred to them;  especially as his refer-
ence to my other writings is respectful and even flatter-
ing.
   The other numbers of the same memoir, contain my
early views, which have not since been materially alter-
ed, in opposition to the  hypothesis of the importation
of yellow fever into  the city  of Philadelphia.   Those
views, when originally  published, were disbelieved by
ninety-nine hundredths of the American community; but,
sanctioned and recommended  by time  and experience,
they are now almost universally adopted.
   When  rigidly examined,  nothing  can  surprise us
more by its  fallacy  and  extravagance,  than  Dr. Chis-   \
holm's opinion respecting the  importation of ye'low fe-
ver into the Wrest Indies, in 1793, and  its  communica-
tion thence,  in a few months, to the numerous and dis-
tant places to which, in his enthusiasm, he professes to
trace it.
   Under the former head  he  asserts, that the disease
was introduced into Grenada,  by the  ship Hankey, on
the  19th of Frebruary, 1793.                          \
   In opposition to this, it is sufficient to state, that that
• vessel was perfectly healthy when she reached Grenada,
 that she had been twice cleansed  before her arrival, and
 had previously touched at  two other islands, and held a
 free intercourse with the inhabitants  on shore, as well
 ts with the  crews of the  Charon  and Scorpion, British
 ships of war, without infecting them. 
                         97
  Why she should, in a  very few days after leaving
St.  Vincents, the last place at which  she had touched,
become such a formidable  nidus of contagion, or why
the people of Grenada should have been more suscepti-
ble of this contagion, admitting its antecedent existence.
than those of the other  islands,  it  belongs to  Dr. Chis-
holm or his advocates to inform  us.   And  until, on
these topics, they shall  have favoured us with satisfac-
tory information, their cause will continue as desperate
as at present.
  But the point on which our author is most unreasona
bly extravagant and erroneous, is  the  unprecedented
rapidity, under the most unfavorable circumstances, of
the supposed communication of  the  disease, by mcaus
of contagion, from Grenada to otherplaces.
   It  is  universally admitted,  that  tropical  climates,
where houses are kept open, and ventilation  is free, are
much  less favorable to the propagation of contagious
diseases, than climates  where houses are closed, and
ventilation  confined.  For the  same reason,  the sum-
mer season is less favorable than the winter.  Keeping
these facts in view, let us  briefly  examine  the alleged
propagation of the  Grenada fever.
  As already stated, that, disease appeared in  the town
of'St.  George, on  the  19th of February, 1793.  Ac-
cording to the history of it, by Dr.  Chisholm, it made
its appearance in the month of April, of  the same year,
in the island of St. Vincents, to which tjgp Hankey her-
self, (having,  as already  remarked,  touched at  that
place, previously to her  arrival at  Grenada,)  had been
unable to  communicate it, notwithstanding the reputed
TOXdimt and concentration of her contagion^
                         O 
9S
   In  May,  it made its entrance  into  Barbndoes and
Demarara, at the former of which the Hankey had also
previously touched, without being able herself to infect it.
   In June, it commenced its ravages in Dominica, An-
tigua, and St. Christophers.  On the 13th of the month
it appeared in the first  of those islands,  and was gene-
rally diffused by the 20th!  For a disease, under thp
heats of a tropical sun, to  overrun  a  community, by
means of contagion, a secreted poison, in seven days, is
an unheard of event!  A progress rapid beyond exam-
ple, or even suspicion!
   Let those who can conceive  of such  an occurrence,
give credence to  it.   / can do neither.
   In July, the complaint attacked the inhabitants of To-
bago.
  In August, those  of, St. Croix.
  In October, the inhabitants of  Martinico, and those
of St. Thomas,  in the  month  of November.  In each
place its spread  was nearly as rapid as in the Island of
Dominica.
   In the mean time, it had been  conveyed to Philadel-
phia, in the month of July, and, about the same period,
to several ports on the  Spanish  main.  Nor was it long
in finding  its way to Ireland,  Gibraltar, and other pla-
ces in the south  of Europe,  and in pushing its devasta-
tions throughout the whole of the West Indies.
   Such is the representation,  given  by Dr. Chisholm,
of the propagation of yellow fever, by means of conta-
gion.   A  single ship, twice  cleansed  and ventilated,
diffused her febrile poison, in a few months, over an ex-
tensive section of the globe !  The plant of contagion,
rooted by  accident in the little  island of Grenada/shot 
99
  forth its gigantic4)ranches with the fleetness of the wind,
  and scattered its  pestiferous fruits,  over all the West
  Indies, a large portion  of the American continent, and
  not a small  one of the  continent of Europe!   Thus
  monstrous and incongruous is the picture presented to
  us !  But to  drop the metaphor.
  <.  In  the rapid propagation of this disease, and the ex-
  tent of space through which it is reported to have spread,
  in so short a period, and from so limited a source, throw-
  ing itself almost  simultaneously  on  many  points so
  widely distant from each  other,  there is somethingjjre-
  ternatural  The  usual and necessary proportion be-
  tween cause and effect  is entirely wanting in it.   The
  idea inculcated  participates  so  much of the wildness
 and extravagance  of romance, that  between it and so-
 ber belief there is no affinity.   The youthful and  credu-
 lous may receive it; but the matured  and the experien-
 ced are compelled to reject it.   It might have suited the
 gloom of the sixteenth century, but by the lights of  the
 nineteenth  its   enormities  are detected.    Had   the
 complaint been  small pox,  and a hundred agents  em-
 ployed to spread it, it could not have been propagated
 with such rapidity.
   An  effect so general and extensive, must have been
 produced by a general cause of equal extent.  So  ma-
 ny concurring phenomena must have had their origin in
 a common  source.   And that  cause  was nothing else
 than a pestilential state   of the atmosphere extensively
prevailing, assisted, in many places, by local circumstan-
 ces.   A  cause more limited in £its scope is* dispropor*
tioned  to the mighty effect.  To those who have studi-
ed attentively the history and laws of epidemical com- 
                        100
plaints, the  influence of such a constitution of* the at-
mospere will abundantly explain  the malignant charac-
ter and unusual mortality of the  prevailing distemper,
which induced Dr. Chisholm to pronounce it a new dis-   i
sa.se.
  As well might you attribute the thunder of the skies,
fa) the discharge  of a  Leyden  phial,  or the destructive
hurricane to the  waving of  a lady's fan, as so rapid and
extensive a propagation of disease, to the slow and lim-
ited  action of  contagion.  Small pox,  by  far the most
contagious of  diseases, could not,  by its mere inherent
power of self-propagation,  overrun the same section of  I
the globe in seven years—scarcely, perhaps, in twenty*.
  Tf called on, in a general  way, for proof of the exis-
tence of a  morbific  constitution of the atmosphere on
an extended scale, I find it in that state of things which
gives rise to Influenza.   That disease is not contagious.
Yet has it  several times,  within my recollection, pervai
d'cd, in a few  months,  the whole  of the United States- '
and  of the West  India  Islands,  and  many  parts  of
South America.    Without afiy peculiarity in the sen-
sible qualities  of the  atmosphere to produce the effect,
the  same complaint has also, on sundry occasions, over-
run, in a few months, a great part of Europe.
  Another memorable example of a morbific constitution
is discoverable in that  condition  of  the  atmosphere,
•vhich, in 1811,1812, and 1813, disseminated irregular
ly over the whole United States, the disease denomina-
ted peripneumonia typhoides.  Neither in the character
of the weather of that period, in the state of the country,
nor in  the mode  of life of the inhabitants,  was there a-
ny thin-  different from what  exists at present.   Nor 
                        101
was the disease,  of which I am speaking, propagated.
by contagion.  Its prevailing for a time, therefore, and
then disappearing without  any perceptible cause suffi-
cient to account for either event, can be attributed on-
ly to the prevalence and  disappearance of a peculiarly
deleterious constitution of the atmosphere.
  Indeed such constitution  must be presumed to existf
in every instance, where,  without  any  discoverable
cause, disease pervades, to an inordinate extent, a whole
community.
  An attempt to derive effects  like these from an agent
so circumscribed and feeble  as that of a poison  secreted
by the human body, is perfectly inadmissible.
  But the foregoing are not the only grounds on which
we are authorized to  deny the introduction  of yellow
fever from a  foreign country  into the port of St. George,
in 1793.
  To physicians acquainted  with the medical history of
the West Indies, the  fact is familiar, that, ever  since
the first discovery of those Islands, yellow  fever  has
been the scourge of adventurers to them from temperate
climates.  Even  the  followers  of Columbus were at-
tacked by it, and  not a few of them  destroyed by  its
malignity.   During  the  long and sanguinary  wars, of
the eighteenth century, between England and France,.
for the sovereignty of North America,  several  cam-
paigns were  entirely frustrated, by the  ravages of that
disease, in the fleets and  armies of the contending pow-
ers.  Nor did any one, in  those early  times, dream of
it as ought but a  native of the  places where. it so fre-
quently prevailed.
  In 1647 it raged with  violence in the Island of Bar" 
102
badoes,and,  at  a subsequent period, but  long before-
the time of Dr.  Chisholm, swept off, in about eighteen
months, one third of the inhabitants of St. Christopher's.
In several other instances, during the seventeenth  and
eighteenth centuries,  which, for the sake of brevity, I
forbear to specify, did it prevail with a mortality no less
deplorable.
   In fact* ever since the West Indies became a theatre
of European war, that  disease has,  in those  regions,
proved much more destructive to fleets and armies, than
fire-arms and the sword. That this is no exaggerated as-
sertion, might be easily proved, did.the occasion admit
of the requisite details.
   In refutation of the hypothesis of Dr. Chisholm, that
the yellow fever of the United States was the offspring
of that of Bulama in  Africa, and that it was first intro-
duced into Philadelphia, from the West India Islands, in
1793,  it is sufficient to state, that,  in the  autumn of
1792, the disease made its appearance  in  New York,
and proved fatal to a considerable number of the inhab-
itants.  Although but little notice has  been  taken of
that occurrence, the mortality produced by it not hav-
ing been very extensive, it is not the less true thai it ac-
tually took place.
   Whatever  might have been the origin, then, of the
American yellow fever, it had no  connection with the
pestilence  of Grenada, which did not appear  in  that
Island, until six months after the commencement of the
fever  of New York.   Nor,  notwithstanding their in-
dustry and exertions  to that effect, were the advocates
of importation able to establish any actual coincidence,
as to either time or place, between the arrival of sickly 
                        103
fessels from  the West Indies, and  the appearance of
the fever in the city of Philadelphia.   But it were use-
less to dwell longer in refutation of an opinion, which
is abandoned by every ingenuous inquirer,  and which
even the author himself would scarcely,  at  present,
have the hardihood  to defend.   To  those who may be
curious of  a more thorough  discussion of the subject,
I beg leave to recommend the  perusal of Bancroft on
yellow fever, and my own Memoirs.
   From the foregoing disquisition, I trust it  appears, on
unexceptionable testimony, that the  yellow fever of
tropical climates is an  endemic of those regions, the
immediate offspring  of  deleterious exhalation, arising
from that process of decomposition  and recomposition
of organic matter, which there  so extensively and con-
stantly prevails.
   H  Is the yellow fever of the South of Europe, and
that of the  United States of America, similar to the yel-
low fever  of tropical  climates, and does it  arise from
the same causes!
   To  both  branches of this question my  reply is af-
firmative.
   As respects  the  yellow fever of the United States,
and that of tropical climates, my knowledge is derived
from personal  observation.  Of them, therefore, it  will
be permitted me to speak with decision.  To pronounce
them merely similar, would be a feeble expression.   In
every essential characteristic  they  are the same.  Tlire
 is true of their access, their progress, their type* their
symptoms, their particular seat, their general pathology,
and the places where they prevail;  and also in relation 
i
                                                     1
                        104
to the descriptions of arsons  most and least  liable to
be attacked by them.
  They  are both ardent continued fevers, having but
one chill, with morning  remissions scarcely percepti-;
ble, and terminate usually from the third to the seventh
day.
  About the third day, in both,  in cases of a high and
perilous grade, a suspension of febrile and  other dis-
tressing  symptoms takes place, and continues a few
hours, to the joy of the inexperienced physician and
attendant, but to the dismay of those who  are familiar
with the  disease.   This flattering but  delusive interval
is the usual  harbinger of a  scene of gastric  derange-
ment, which, after infinite distress, terminates, for the
most part, in black vomit and death.
  Of cases highly malignant,  the  characteristic symp-
toms in both are, a yellow skin, (whence the name o!
the disease,) a muddy or reddish and watery eye, obsti-
nate vomiting, a  soreness of the  epigastric  region to
the touch,  united with a  sensation  of burning in the
part, black vomit as already  stated, and  hemorrhage
from the stomach, gums, and  other  parts  of the body
In each, the  biliary secretion  is sometimes defective
and at other times redundant, as is the case in all fevera
©f a gastric character.
  The immediate seat of both is  gastric or  hepatic—
certainly in some of the chylopoietic viscera—and their
general pathology, inflammatory or congestive.
   Post-mortem dissections exhibit, in both, similar de-
rangements of the same abdominal viscera.  In each of
them the brain is  also discovered, at times, to he affecteji 
                         105
 alike by inflammation or congestion.  But in neither of
 them is this a predominant symptom.
   The place  of prevalence of both is the  low, humid
 or marshy ground of some considerable body of water,
 or a place assimilated to it by  artificial causes.
   They both attack the natives of temperate and cold
 climates, but suffer the native and  acclimated inhabit-
 ants  of the tropics  to escape.  Creoles, and negroes
 from Africa are peculiarly exempt from them.
   They are again similar in  their capability of attack-
 ing the same individual sundry times, but less violently
 and dangerously on each suoceeding attack.
   Finally* they are similar, as  will  more  fully appear
 hereafter, in their freedom from contagion.
   Having never witnessed a recent case of yellow fever
 from the South of Europe,  I must rely, for my knowl-
 edge of that disease, on the testimony of others.  But,
 fortunately for the cause of truth and science, there ex-
 ists, on the subject, evideace that is conclusive. Authors
 of competency  and  character  have written on  it,  and
 whatever we may think of their opinions, we are for-
 bidden to  question their statements of facts.
   From these we learn, that,  historically considered,
 the yellow fever of Cadiz, Seville, Salamanca, and oth-
 er parts  of Spain,  and that  of the United States  of
 America,   are,  in every essential   characteristic,  the
same.
   Like that of the United States, the yellow fever of the
 South of Europe appears only during the summer and
 autumnal  months, in flat and depressed situations, after
 heavy rains, and heats  of unusual  intensity and dura-
 tion.  Nor are those diseases less alike,  in  relation to 
                        100
the time and manner of their disappearance.   On  the
commencement of cold weather, towards the  close  or
"autumn, or the beginning of winter,  it* is known  that
they both immediately cease  to  prevail.
   The yellow fever of the  South of Europe,  like that
of the United States, spares  the native and acclimated
inhabitants  of tropical  regions, and attacks only the
natives of temperate and high latitudes  And the cold-
er the climate, in which the subjects hive been born and
reared, the more  liable are they to the  complaint, and   ,
the more malignant and  dangerous does it usually prove.
   Another important point of similarity between these
two diseases, is, that neither of them can spread in the
salubrious atmosphere of elevated and dry places,  and
that they are, therefore, equally free from contagion.
   They  are  further alike in  banishing, during  their
continuance, all other febrile  diseases,  from  the situa-
tions where they prevail, or in imprinting on them their
own predominant features.   Nor is it unworthy  of re-   '
mark, that they are usually alike fatal  in their  attacks
on the intemperate, especially on those that are habitual
drunkards.
   In relation to  their  characteristic symptoms, these
two  diseases are specifically <he  same.  That this is
true, appears from a comparison of the description of
the American disease already given, with the  following
extract from the  work of an  accurate medical observer^
who had  been extensively conversant  with  the yellow
 fever of  Spain.  In describing  that disease,  he repre-   j
 sents the symptoms, in malignant cases, to have  been,     j
   " La hemorrhagia de narices, la vomicion sangurneo-   j
lenta por la  boca, la melena deyecciones de  sangre, la 
                          1A7
 ictericia, las petechias, y ultimamente el  vomito atrabi-
 liario, a que han  qut rido llamar vomito prieto, seme-
 jante al quo es endemico en ciertas estaciones del ano,
 en Vera Cruz, Honduras," &c.
   "Hermorrhagy from the nose, sanguineous vomitings,
 bloody and dark discharges by stool, yellowness of the
 skin, petechia?, and finally, black vomit, such as, at cer-
 tain seasons of the  year,  are endemical  at Vera Cruz,
 Honduras," Sfc.
   That the immediate seat of the yellow fever of Spain,
 like that of the same  disease  in the United States of
 Americans gastric and hepatic, and that congestion and
 inflammation in the viscera of the abdomen, constitute
 its pathology, is obvious, not only from the symptoms
 just enumerated, but from the  appearances exhibited in
 dissections of the dead.
   That there exists, then, between  the yellow fever of
 tropical climates, and that of the United States, and be-
 tween the yellow fever of Spain and that of the United
 States,  a resemblance  tantamount to  actual identity,
 satisfactorily  appears from the foregoing  exposition.
 But, by mathematical  analogy, things similar to  one
 and the same thing are similar to.one another.  Hence,
 the yellow fever of tropical climates and that of Spain
 are also alike.  Exhibiting each aperfect  resemblance
 to the yellow  fever of the United States, their resem-
blance to each other must be equally perfect.  Instead
of being called the  ye low fevers of particular places,
 they  should be  regarded  as constituting, collectively,
the identical yellow fever  of everyplace, where moisture
 and dead organic matter abound, and an elevated atmos-
pherical temperature prevails. 
                        108
  If then, the yellow fever of tropical  climates, of the
United States of America, and of the South of Europe,
be a unit, the cause productive  of  them must be also a
unit.   Under the existing  constitution  of things in the
Universe, of which we  form a part, identity of effect
necessarily  implies identity of cause.  Were the case
otherwise, that  connection between  cause and  effect,
on which the  harmony and order  of  creation depend,
and on which all our reasoning, and all our calculations,
as to the future are founded, would be  dissevered, and
universal uncertainty and confusion would  ensue.
   To throw on this subject all the further light of which
it is susceptible, and all that seems requisite, to estab-
lish the point for which I  am contending, a  succinct
recapitulation  of the  principal identities  exhibited by
those diseases would seem to be important
   They arise and prevail  only in  places  of the  soma
description, during the same  season of the  year, and
after and under the same kinds of weather as to humidi-
ty  and temperature; and they are extinguished by  the
same kind of change in the weather.   They attack par-
ticularly natives  of the  same climates and  countries,
and suffer natives and habitual residents of the same
climates and  countries to escape.   .When they take
effect, they are in the same manner graduated in their
violence, according as the  individuals attacked are na-
tives and residents of colder or warmer climates.   The
colder the region, where those affected have been born
and reared, and the more recently  they have left it, the
more  malignant and dangerous is their sickness.
   But this is not all.   The characteristic symptoms of
those  diseases are the  same, their type,  course, and oh- 
                         109
 ration the same, and, as both symptoms and dissection*
 »atisfactorily testify, their particular seat and patlwlogy,
 the same.   To  all of which might be  added, that the
 most successful mode of treating them is the same.
   Influenced by these  identities, which  are not only
 numerous but  vitally important, we  are compelled to
 believe,that the diseases which exhibit them, are neces-
 sarily the offspring of the same causes.   The  inference
 to this effect is not only legitimate, but irresistibly.
   III. Is Yellow Fever a specific disease, or only a high-
 er grade of thdfintermitting"and remitting fever, endemi-
 cal in hot climates?
   To this question a direct and categorical reply  can-
 not be rendered.   Nor, practically considered, would
 such a reply be of much importance.
   That yellow fever  belongs to the  same genus or
family with the intermittents and remittents of hot cli-
 mates, there is no cause  to  doubt.   They are  all alike
 the offspring of the putrefactive process; or, at least, of
 the decomposition and  recomposition of  organic mat-
 ter.   The  same  mode of prevention, therefore, is appli-
 cable to them all.
   But whether they  constitute, collectively, the same
 specific disease,  modified  only by higher  and lower
 grades, like  the distinct and confluent smallpox, or the
irritative and congestive forms of typhus fever, may be
 seriously questioned.
   Although, as just stated, the yellow fever, and the in
termitting fever certainly arise from a common source,
*hey require, for their production,  very different kinds
of weather.   To generate the former,  hot  and dry
weather is essential, a sufficiency of rain  having previ> 
                         110
 ously fallen.   To  produce the latter, weather moist
 and moderately cool is most suitable.   Such is unques-
 tionably the general rule, to which, if  exceptions occur,
 they are but exceptions.
   That a long  continuance of hot and dry  weather
 may produce, by putrefaction, (by which, I always mean,
 the natural decomposition and recomposition of organ-
 ic matter,)  a  poisonous  gas materially  different from
 that  arising from the same  process, under the influence
 of moist and cool weather, is, by no means, improbable.
 On the contrary, it is   an event which we have reason,
 perhaps, on principle,  to expect.  And, as far as analo-
 gy may avail, it favours the expectation.  Of directev-
 idence, on the subject, we have none.
   Marsh miasma is the poisonous gas to which 1 have
 refered.
   Without pretending to  any knowledge of the real
 nature of that substance, let us, for the sake cf  illustra-
 tion,  suppose it to  be  composed of oxygen,  hydrogen,
 and nitrogen, or any two of these ingredients.
   It  is a principlejn chemistry, that, in the formation of
 compound bodies, a greater or less proportion of any of
 the constituent parts, entering  into  the  compound, or
 those parts  uniting, perhaps, with each other more or
 less perfectly, produces, in the result,  a material differ-
 ence.   In illustration and  proof of this, a  number of
 pertinent examples  may be adduced.
   Carbonic oxid and carbonic acid, formed by different
proportions, and probanly different degrees of union, of
 the same elements,  differ from each other exceedingly,
both in their nature and their properties.
   The same  is  true of the phosphorous  and the phos- 
Ill
phoric acids, the  sulphureous and the sulphuric acids,
the arsenous and the arsenic acids, the several modifica-
tions of the muriatic acid,  and, more especially, the va-
rious nitrous  and nitric productions, arising from the
union of oxygen and  nitrogen.   I might add, that, by
fermentation and distillation,  carried on under different
circumstances, compounds  differing greatly from each
either arise out of the same elementary ingredients.
   In the formation of these compounds,  the process is
probably more active  and vigorous in one case than in
another, and the relative proportions of the component
"parts, as well  as  their  degrees of union, different, the
parts themselves being in substance the same.  But, be
this as it may, in their nature, properties,  and modes of
action, the compounds thus formed out of the same in-
gredients, are  widely different.
   In relation to the deleterious gas, resulting from the
natural  decomposition  and recomposition  of organic
matter, the same thing may  be true;  and hence it may
be  productive  of  different diseases.  The poison of
yellow may bear to that of intermitting fever, the same
relation that the longest of the  acidified compositions
bears to the weakest
   But, perhaps the most solid  ground of belief,  that the
yellow and  intermitting fevers do  not arise from the
same specific poison,  differing only  in degrees  of con-
centration, is, that they  never, in the same  place, prevail
at the same time.  Did the causes producing them dif-
fer only in strength, as  wine diluted with water differs
from pure wine, the phenomena presented to us would
be different.  In that case, the miasmata, acting as from
a center to a circumference, would produce, at and near 
\\2
to  the  source  of  exhalation, yellow fever, within lim-
its more remote, remitting fever, while at points remo-
ter still, intermittents would prevail.
   But su^h a series of phenomena never presents itself.
Wherever genuine yellow  fever reigns, as an epidemic,
it reigns alone.   Within the sphere of action of its poi-
son, no other febrile disease, smallpox, perhaps, except-
ed, can cotemporaneously exist.   And even it does
homage to the dominant distemper, by submitting to be
characterised by some of its symptoms,  (c)
   Hence, when yellow fever prevails in Philadelphia, it
is most malignant in water street, where it always first
appears,  and which  constitutes  the  low ground of tbe
river Delaware.  In fronts and more especially from
that to  second street, where the ground  is higher, and
more remote from  the river, the disease is less violent,
and toward the more elevated and  distant grounds of tj
third, fourth, and  fifth streets, where it  usually termi-
nates, it becomes  still lighter.*  But, throughout  its
whole range, its type is the same.  It  continues to be
every where yellow fever, although,  in different places,
of very different grades.   Under  m  lightest and sim
plest modification, it is less severe,  and more easily cu-
red, than intermitting fever.   Yet, in type  and charac-
ter, it is as different  from  that  disease  now, as when
marked by its highest grade of malignity.   Its strenjrjh
and power to injure are gone, but, in its form, it hassuf
fored no mutation.
  *Tlie author does not denjr that many malignant and fatal casei of
\ellow fever occur at considerable distances from the river.  But he
asserts the general rule to be, that, as it recedes from the river, the di«
>"We becomes lighter. 
                         113
   Did the yellow and  the  intermitting fever arise from
 the same poison, differing  only in concentration, and
 strength, the following phenomena, in epidemic seasons,
 would be likely  to  present themselves,  in the  city ot
 Philadelphia.
   In water street, would be found malignant yellow fe-
 ver, in front, and towards second street,  the same form
 of disease, but less violent, from second to third street,
 remitting fever, while from third to fourth and fifth, in-
 termittents would prevail.
   But as nothing of this description takes place, yel-
 low fever reigning alone, whenever it occurs in  an epi-
 demical form; and as,  for the  production of it and in-
 termitting fever, different and almost  opposite kinds of
 weather are  requisite, it  appears most  probable, that,
 although of the same family, their common parent be-
 ing the putrefactive process, they are the immediate off-
 spring of different poisons.   But those poisons  attack
 the same organs of the body,  and each produces a gas-
 tric form of disease.
  What I have said of Philadelphia, in relation to the gra-
 dations  of yellow fever, in Water, Front,  Second, Third,
 Fourth, and  Fifth streets,  is equally  applicable to the
 varieties under wbichthat disease appears, in the lower
 and the more elevated streets, of New-York, Baltimore,
 and other large commercial cities.  Wherever the com-
 plaint occur*, it always appears first,  and assumes its
 most  malignant character, in depressed and humid situ-
 ations, and intermittents are never its concomitant.
   Finally, it has been already observed, that the natives
 and acclimated inhabitants of intra-tropical regions en-
joy an exemption from  yellow  fever.  But. in relation
                         Q 
                         114
to intermittent, they have  no such immunity, being as
liable to them, as the inhabitants of other places.   Dkl
those two forms  of fever arise from the same specific
cause, it does not seem probable, that individuals proof
against the poison  in  a concentrated, would be injured
by it in a diluted condition.
   IV*  Does it prevail as an epidemic in the  low grounds
of the seacoast only, where it has  heretofore appeared.
leaving the more elevated situations untouched?
   Although yellow fever has prevailed most extensive-
ly, and, in the main, in its most malignant  form, in low
 maritime situations, it is  not necessarily  confined to
them.  In interior situations, on the borders of lakes,
 and the margins of rivers,  it has  often  appeared with
 alarming mortality.   Corroborative of this, testimony,
in the United States,   may be drawn abundantly from
the flats of Lake  Ontario,  and the banks of the Ohio^
the Arkansas, and the  Mississippi.   Nor,  were such tes-
timony wanting here,  could we fail to collect it on the
borders of rivers in South  America,  Africa, and some
parts of India.
   In fact, this disease is the native growth  of  every ex-
tensive tract  of low ground, whether maritime or inte-
rior, where a sufficiency of heat and moisture prevails,
and dead organic substances abound.
   But, in elevated and dry situations, yellow fever has
never prevailed, in an epidemic form; nor  can it so pre-
vail, unless by the want of wisdom, or the  carelessness
 of man.
   Did a large and populous city occupy such a situa-
tion, were its police so unwise and inattentive as tosuf;
fer humidity and filth greatly to accumulate  and remain 
115
in the streets, and, under these circumstances, should a
dry, hot, and epidemic  season occur, real yellow fever
might be the issue.   But, as such a concurrence of cau-
ses can scarcely take place, it is not material that we
dwell on its result.   In the main, yellow fever, endemiqr
or epidemic, is not to be looked for on elevated grounds,
and in inland situations.
   V. Does yellow fever appear  more frequently  as a
sporadic complaint, and only occasionally as an epidem-
ic, dunng the hottest season of the year?
   In a sporadic form, this disease always exists in tro-
pical climates; but, in temperate and cold ones, sporadic
yellow fever  rarely  appears.   During  twenty years of
ordinary health,  a physician  in  Philadelphia, engaged
in extensive practice, will hardly meet with a dozen  of
such cases^—perhaps not half so many.
   In years of disease, when a deleterious constitution
of the atmosphere prevails, attacks which appear spora-
dic, are often, for several months, precursors of the com-
plaint in its epidemic form.
   In those years in Philadelphia, in which the fever be-
gan to prevail  epidemically in  August,  cases seemingly
sporadic, made their appearance, on several occasions,
during the months  of May, June, and July, and* in the
year 1T98, as early as the month of April.
   But in strict language, such cases ought not, perhaps,
to be denominated sporadic,  as they are evidently con-
nected with the general  state of things,  which produces
ultimately the impending  epidemic.   The  confirmed
prevalence of almost every epidemical distemper  is thus
ushered in by scattering cases,  as, in war, the skirmish-
ing of advanced parties usually precedes the heat of the 
                        116
battle; and,  in  the physical world, the "grey of mor-
ning" is the uniform harbinger of the "full-blown day.11
  During the memorable pestilential  period, which, in
the United States,  as well as in the West Indies, and a
large portion of South  America, extended, with but
little interruption, from the year  1793 to that of 1805
inclusively,  many  sporadic  cases of gastric disease,
strongly resembling yellow  fever, occurred in Philadel-
phia, and I believe  also in  New York,  Baltimore,  and
elsewhere, even during the winter season.   A summer
temperature would have rendered them much more  ma-
lignant and  fatal.  It  would,  no doubt, have clothed    i
 them in all the  characteristic  symptoms of  real yellow
 fever.  They furnished incontestible evidence of the ex-
 istence of a deleterious constitution of the  atmosphere.
   In temperate climates, yellow fever can appear epidem-
 ically only during the hottest season of  the year.   But,
 during no season, as  already stated, can the sensible
 qualities of the atmosphere aloiw produce it in  that   ,
form.  It is therefore that it occurs in such  a form  only
 occasionally, and not uniformly and necessarily in every
 instance, when a high temperature and an arid state of
 the heavens concur to invite it.                          i
    Intense and long continued heats are essential to the    j
 generation of it; and so, in most instance?,  is protracted   i
 drought.  But, I repeat, that, for the  production of it,   j
 in an epidemical form, these two conditions of  the at-
 mosphere, aided by  putrefaction, do  not appear to be
 alone sufficient.  As a further auxiliary, a  general con-
 stitution of the season, favourable to the generation of
 malignant fever is essential.   Without the latter, yel- 
                         117
low fever has  never been epidemic  in  any part of the
United States.
   In  confrmation  of  this, summer and autumnal dis-
eases, generally, in whatever section  of our country
they have appeared, have never failed to be unusually
violent, at the times of the epidemic prevalence of yel-
low fever in our commercial  cities.   In  further cor-
roboration of the same point, when no  manifestation
has been given of an  existing constitution  unfriendly
to health, some of our hottest and driest summers have
passed away, without  giving rise to the disease  as an
epidemic.   They have  produced sporadic  cases, and
nothing more.
   From the foregoing  view of things, my reply, in brief",
to the question I am considering, is,
   That, in temperate  climates, yellow  fever  does not
often appear in sporadic cases, and that  it prevails only
occasionally in an  epidemic form, during  the  hottest
seasons, when  to a temperature • inordinately high, is
added a congenial constitution of the atmosphere.
   VI. In the most violent and malignant form of yellow
fever, is any thing secreted and thrown out from the body,
which can communicate  the disease, eitlier directly or
indirectly, from the sick to the well?
   The nature of my reply to this question, which vir-
tually embraces,  in itself, all that is most important in
the others, may be easily anticipated, from  sentiments
which I have already  unreservedly expressed.
   But, that this reply  may, in  all its relations, be  the
better understood, by  being  accompanied  by whatever
of illustration I am prepared to bestow on it, I shall
here, as clearly and succinctly  as practicable, enunciate 
118
my chief reasons for believing, that, under no circum-
stances, can yellow fever prove contagious; and, that, to-
become so, it must first cease to be yellow fever, and turn
to some other very different complaint.
   By way of preliminary,  it  will be permitted  me to
observe, that a mere increase  in the malignity,  effets
no real  change in the nature,  of a disease; and  that a
complaint,.contagious in any form, is so in every frm it
can assume, otherwise it  is no  longer the same com-
plaint.  In proof" of this, distinct is equally communi-
cable with confluent small pox; and lues venerea, in a
simple  shape, with the same disease  in the most compli-
cated and alarming shape it can put on.
   In like manner, if yellow fever be contagious at all,
it must be as essentially so, in mild  and manageable, as
in the most malignant and intractable cases.
   That it is not communicable by contagion, either di-
rectly or indirectly, from the sick to  the well,  appears
satisfactorily from the following considerations.
   1. It prevails only during a certain season of the year,
and under a given temperature and  constitution  of the
atmosphere.
   This is true  in relation to climates without the tropics.
The disease prevails there, only in summer and autumn,
during a high temperature, and a malignant or  pestilen-
tial constitution of  the atmosphere.   If it be, in an en-
demic or a sporadic form, perpetually prevalent in tro-
pical regions, it is because, there, the requisite tempera-
ture never ceases to exist.
   But this is no characteristic feature of a disease, that
is essentially and absolutely contagious—that possesses
unequivocally, an inherent power of self-propagation. 
                         lltf
  Of a disease of this  description,  small  pox  affords
the most perfect example.  Among febrile diseases, per-
haps the only perfect example.
   Of its contagion no doubt has even been  expressed,
because it rests on evidence that is indubitable.
   Analytically considered, this evidence  is, that the
complaint may  be propagated by a  voluntary act, in a
way that  is visible; that it  is  communicable casually,
at all times, and in all places, in the spring, the sum-
mer, the autumn, or the winter; during  a condition of
the atmosphere, humid  or dry, intensely hot, agreeably
temperate, or severely  cold; in situations elevated or
low, maritime or interior; in  cities  or in  the country,
near rivers or lakes, on plains, among hills, or in moun-
tainous regions.
   Unless a complaint be communicable  under all these
circumstances, no matter by what name it may be known
—yellow fever, typhus, or pestis vera, it is not of a na-
ture  unequivocally contagious.
  That yellow fever cannot be thus  communicated, is
universally acknowledged.  The attribute of contagion,
therefore, does not belong to it.
  2. When this disease prevails epidemically, its com-
mencement can never be traced to an  intercourse with
contagion, but always  to a source  of deleterious ex-
halation.
  By all intelligent and observing physicians, who have
had experience on the subject, and by a  very large ma-
jority of the most enlightened inhabitants of the com-
mercial cities of the United States, the truth of this
assertion is no longer questioned.
  On every fresh occurrence of yellow feveri in  an epi- 
120
 demical form, in Philadelphia,  New York,  and Balti-
 more, fresh attempts, the most zealous and active, were,
 for many years, perseveringly made, to trace the distem-
 per to a contagious source.  But in vain.   The nidus
 of contagion  was never discovered.   In Philadelphia,   ^
 the origin  of the disease  was  universally found in the
 contaminated atmosphere  of the low  ground of the
 river Delaware,  and in similar situations in the other
 cities.
   Having been myself very repeatedly engaged  in this
 investigation, I  pledge,  for the  truth of my  statement,
 whatever of reputation and standing I possess.  Were
 other testimony wanting, the most ample  and substan-
 tial might  be easily adduced.
   3.  In a  pure atmosphere,  it is  never communicated
 from the sick to ihe  well.                              j
   Fortunately for the  comfort and  welfare of the dis-  M
 eased, and the general interest of the human family, the   j
 truth of this is no longer questioned.   In Philadelphia   j
 and elsewhere, the  experiment has been  made so re-
 peatedly, on a scale  so extensive,  and in a manner so
 decisive, as to satisfy reasonable doubt, and silence even
 prejudice and clamorous scepticism.
   When, in that city, the disease prevails epidemically,
 and in the most  malignant form, in Water, Front, and
 Second  streets,  cases  removed  thence to the higher
 ground and purer air of Third and  Fourth streets, nev-
 er communicate it.   So true is this,  and so confidently
 is the truth recognized now,  that, in  the latter places,
 those confined by yellow fever are nursed and attended,  ,:
as in other  complaints, without  the  slightest dread of 
121
 oontagion.  Nor, by this intercourse, has a case of sick-
 ness ever been produced.
   When the disease appeared in Philadelphia, in 1793,
 and for several years afterwards,  its reputed contagion
 spread terror and dismay through the surrounding coun-
 try.  An individual from the city, while the fever was
 prevailing in  it, was dreaded and  shunned, as  if he
 breathed forth the deadliest  poison,  in  a visible  form.
 But the  scene is changed.  Time, the test of truth, uni-
 ted to experience, the parent  of knowledge, has dissipa- >
 ted apprehension, and no one, now, dreams of the  com-
 plaint being propagated in the country by means of con-
 tagion.  Hence, when the city is diseased, the  inhabi-
 tants  retreat to the neighboring villages, where  they
 often sicken and die, without being regarded as sources
 of danger, and  deserted, as  formerly,  or, in  a single
 instance, infecting  the individuals who linger in  their
 ehambers and  minister to  their wants.  If these facts
 are not recorded as  extensively as they might be, it is
 because they are so  numerous and  familiarly known,
 and, therefore, so much matters of course, that no  one,
 now, thinks it important to report them.
  During the prevalence of yellow fever in  Philadelphia
 in 1793, the general hospital  for the  accommodation of
 the  sick was  established at Bush-Hill, about three
 miles from the seat of the epidemic.
  To the wards of that asylum was  conveyed  an  im-
 mense  number  of diseased individuals.  It is  hardly
necessary to remark, that into such a receptacle, the very
worst forms of the  complaint would  necessarily  find
their way.   Although every thing practicable was done
to effect it, cleanliness in the  hospital could not be  pre- 
\12
%erved.   The' establishment  had been very hastily and
defe lively prepared, in the midst of great confusion, and
a want of means.  The nurses, in the beginning,  were
inexperienced and unfaithful; and even  of that descrip-
tion, a competent number could not be procured.   The
consequence of such  a state  of things must be rea-
dily perceived.
   By exhalations from the sick, the dying, and the dead,
the atmosphere of the building was thoroughly impreg-
nated.  From the  neglect of those in attendance, por-
tions of the floor were often covered with the matter of
black vomit.   Owing to the same cause, the natural ex-
cretions of the  patients  Were  not, at all  times,  very.
promptly removed.  For  want  of more suitable apart-
ments, the nurses and  attendants ate, drank, and slept,
in the wards  of the sick.   Nor were any precautions
employed—indeed, in such a place, none could be  em-
ployed, to guard against infection.
   Had  contagion existed,a more suitable arrangement
for the  propagation  of fever  by it, could scarcely have
been imagined.  The closing of the doors and windows
of the edifice would have rendered it complete.    Yet
nurses nursed, attendants waited, and physicians visited,
without the production of a case of disease.   The siclr,
introduced from the pestilential section of the city ex-
cepted, the establishment presented, throughout the sea-
son, uninterrupted health.
   Of such notoriety are these facts, and so  authentic
is the ground on  which they are reported, that I pur-
posely decline to  adduce evidence in  support of this
statement.  For an abundance  of it, I might refer to 
  most of the American medical  publications on yellow*
  fever, dated about the close of the last century.
     But, for proof that this disease cannot be propa-
  gated by means of contagion, I  need not confine myself
  to the well known events of 1793.   The history of the
  Philadelphia Hospital, during each succeeding epidemic,
  is precisely the same  with that I  have recited.  Not-
  withstanding  every  possible  exposure of  nurses and
  attendants, the records of that institution do not,  since
  its establishment, present a single  instance, in which
  yellow  fever  was communicated from  the sick to the
  well.
   In relation to the hospitals of New York, Baltimore,
 and other.cjties of the United States, I am authorized
 to assert,.that the same thing is true.   Their  records
 are alike free from cases of yellow fever produced by
 eontagion within their walls.
   The conclusion, then, is irresistible, that that disease
 is the  creature of exhalation from  putrefying  filth, at.
 least from the. decay and chemical  changes of  organic
 matter, not  of  a secreted poison  issuing from the  sick
 and attacking the  healthy.
   4. This disease is  perfectly under the control of the
 weather, and, on the occurrence of a change of  season,
 suddenly ceases to prevail.
   In the history of yellow fever* this is a circumstance
 of peculiar  moment, because, when  duly considered, it
 furnishes  an  argument again«t  its contagion,   which
 ought to be received as alone sufficient.   A brief anal-
ysis of it will illustrate sufficiently its bearing and force.
Let the seat of the epidemic be the city of Philadelphia,
where I have been accustomed to observe it. 
124
  September and October being warm and dry, the dis-
ease rages without abatement, many  new cases occur-
ring daily.
  On the first of November the northeast wind begins
to blow, the sky is soon  darkened by heavy clouds, a
rain of several days succeeds, terminating, perhaps, in
a fall of  snow, and the  mercury sinks  from fifteen to
twenty-five  degrees of Fahrenheit.   Autumn passes
precipitately into winter.
  On the first occurrence of this change in the general
state of the atmosphere, many persons, who have alrea-
dy  received into their systems the seeds of disease, will
be likely to sicken; and not  a  few,  perhaps, of  those
who are ill of it, will  be rendered worse.  But the epi-
demic is at an end.  During the season, another case of
it does not show  itself.  Did superstition  prevail, the
event, from its suddenness, might be ascribed, as simi-
lar  events often have  been, (d) to an   immediate act of
Divine interposition.
  This picture, although seemingly a fancy-piece, is a
correct representation of what has frequently occurred.
On what principle, then, does the epidemic cease?
  The city contains, now,  ten  times as many cases of
fever as it did in the  second or  third week of August,
when the complaint had been spreading, perhaps, twelve
or fifteen days.
  If it be contagious,  whence is it, that five hundred
persons labouring under it in November, cannot com-
municate it, in a single instance,  to any  of their atten-
dants, while, in the month of August, fifty or even ten
individuals affected by it,  diffused it  rapidly  through a
whole community?  Has a mere change in the tempera- 
                        125
ture of the weather a'tered  entirely  the nature of the
disease?  Did the  bodies of the sick secrete a specific
poison on the last day  of October,  and have they ccas
ed to secrete  it on the  first of November, their disease
being the same, for  no other reason but because the  mer-
cury in the thermometer has fallen?—This cannot be.
The cause assigned  is palpably inadequate  to the effect
produced.  Indeed, in  relation to  most of the sick, it
has substantially, no existence.
  In the chambers  of disease the  temperature has not
generally fallen—not at  least where  comfort obtains—
because, there, it  has been  maintained by the closing of
doors and the kindling of fires.
  Far from being ameliorated by the alteration in the
weather, the  fever, in many of those labouring under it,
has been rendered, as already stated, much more severe
and dangerous.  But its nature continues the same.   If
contagion, then, were  secreted by it  before the change,
it ought to be secreted more  abundantly now;  while the
closing of the doors and windows of the  sick rooms
should  give  it, by confining  and  concentrating  it, a
much better opportunity  to propagate disease.
  Wherefore, then, I repeat,  does the complaint so im-
mediately cease to  spread?   The question is addressed
to contagionists, and  they  are bound to  answer it.
Will  they tell me, that the specified change in the  wea-
ther, passing by the sick, suddenly  alters, in such a de-
gree, the susceptibility of the well, as to render them in-
capable  of contracting  the  disease?—That,  in a few
hours, it so metamorphoses their very nature, as to bes-
tow on them the privilege  of being contagion-proof l 
126                 t
   Such sophistry  as  this is unworthy of a reply, and
 shows  the  desperate condition of the hypothesis in
 favour of which it is employed.
   The truth is, that the change of weather which has
 occurred, neither extinguishes, in the sick, the power to
 secrete contagion, nor, in the healthy, the capability of
 being affected by it.  It acts on the atmosphere without
 the  houses, destroying its  pestilential character, not on
 the systems of individuals within them.   It condenses
 and beats down the deleterious exhalation, which, em-
 poisoning the air, had been  the cause of the epidemic,
 and prevents  its regeneration, by  extinguishing putre-
 faction from whif h it arose.  Hence the immediate ces-
 sation of the complaint.
   Did the existence and propagation of the disease de-
 pend on contagion,  the  effect of the  change of wea-
 ther would be not only different, but opposite.  In that
 case, the secretion  Qf contagion by  the systems of the
 sick still continuing,  and the  poison thus secreted be-
 ing, as already stated, confined  and concentrated by the
 closing  of houses, febrile  cases  would  be multiplied,
 rather than diminished  in  number.  This induction is
 legitimate and cannot be resisted.
   Like, small  pox, then,  yellow fevcr> if contagious,
 would cease to prevail, only  when  it could  no longer
 find susceptible subjects.
   5.  The disease  cannot be communicated either by
 inoculation, or by any other mode of employing the se-
 cretions of the sick, nor yet  by inhaling  their breath,
provided the experiments be  made in an  uncontamina-
ted atmosphere.
  Without entering into a circumstantial detail of them, 
127
it will  be sufficient to  observe,  that  every experiment
for communicating yellow fever, that  man could under-
go, or ingenuity  devise, was  performed, without effect,
on his own person, by the late Dr. Ffirth, then of Phil-
adelphia, during the epidemics of 18Q2  and 1803, and
most of them afterwards published by him in his Inau-
gural Dissertation.
   That intrepid experimenter slept not only in the same
room, but on the same bed,  with individuals ill of this
disease, in its highest malignity.  During their livesvhe
inhaled their -breath,  swallowed  some of their blood,
and smeared and inoculated  himself with the same flu-
id.  WTith their perspirable  matter, the serum dischar-
ged from their blisters, their saliva, their expectorated
mucus, and even their urine, and the bile taken from
their gall bladders  after death, he did the same.   He o-
pened and examined many dead  bodies, and, during the
process, exposed  himself to every  hazard he  could
think of.
   But this was not all.  Witlrthe matter of black vo-
mit his experiments were numerous  and greatly diver-
sified.   He rubbed it on his skin, introduced it into his
eye, inserted it into  his arm, in the way of inoculation,
confining it in the lancet-puncture  by means of  stick-
ing plaster, and inhaled  the steam arising from it, first
when recently discharged,  and afterwards when lying
on plates of heated  iron.  Nor did he stop here.  Ha-
ving dissipated, by heat, the liquid part of  it, he made
into pills the dark inspissated substance that remained.
and swallowed a considerable  quantity of it.  Taking
another portion  of it, in a fluid state, he diluted it with
water, and drank the mixture; and, to elose his experi- 
                          128
 nients, swallowed two ounces of it undiluted, immediate-
 ly after its ejection from the stomach of an expiring in-
 dividual.
   All these  experiments,  in presence of several  wit-
 nesses, I myself being often of the  number,  Dr.  Flirth
 very  repeatedly performed, and  still  retained  uninter-
 rupted health.   While engaged  in  them, the only pre-
 caution he observed, was never  to  expose  himself to
 the atmosphere of the pestilential section of the city.
 It is important to observe, that he had never in his per-
 son  experienced the disease, nor been before exposed
 to it.
   During  the greater  part  of the  time  bestowed on
 these experiments, the  temperature  of the atmosphere
 was of that elevated degree, which is deemed best cal-
 culated to awaken the susceptibility of the  system to
 the cont igion of yellow fever.   Indeed,  nothing was
 left untried to render the course  irresistibly conclusive.
 And such was the light in which it was regarded.  No
 one assailed it by an objection  or a cavil. Many who
 had, previously, been sturdy contagionists, abandoned
 their ground, and enlisted under the banners of the op-
 posite party.   Others who did not become immediately
 the open  advocates  of  non-contagin, ceased to be its
 opposers.   Of the force of evidence by which this
 change of sentiment was effected, the  enlightened and
 liberal will judge for themselves.
  6. Those physicians, who, from intellect and oppor-
tunity, are best qualified to judge and decide,  are  the
most confirmed disbelievers in the contagion of yellow
fever.
  That by far the ablest  class  of writers on this dis- 
129
 *ase are non-conlagionists, will not be denied by  any
 one acquainted with the medical literature of the present
 century.
   The works of the last  century, on this  sub;ee*,Tre,
 and ought to be, of less weight, because, at  that period,
 the  complaint  was  but very  imperfectly  understood.
 Yet, as far as they speak a decisive language, even they
 are, for the most part, opposed to contagion.
   If human authority, then, may, in any measure, avail
 —and  the mere  opinions of  distinguished characters
 ought not  to  be  disregarded—it preponderates beyond
 calculation in favour of the doctrine I am endeavoring
 to maintain.
   7. When yellow fever has made its appearance, as an
 epidemic,  it spreads too rapidly to be  propagated by
 contagion.
   A febrile disease really  contagious, ought to spread
 with a rapidity directly  proportioned to its power  of  in-
 fecting.  To the truth of this, as an axiom in medicine,
 every one must assent.
   That the contagion of small pox is much more ac-
 tive and indestructible than that of yellow fever, (admit-
 ting the latter to be contagious,) cannot be  questioned.
 But, in its progress through a city, the  march  of the
 latter is tenfold  more rapid than that of the  former.
 In  the  space  of  a month,   yellow  fever has  often
 pervaded a community, which, by the unassisted action
 of contagion, small p^x would not overrun  in  a year.
 The reason of this is obvious.   The former complaint
 is propagated by a contaminated atmosphere, which eve-
ryone must breathe and  swallow, while the latter is
communicated by  a secreted  poison,  whose sphere of 
                         130                            J
                                                        i
 action being very limited, may, with caution, be readily   j
 shunned.  The one is  a local  and  visible, the  other a
 universal but covert foe.  The first lurks chiefly in the   -j
 chambers of the sick, the last, every where.               ■
   8. In overrunning a city, yellow fever does not pur-   <
 sue the regular  march of a  contagious  disease,  but   1
 spreads  in a desultory manner, appearing  in sundry re-
 mote and disconnected places at the same time.           J
   9. A  similar remark is  applicable  to its  mode  of   1
 spreading through a family.  It does not, in its progress,
 pass gradually from  one individual to another, but at-   i
 tacks several  at  the same  time, or in  a succession by   J
 far too rapid to be effected by secreted contagion.          J
   The  truth  of these  Statements  is familiar to every   1
 one who is  observant  of the  movements  of epidemic   m
 yellow  fever.   The  facts they enunciate speak a Ian-   1
 guage  that cannot  be  misinterpreted,  and furnish an    j
 argument not to be resisted.  Fevers truly contagious   m
 are and must be, communicated first  to those individuals    1
 most immediately exposed  to their  influence.  Hence,
 nurses and  attendants are the earliest  sufferers; while    j
 others sicken in the ratio of their exposure.              ,
   But, in relation to yeHow fever, this  is not the case.
 Here nurses, attendants, physicians,  and neighbours    ^
 often escape, while, without having been near to the
 atmosphere of the sick, persons at a distance  are unex-
pectedly attacked.                                       a
   10 When yellow fever is prevailing,  those who be-   <jj
eome its subjects can rarely trace their attack to an in-   . j
tercourse with the sick.                                  '1
   To such an extent is this true, that, more than  nine
tenths, I  might say, nineteen twentieths, of the patient* 
                          0
                          1S1
  I have interrogated on  the  subject—and my  examina?*
  tions have  been  numerous—have declared themselves
  unconcious of the source  of their disease.  Indeed,
  while the doctrine of contagion was  predominant, the
  sick, at the commencement of their attack, scarcely
  ever believed their complaint to be yellow  fever,  on
  account  of their  ignorance whence it had been con-
  tracted.
    IL The survivers of this disease, without  cleansing
  them, often, with impunity, wear the  apparel, sleep  on
  the beds, and occupy the dwellings, of  those who have
 died of it.
   I  allude here to what takes place immediately after
 the season has changed, and the epidemic disappeared.
   That in every city of the United States, where yel-
 low  fever has prevailed, this event has  repeatedly oc-
 curred, is matter of notoriety; and, in  the West Indies,
 the practice is still more generally pursued.  Indeed,  in
 the   latter place, purifications of the  kind are rarely
 thought of.  Nor does the neglect of them ever become
 subversive of health.
   In the estimation  of all  who discard  prejudice, and
 view things as they are, these facts must prove fatal  to
 the belief, that the poison of yellow fever may be con-
 veyed from one country to another, in  clothing or mer-
 chandize*.  As well might we talk of gathering up and
 carrying to a distance the prismatic spectrum,  after the
 sun has withdrawn his beams, or the tones of a  piece
 of music, after the chords  of the instrument  emitting
 them have ceased  to vibrate.
   12. Yellow fever  having appeared  in  an epidemic
form^ can never be extinguished until the change of the 
                        132
                                                       ■.
season, by the most rigorous separation of the diseased
from the healthy.                                        1
  That this is true, the records of the proceedings  of    |
the Boards of health, in Philadelphia, New York, Balti-    1
more, and elsewhere, with their uniform failure to eradi-   *
cate the disease, conclusively testify.                     .
   In relation to small pox, the case is otherwise.   By    '
immediately  removing the sick to a hospital, and pro-
hibiting intercourse between them and the healthy, that    i
disease has been ojUn extinguished    In this way, when
not epidemic, its progress may be always arrested.  The
reason is manifest.  It is  communicated  by  contagion
alone, which is thus avoided; whereas to check and ex-
tinguish yellow fever,  whose  source  is in the air, you
must revolutionize the contaminated portion of the atmos -
phere, an achievement to  which,  in the present state   J
of  science, the powers of man are incompetent;  or you
must prohibitin dividuals from  entering that portion,the
only preventive expedient on which  we are authorized
by experience to rely.                                  "
   13. Yellow fever, when it prevails extensively, is
always preceded,  accompanied, or followed,  by certain
phenomena in the vegetable or animal kingdom, or in    |
the Heavens, which testify to its connection with the
constitution of the atmosphere, and, therefore, proclaim
it a genuine epidemic.
   The phenomena alluded  to  are various.
   As connected with the  Heavens, they are,  inordinate  •  \
heat and drought, preceded or followed  by excessive
rains.  Lightning and thunder, luminous meteors, and
other electrical phenomena  are defective or superabun-    j
dant, the atmosphere is unusually smoky or foggy > calm? 
                         133
or winds that are not customary prevail, or storms and
tempests are more than ordinarily frequent and violent.
   As relates to vegetables, their growth  is excessively
luxuriant or defective,  they are unusually sickly, espe-
cially in their fruits  and  seeds, and certain diminutive
and parasitical plants appear in  crops inordinately
abundant.   Hence, epidemic complaints, which are of-
ten attributed to the diseased  vegetable  productions of
the year, are nothing  but  concomitants of those produc-
tions, arising from a common  cause.   And this cause
is to be found in the peculiar constitution of the atmos-
phere.
   With respect to the animal kingdom, many species of
it are subject to tbe same distempers  with man.  This
is more especially the  case  in relation to our domestic
animals   ifence,  in Philadelphia and  other cities of
the United States, epidemic yellow fever has been re-
peatedly ushered in and accompanied by sickness among
dogs (e) and hogs, and an unusual mortality among cats.
 So true is this, and so  generally  observed, that  disease
 attacking those animals, in the  summer season, is con-
 sidered premonitory  of  the approach  of  human  dis-
 ease.
    Homer, therefore, in describing the pestilence, which
 wasted the Grecian forces,  while besieging Troy, is no
 less of a  historian than a  poet, when he tells us, that
           •'On dogs and mules the infection 6r6t began,
           •'And last its vengeful arrows fixed in man."
    By the slaughterers of hogs, for the Philadelphia mar-
 ket, in 1793, when yellow fever prevailed in  that place,
 it was observed  that  the livers  of those animals were
 unusually diseased. 
                        134
   But domestic animals are not  the only sufferers, du-
ring years of epidemic  sickness.   Wild quadrupeds,
undomesticated  birds,  and even the inhabitants of the
waters, are known to participate, at times, in the calami-
ty.   For numerous  facts  confirmatory of this, the rea-
der is referred to the first volume of Webster, "On epi-
demic diseases."
   Another phenomenon, not unworthy of observation,
presented by  the animal kingdom, during periods of epi-
demical disease, is  a superabundant production of in-
sects and worms.   That this is true,  in  the United
States, a faithful record of several of our sickly seasons
would satisfactorily demonstrate; and, in the climates of
the  east,  the  locust, the grasshopper, and the palmer
worm, are the usual companions of epidemical pestilence.
   In the summer of 1798,  one of the most calamitous
epidemic years that Philadelphia experienced, the country
around it  was unusually infested by grasshoppers and
catterpillars.   In a lower degree, the  same thing was
true of the summer of 1802.   And, in 1797, the mos-
quitos within  the city were almost as annoying as the dis-
ease itself.  Nor was  there  any thing  peculiar in the
sensible qualities of the  atmosphere, to aid  us in ac-
counting for these phenomena. Yet, within the recollec-
tion of the oldest inhabitant of the place, such a super-
abundance of those insects bad not previously occurred.
   Their productiveness, then, during that year, must
have arisen from some quality  in  the atmosphere not
cognizable to the senses.  In other words, from its con-.
stitution.
   For much  curious and valuable  information, on this 
                         1-35
subject, those who may be desirous of it,  are refered W
Webster's History of epidemical diseases.
   13.  In the true character of an epidemic, yellow fe-
ver either banishes,  during  its prevalence, all other fe-
brile diseases, or imprints on them many of its own fea-
tures.
   Even before the actual  occurrence  of yellow fever,
other febrile  diseases  often disappear, so that the epi-
demic is immediately  preceded by a short period of un^
usual health*.                                        ,
   As far as I have reflected on  the subject, there appears*
to be but one principle, on which this fact can be satis-j
factorily explained.                                  >
   Most febrile diseases are  the result of atmospherical!
influence.  Epidemic fevers  are necessarily so.         .
   While the atmosphere  is  undergoing that change,
whatever it may be, which is requisite  to qualify it to
co-operate efficiently in the production of yellow fever,
it passes first into what, may be denominated a medium
or neutral state—a condition not congenial to any giv-
en disease.   It is not yet prepared for the generation of
yellow fever, but is  so far altered  as not to favour the
existence of other febrile complaints.   Qn the contrary,
it prevents such existence.   In this state of things, dis-
ease makes a pause.   But it is  like the calm which of-
ten precedes the hurricane.  Nature seems to be taking
breath, as if  preparatory  to  some fearful exertion.   By
the operation of certain  undiscovered causes, the epi-
demic  constitution is at length  matured, yellow fever ap-
pears,  and, until a  change in the  season, reigns alone.
By the agency of a  mere secretion of the body—and
contagion is  nothing else—this  autocrasy could never 
136
 be attained^ because, by a power so limited, the qualitiei
 of the  atmosphere could  never be  controlcd.   Yet
 they are controled, and reduced to a congeniality with
 the nature of yellow  fever, else  all  other febrile com-
 plaints would not  disappear, and that prevail without a
 rival.
   In opposition to the  sentiments here advanced, it is
 contended by some, that  two epidemical febrile diseas-
 es may prevail in the same place at once.
   Such an event  is impossible. •  As well may two bo-
 dies occupy simultaneously  the  same  point  of space,
 two general diseases prevail at once in the human sys-
 tem, or the same thing be, and not be at the same time.
   One epidemic may  so immediately  succeed another,
 that before the last  attacks  of the preceding shall have
 ceased, the first of  the succeeding shall  have made their
 appearance.
   In  this state of things,  like light and darkness in the
 formation of twilight, the two diseases mternvngle their
 cases.  But, for them both to prevad,  at once, in full
force, in the same situation, I repeat,  is impossible.  As
 soon shall  we witness the  simultaneous existence of
 the gloom of midnig11,and the blaze of noon.
   It is indeed possible for two febrile  diseases, appa-
 rently different,  to prevail  epidemically at the same
 time within the same community.
   Among those, for example, who have never before ex-
 perienced that disease,  scarlatina  may exist, while par-
 turient females shall be attacked epidemically by  puer-
peral fever.
   In  this case,  the latter disease is nothing but the
 former concealed under  a.mask. 
137
   When scarlatina is spreading vigorously as an epi-
demic, the diathesis predisposing to it exists  very gen-
erally, as is often manifested by a prevalence of  some-
what of the exanthematous affection which belongs to
that complaint.
   Under these circumstances,  puerperal fever is noth-
ing else than the  general inflammatory diathesis of the
time, thrown on the pelvic and abdominal viscera, by the
influence of gestation, and ripened into actual disease
by parturiency, as an exciting cause.  Under the rubeo-
lous and the bilious diathesis, the same event has repeat-
edly occurred.
   To conclude this head of my subject, I  venture to
assert, that no one can render a single reason in support
of the notion  that yellow  fever  is  contagious, which
may not be applied with equal  pertinency and force, to
establish a belief in the contagious nature  of intermit-
tents,or any other form of bilious  disease.   Nor can
an  argument  be advanced against the contagion  of
the latter  complaint,  which may not be  urged,  with
equal effect, against that of the former.
   But, say some, although not absolutely and always so,
vellow fever is contagious  "under certain  circumstan-
ces."
   When brought to the test of  strict analysis, this po-
sition is discovered to be not only without foundation,
but without a meaning.
   There are no half-truths in medicine any more than
in religion.  Man is either a saint or a sinner, because
piety and impiety can never  amalgamate with  each
other.
   In like manner, disease  is contagious, or it isnof,
                         T 
138
 To assort it to be neither the  one nor the other, is to
 utter an absurdity.   A complaint contagious only  " un-
 der certain circumstances," is not contagious at all.
   Contagion  is a secreted poison, deleterious per se, in
 its relationship to man,  and must act at all  times in
 conformity to its nature.  To render it either inactive,
 or inn cent in  its action, you must  change  its nature.
 Unless thus changed, it will  poison not " under certain
 circumstances" only, but under all circumstances, as
 certainly  as oxid of arsenic, prussic  acid, or  the juice
 of the Ticunas.
   What are the circumstances  under which the conta-
 gion of yellow fever wiH poison, and those under which
 it will»?o/?  Tbe advocates of the doctrine have never
 yet informed us.
   If they consist in any peculiar  alteration  in the  na-
 ture of the poison,  it is a poison no longer.   Nor can
 it regain its power   to injure, by any mere change  of
 either time or place.  If it  lose this power in Novem-
 ber, it cannot recover it  in July or August following.
 Nor, if it lose it  in Philadelphia, New  York,  or Balti-
 more, can it regain  it by a  transportation to the West
 Indies, or  the  South of Europe.  Yet,  that it  can and
 does thus  lose and recover its deleterious  qualities,  has
 been virtually  if not expressly asserted.   On  the  ab
 surdity of such a notion, it were superfluous to dwell.
   But, perhaps it will be contended,  that the  circum-
 stances under which the contagion of yellow fever acts,
 consist in  a peculiar susceptibility of the human system,
which is developed during a  part of the year,  and lies
dormant during the remainder—which,  in temperate 
139
latitudes, is awake from July until November, and asleep
from November until July.
  This hypothesis, although attempts have  been  made
to sustain it, is too ludicrous to be seriously considered.
In relation to it, therefore, I shall only observe, that did
the  system of man, on the passage of autumn into win-
ten, lose  its susceptibility to the poison of yellow fever,
it is scarcely possible  that  its susceptibility  to  some
other  poison would not be also affected by the change.
But, that such is not the case, is universally known.
  I do not perceive that I can, in any other way, more
suitably conclude this head of my subject, than  by in-
troducing a quotation from my manuscript  lectures, on
the  same topic.
  " Why should the supposed contagion of yellow fever,
when  exceedingly abundant, suddenly cease to act in
the  city  of Philadelphia, in the  month  of  November,
and, when infinitely less in quantity,  act  again with
vigour, in the same place,  in  the monih of August of
the  succeeding year? Wherefore should it  lie dormant
nine months in the year, and be awake only  three? Or,
to vary the question, why should man's susceptibility
to its  action sleep so much, and be awake  so  little?
Is there, within the compass of nature, another poison
against which,  by any  change, or on any principle, the
human system  is  proof nine months in the year, and
liable to be afflicted by it only three?   If there be, the
advocates of contagion  are called on to indicate it.
  " How is it  with the poison  of small pox, of lues
venerea, of variola vaccina, of rabies canina, of arsenic
of opium, of laurel water, or any other, native or mor-
bid, that  creation affords?  Does  either of them lose 
140
its power of action, or to either of them does man  lose
his susceptibility, three fourths of the year, and regain
and hold possession of it during the other fourth?
  " These questions, I say, are proposed to contagion-
lsts.  Let them either answer them rationally, on prin-
ciples  consistent  with  their favourite hypothesis; or
abandon that hypothesis, as visionary and untenable.
   " In fine, a disease  which can prevail only at a given
time, in a given place, and under  a given  condition of
the atmosphere, is indebted for its  existence,  not to an
inherent power of self-propagation, but to the  combined
influence of season and temperature, topographical situ-
ation,  and atmospherical constitution.  If this be  not
sound sense, as well as sound science, I have no knowl-
edge of either."
   VII.  What degree of temperature is necessary to pro-
duce the disease, (yellow fever,) and render  it epidemic,
and to what degree of north latitude has it heretofore
extended?
  In reply to the first branch  of this  question, I  can
furnish nothing more  appropriate  than an extract from
an essay on yellow fever, which  I published in  Phila-
delphia in 1807.   After representing  that disease a6
an indigenous production of tropical climates, the Essay
proceeds as follows.
  "ft  is necessary to observe,  that  in  intra-tropical
countries, particularly in plains and maritime situations,
the mean  annual temperature of the atmosphere is
about 80 deg. of Fahrenheit; (it is in reality from 80 to
83 deg.)   Accordingly, therefore, as the temperature of
our summers (in Philadelphia.) continues as high as 80
deg. of Fahrenheit, for a  greater or less proportional 
141
part of their duration, in the same ratio must they be
said to resemble real tropical seasons.
  It is well recollected  by our  citizens, that the sum*
mer and autumn of  1793, (the year in  which yellow fe-
ver made its fir.t appearance, and  produced its great-
est mortality, in  Philadelphia,) were extremely hot and
dry.   The state  and temperature  of  the atmosphere
were of a character  truly tropical.  But,  as I have no
actual register of the weather for that season. I cannot
include it in my  comparative view.
  "Within the last  eleven  years, that is, since the be-
ginning of the year 1796, yellow fever has prevailed in
Philadelphia  six times, namely, in 1797, 1798,1799^,
1802,1803, and 1805.   In 1796, 1800, 1801,1804,
and  1806, we were  exempt from it.   Of these eleven
years, I have had access to a meteorological journal of
only eight, viz. 1796, 1798,  1799,  1801,  1803,  1804,
1805, and 1806.  Of these  eight years, four, as above
stated, were marked by the  prevalence of yellow fever,
namely, 1798, 1799,  1803,  and 1805; whereas, in the
other four, viz. 1796, 1801,  1804,  and 1806, that dis-
ease did not make its appearance.  Let us, now, taking
the mean  of tropical heats, namely 80 deg. of Fahren-
heit, as a standard,  compare the temperatures of these
eight summers with each other.
  "During the summer of 1796, the mercury rose  to
the standard of 80 deg. for only twenty-four days, and
we had no yellow fever;  During the summer of  1798,
it rose to the  same  standard for as  many  as forty-one
days, and we had yellow fever.   During 1801, for thir-
ty-two days—no yellow fever.   During 1803, for fifty-
one days—yellow fever.  During 1804. for thirtj-two 
142
days—no yellow fever.  During  1805, for sixty-eight
days—yellow fever.   During  1806, for thirty four days
no yellow fever.
  "These several summers, with their temperatures and
effects, as to the production of this disease, may be thus
arranged in  a tabular form: viz.
Sn.nniiTof 1796 Temperature 80deg. for 24 days, No Yellow Fever.
do	1798	do	CO	41	do	Yellow Fever.
do	1799	do	80	45	do	Yellow Ferer.
do	1801	do	80	32	do	No Yellow Fever.
do	1803	do	80	51	do	Yellow Fever.
do	1804	do.	80	32	do	No Yellow Fever.
do	1805	do	80	68	do	Yellow Fever.
do	1806	do	80	34	do	No Yellow Fever,
   " This simple statement,  as far as it goes, seems to
operate with demonstrative force.  It sets  forth, in a
manner the most clear and satisfactory, first, that yel-
low fever cannot, or at least, does not, break out in our
city, except  as the consequence of a  long continuance
of tropical heats  and secondly, that  such a continu-
ance of these heats has very seldom, of late years, failed
to produce it.   It teaches us, that if,  during the Course
of the summer, the temperature of the atmosphere does
not rise to 80 deg. of Fahrenheit, for more than thirty
days, no apprehension need be  entertained of the ap-
pearance of  disease; but, that if, on the other hand, the
temperature attain such an elevation,  for forty days, or
upwards, the public health is seriously endangered."
   The work, from which this  extract is  derived, was
published, as appears from its date, nearly  twenty years
ago.
   Since that period,  the facts  which  it  contains, even
the entire substance of it, have been  stated, in various
publications, treating of  the  causes of yellow fever.
But, as far as the author of this  memoir is informed. 
14S
 no reference has ever been made to the work in which they
 originally appeared.  Whether  this omission to quote
 was intentional or accidental, the liberal and enlighten-
 ed will judge for themselves.
   The facts aud observations refered to^  never did ap-
 pear in any work  in this country,  nor, as far as the au-
 thor is informed, in any  other,  until long after he had
 published them,  first in a  Philadelphia newspaper, (he
 believes it  was the  True American,) and afterwards in
 his Essay on the Yellow Fever of  1805, which was not
 printed until the year  1807.
   Such, then, were my  sentiments, on the present sub-
 ject, in 1807, and I have, since that period, found no rea-
 son to change them.  I shall, however,  repeat the be-
 lief which I have already avowed, that, without the con-
 currence of a favouring constitution of the atmosphere,
 the  specified  temperature  will  not produce epidem-
 ic yellow fever.  The stronger  that constitution is, the
 less amount of tropical  heats is  requisite for the effect.
   In reply to the second branch of the question, I  shall
 observe, that, in the  United  States, yellow  fever has
 never  appeared, in an  epidemic form, northward of Bos-
 ton, which stands in 42 deg. 22 min. N. latitude.  Even
 there its prevalence has  been limited both in extent and
 duration; and has occurred, I think, but twice within the
 last thirty years.
   But the summers of the United States are  considera-
 bly hotter than those of  Europe  in corresponding  lati-
 tudes.   The difference is equal  to  a difference in  lati-
 tude of six  or eight degrees.  According to this rule,
from the  thirty-fjurth to the thirty-sixth degree, ought
to constitute the  northern boundary of  yellow fever 
                        144
in the old world  But that parallel lies to the southward
of Spain, where the  disease has prevailed  with great
malignity.   Italy has been also the theatre of its rava-
ges.
   To the northward  of those  two  countries,  I do not
know that, in Europe, real yellow fever has ever appear-
ed, in an epidemic form.
   Along the borders  of the German sea, and even of the
Baltic, malignant  bilious fevers prevail.   But severe
and fatal as they often are, we cannot,  I think, bestow
on them the  name of yellow fever.   In that case every
violent bilious fever might be so denominated.
   VIII.  May not the disease arise andpevail, as an ep-
idemic, on the seacoast of northern Europe, especially on
the northwestern borders of Germany, during the hottest
months of summer, or is it peculiar to  warm and tropi-
cal climates?
   From  the sentiments already advanced, under the
head of the last question,  my reply to the present one
may be easily anticipated.
   In the ordinary course of things,  in no part of north-
ern Europe, maritime or interior, is  it probable that yel-
low fever can arise  and epidemically  prevail.  Under
the influence of an extraordinary season, such as can
scarcely  be looked for  once in an age, the event is pos-
sible.  For, throughout nature, an identity of cause can
never fail to   produce an identity  of effect.   Copious
falls of rain, therefore, having preceded a summer of in-
ordinate  heat  and drought,  co-operating  with a highly
deleterious constitution of the atmosphere,  may, even
in northern  Europe, become  productive of epidemical
yellow fever. 
145
  But, under the  ordinarily short  and temperate sum-
mers of that region, I repeat, that the event is not to
be  dreaded.   Earthquakes may  occur,  and volcanos
burst forth, in places which, previously, they had never
an noyed.  B ut these are exceptions to that general course
of things, on which the calculations of philosophy must
be founded.
  In  sporadic  cases, yellow  fever may appear in any
region.   But, epidemically, it is as peculiar to warm
jnd tropical climates, as  the olive or the plantain.  In
northern Europe, those plants maybe  reared, in the at-
mosphere of a  hot-house.   But they  will be  stunted
and feeble,  and their artificial existence precarious and
short.  For the olive, the  climate must be warm, for the
plantain, tropical.
   Such is the case with yellow fever.   Perhaps within
even the arctic circle, an  artificial hot-bed of disease,
or an extraordinary season, may produce it; but not in
its  native luxuriance and vigour.
  IX. SJiould question VI, respecting the contagious na-
ture of yellow fever,  be  arswered in the affirmative,
must we not, then, conclude, that  the disease, although
not capable of arising and spreading as an endemic or
epidemic, on the seacoast of the  north,  on account of
the low summer temperature of those regions, may yet
be introduced and propagated there in  a contagious and
sporadic form, by  vessels  arriving from  its native cli-
mate, having on board infected  merchandise, individu-
als, or clothing?
   My reply to this has been given already, under the
head of question VI.
   Yellow fever, not being contagious,  cannot be corri-
                          U 
146
municated in any form, sporadic or epidemic, from its
native regions to the north of Europe.
  Were it contagious, it might, and necessarily and re-
peatedly would, be thus communicated.   Not a seaport
of either Great  Britain,  Ireland,  or  the continent of
Europe, could escape it.  The fact,  then, that  they
do escape, is a powerful argument against its contagion.
  Render this disease as  contagious  as small pox—
and, according  to  the representations given of  it by
contagionigts,  it is much more—and, her intercourse
with tropical  countries  continuing as at present, Eu-
rope, continental and insular, not  excepting even  Rus-
sia and  Norway,  must annually suffer  from it, in her
maritime borders.  Under these circumstances, its ex-
istence and  ravages must become  as extensive and per-
petual,  as  the  spread  of commerce.   In  prevention
of the calamity,  measures of quarantine  will  prove un
availing.
   To show  that I  do  not thoughtlessly hazard this as-
sertion, let us  suppose the West Indies, and other  intra-
tropical countries, to  be the perennial birth-place, not
of yellow fever, but of small pox, and the human sys-
tem to be susceptible, not merely of one, but of reitera-
ted attacks of it.
   Of such  a  state of things,  the consequence is evi-
dent.  Commercial intercourse continuing, Europe and
America, continental and insular, maritime and interior,
would be as uniformly and perpetually the receptacles
of West India variolous contagion, as they are now of
West India sugar and coffee.  In contravention of such
an issue, human precaution would be ineffectual. (/) 
14?
   X. Mlhough incapable of generating the same coin-
plaint,  can the contagion of yellow fever produce,  in
northern latitudes, any other destructive disease?
   In showing that yellow  fever is not contagious, this
question has already been virtually and practically  an-
swered.
   Admitting, however, that in the course of the fever,
a specific poison were secreted, that substance, wherev-
er transported, must produce the same disease, or none.
Poison  is the same, and man the  same, in  every region
of  the  globe.   Difference of climate,  situation, and
manner  of living, can modify a complaint, but cannot
radically alter its nature.   Certain descriptions of men,
beyond others, escape certain diseases;  but, when  at-
tacked, their symptoms  are those that  belong to the
distemper.   Arsenic in Norway, and arsenic in Hayti,
when acting on the human stomach, produces the same
effect.
   With some  difference  in  violence and danger, the
poisons of  small pox, kine pox,  and lues venerea, prop-
agate their parent  diseases throughout the world.  So
must the contagion of yellow fever, had it any where
an  existence.   The  fundamental  law of creation  is,
that every thing must act according to its nature.  Abol-
ish this, and  chaos is recalled.
   As well, by change of climate, might a chesnut pro*
duce an oak, or an acorn, a fir tree, as the contagion of
one disease,  generate another.   Somewhat to  modify
the productions of nature, belongs  to created causes;
completely to revolutionize them, to God alone.
  XI.  If the answer to question IX,  being affirmative,
admit that yellow fever may be translated to the climates 
118
Of the north, and there prevail, if not epidemically, u(
least in a sporadic form,
   a.  What means should be adopted to prevent its intro-
duction, especially if the rontagion can be conveyed in
merchandise brought from infected ports?
   b.  If the answer be negative', ought the  institution of
quarantine to be abolished?
   Substantially, the first of  these  questions has been
already answered.
   Yellow fever not  being  transportable and communi-
cable by contagion, no means annoying to commerce,
and subversive of interest, ought to be employed to pre-
vent its introduction  into the  north of  Europe, by in-
fecttd goods, or diseased individuals.  Measures of this
description being unequally oppressive, and exclusively
injurious, are absolutely wrong.  Mistaken  notions were
their parent, and  prejudice  is their nurse.   Science
disowns them, and philanthropy has long deplored their
existence.   The  interest of nations, and the honour of
the nineteenth century, demand their  abolition.   That
 ruler who shall set the first example, in subverting them,
 will  deserve,  andx  receive,  in the gratitude  of pos-
terity, a monument beyond  gold in price,  and adamant
in duration.
   Involving matters of vital importance to. the  welfare
of man, the  second  question  invites  the  most serious
consideration.
   Although yellow fever cannot be introduced into the
north of Europe, by infected merchandize, or distemper-
ed individuals, the case is different with regard to dam-
aged cargoes and foul ships.   By means of these, oth-
er circumstances  concurring with them, there is rcaso* 
149
to believe that, sporadically at least, it maybe,  amu
perhaps, has been, introduced
  That  the foul  air of a ship, arising from a damaged
cargo, or some other internal repository of filth, has gen-
erated malignant  fever, at sea, cannot be doubted.  For
the production of febrile miasmata, such a vessel con-
tains in  her hoid, or among  her timbers, every thing re-
quisite—heat, moisture,  and perishable matter.  The
formation of such miasmata, then, and their consequent
action, on the systems of those that are exposed to them,
become inevitable.   Even  contagionists, who  once de-
nied them,  are compelled, now, to receive these facts as
conclusively established.
  But exhalations  that are deleterious in  one place,
cannot be expected to be harmless in another.   If they
produce fever at sea, they will scarcely fail, on the arrival
of the Vessel in  port,  to do the  same thing on shore.
Against their effects, therefore, as a source of disease.
every precaution that  is practicable should be adopted.
  In the city of Philadelphia,  (I  still refer to that me-
tropolis, because it was long the theatre of my observa-
tions,) the cause I am  considering has  been deeply ca-
lamitous.   Th it  many cases of yellow  fever have baen
generated there, as well as in other ports, by cargoes of
damaged coffee, indian  corn,  limes, and other articles
of a perishable  nature, is  now  universally  admitted,
because, when formerly denied, it was satisfactorily pro-
ved.
  In the years 1793,  1797, and   1805,  the  first cases
of disease proceeded  from  sources of this description.
For evidence of this, I might  refer to the writings of
Dr. Rush,  and othe> publications which  the occasions 
                        15b
produced.   But, relying on personal observation, I as-
sert the fact on my own responsibility.  In investigating
the subject,  in the  two latter years, I  was actively con-
cerned; and the  evidence  collected was abundant and
satisfactory.   Nor did I  fail,  at the  time, to lay much
of it before the public, in one or two dissertations, which
are still extant.
  Even in the northern  and healthy port of Boston, in
the summer of 1819, a memorable example of the same
kind occurred.   In almost every one that approached it,
a canro of Indian  corn, in  state of  deep putrefaction,
produced a disease exceedingly malignant, and, in most
instances, fatal.   Not less  than  thirty individuals be-
came its victims.  The character of  the season not be-
ing congenial to it, the disease was fortunately but lim-
ited in its range.   To extinguish  it,  the vessel was re-
moved to a distance from the wharf where she had lain,
and, if my memory be not fallacious, scuttled and sunk.
Of the event,  generally,  I speak  with  confidence, be-
cause I was in Boston at the time of its occurrence.
  But even  when their cargoes had not been damaged.
vessels have often given rise to fevers in port, by dele-
terious exhalations,  emitted by  filth deposited among
their timbers.  In the summer season, this event may
iiappeninany climate,  and arrangements to prevent it
should every- where exist.
  Persuaded of the  correctness  of this  view  of the
subject, I should deem it inexpedient and hazardous to
al^Ihsh, in commercial seaports, all measures of defence
against the  introduction  of disease, by foul ships and
damaged goods.
  Let their  institutions protective of health,  then,  be 
151
maintained, and their regulations to that effect, rigorous-
ly executed.   But, let their object be, the exclusion of
filth and deleterious miasmata, which do exist and pro-
duce disease, not of contagion, of which neither is trv<\
To this end, let their  means of defence be  directed a-
gainst impure vessels and putrid cargoes, not against in-
fected goods  and  distempered individuals.   Their an-
tagonist, then, like a real substance, will  be tangible and
confined to some place, not like a phantom, to the super-
stitious and the timid, every  where  suspected,  and no
where to be found.
   Under this system,  I repeat, Quarantine, in the strict
interpretation of the term,  will be abolished.  We shall
hear no more of keeping vessels forty  days at anchor,
to free them  from  contagion, by the  magic of numbers.
 The measures pursued  will  be no longer derived from
 the cloistered superstition of the dark ages, but dictated
 and approved, by the  experience and philosophy of the
 present age.
   Conformably to this, diseased  individuals will be im-
 mediately received, under proper regulations, into suita-
 ble hospitals, those  that are healthy, instead of being
 detained on ship-board,  until, by confinement, chagrin.
 and want  of exercise, they contract sickness,  will be
 suffered to go on shore, without restraint, all undamaged
 goods will be landed, being first,  if deemed expedient,
 carefully ventilated, such as are damaged will be remo-
 ved, purified, or destroyed, and the versel will undergo
 a thorough lustration.
    In common cases, all this may be effected in five days,
 as perfectly as in forty.  I speak from experience, ha-
 ving been myself a member of a Board of Health, and 
152
eii'>a«cd in directing and enforcing what I now recom-
mend.   Had not my  opinions been sanctioned by j rac-
tice, I would not have written on the present occasion.
   He that conscientiously  prepares himself to deal out
practical instruction, must do it by the acquisition of ex-
perimental  knowledge.   Book-learning  and closet-re-
flections  will enable  him  to theorize,  but experience
alone can qualify him either to act or direct.
   By a Board of Health, sufficiently vigilant, even heal-
thy vessels from healthy ports,  will  be carefully exami-
ned, during the summer season.  If they be leaky, or
freighted with hides or fruit, coffee  or grain, especially
in bulk, or other articles liable to putrefaction, sickness
may be produced by admitting them into port, and empr
tying their holds, or opening their  hatches.   In such a
case, let them be inspected by competent officers, and, if
discovered to be foul, measures of purification should be
rigidly enforced.  By this procedure, their pent and con-
centrated miasmata will be dissipated or destroyed, and
disease prevented, which might have been otherwise en-
gendered, (g)
   In a large and populous  seaport, the only certain pre-
ventive of  yellow fever, consists in general and perfect
cleanliness.  And that, if rigorously practised, it may be
confidently asserted, will never fail.
   But, to be effectual, it must  extend, not  merely to
cargoes and vessels, but to  docks,  and  wharves, and
streets, and alleys, and every other repository of putri-
fying filth, which the city contains.  Whatever can, in
any degree, contaminate  the atmosphere, it must cor-
rect or remove.   Let it   be thus  comprehensive  and
complete, and, I repeat, that, as a measure of protection
from yellow fever, it will be found sufficient. 
153
       •But if, regardless of purity, and immersed in foul ex-
     halations from a thousand sources, the officers of  health
     busy themselves only about tbe prohibition and removal
f     of goods and  individuals suspected of contagion, their
     measures are unwise, and their exertions will be una-
     vailing.   Malignant fever will assail them, should a con-
     genial constitution and season concur.
       Whatever my mere opmuns might have been, had I
     not witnessed very  different results  from  different
     schemes  for  the  preservation  of the  health of com-
     munities, according as they were directed against conta-
     gion, or miasmata,  I would  not have expressed myself
     !so confidently on  the  subject.   Nor would I have ven-
     tured so warmly  to  recommend the latter,  had  not
     experience convinced me of  its superior usefulness.
       A few observations on the pathology and general
     treatment of yellow fever, shall close this memoir.
       The immediate  seat  of that disease is the internal
     coat of the  stomach, the local  affection extending, at
     times, to the  duodenum,  and perhaps further.  But its
     foundation is laid  in an  extensive  congestion of the ab-
|     dominal viscera.   From this  congestion,  not, perhaps,
     an organ within the range of the portal circle is entire-
     ly exempt.  In different cases thn  livjer has been found
!     engorged in different degrees; at times but very slightly.
     When that organ has  been discovered to  be least affec-
i     ted, the congestion  in some of the  other abdominal vis-
     cera, particularly the stomach, has been the deeper.
       The state of congestion generally, is also exceeding-
     ly different in different cases of the disease.  It is exci-
     iive, inflammatory, or of a degree, so high as to prostrate
     ffie systemMnd take from it entirely the power of reaction,
■
< 
151
  As in all  other  complaints, congestion here is the
product of antecedent irritation.   That  irritation, a-
gain, is but another  name for a deleterious impression,
effected through the property of irritability, by means of
a specific aerial poison.
  If, then, yellow fever consist in abdominal congestion,
inflammatory or otherwise,  the curative indication is to
remove it, and  equalize the broken  circulation and ex-
citement.  Internal  congestion is accompanied by an
external deficiency of blood.  To carry this indication
into effect, different means must be employed,  according
as the congestion is  more  or  less intense.  With this
intensity correspond the  violence and  danger of the
complaint.
  The modes of removing congestion are two, depletion
and veihdsion.   Depletion is effected  in two  ways, ve-
nesection, and  secretion.   Revulsion  is  produced  by
counter-irritation.    Wrhen  the congestion is  internal
the counter-irritation is excited on the skin.  When  ex-
ternal, it is often removed by irritation in  the stomach,
skilfully directed.
   Secretion, to be effectual,  must be more or less gene-
ral.  But that  form  of secretion is most immediately
useful, whose org9n  is nearest to the seat of congestion.
In  the observations  about  to  be offered, on the treat-
ment of the disease under consideration, the applicabili-
ty of these remarks will be rendered apparent.
   Yellow fever appears in four several grades, consti-
tuting so many varieties or forms of  the disease.
   In the first  of these, it is a  very mild complaint, and
easily cured; much less obstinate, and not more danger-
ous, than a common case- of tertian intermittent.  The
• 
155
 stomach is retentive of the requisite medicinal substances,
 the febrile heat  and other symptoms  are not intense,
 the head is rarely  affected with  severe pain, the intel-
 lect although debilitated is  never deranged, the consti-
 pation of the bowels is seldom troublesome, and the dis-
 charges from them are always accompanied with a show
 of bile.   The only truly distressing symptom is, a feel-
 ing of weakness and  prostration,  greatly beyond the
 seeming  amount of disease.   When, in  a recumbent
 posture, the patient is  comfortable, and fancies himself
 nearly wrell.  But an effort to  walk, stand, or even sit,
 convinces him of his error.   The complaint continues
 from five to seven days.
   The treatment of this form of the disease is exceed-
 ingly simple.   It consists in a recumbent posture, per-
 fect quietude  of body and mind, diluting drinks, a mild
 vegetable farinaceous diet in very small quantities, and,
 perhaps, a few doses of calomel to promote hepatic, gas-
 tric, and intestinal secretion.
   This variety of the complaint is  never fatal;  nor is
 blood-letting, puking or blistering, necessary in the cure
 of it.   Such  is  its   uniform  mildness,  that many prac-
 titioners who  are ignorant of the laws and characters
 of epidemics, are unwilling to denominate  it a form  of
 yellow fever.  But, to the eye of the scientific and ex-
 perienced physician, it stands confessed  a modification
 of that complaint.
  The second variety of this  disease  is  more severe.;
but, under the influence of early and skilful treatment,
 it also is free from danger.
  The stomach  here is  more irritable than in the variety
just considered, the epigastric region is slightly painful on 
                         15Q
sustaining pressure, the febrile excitement is higher, the
skin dryer, the urine scantier and more highly coloured,
the head-ache more troublesome, the intellect more affec-
ted yet not often deranged, the countenance flushed, and
the eye somewhat suffused and  watery.   Add to  thisj
severe thirst, the tongue considerably furred,  a consti-
pated state of the bowels, and  a secretion of bile  de-
fective and vitiated.   Every symptom clearly indicates
stronger centripetal action, and a deeper congestion of
the abdominal viscera.
   In this form of the complaint, the treatment must be
more energetic than in the last.   The  congestion  here,
although not strictly inflammatory,  is  highly excitive.
Secretion and revulsion are both required; yet the action
of the system is above  the secretive and revulsivepoin's.
   By the antiphlogistic treatment must  this  inordinate
action be reduced.  A recumbent  posture and perfect
tranquility must be enjoined,  venesection practised to
the  requisite extent, cool diluting drinks administered,
and the surface  of the  body repeatedly  spunged  with
cold water.
   The excitement of the system being, by these means,
sufficiently reduced, let appropriate secretory remedies
be administered.  These consist in calomel alone,  or
united with tartar emetic, in such proportions,  as to
produce, at once, both vomiting and purging.  A mod-
erate cholera morbus thus excited, is often productive of
the  most salutary effects.   If it does  not considerably
shorten  the  course  of the complaint, it, at least, very
greatly detracts from its violence and danger.  By the
gastric,  hepatic,  pancreatic,  and intestinal  secretion
which it excites, it tends immediately to the diminution 
157
and  removal of abdominal  congestion.   And to the
same end it contributes  more wmotely.  by awakening
the secretory action of the  skin.   No sooner does the
bile  begin to flow in liberal quantity,  than  the surface
becomes soft, its temperature abates, and a free perspi-
ration  makes its appearance.  In  the mean  time, the
tongue becomes moister  and  cleaner, and the urine, if
it does not increase in quantity,  changes its  character,
and begins to deposit somewhat  of a  sediment.   Con-
tinue these secretions, for the requisite period, by ad-
ministering, from time to time, suitable doses of calomel
and  tartar emetic,  and the case cannot fail  to terminate
favourably.
   If, as may be sometimes  the  case, there  exist any
reason why tartar emetic should  not be exhibited along
with calomel, ipecacuanha may be made its  substitute.
   Another mode of practice which often  proves suc-
cessful, is, to administer the  calomel alone, and follow
it, in from  one  to  two hours, with moderate doses  of
tartar emetic, dissolved in water, until the bile and oth-
er secretions begin to appear.  For, let it be always re-
membered, that the prime object in view is  the excite-
ment of secretion.   Nor ought it to  be  forgotten, that,
to act  on the liver and procure bile, tartar emetic is one
of the most certain and powerful of remedies.
   In other cases,  the  exhibition of calomel, with the
subsequent employment, within a few hours, of an infu-
sion of senna,  or a  solution  of sulphate of magnesia.
has  excited secretion and subdued  the disease.
   In this form of  the complaint,  provided medical aid
be opportunely employed, neither blistering, nor saliva-
tion.is ever found necessary.  Nor is  yellowness of the 
15b
skin either a frequent occurrence in it, or deep, when it
does occur.
   The third  grade of  yellow fever is violent and dan-
gerous in the highest degree.   Under  the most skilful
and vigorous  treatment, many die of it;  and,  without
such treatment, but few recover.   That abdominal con-
gestion  in it  is intense and inflammatory,  and very
strongly  determined to the stomach, post-mortem ex-
amination, as well as all existing symptoms, conclusively
testify.
   The  symptoms which  more particularly give evi-
dence to this effect, are, an  extreme irritability of the
stomach, manifested by an immediate rejection of every
thing swallowed, a sense of  fulness, tension,  and  burn-
ing in that organ,  an exquisite  sensibility and soreness
of the epigastric region to the touch, and sometimes a
fulness  and tenderness of  the  whole  abdomen.   So
acutely sensitive, in some instances, is the region of the
stomach, that  the  weight  of the  bed-clothes  gives in-
tolerable pain.
   To these symptoms  may be added, great anxiety and
restlessness, high febrile excitement, as evidenced by an
augmented temperature, a fense, contracted, hard, quick,
and frequent  pulse,  and a degree of fiery and distress-
ing thirst, that nothing can  extinguish.   To these add,
a violent throbbing in the carotid and temporal arteries,
a flushed countenance,  a muddy, red and watery  eye,
high delirium, and an entire inability to sleep, or unre-
freshing sleep, frequently interrupted by sudden start-
ings and frightful  dreams.   The constipation of the
bowels is obstinate, and if, in such partial evacuations
as can be procured, any bile appear,  it  is defective in. 
159
quantity and deeply  vitiated.  In  very many  cases, no
bile is secreted.   The same thing is true,  at times, in
relation to the urine.   The secretory action of the kid-
neys is entirely suspended, constituting one of the most
fatal. symptoms of  the disease.   A single recovery
where it occurred, the writer of this  memoir has never
witnessed.  It is to this form of the disease  that a yel-
low skin  and  genuine black vomit  peculiarly  belong.
The prostration of strength in it  is not so great, asiit
is in the lighter forms of the complaint.  So  true is
this, that the patient  often  leaves his bed,  and moves
about his chamber,  as if he  were but slightly indis-
posed.
  In  this, as in every other grade of fever,  the object
of the practitioner  is to produce secretion.   But the
degree  of  excitement is greatly above the secreting
point.  The first remediate effort,  therefore, is to reduce
it.   To effect this, the treatment must  be strictly  and
vigorously antiphlogistic.
  Quietude must be  perfect, irritants  of every  descrip-
tion must be  removed, blood must be liberally drawn,
not by measure, but for effect, cool, acidulated,  diluting
drinks must be given in such quantities as  the stomach
can, without  inconvenience,  retain, the surface of the
body must be repeatedly spunged with cold water, so
that the  temperature  may be preserved, as near as prac-
ticable, at the standard of health, and efforts  must be
made to evacuate  the bowels by  means of injections.
But, in the early stage of the complaint, even the injec-
tions  ought not be very irritating.-'
  Should the  irritability and convulsive action of  the
stomach continue, so that every thing received into that 
160
 argan is immediately rejected,  leeches or cupping glassr
 es may be advantageously applied to the epigastric re-
 gion, so as to unite  to those  of general,  the  effects of
 topical,  bloodletting.   But  let  the  general excitement
 of the system be previously subdued, else the local evac-
 uation will prove unavailing.  If, by these remedies, the
 irritability of the stomach be not removed, a large blis-
 tering plaster may  be advantageously applied over the
 whole of the  epigastric  region, while, to the inside of
 the wrists, a similar application is made, at times, with a
 similar result.
   The stomach being tranquilized  by the  reduction of
 its irritability, and the general excitement being brought
 down to the secreting point, secretory remedies are now
 to be administered.   Of these, calomel  is to be chiefly
 relied on,  as being best suited to the production of the
 gastric, hepatic and intestinal  secretions, which  are
 again best calculated for the removal of portal conges-
 tion.   After the exhibition of a  few suitable  doses of
 ealomel—and  oftentimes full doses  irritate much less
 than small ones—let some  more active purgative be ad-
 ministered, to  qwaken the peristaltic motion of the bow-
 els.   For this purpose, jalap, epsom  salts,  soluble tar-
tar, and an infusion of senna, have all, at times,  been
advantageously  used.    The  practitioner  may  select
either of them, at pleasure, or such other purgative, as
be may deem  most suitable to the peculiar exigency and
 condition  of his patient.
  If, by this  process, bilious  evacuations can  be copi-
 )usly procured, even although of a vitiated character.
 he prognosis is favourable.   The  patient may, and
 >robably will, recover; because  the abdominal conges. 
161
tion is likely to be removed.  And, synchronously with
the liver, the other secreting organs begin to act.  The
skin becomes soft  and moist, the urine flows in larger
quantities,  and of a more favourable  appearance,  the'
tongue becomes less  parched and cleaner,  and even the
bronchial mucus  is more abundant.  Every thing indi-
cates that centrifugal action begins to predominate.
  But if the biliary  secretion  cannot be excited, the
prospect is unpromising, and the danger great.  Unless
the diseased condition of the system, particularly of the
abdominal viscera, be speedily  changed,  the derange-
ment of the stomach will be augmented, black vomit
must ensue, and the patient will die.
  In this conjuncture of difficulty and peril, the practi-
tioner's reliance,  and the patient's hope, rest on the stea-
dy and persevering use  of calomel, in moderate but fre-
quently repeated doses,  until an incipient ptyalism indi-
cates  that the mercury  has produced  its constitutional
effect.
  As a general rule, no sooner  has the saliva begun to
flow, than the bile also  appears, and the urine and per-
spiratory discharge  become  more copious.  Maintain,
for a time, this state of things, and the patient will recov-
er.
  In this form  of yellow  fever, where the irritability of
the stomach is so inordinate, neither  tartar emetic nor
ipecacuanha ought to be  given without  great caution.
When imprudently administered., in  an early stage of
the disease, previously to the  employment  of deple-   ^
tion by the lancet, and  while gastric inflammation con-
tinued intense, the mischief effected by them has been
too often irreparable.   They have  produced a puking 
lGi!
which nothing could allay, until  its termination in real
black vomit and death.
   But after  gastric irritability  has been sufficiently
appeased, by the  remedies already indicated, and when
calomel is retained  in  moderate  doses, repeated every
hour or two, small quantities of tartar emetic, dissolved
in water, maybe given in the intervals between the do-
ses of calomel, with great advantage.  When thus ad-
ministered, that important remedy aids, not a little, the
mercurial preparation, in awakening the secretory ac-
tion of the stomach  and  liver;  while, at the same time,
it promotes secretion by the skin, and augments mate-
rially the bronchial discharges.   Skilfully directed, ipe-
cacuanha may, in  some  cases, be made to contribute to
the same ends.   So ma jr opium,  united with these arti-
cles, by deadening  irritability, and rendering the sto-
mach more certainly retentive of .them.
   Such, in the  treatment of this form of yellow fever,
are the  modes of  employing  the heroic  remedies, in
Which the confidence of the practitioner is  to be chiefly
reposed.
   Should it become  requisite, on account of the state of
the complaint, to have recourse  to rubefacients, sina-
pisms, blisters, and internal stimulants, the use of them
must be directed  by the same rules,  which govern their
adminisftation  in  other diseases.   The  ends to be
attained iry them are, to  sustain action, and produce re-
vulsion.   And, for these purposes, when requisite, they
should be vigorously employed.
   Fortunately for man, yellow fever but rarely assumes
the unsightly garb  and fearful  character of its fourth
i.nd highest grade.   For, when it does, as far as the ex- 
163
perience and observation  of the author have extended^
it is always  fatal.
  In this modification  of the complaint, all the powers
4>f the system are prostrated,  from  its commencement,
far  below the point of reaction.
  The  cerebral  and  nervous  energies   are  extinct
Hence the countenance is dull, vacant, and sepulchral,
the intellect frozen  and fatuous, and the voluntary
powers most alarmingly  debilitated.  The skin is of a
dusky marbled,  or  a   mahogany  colour, somewhat
smooth to the touch, and cadaverously cold.  The pulse,
if at all perceptible, is exceedingly feeble,  slow, and ir-
regular.  The  slightest  pressure on  the  artery stops
entirely the lazy current that lags within it.
   The stomach and bowels are  either entirely torpid
and inactive,  or discharge, at  intervals,  without  any
seeming conscious effort, on the part  of the patient, a
peculiar fluid, dark and flaky in  appearance, and of an
odour nauseously offensive.
   Corresponding  with  the condition  of every other
function, respiration is extremely  feeble and imperfect.
The temperature  of the  air expired,  differs but little
from that of the air inspired.  In the language common-
ly applied to such cases, "the breath is  cold."  The
process of the arterialization and consequently the vi-
talization, of the  blood,  is either extinct,  or performed
in a degree  that is fatally  defective.  Hence the livid or
modena colour  of the lips, nails, the skin immediately
under the eyes,  and the petechia? or vibices which make
their appearance on various parts of the   body.  And
hence the alarming want of vitality% in aljl the organs of 
164
the system, which can be received only from arteriabzed
blood  Suspend, or deeply deteriorate, in any way, the vi-
talizing action of  the lungs on the blood, that fluid be-
comes venous, and the system fails in  its living energies.
To this  effect, evidence  is  abundantly derived from the
condition of those unfortunate  individuals, denomina-
ted, in  common language,  "blue boys,"  in whom, the
foramen ovale, and the ductus arteriosus remaining
open, but a moiety or perhaps  much  less of their blood
passes through the lungs, to receive the arterializing in-
fluence  of that organ.  The complexion  of these  sub-
jects is known to be livid, and their   debility great.   In
the defective condition of  all their functions, their inca-
pacity to sustain labour without unusual fatigue, and the
general  debility of their systems, their want of the  cus-
tomary amount of vitality is conclusively manifested.
   In the dismal  form of the disease under considera-
tion^the entire action of the system,  as far  as any may
be said  to exist,  is centripetal.   Hence  all secretory ac-
tion is  suspended, not excepting that of the  kidneys,
which, as already stated, constitutes  one  of the dead-
liest  symptoms.   As the complaint usually termin-
ates fatally in less than twenty-four hours, and not un-
frequentlyin from ten to twelve,or even in a period  still
shorter, no yellowness of  the skin is produced.  On  this
account, superficial observers and  puny  philosophers,
have often denied it to be yellow fever.  It is  thus  that
by far the most malignant cases  of true plague are fre-
quently  denied  by similar  characters  to belong to that
disease, because they terminate fatally in a few hours,
without the formation of bubos or carbuncles.
   But the production  of both  bubos and  carbuncles 
165
in plague, and of a yellow skin in yellow fever, indicates
the existence of no  inconsiderable degree of vital ac-
tion;  and that  action  of  a centrifugal  character.  In
the form of those  diseases,  however,  which is  now
under consideration, such  action does not exist.   The
complaint is too malignant, and too much confined in
its  ravages to  internal and more  vital  organs, to give
rise to any affection of the  skin.   Primitively and sym-
pathetically, it assails  more particularly, with its dead-
liest poison, the stomach and  abdominal  viscera  gen-
erally, the  nerves, the brain,  the  lungs, and the heart.
Its attack is  as sudden as  that of apoplexy.  The pa-
tient  sinks  almost  motionlessv under  the  paralysing
force  of the deleterious impression  which the poison
produces.
   In relation  to the treatment of this form of yellow
fever, the author  of this  memoir has but little to re-
mark.   His object has been, to communicate to the pub.
lie his own experience.   But, unfortunately,  his experi-
ence has taught him only the  fatality of  the  complaint,
and the insufficiency of every mode of practice  he has
hitherto employed.  For, he repeats, that  every case of
this ultimate grade of the disease, that he has witnessed,
has terminated  in death.
   He certainly  has in reserve a  scheme  of treatment
which he has never yet practised  in  this terrible com-
plaint;  but which he  has  resolved to practise,  should
an  opportunity  at  any time  hereafter occur.   But as
this scheme  is  not sanctioned by his  experience, he
deems it premature and improper to recommend it.
   He will only observe, that, in this, as  in every othe
form  of yellow fever,  the ultimate object of the prat 
                          166
 titioner should be, to excite secretion.   But the action
 of the system is far below tlie secreting point.   The first
 step,  therefore,  is to  raise it to that point—in other
 words, to rouse the system to reaction, and produce, if
 $oss\b]e,febrile excitement. To effect this, the most pow-
 erful stimulants, both external and interna], should be
 abundantly, skilfully, and perseveringly applied.   But,
 as the mass of blood is too weighty  for the  action of
 the enfeebled heart to maintain in motion, to diminish •
 and lighten that  mass, by means of venesection, cau-
 tiously employed, (h) in tbe midst of the use of awaken-
 ing and strengthening stimulants, is a mode of treatment
 which the perilous nature  of the complaint justifies,
 which reason  and analogy seem to approve, and which
 no established principle forbids.   Although the author
 does not recommend  this  practice to  others, he would
 not hesitate, under a pressing emergency, to  pursue it
 himself, with such precautions as circumstances might
 suggest.  Many a vessel, likely to founder in a troubled
 sea, has been eventually saved, by throwing  overboard
 a part of her  cargo, and  spreading  more canvass to
 force her through the waves.  In the present case, the
 blood is the  cargo, the stimulants, the sails.
   If, by the means here suggested, reaction and febrile
 excitement can be awakened, the patient may  be saved.
 The next step will be, to produce abdominal and gen-
eral secretion? together with the requisite revulsion, by
the medicinal articles recommended for these purposes,
when the cure of the third form of this disease was
under discussion.
  As far as  the author may rely on his own experience,
he is perfectly persuaded, that convalescence, from eve- 
fy form of yellow fever, is best conducted without tiu
use  of medicinal tonics.   If congestion be completely
removed,  those  articles are unnecessary;  and if it be
tiot removed, they are injurious.
   The most safe  and efficacious course of tonics con-
sists in the  proper regulation of  what  is  fancifully
termed the non-naturals, which consist of,  air; aliment;
exercise and rest; passions and affections of the  mind;
wakefulness and  sleep; repletion and evacuation.
   A skilful administration of these agents, aided by  a
judicious  regulation of the article of dress, will  rarely
fail to prevent relapse, and render the march of conva-
lescence secure and rapid.
END OF MEMOIR II
* 
NOTES TO MEMOIR II.
                 Note (a) page 89.
  By the term putrefaction, as used in this Dissertation,
I  mean, that natural process of decomposition and re-
composition, which dead organic matter sustains, when
under the influence of heat, moisture, and atmospheric
air.
                  Note (b) page 94.
  When the Oriflamme sailed from  Siam, the port  and
the ship were both Jiealthy.  Nor was the health of her
crew affected  vvhen she  arrived  at  Martinique.   But
soon after  her arrival, a malignant  fever made its ap-
pearance in the vicinity of the  place where  she lay;
and some of her crew were among the first subjects of
it.  Hence the introduction of  the  complaint was at-
tributed to  her.
   Such were  the  facts.   Their explanation  appears
equally simple and plain.
   Either the Oriflamme, in the course of a long voyage,
had become foul; and, when undergoing  a cleansing in
dock, with  her ports and  hatches all open, sent forth a
deleterious gas, which  engendered disease; or  she ar-
rived at  Martinique, just as an epidemic  was about to
commence, and, very naturally, some of  her crew, be-
ing strangers in the place, were  among the first  who
sickened.   Most probably both these  circumstances
existed,  and united  their influence  in effectuating the
result.
                 Note (f) page 112.
   In Philadelphia, the yellow fever of 1798, was  pre-
 ceded b\ a considerable spread of small pox. 
169
  When the former disease  appeared, and  assumed an
epidemic form, the latter became more  malignant and
fatal, and was marked, in many cases, by genume black
vomit   It yielded, at length, completely to the predom-
inancy of tlie epidemic, and  entirely  disappeared, long
before  the termination of that complaint.

                 Note (d)page 124.
  The sudden cessation of the plague of the Nile, at a
given period, is ascribed, by the natives, to supernatural
agency, and homage is paid,  in  gratitude for it,  to the
tutelary Divinity, or Saint,  of the place.

                  Note (e)pigel33.
   In the year 1805, yellow fever appeared first in South-
vvark,  one of V e suburbs of Philadelphia, in the vicini-
ty of a very large  pile of oyster shel s and damaged
oysters, that sent f>rth an odour peculiarly offensive
   For some weeks previously to the occurrence of the
disease, many dogs,  in the neighborhood of this mass
of putrefying matter, sickt ned, and several  of them died.
Their complaint was intestinal, as appeared  from  their
symptoms while living, as well as from an examination
of their bodies after death.

                 Note (f) page 146.
   Similar remark smay be applied, with equal propriety
 and force, to pestis vera, or oriental plague.
   Were that disease capable  of being propagated by
 contagion,  and  were commercial intercourse with the
 countries where it prevails regularly and constantly main-
 tained, as it is  at present,  all  the quarantine establish-
 ments that  man could erect and administer, could not
 exclude it from the seaports of Europe.   And  were it
 in the seaports, it wouid reach  the interior, and Eu-
 rope entire  would be  the theatre of its ravages.
   Nor would the  evil terminate here.   From the old
 world it would inevitably  pass into the new, until final-
 ly, ifsZiraifc would be the same with those of the  inter-
                          X 
                        17$

fifurse of nations iviih each other.   Its range would be
the same, and its perpetuity the same with those of small
pox.
   Admitting it to be contagious, it is impossible to ren-
der a substantial reason why  it should  not spread  as
extensively, and prevail as constantly  as small pox, or
any other contagious malady.
   But pestis vera is not propagated by  contagion.   In
attempting to prove that it is, Russell, tbe great apostle
of that doctrine, has virtually  and satisfactorily proved
the reverse.  It originates from  the same  causes that
engender yellow  fever—temperature, humidity, dead
organic matter, and a favoring  constitution of the at-
mosphere.   It  is  yellow  fever,  modified  by  climate,
situation, and a few other circumstances.
   Sentiments to this effect I  publickly uttered in  the
year 1801, in an  oration,  "on the analogies  between
yellow fever and  true plague," delivered to the  Phila-
delphia Medical  Society, and published by  that  body;
and all  the  additional  informat on I have  since been
able to acquire  on the subject, has tended only  to con-
vince me that they are  true.   The following extract is
from that production.
   aBut  epidemic plague and yellow fever resemble each
other in their decline and termination, no less than they
do  in their rise and progress.
   Having raged with more or less violence  throughout
the summer and autumnal months, the career of both is
immediately closed on the accession of cold weather.
So completely are their semina blasted by  a moderate-
frost, that, after such  an occurrence, there remains in
general no  shadow of ground to dread  their influence.
It is indeed true, that sporadic cases of these disease!
appear even  in the depth of  winter: but they are  the
offspring of causes which  operate only on a circum-
scribed scale.  It belongs  to   spring, summer,  and au-
tumn, particularly to the two latter seasons, to render  the
plague and yellow fever epidemic.   The  reason of this 
171
     is obvious.   It is during these seasons only, that a suffi-
     ciency of putrid exhalation can be  evolved, to impreg-
 ,    nate the atmosphere to the pestilential point.
        To the foregoing  account  of the  termination of
>    plague, I am not ignorant that there exists an exception.
,    Instead  of continuing  till the commencement of win-
     ter, this disease, in  Egypt and Syria, terminates uniform-
     ly about the  summer  solstice.  Hence  it has become
     proverbial, that  extremes of heat  and  cold are alike
     destructive to pestilential contagion.
        Does not this circumstance, it may be asked, consti-
     tute an  essential difference between  plague and yellow
     fever? I answer, it does not.  For did the latter disease
     visit the above mentioned countries,  it would terminate
ft    at the same season with the former.
        However paradoxical it may appear, it is unquestion-
     ably true, that in Syria and Egypt,  plague expires du-
[   ring the heats of summer, on the same principle, which,
■   in European  countries,  leads to its  termination on the
W   commencement of winter.  The cause,  in  both cases,
i    is a failure of the  food  of putrid  exhalation.  For, as
I    already observed, plague and )dlow  fever prevail only
     at such  times  and in such places, as  are favorable to
     the production of this gaseous poison.
        In most parts of Asia and Africa the  climates are
     materially  different from those  of corresponding lati-
 *    tudes in Europe and America.  This difference is in a
     great measure attributable to the burning desarts of the
     East, which, by communicating their  temperature to
     the surrounding countries, render  them much warmer
     than others remote  from such torrid regions.   But epi-
     demic diseases are known to be greatly under the con-
     troul of the temperature of the atmosphere.   We must
     therefore expect, that the epidemics of countries so dis-
     similar in their  climates  as those  just mentioned, will
     not only be somewhat different in appearance, but will
     rise and terminate at different seasons of the year.
       Syria and Egypt may both be considered as southern 
m
regions, subject  no less to extremely  dry,  than to in-
tensely hot weather.  In  the former country  no ram
falls from the middle of May until  the middle of Sep-
tember, while the latter suffers a drought of a much lon-
ger continuance.   Nor has nature been more liberal in
supplying them with  terrestrial streams, than she is in
refreshing them with the waters of Heaven.   Syria con-
tarns no river of note but the Orontes, and the Nile is the
only one that waters  the  land  of the  Pharoahs.  The
existence of smaller streams  is rendered impracticable,
partly by the scanty falls of rain, and partly by the thirs-
ty nature of the soil.
   In consequence of this deficiency of moisture, co-ope-
rating with  the  extreme  heat  of their climates, these
places, throughout the summer months, exhibit the most
parched  and dreary  aspect.    During  this  inclement
season, so completely suspended are the powers of ve-
getation, and so  dead and withered the foliage of most
plants, that both countries appear as if  scorched by fire.
Exhausted of their waters, to the last drop, even the air
and the earth contribute to heighten the general aridity.
Under such  circumstances, putrefaction, no  longer able
to go forward for  want of humidity, ceases to  impreg-
nate the  atmosphere with deleterious effluvia.  For, to
the existence of this process, moisture  is no less neces-
sary, than it is to  preserve the  verdure, or to promote
the growth of the  tenderest vegetable.
   No sooner have the  heat  and drought of the season
produced in every tiling such  an  excess  of dryness,
which happens about the 20th or 24th of June; no soon-
er has the atmosphere become thus  depurated of putrid
exhalation,  than  the ravages of the plague, which had
been kept up by the  putrefaction of the vernal months,
are immediately at. an  end, as  if staid by the influence
of supernatural  agency.  Deprived of its  proper ali-
ment, in consequence of this  deficiency  of water, the
monster may be said to  perish  by famine.   Were Syria
and Egypt supplied with uniform  rains, like the coun? 
173
tries of Europe, there is no doubt  but summer and au-
tumn would be their principal period of suffering from
this disease.   After the  autumnal rams of Syria, there
is not a sufficiency of heat, previously to the commence-
ment of winter, to generate afresh the seeds of pesti-
lence.
  We may lay it down, then, as a physical axiom, that
the destruction  of putrid exhalation,  whether effected
by the frost of winter, or by the  co-operation of heat
and  drought, will  arrest  the  desolating  progress of
plague.  But the same thing is true with regard to yel-
low fever, which depends for its origin and propagation
on the same  effluvia.   In this particular,  therefore, no
less than in others already mentioned, these two diseas-
es exhibit a striking affinity.
   I am not ignorant that several writers of note, have
ascribed the cessation of the Egyptian plague to a dif-
ferent cause, namely,  the superfiuxoi the Nile, which
they  allege  purifies  the  air, either by  drowning, or
washing from the neighboring country, all existing sour-
 ces of  putrefaction   But a  reference to dates will im-
mediately convince you that these authors are mistaken.
  The Nile begins to swell about the seventeenth of June,
rises at the rate of four inches a day, and does not over-
flow its banks until  the  middle of August.   But the
plague ceases  uniformly  about  the twenty-fourth  of
June.  How then is it possible, that the waters of this
river, which do not begin to  inundate  the country for
nearly two months afterwards,can, atthis period, either
 overwhelm or wash away the filth of its surface?
   Were the face  of Egypt covered with water, at the
 time when the Nile is in reality only beginning to swell,
I would  Oe  disposed to  attribute the ceasing  of the
 plague to this inundation.   For  an excess is no less in-
 imical than a  deficiency of water to  the putrefactive
 process.   But, as every cause must necessarily precede
 its effect,  it is unphilosophical, not to say absurd, to as-
 .-ribe the cessation of the plague of Cairo, on the twen- 
m
ty-fourth of June, to the  overflowing of the Nile aboufc
the middle of August.  Although the superflux of this
river is the saviour of Egypt from depopulation by fam-
ine it does not appear, fiom our latest and best accounts
of that country, to have any particular influence on the
health of its inhabitants.
   Those persons acquainted with my infidelity respect-
ing the contagion of yellow fever, will,  no doubt, sup-
pose me at a loss to discover, on that score, any analogy
between this disease and the pestilence of the East.
   On this subject it becomes me to speak with diffi-
dence and cauti|)n, because I am unable to speak from
observation.  To the writings and conversation of oth-
ers am I indebted for the principal part of what know-
ledge I possess,  relative  to  the  nature of true plague.
But from all I have  been able to collect, through these
channels, I find no solid ground of belief, that this dis-
ease is really contagious.  On the other hand, the fur-
ther I pursue the inquiry, the  more am I inclined to con-
sider  it  as propagated, not  by  contagion,  but  solely
through the medium of a vitiated atmosphere.
   My principal  reasons for this opinion  I will endeav-
our to lay before you in a few words.
   I. Plague prevails only under certain constitutions of
the atmosphere, which medical writers denominate pes-
tilential, and during those seasons  of the year, which
favour the generation of putrid exhalations.   Two cir-
cumstances therefore seem essential  to its existence and
propagation, an atmosphere  radically malignant,  ren-
dered still more  so by the admixture of deleterious gases.
On the aid of these two adventitious causes it is as de-
pendent, for its prevalence, as combustion is on that of
vital air.
   But, how d'fferent is the case with small pox, lues ve-
nerea, and other truly contagious diseases?   Possessed
of an inherent and independent power of self-propaga-
tion,  these maladies prevail and  spread at all seasons of
the year, and under  every varying  constitution of at- 
155
mosphere.   To their communication  from the sick ic
the well, foul air  is no more necessary, than it is for the
spreading of flame from one combustible body to another.
   If. When plague is epidemic  in a town or city, and
cases of it are removed to healthy situations, in the sur-
rounding country, or to neighboring towns and villages
free from disease, it is not communicated to the nurses or
attendants  of the sick.  This fact is amply attested, and
seems to declare, in the most explicit terms, that the dis-
ease in  question  is not  possessed of any specific conta-
gion, or inherent power of self-propagation, bat is alto-
gether  the  creature of  adventitious  causes.   Under
similar  circumstances, how different are the phenomena
exhibited by small pox? Like an electron perse,this dis-
ease, by means of an infectious  power, of which noth-
ing can deprive it, propagates itself alike in every situa-
tion .
   III. The sudden and entire  cessation of plague, in
Syria and Egypt, about the summer solstice, andin^Con^
stantinople  on the accession of cold  weather,  is inimi-
cal to a belief in its  contagious nature.   Immediately
after its termination  in those places,  (which  is some-
sometimes almost instantaneous, and where a belief  in
the doctrine of fatality prevents every measure for the
removal or destruction  of contagion,) the  apparel of
the dead is worn  by their surviving connections, their
beds are slept  on, and their furniture  in  general  used
and handled in the most familiar manner.   Nor  is this
all:  Even the low filthy hovels, which  had been utterly
depopulated by the  disease, are,  without purification,
presently filled up again by  fresh  inhabitants.  Yet,
from all this  intercourse, apparently  so  inconsiderate
and dangerous, no inconvenience  whatever  is experi-
enced.   Instead  of immediately  sweeping off tUose,
who thus plunge  into the midst of its supposed  fomites,
the disease is heard of no more, until the return of the
next  season of exhalation, or  perhaps  until  a much
more distant period,.and then appears again without b«« 
17G
ing attributable to any cause, except  the existing  state
of the atmosphere.
  Under the foregoing circumstances, plague  ceases at
the very  time  when  its supposed mattir of contagion
would seem to exist in the greatest abundance, and when
things  would consequently  appear to  be  in  the be.->t
state of preparation for the continuance of its ravages.
But  if this disease  cannot  be continued in action,  by
such an  immense volume of fresh  contagious  matter,
issuing immediately from  the bodies of many thousand
si-iv and dead,  how  can it  be called into being again,
some time afterwards, by an inconsiderable quantity of
the same- contagion,  (now  perhaps  grown stale  with
age,)  adhering to a bale of goods,  a chest of clothes,
or even a single  article of  wearing apparel?  As well
mi-iht we attribute to a solitary and  fading spark, a
power of producing and propagating flame, superior to
that.possessed  by an extensive and vigorous conflagra-
tion, as to allege, that from asm..11 and weakened por-
tion of contagion, a disease may originate,  which  an
incalculable quantity of the same contagion, in the most
active state, was unable even to preserve in existence."
   Respecting the contagion  of plague,  rational  investi-
gation  is  beginning to be instituted.  Nor will it be
fruitless in its result.   On the contrary,science, human-
ity, and national interest, will be equally benefitted by it.
It will dissipate  one of  the  rankest of superstitions,
u hich, commencing in the cloistered ignorance ot the
d.irk a^es, has  continued to the present period, the ter-
ror and  scourge of man, and the disgrace  of medicine.
ft will  clearly demonstrate, that the pestilence of  the
cast and  that  of the west  are the same disease—that
they are  both the product of a malaia. arising from
the  dissolution of organic  matter,  and that neither of
them can be propagated from country to country, in  an
epidemic form, by commercial intercourse.
   The result  of the inquiries which are now in opera-
tion will be, an entire change  in the objects of  quaran- 
177
 tine  establishments, whether they  be erected against
 yellow fever, or oriental plague.   Instead of sickly crews
 and infected merchandise, health  officers will then look
 for foul ships and  damaged cargoes.   Perfect cleanli-
 ness  will be the end at which they will aim.
   Under this ameliorated condition of things,  reason
 will ascend the throne which superstition  had usurped,
 and  the  notions  and stories of peshlerdud  covtagion
 will  be classed and  forgotten with those of ghosts wrapt
 in winding sheets, and witches sailing in egg-shells.
   Nor is the notion of the contagious nature  of typhus
 fever, scarlatina, hooping-cough, or dysentery, any bet-
 ter founded.  These are all atmospherical  diseases, ari-
 sing  either  from a general mo bific constitution of the
 atmosphere, or a vitiation of it from local > auses.   That
 none of these complaints are contagious, the  writer  of
 this memoir  has long contended.  Nor does he recol-
 lect,  at present, any thing to the contrary, but that, for
 many years, he contended alone.  In numbers, the odds
 against him  were  certainly very fearful   But  he has
 the gratification to learn, that, of late, the doctrine  of
 non-contagion, on a  liberal scale, is advocated, by some
 of the ablest pathologists of the day.
   That the  author  has long entertained doubts of the
 contagion of measles, is  well known to those who have
 attended his lectures.  But more of this on some future
 occasion.
                 Note (g) page 152.
  The only means  I have ever  found it  necessary to
 employ in  the purification of vessels,  are water, soap,
 lime,  and  ventilation.  If applied judiciously, and to
 the proper extent, these can be confidently recommend-
 ed as  sufficient.
  In  the efficacy of  the various fumigations, respecting
 which report has been   so  favourable  and  loud, my
 confidence  is limited   That  they  are calculated to
neutralize the poison of yellow fever,  I do not  know;
 and that they  can effectually expel it from the  h( Ids, or
from among the timbers, of vessels, I  do not believe.
                          Y 
178
                  Note (h) page 166.
   When venesection is  practised  in  this  form of the
 disease, let the physician keep his  finger on the pulse,
 while the blood is flowing.
   If the  circulation be enfeebled by the loss of blood,
 let the orifice in the vein be  immediately  closed.  But
 if it  become more free and vigorous, let the process go
 on, until the effect desired is produced.
   Although the  circulation may  be  weakened by the
first attempt to draw blood, it does not necessarily fol-
 low that it may  not be  strengthened by a subsequent
 one.
   After the practitioner,  therefore, shall have closed
 the orifice, and vigorously applied his stimulating agents
 some time longer, he may again try trie effect of a fur-
 ther  abstraction  of blood, and  govern his future pro-
 ceedings  by the result. 
MEMOIR IK
                   THOUGHTS ON

       THE ANALOGIES OF DISEASE.

  The phenomena,  whether they be objects or events,
which present themselves  in the several departments of
creation around us, and on which we bestow the denom-
ination of facts,  with the relations  which they bear to
each other, and to the whole, constitute the true founda-
tion of science.  Remove,  subvert, or in any way de-
range them, and what we now call science would have
no longer an existence.   Should  any  thing deserving
that name still  exist, it would be  altogether different
from that on which  we bestow the appellation at pre-
sent.   For science is nothing but a knowledge of facts
and their mutual relations; general principles being the
result of such relations.
  Yet the amount of useful knowledge which different
inquirers possess, and the degree of instruction they im-
part, in the communication of it, is not in proportion to
the number  of facts they have accumulated, andean
respectively detail.   Many individuals, opulent in their
stores of these elementary ingredients, are deficient m
the principles of science, because  they  are wanting in
the powers that  can alone  construct them.   They are
qualified to observe and  amass  facts; but  they cannot
compare, judge, classify, and generalize them: they can- 
ISO
•not arrange and unite them into those chains called pin"
ciples, because their relations and affinities arc not per-
ceived by them.   Characters of this description, deal-
ing too much in details, and  dwelling on detached parts,
instead of attempting  to  unite  them  into a whole, can
never become distinguished either as writers or teachers.
The reason is, that their  intellect, sufficiently powerful
in some of its inferior faculties, is  feeble in those that
are more elevated and important.
   Others again, on  whom  nature has  bestowed an in-
tellect of a different and much higher order, abound in
principles, while their store  of facts is  comparatively
limited.    The'r  chief powers lie in their reflective fac-
ulties, and their favourite employment consists in gene-
ralization and induction.   All their facts  they construct
into principles, their raw materials  of knowledge  they
 so digest and assimilate  to their own  intellects,  as to
 impart to all their attainments  the  matured  and regu-
 lated  character  of science.  Individuals of this  des-
 cription are capable of distinction  both  as writers and
 teachers.  They, in the true interpretation of the term,
may  be denominated philosophers, while those  who,
 without forming principles, have only collected facts—
 no matter how  extensive  and  multifarious  their col-
 lections may be—are nothing more than men of infr-
 mation.   The latter want  the power of comparing,
 judging, combining and  infering.   The  former possess
 It in an eminent degree.
   In contemplating nature as   she discloses herself to
 his view,  it  is the  constant aim of the  philosopher to
 compare with each other, her diversified phenomena, and
 thus classify and generalize* them,  to as great an extent 
181
    as his collection of them will justify.   In this way only-
    can he maintain his  standing in the community of sci-
    ence.  To decline  classification and generalization al-
    together^ falls as far short of the spirit of philosophy,
    as an attempt to generalize beyond facts, is a perversion
    and abuse of it.   Either practice  i*  faulty, in its re-
    lation to science,  although not  perhaps exactly in the
    same degree.  The one fails, from intellectual feeble-
    ness, or  indolence,  in the establishment  of truth, the
    other, from an exorbitant love of  hypothesis, contri-
    butes at times, to the propagation  of error.   The for-
■    mer  arises from a defect of intellect, which  no time is
i    likely to remedy, the  latter,  from a description of men-
    tal exuberance, which,  being more particularly charac-
 ;   teristic of  youth, is usually corrected by experience and
    years.  An attempt to fathom transcendentalism rarely
    belongs to the maturity of age.  The two states of in-
    tellect here alluded to, bear  to each other somewhat  of
    the mutual relation of idiotism and madness.   The one
    consists  in a want of  powers which nothing can supply,
    the other,  in a deep derangement of powers  which may
    be restored.
\      The individual who  acquires knowledge for  no oth-
    er than  colloquial and  common purposes, or  merely
    with a view to his own amusement, is rarely solicitous
    aboutthe establishment of principles.   Nor is it impor-
    tant that  he should  be; because the end at which ho
    aims can be attained  without them.
       The object of  conversation, whose chief charm and
'    excellency are its simplicity, sprightliness, variety and
:    ease, is as much  to amuse and refresh  the intellect, du-
    ring its relaxation from severer exercises, as  to  instruct
i 
182
or strengthen it.   To be suited, therefore, to this pur-
pose, its topics must be  comparatively light and easily
handled.  Hence, even  among the  scientific and the
erudite, it is not the custom, nor would it be held either
expedient or decorous, to clog its  course,  or render it
laborious or monotonous, by frequent  and  studied ef-
forts to establish or inculcate general principles,  or ab-
struse propositions.
  To prove at once a source of rational enjoyment, and
real usefulness, and to answer,  in all  respects, the ends
for  which it is  intended, conversation must  hold, both
m matter  and manner, a middle rank between  empty
prattle  and formal  harangue.  When  it degenerates
into-the former, it becomes  frivolous and degrading,
and it proves uninviting, if not offensive, when it  swells
to the latter.  In the one case, it is disgraced by a want
of intellect, in the  other, it fails in  interest and  attrac-
tiveness, from an equal want of judgment and taste.
  But, very different is the object of an effort to instruct
in science, whether  it be that of a public or private
teacher, in the form of lectures, or of a writer, by means
of a production from the press.   In either case, the end
in view is, not to dwell on  insulated facts,  which the
pupils and  readers might  themselves  collect  without
difficulty, but,  from a judicious and comprehensive clas-
sification of facts, to inculcate  principles, accompanied
by so much of specification and detail, as may; be  requi-
site for the purposes  of illustration  and proof.   The
public teacher who  does not thus* proceed,  will never
prove  a useful,  nor  require  the reputation of an able
instructor   On the contrary, he is either incompetent
or unfaithful, in relation to  his  duties, and unworthy of 
183
►the elevated and hjghly responsible  station  he holds.
 His pupils may receive from him a certain  amount of
 commonplace  information; but, if they ever become
 men of real science, they must derive their improvement
•from some other source, and  form themselves on some
 other model, than that of their preceptor.
   If the chief intention entertained by pupils  in study-
 ing a science, is to acquire a knowledge of the princi-
 ples of it, (and no instructor need attempt  to  impart
 more,) the true and only efficient mode of teaching it
 is, to communicate those principles, in the shortest time,
 and by the most intelligible and impressive process,
 that may be found practicable.
   And this process is  synthetical.   It  is, clearly and
 correctly to announce the principles, in the form of the-
 orems, and  briefly state a few acknowledged and perti-
 nent facts, by  which they are supported,  refering those
 receiving instruction, for further details, to such sources,
 whether in books or in nature, as may most abundantly
 contain them.
   It is in this way that inquirers are most expeditiously,
 efficiently,  and  permanently  informed; and,  at the
 same time, instructed in the true mode of teaching them-
 selves.  It is in this way that tbey render their knowl-
 edge a subject of reason and  judgment, not exclusively
 a matter of memory.
   If, in many  of our  institutions,  established for the -
 purpose, a knowledge  of several branches of science
 is acquired now, in a much  shorter period than it was
 formerly, the fact is to be attributed chiefly to  the im-
 proved method of teaching them, through the  medium
 of principle.  Were they not thus taught, the lab*»r of 
                         1 84
"learning them now, would  be  nearly  as  great,  and the
 processes tedious, as  was that of studying and estab-
 lishing them originally.
   To no branch  of science are these remarks pore
 strictly applicable  than to that of medicine.   Taught
 through principle, the knowledge  of it can be easily
 and pleasantly acquired, in a  period  of time  that  can-
 not, from its length, be discouraging to any one.   Three
 years study of it noio, is equal to four if not five, even
 as late as about the  close  of  the  last century.   At an
 earlier period, the labour and difficult}', encountered in
 acquiring a knowledge of it, wei e still greater.   And, in
 time to come, they  will be yet further diminished, by a
 further and more perfect development of general princi-
ples; or, if the  expression  be less exceptionable, for its
 meaning is the same, by a further discovery, comparison,
 and generalization of  facts.
   Persuaded of the 4ruth  and  importance of these
 views, in relation to  the best scheme  for hastening the
 march and facilitating the acquisition of scientific knowl-
 edge, and feeling it his duty to contribute, as far  as pos-
 sible, to  the  attainment  of an end, which lie deems so
 momentous to the  well re  of  man, it is  the intention
 of the author of this dissertation, to present his read-
 ers with a succinct sketch of the Ji a logics of disease.
   This  is a mode of so genera'izing in medicine, as
 to class complaints under the head of one great commu-
 nity, which he thinks maybe rendered useful, both scien-
 tifically and practically, and which he is inclined to be-
 lieve is altogether new.  At least, he recollects no wri-
ter who has expressly treated of the subject.  The  at-
 tempt made by Dr.  Rush to prove the  entire unity of 
                              185
     disease, was  altogether different.   The truth  of this
     will fully appear in the course of this disquisition.
       In this enterprise, the author engages the more willing-
     ly,and with the livelier hope that his labours will not be
     altogether fruitless, from  a  thorough  persuasion,  that
     every new and successful effort to disclose the affinities
     which nature has established between morbid affections,
     and which render a knowledge  of  one of them essen-
     tially subsidiary to the understanding of the others, can-
     not fail to result in  important practical good.   On the
     subject of their pathology, general as well as particular,
     it exhibits broader, clearer, and more satisfactory views,
     throws additional light on their curative indications,  and
     gives a  more  entire  knowledge and command of the
»     means to be used in their prevention and retrieval.   In
     medicine, as in every  other department of science, an
£    increase of  knowledge  is an increase of power.  But
     an increase of  power is an  increase of usefulness, pro-
i     Vided the possessor be  honest and faithful and industri-
     ous, in the employment of it.
       As a further preliminary it  is requisite to observe,
■     that by disease, is to be necessarily understood, derange-
     ment of parts, as well as of function.
       1. The first and most fundamental analogy, important
    to be noticed, as existing between diseases, is, that they
     all bear an exclusive relation to living compound matter.
>     Neither  of spirit,  of  dead matter, nor  of matter in a
    simple condition, is disease predicable.
       To be susceptible of disease,  substance  must be ex-
    citable.  Neither a  simple created  substance, nor one
f    destitute of excitability, can perform a function.  But
    the spirit of man is simple,  and dead matter is so de-
                              Z 
186
nominated,  because it  is  unexcitable.   Nothing, then,
but compound excitable matter can  become the subject
of disease.
   As already observed, disease implies a  derangement
of component parts.  The truth of this is sustainable
by analysis.   But neither spirit nor simple matter  con-
sists of parts,  and cannot, therefore, be  subject to de-
rangement.   To speak  of a disease purely mental, is
to be guilty  of folly.
   2. A second analogy  between diseases, consists  in
their being all the result of irritation, by which is meant,
a  kind  of excitement  unsuitable nnd  injurious to the
part sustaining it; and which is,therefore, produced by
morbific impression.
   When  we  contemplate the subject, as pathologists,
acquainted  with  the present condition of our science,
we cannot, on first principles, conceive of the production
of a morbid affection  in any other way; nor does ob-
servation present us with a single objection to the propo-
sition stated.
   For the better  illustration of this subject, it is requi-
site to observe, that there  are two kinds of impression^
the irritative and the sensative,  by both  of which dis-
ease may be  engendered.  The former belongs to all
living matter, while the latter would seem to be an ex-
clusive  attribute  of brain and nerve.  Extinguish the
susceptibility of both, and every avenue for the admis-
sion of disease will be effectually closed.
   But by such extinguishment, life itself would be de-
stroyed; for irritability or a  susceptibility of stimula-
tion is an  essential attribute of it.  But  wherever irri-
tability exists, morbific impressions may produce irrita* 
                           187
  Hon, which is here used  but as another name for mop*
  bid excitement.   Hence, constituted as living beings are,
  a liability to disease is a condition of their existence as
  radical and necessary, as  those of specific temperature
  and specific form.
    It is understood,  that, by an irritative impression is
  meant, one that is  productive  of no sensation.  The
  living being impressed, has, of course, at the time,  no
  perception  of the fact, and  remains unapprized of it?
  until its effects  have  appeared.   But,  when powerful
  and long continued,  the natural  tendency of irritative,
  is to lead to sensative  impression.
    From irritative impression arise all endemic, epidem-
  ic, and contagious  fevers.  From this source, indeed,
  arise all  diseases, of whatever description, that are en-
  gendered by the  insensible qualities,  usually denomina-
  ted the constitution, of the atmosphere.   Those quali-
 ties, called  insensible,  because  they  do  not  manifest
 themselves to our senses, produce,  of necessity, all their
 effects, whether salutary or injurious, by irritative im-
 pression
   The poison of  bilious fever, whatever type  the affec-
 tion may assume, intermitting, remitting,  or continued,
 and whatever may be its degree of  intensity, excitive, in-
flammatory, or congestive, invades the system through
 irritability alone, sensibility being,  at first, in no degree,
 affected by the impression.  Nor is any diseased sensa-
 tion experienced, until after irritation  has  made consid-
 erable progress.    When congestion  has  taken place,
 then does the impression become sensative.  Then, and
not before, is a. feeling of disease awakened.
  Similar remarks  may be made  in relation to typhus 
188
fever, pestis vera, scarlatina, influenza, measles, small
pox, cow-pox,  and lues  venerea.   At its  commence-
ment, the deleterious impression which produces them
is  exclusively  irritative, and becomes sensative  only
when congestion  has ensued   Individuals  attacked by
these diseases, experience no sensation to apprize them
of the time of the invasion of the poison.   The actual
smseof disease, as already stated, follows as one of the
effects of congestion.
  The catalogue  of complaints, produced  by irritative
impression, might be greatly increased, by the addition
of tetanus, hydrophobia,  scurvy,  epilepsy, the  class
Neuroses generally, and a very extensive family of cu-
taneous  affections.  In  all  these, the  impression be-
comes sensative, only as the effect of previous irritation.
  The family of diseases produced  by-impression origi-
nally sensative, is also numerous.   It consists of those
that arise from  vicissitudes in  the  sensible qualities of
the atmosphere, from the passions of  the mind, from in-
tellectual operations  generally, from mechanical inju-
ries, from certain  poisonous  substances, from caustics,
and from the action of caloric, when in such excess, as
to terminate  in burning.   They are produced, in fact,
by any impression that gives  rise to sensation.
  3. A third analogy between diseases,  consists in a
derangement of the balance  or equability of  excilemerd^
or circulation, or both.   This  derangement belongs, as
an essential attribute, to every morbid affection.   With-
out it, imagination cannot   even conceive of the exis-
tence of such an  affection.
  All enlightened physiologists agree, that perfect health
consists in general equability of excitement and circu- 
189
lation.  Disease, therefore, being  the  reverse of this,
must necessarily consist in a breaeh of that equability.
  In maintaining  that  health is thus constituted, I do
not mean that  excitement and  circulation exist in the
same degree in  all the various tissues of the body. Phy-
siologists know that this is not the case.   In bones, ten-
dons, fasciae, and fibrous membranes generally, those at-
tributes of life do  not  prevail  in as high a degree, as
they  do in  brain,  nerve,  muscle,  cellular membrane,
and skin.   My meaning, then, is, that they exist in the
same degree in all the several parts of the same tissue;
and that a deviation from this constitutes disease.
  4-   Another analogy between  diseases is, that they
all have their origin in the  solid parts of the body; and
that in cases  where  the  fluids become  deteriorated,
the change is effected exclusively through the agency of
disordered  solids.   The most slight and transient ex-
amination of the human body must convince us, not on-
ly that this is true,  but that, in  the existmg state of
things, it cannot be otherwise.    Such is the relative sit-
uation of the solids and fluids, that no deleterious a-
gent can reach the /after, and produce on them a morbific
impression, without having  passed  through and injured
the former.  As well may  it be alleged that a sword, a
bullet, or a bayonet, can make its way through the skin,
the muscles, the blood vessels^ or the lymphatics of the
body, with safety to  the parts which it has thus penetra-
ted, as marsh miasmata, the  matter of small pox, the
matter of measles, or  any  other poisonous substance.
Nor can we conceive of any process, by which a delete-
rious quality can  be  engendered in the blood, or other
fluids, except by the morbid action^ of the organs that 
                            1*0
    have formed, or the vessels that contain them.   The flu-
    ids of the body  being  the product  of the solids, must
    necessarily conform to their mode of action.   Nor can
    that action be otherwise than healthy, while the solids
    arc uninjured.  Hence, all disease  must necessarily o-
   riginatc in that portion of the body,  which is alone pri-
   marily accessible to its causes.
     5. A fifth analogy is, that all diseases are necessarily
   local in their  commencement; and,suh of them as be-
   come general, pass into that  state through the medium
   of sympathy.  Thus  tetanus and inoculated small pox
1   begin each in a small punctured wound, hydrophobia
   begins in a wound not dissimilar, inflicted by the tooth
   of a rabid animal,  syphilis in a local irritation produ-
   ced by a peculiar poison, and febrile  diseases generally,
   from deleterious impressions  made on the stomach, the
   skin, the lungs, or the  brain; on the latter organ by mo-
   ral and intellectual causes  Even scurvy and diabetes,
   the strongholds of humoralism, can be proved incontes-
l   tibly to originate in local affections of  the solids.   That
'   this is the case, with respect to every complaint, wheth-
t   er corporeal or intellectual, is a position as clear and as
   easily maintained,  as  any embraced in the  science of
   medicine.  The most deliberate  and severe scrutiny
   will clearly and satisfactorily demonstrate,  that, in its
  primitive action, every cause  of disease is neeessarily
   confined to a circumscribed portion of the human body.
     6. But the most important analogy remains to be
  mentioned.  It is, that the internal pathology or imme-
  diate cause of  every disease,  consists in congestion, in
  some given organ and tissue of the body.
     This assertion, hazardous,  perhaps, in the estimation 
                         191
ef many, will, no doubt,  by some, be pronounced to he
unfounded.   But, not to  speak of absolute d monstra-
tion, it can be  clearly shown  to  rest,  at least, on the
height of probability.   In most  cases it is susceptible
of as positive proof, as any other opinion in the science
of medicine.   Its importance  both in pathology and
practice, gives it a fair claim to a brief analysis.
   By the immediate or proximate cause of a disease, is
to be understood, that particular condition of some part
of the system, from which  the complaint arises; which
being present, the disease exists, and which being remo-
ved, the disease is eradicated.  That,  in all cases, this
condition consists  in  congestion,  satisfactorily  appears
from the following considerations.
   By congestion is to be understood, a preternatural ac-
cumulation of blood  in the vessels of any part of the
body, either with or without inflammatory action.  Al-
though confined, for the most part,  to the capillaries, it
is not always or necessarily so; and is situated in the ar-
teries or veins, or in both.
   To render our analysis somewhat systematical, and
therefore the more easily  comprehended  and remember-
ed, we shall  take a view  of diseases as  situated in the
several subsystems of the body.   For our present pur-
pose it will be sufficient to consider those subsystems as
divided into the chylopoietic, the respiratory, the circular
tory, the absorbent, the nervous, the cerebral, and the cu-
taneous.  What is  true, on the score of congestion, as
relates to diseases situated in these  subdivisions of the
body, can be shown to be  true of all others.
   Of the ehylopoietic apparatus  the diseases are vari-
ous.   Some qf the most prominent  ef them,  are, dys- 
192
 pepsia, diarrhea, cholera,  dysentery,  colic, jaundice,
 hepatitis, acute and chronic, and the affection produced
 occasionally by worms.
   Of these complaints, congestion, in some of the ab-
 dominal viscera,  at times throughout the whole  extent
 of the portal circle, may be satisfactorily shown to be
 the proximate cause.   In support of this assertion, the
 following considerations appear to be conclusive.
   1.  In each of  the diseases specified, there exists irri-
 tation, i. c. morbific impression, as  the feelings*of the
 patient abundantly testify, in some one of the chylopoi-
 etio  organs.  But, as already stated, irritation in the
 capillary system  never fails to  produce congestion.   If
 there be individuals win entertain  doubts on this sub-
ject, let them irritate, in any way, the tunica albuginpa,
 the skin, the lips, the tongue, the gums,  the fauces,  or
 any other visible  part of the body; and they will  find
 that  congestion will presently ensue.  Abrade a portion
of cuticle, and  the  cutis vera thus exposed, white at
 first, will  soon  become red and distended with blood.
 Nor can pain remain  long in any part of the body, with-
outd roducing a similar effect.
  2. The leading and characteristic  symptoms of the
complaints, we are considering, indicate clearly the ex-
istence  of a centripetal  state  of  action, which must
necessarily  produce internal congestion;  while certain
 other phenomena or symptoms, to be mentioned  pre-
 sently, testify that this congestion  is in the  abdominal
 viscera.
   The symptoms particularly  indicative of a centripe-
tal state of  action are, a dryness or defective  secretion
 and contractedness  of the skin, with a bloodless con- 
                          IdS
 dition of that organ, a drying up of ulcers, and a disap>
 pearance  of cutaneous eruptions, if any have existed,
 and a coldness and diminished size of the features of the
 face, the ears, and the upper and lower extremities. To
 speak in more  general terms,   the  centripetal state of
 action is indicated by a reduction  of bulk of the whole
 exterior of the  body, particularly of those parts most re-
 mote from the  center of circulation.  To these symp-
 toms  must.be added,  a preternatural  dryness of the
 lips, tongue  and-fauces,  and of the schneiderian mem-
 brane generally, with  a marked diminution of most of
 the other secretions of the body.
   From the uneasiness and  want of facility, not to call
 it actual stiffness, which the  sick experience in volunta-
 ry motion, there can be little doubt  of the diminished
 state of those secretions, by which the  sheaths of the
 muscles and tendons,  and the capsular  and other liga-
 ments of the joints are lubricated.   Indeed general dis-
 ease, and a  general defect  of secretion, appear to be
 naturally and necessarily associated.   But  secretion
 consists in centrifugal action.  Hence a suppression of
 it indicates, of course, an opposite movement.
   We derive much additional testimony, to the  same ef-
 fect, from certain internal and deep  seated symptoms,
 which mark diseases of the chylopoietic viscera. These
 are, a sense of heat, tensioa,  fulness, and weight, which
the sick experience in the abdominal viscera, with an in-
crease  in the  size  of those organs, and a  tenderness, at
least, if not a soreness,  to the touch.  From nothing
but a  preternatural accumulation of blood  can  such
symptoms arise.
  Of the same import is tbe augmentation of secretion
                         Aa 
1 lJ4
fromtne  liver, pancreas, and internal surface of the ali-
mentary canal, which takes place in diarrhea, cholera,
and dysentery.  No organ can, for any length of time,
secrete superabundantly, without a superabundant influx
of blood, from which the secreted fluid  is derived. And
of this superabundant influx, the immediate and neces-
sary effect is congestion.
   But on this topic, dissection affords us conclusive tes-
timony.   In relation to the  diseases of  which we are
treating, that mode of examination has been practised^
of late, on an extensive scale.  And, in every instance,
it has disclosed the presence  of deep and extensive ab-
dominal congestion.   It has  exhibited the whole portal
circle engorged with blood.   Nor does the evidence it
has afforded terminate  here.   The coats  of the stom-
ach  and bowels have been found inflamed,  thickened,
ulcerated, or in a state of  sphacelation; the most indu-
bitable and characteristic testimonials of congestion the
parts can manifest.
   Of this family of diseases, then, the question of the
proximate cause is decided.  Abdominal congestion pro-
 duces them.  Remove that congestion, and they cease-
 to exist.
   With the preceding affections, as already mentioned.
 may be classed that produced in the  human system by
 epizootic worms.
   Of this disease the proximate cause is gastric, intes-
 tinal, and general abdominal  congestion, as manifestly
 appears, not only from its  symptoms and requisite mode
 of treatment, but also from  examinations of the bodies
 of those to whom it Uas proved fatal.
   In the production of this complaint, the worms, being; 
                         195
 themselves the  offspring of  antecedent diseased action
 in the alimentary canal, would seem to be only the ex-
citing causes.
   The abdominal congestion results sympathetically from
 the deleterious influence of atmospherical properties,sen-
 sible and insensible, on the  surface of the  body, or dir
 reclly from improprieties in diet or regimen.  From tbe
 congestion arises an augmented degree of irritability in
 the part  On this heightened  irritability the worms pro-
 duce an amount of morbid  irritation, with all its dele-
 terious  concomitants  and  consequences, which, in a
 healthy condition of the alimentary canal, they could
 not effect—w^kh they ivould  not produce, were there no
 congestion.   But by their irritation  they  augment the
 congestion.
   Hence the periodical character of the worm disease,
and its obvious  connection  with  certain states of the
moon.
   That planet, at the times of her full and change, af-
fects the atmosphere.   The  atmosphere, thus affected,
produces, by its action  on the  surface  of the bodies of
the valetudinary, abdominal  congestion, accompanied
by augmented irritability.   In this  condition of things,
the worms already existing in the alimentary canal, en-
gender irritation  and excite  disease.
   Of the respiratory apparatus,  the only affections to
which I shall invite the  attention of the reader are, asth-
ma,  hooping-cough, hydrothorax,  and peripneumonia
notha.  Of these, I am  aware that, by nosological wri-
ters, the two latter are not classed with respiratory dis-
eases.   But, as far as  respects the present disquisition,
thev are sufficiently of  that  description to be here con* 
                        196'
sridered.   Indeed,  to say the  least,  peripneumonia no-
tha is as much a  disease  of the lungs as of the blood
vessels.
   Of these three complaints, the  proximate cause  is
manifestly congestion.   In  proof of this,  the evidence
is the same with that adduced to establish the cause of
chylopoietic affections.
   The action of the system is centripetal, as chilliness,
paleness of the skin, with  a contracted state of that or-
gan, shrinking of the extremities, and all other exter-
nal phenomena positively announce; the feelings of the
sick and the  increased  amount  of secreted matter, be-
speak in the  lungs  the presence of a superabundant
quantity of blood; and of such  superabundance dissec-
tion affords  decisive  testimony.   The examination of
the bodies oT those who have died  of the diseases we
are now considering, has never  failed  to  disclose a fa-
tal degree  of thoracic  congestion—a  degree, constitu-
ting the  proximate cause  not only of disease but of
death.
   The diseases of the circulatory are much more nume-
rous/than those of any of  the other  subordinate sys-
tems.   By nosological writers they are arranged under
the three heads of Fewer, Inflammation, and Hemorrha-
ge
   But these  are, in reality, nothing  more  than  indi-
viduals of the same family, diversified  in aspect by  a
few dissimilar features.   Radically and  substantially
they are  varieties of the same  disease,  their general
likeness preponderating greatly over  their  slight dis-
similarity.
   Between fevers and  inflammations, there exists. n» 
                         197
 difference that can be regarded as very important, much
 less essential.  They both originate  in local  affections,
 and those affections  are  always  congestive, and  very
 often in both alike inflammatory.  The chief difference
 that obtains  between the topical affections, anses out of
 their situations.  In fevers, those affections  have  their
 seat always in a mucous, and in inflammations, generally
 in  a serous membrane.  In  the  former, the  internal
 coat of the stomach is principally, if not  exclusively
 affected, in the  latter, the peritoneum, the  pleura, and
 the  membranes  of the  brain most frequently suffer.
 Catarrh, croup, quinsy, and  a few other exceptions to
 the latter part of this proposition, constitute no objec-
 tion to the general rule.
   The reason why the topical affection is  noticed  in
 inflammations and not in fevers, is the pain that accom-
 panies it  in  the former,  the  sensibility  of  the serous
 membrane, when inflamed, being much more acute than
 that of the mucous.   Yet, in bilious, typhus, and other
 fevers, particularly when violent, the tenderness of the
 gastric region to the touch is  always  perceptible, and
 sometimes exquisite.  Change reciprocally  the  seats of
 the topical affections, in bilious fever  and peripneumo-
 ny, transferring the affection  in the formor disease  to
 the serous membrane of the thorax, and, in the latter, to
 the mucous lining of the stomach, and the two complaints
 will be converted  into each other.  Peripneumony will
become bilious fever,  and bilious fever, peripneumony.
The same thing may be said of typhus fever and phreni-
tis, or even  of pestis vera and rheumatism.   Make, as
to place and tissue, a mutual transfer of the topical af- 
198
 fections, which  constitute  the radices of thoSe com-
 plaints, and you convert the complaints into each other.
    Between inflammations and hemorrhages, the strong-
 est possible affinity exists.  They occur in similar sub-
 jects, under similar circumstances, with  similar phenom-
 ena, and at the same  seasons of the year.  The only
 appreciable difference  between them,  consists in  the
 actual flowing of the blood.  Rupture, or otherwise open
 the blood  vessels of the part inflamed, and the com-
 plaint  becomes  hemorrhagy;  close too  suddenly, in
 hemorrhagy, the  bleeding vessels, and  the disease be-
 comes inflammation.  Every febrile  hemorrhagy would
 be inflammation, did not the  overloaded  vessels give
 way; and were the vessels of  a congestive  part always
 to give way, inflammation could never ensue.
   But the  strong analogy existing  between inflamma-
 tion and fever,  has  been already demonstrated; there-
 fore, fever and hemorrhagy  must be also very strongly
 analagous  to each other.  Hence the analogy between
 the three forms of disease must be equally striking.
   But to consider the subject more in  detail.
   Of that  division of  disease denominated fever, ab-
 dominal congestion, sometimes inflammatory, and some-
 times not, constitutes incontestably the proximate cause.
 This is as true  of typhus, as  it is of common bilious
¥ever; as true of pestis vera, as it is of yellow  fever;
 and as true of small pox, scarlatina, and other exanthe-
 mata, as it is of either.
   The  correctness  of this representation,  appears as
 well from the external pathology or  symptoms of the
 complaints, as from the more  conclusive evidence fur-
 nished by dissection. 
199
  In all febrile affections, the action is, at  first, very
strongly centripetal.   Hence the balance of circulation
is broken, the vessels of internal parts receiving a pre-
ternatural quantity of blood, which necessarily throws
them into a state of congestion.  And  that this conges-
tion is In some of the viscera of the abdomen, the irri-
tation,  soreness  to. the  touch,  general  uneasiness,
anxiety,  and  distress, with  the  sense  of  fulness,
weight, and burning, experienced in some part of that
cavity, indubitably  testify.  The nausea and vomiting
that so frequently occur,  indicate specifically, conges-
tion of the  stomach.
   But, did these symptoms permit any doubt to remain
as to the  proximate cause of fever,  the testimony  of
dissection  entirely removes  it.    On examining  the
bodies of those that have  died  of febrile  complaints,
•vidence of .abdominal  congestion is always discovered.
Without internal congestion of some  kind, neither can
death take  place,  nor  disease prove dangerous.   Ex-
 ternal congestion  annoys and distresses, but does not
 kill.
   That local congestion exists as  the proximate cause
 of inflammation, is a point so clear, and  so  universally
 admitted, that to dwell on it, with a view to illustration
 or proof,  would be superfluous.   The  very name  be-
 stowed  on the  disease is a  recognition of the  fact.
 Phlegmasia means  an  inflammatory complaint; and to
 inflammation,  congestion  is  essential.  It is one  of
 its indispensable elements, without which it cannot ex-
 ist.
    Is the local inflammatory  affection situated external-
 lv  on the  tunica adnata, or any portion  of the skin t 
208
The augmented redness and size  of the  part,  render
the congestion perfectly visible.   And if it be internal,
the nature of the  affection  is equally indicated by the
symptoms that exist.   But here, as in other  cases, the
proof derived from dissection is positive.
   To  hemorrhagy,  similar  remarks  may  be applied.
Does the flux of blood take place from an internal part?
The  precursory  symptoms  of  a  sense  of  heaviness,
heat, tension, and fulness, indicate conclusively the pre-
sence  of congestion.   Is the hemorrhagy more exter-
nal, as inepistaxis?   An itchiness of the part, an aug-
mented redness of the  schneiderian membrane within
the nares, and a similar redness and  wateriness of the
eye, give satisfactory evidence to the same effect.
   Add to these considerations, that without a  preter-
natural accumulation of blood in a part, where all the
vessels  are  capillaries, a copious hemorrhagy from it
would be-impossible.
   It appears, then,  from evidence not to  be controvert-
ed, that the diseases, of the circulatory system are strong-
ly analogous, not only to each other, but also  to  those
©f the chylopowlic and the respiratory.
   Of the absorbent  system, scrophula is the only dis-
ease to which I shall direct the attention of the reader.
On the subject of this, my  remarks  will be but few, as
our knowledge of it is  but  limited.   It consists chiefly
in a torpid  condition of the  absorbing vessels, manifes-
ted by a preternatural  enlargement  of the lymphatic
glands, running on to inflammation and suppuration, as
far as the parts are capable of the latter process.   But,
refering the reader to what has been  already said, on the
subject of inflammation, it is scarcely requisite to add,
/ 
                         201
 that torpor of action begets congestion, and that of eve-
 ry preternatural enlargement congestion is the essence.
 This view of the  subject is confirmed by  dissection.
 1  shall only further  observe,  that  the  most  hopeless
 form  of consumption, which  all acknowledge to be a
 congestive disease, is nothing but scrophula thrown on
 the lungs.
   As diseases of the cerebral system, may be  mention-
 ed, apoplexy, palsy, delirium, epilepsy and madness.
   Of  the three first of these,  the proximate cause will
 not be doubted.   That it consists in  congestion of the
 blood vessels of the brain, is not only rendered obvious
 by symptoms, and admitted  by all enlightened patholo-
 gists, but demonstrated by dissection.
   Nor, as relates  to epilepsy,  is  the testimony we pos-
 sess less  satisfactory.  The paroxysms  of that  com-
 plaint  are marked  by  an  unusual fulness and protrusion
 of the eye, a frothing at the mouth, and a stupor as deep
 as that of  apoplexy.   The disease, moreover, often ter-
 minates in hydrocephalus internus, idiocy, and insanity.
 But while these affections clearly point  to  the  exis-
 tence of  congestion, as  their  proximate cause, dissec-
 tion again confirms it.
   Madness is  chronic and confirmed  delirium.   It
 stands  related to acute or real delirium somewhat as pal-
 sy does to apoplexy, or chronic to acute rheumatism.  It
 is  usually marked by  obstinate wakefulness, often by
 a red, protuberant, and  watery eye, and,  like epilepsy,
 terminates, at times,  in  hydrocephalus internus.   The
 action of the carotid  arteries is preternaturally strong,
 and the senses of vision and  hearing, and sometimes al-
so that of smell, are inordinately acute.
                         Bb 
20S
   But it need scarcely be observed,  that these phenom-
ena afford strong ground to infer the existence of cere-
bral congestion,  an inference which dissection, as far
it has thrown any light on the subject, tends to confirm.
   In relation, then, to cerebral disease in general, there
is reason to believe that its proximate cause is cerebral
congestion.
   A3 belonging  in  any measure distinctly and exclu-
sively to the nervous  system, I shall specify but three
diseases, tetanus,  St. Titus's dance, and hysteria.   Al-
though hydrophobia is essentially  a febrile disease, it
exhibits, notwithstanding, such  a deep and peculiar af-
fection both of the nerves  and brain, as to deserve to
be noticed under the present head.
   Of tetanus, St. Yitus's dance,  and hysteria, the  two
first have their  seat  more  exclusively in the nervous
system, while the latter  would  seem to  be of a more
mixt character, gastric,  but  more  frequently, perhaps,
uterine congestion, as the name of the  disease imports,.
constituting a part of it.
   In relation to the  proximate  cause of these diseases^
it is a matter of regret,  that dissection has not yet  fur-
nished us with lights  so  abundant  and satisfactory, as
those we have derived from  it with  respect to most oth-
er complaints.  As far, however, as it has gone, the ev-
idence it has afforded us  is clearly indicative of nervous
 congestion.   From that evidence it appears, that, par-
ticularly in tetanus and hydrophobia, (a)  the vasa ner-
vorum, or minute vessels which carry blood to the nerves
 and spinal marrow,  are preternaturally distended with
that fluid.   In a few cases  they have  been found to be
 as perceptibly,  although  not so extensively,  injected 
                         2m
mth blood, as are the vessels  of the tunica adnata,,in
inflammations  of that membrane.   One  of the  most
painful and violent  cases of convulsion I ever  witness
ed, proceeded from congestion, certainly in  the spinal
marrow, and perhaps in some of the nerves immediate-
ly connected with  it. (b)
   But other circumstances  afford strong collateral tes^
timony.
   In the diseases we are  considering,  the susceptibility
of the nerves to the impressions of certain stimulating
agents is preternaturally augmented, which clearly indi-
cates  in them a superabundant  amount of vital power.
But as far as reason and  analogy may be confided in,
such  superabundance can arise  only from congestion,
or a superabundance of fluid in the  vessels that supply
them  with blood.
   Arterial blood, having itself,  acquired, in the process
of respiration, the vital prin-e-iple, conveys  and imparts
it to the solids of  the body.  But, to bestow a supera-
bundance of it on any organ or part, it  must itself su-
perabound  there.   In other words, in the vessels of
that organ there must be  a congestion of arterial blood.
   Such is the inference reason would draw, and facts,
are not wanting abundantly to confirm it.
  Wrhen it is required of  any organ to make, in  the per-
formance of its function,  a preternatural expenditure of
vitality, as is the case in  secretion,  digestion, the heal-
ing of wounds,  and  the imparting of nourishment and
life to the foetus  in utero,  that organ is always  supplied
with a superabundant  quantity  of  arterial blood.   In
other words, the organ  is, for the time, in a state of ao
tual congestion. 
204
   Unless the parts immediately around an incised wound
 become distended, preternaturally red, and increased in
 temperature and sensibility, union by the first intention
 never takes place.
 . During the  period of gestation, the congestion of the
 uterus is known to be great.  Remove it by hemorrha-
 gy, or in any  other way,  and the death  of the fcetus"
 must necessarily ensue.
   While performing the important function of digestion,
 the stomach is a center of fluxion,  and receives of arte-
 rial blood much more than its customary supply. Were
 it  not for this, it would  be  so far exhausted of its vital-
 ity and strength, as to be  rendered unfit for the execu-
 tion of its office.
   When the brain is labouring intensely in the work of
 intellection, it requires and receives  a superabundance
 of blood.   Place the body in a position inclining to the
 horizontal, and this superabundance is most readily sup-
 plied.  Hence many individuals use their intellect to the
 greatest advantage, in a recumbent posture,  (c)
   The same thing is true  of every organ  of the body,
 when engaged in any unusual exertion.  To render it
 equal to its task, it is supplied with an unusual quanti-
 ty  of blood.  And, as far as the laws  of the system are
understood, it does appear, that in no other way can an
augmentation  of  vital  power be  effected.   Another
striking example to the same effect we have in the san-
 guineous congestion of the  penis masculinus, which
alone prepares  it  for the performance of its function.
Prevent this congestion,  and the propagation  of the
species will immediately cease.
   From these  premises, which might be strengthened 
                          205
  by many additional facts, the inference seems  not only-
  fair but irresistible,  that  in  tetanus, St Vitus's dance,
  and other diseases  of the same  family, the inordinate
  augmentation  of vitality in the nerves,  arises from a
  congestion of arterial  blood in  the  vessels  that supply
  them with that fluid.  I  mean,  of course, the capillary
  vessels, or what may be denominated the  vasa nervo-
  rum.
    However numerous and important the diseases of the
  cutaneous system may be,   sanguineous  congestion is
  their proximate cause.   They are divided into pyreclic
  and apyreciic, or general and local.
    In  all  exanthematous fevers,  such as  small pox,
 measles, kine pox,  chicken  pox, scarlatina, erysipelas,
 and urticaria, the eruption is to be regarded as a cuta-
 neous affection   But  it  is  scarcely necessary to add,
 that to the existence of this affection, congestion  is es-
 sential.  The evidence of the  fact  is  ocular  and  de-
 monstrative.   All eruptive  fevers exhibit so many in-
 stances of centrifugal, and therefore salutary metastasis,
 in which gastric is converted into cutaneous, or at least
 internal into external, congestion.
   As relates to my present object, it would be superflu-
 ous to dwell on  the  local diseases of the system I  am
 considering.   It is sufficient for  me  briefly  to observe,
 that we cannot even conceive  of cutaneous eruption,
 as an effect, without connecting  it  with congestion as
 its cait.se.   The  latter  bears to  the  former  the same
 relation that the root of the plant does to the stalk and
 branches,  which  it  sends forth and nourishes.  The
 idea of  a rootless oak would  not  be more  incongruous;
than that of an eruptive affection  without congestion. 
                        20b*
  Were it requisite to proceed in this investigation, it
would be  easy to show, that of dropsy,  diabetes and
scurvy, congestion is as obviously the  proximate cause,
as it is of either of the other diseases of which I have
spoken.   The two first of these complaints consist in
excessive secretion.   But it has been already remarked,
and is now repeated, that  without congestion such ex-
cess can never occur.   And in real scorbutic affections,
dissection has shown, that gastric and general abdominal
congestion always exists.
  From  the foregoing facts  and observations, which
might be multiplied and extended to an  indefinite length,
it may be infered, I think,  as an  axiom  in medicine,
that, congestion is  essential to the existence of disease.
It is itself,  indeed, the necessary  result  of preceding <
irritation.  But without  it, the  constitution could  not,
by irritation alone,  materially suffer.
  But if diseases are  so  strikingly analogous to each
other in  their pathology,  consisting in  congestion in
some part  of the body, reason w ould  seem to warrant
the conclusion, that they are analogous also in their in-
dications of  cure.  And such, on examination, appears
to be the fact. ■
   The  gencretl  indication, including all subordinate
ones, as parts  of itself,  and  applying indiscriminately
to every complaint, is to remove congestion, by equals
zing  circulation  and  excitement.  That being effect-
ed, the disease resulting from  it will necessarily cease.
  In all cases where it is practicable, the first thing to
be done, in the removal of congestion,  is  to extinguish
the  irritation by which it has been produced.  Has it
been  excited by the introduction  into the flesh of a  m^ 
                         207
tthanical substance, such as  a briar, a thorn, or a nail?
Extract immediately the offending body.   Has  it been
brought on by mechanical pressure? Remove it.  Should
the irritating cause be permitted to operate, the conges-
tion, even  if resolved, will necessarily return.
   As essential, then, to successful practice, it is the du-
ty of the   physician  to free his patient, as speedily  as
possible, from the influence of the remote  and exciting
causes of his disease.  What these causes are, and how
they are to be removed, arc points  respecting which no
specific directions can be  given, without entering into
a minuteness of detail, which the nature of this disser-
tation forbids.  To the judgment and skill  of the at-
tending physician must the adjustment of that matter
be necessarily refered.
   The  fundamental  irritation being properly disposed
of, the subordinate indications for the removal of conges-
tion are four, compression, depletion, revulsion, and stim-
ulation.  By  the well-timed and skilful  application  of
these, does the educated physician distinguish  himself
from the empirick.
   Compression.   This is to be effected in part  by fric-
tion, but chiefly  by the judicious  and dextrous use  of
the bandage.  It is   applicable  only, or at least princi-
pally, to cases of external congestion, such as whitlows,
enlargement of particular glands, anasarcous affections,
swellings of joints and muscles that can be compressed,
and certain other  projecting tumours.  It is also ap-
plicable, to a limited  but very useful extent, in cases  of
congestion of the abdominal  viscera.   In  the treatment
f>f diarrhea, cholera infantum, and protracted dysentery. 
208
 the bandage around  the abdomen, has been often ap-
 plied with the  happiest effect.
   This remedy operates in a twofold, vviy.   It promotes
 absorption, and sustains and aids debilitated vessels in
 their circulatory action.   Make the bandage of flan, el,
 or of a soft cotton fabrick, and it contributes also some-
 what  to  the  promotion  of  perspir aion.   On  each
 principle its  action is salutary.    To  prove  effectual,
 it must be kept in constant operation, until  the  morbid
 affection disappears.
   Friction may be performed with the hand, with a  flan-
 nel cushion well stuffed, with  a flesh brush, or any oth-
 er a: tide calculated for the production  of moderate ex-
 citement and agreeable  sensation.  Us action is aided
 by the use of certain  stimulating substances, both dry
 and liquid-   It may be usefully employed in many cases
 of disease, deep-seated as well  as superficial; but more
 especially in  those that are chronic and indolent.  To
 derive from it ail the  benefit which it is capable of af-
 fording, it should be frequently repeated, long continued
 at each repetition, and perscveringly pursued.
   Depletion.   When examined and understood, in all
 its bearing?, this remedy also is perceived to operate  in a
 variety of ways.  It promotes  absorption, reduces the
 force of morbid action, so as to bring it within the  con-
 trol  of the curative  powers  of nature, and  abstracts
 the blood from the overloaded vessels.  The modes of
effecting it arc  two, bloodletting and secretion.  To the
 latter belong both puking and  purging.
   Bloodletting  is either local  or general.  It is local
 when  the  blood  is  drawn   immediately  from  the
vessels of the part affected.  In cases where general fe- 
                          20y
 ^ er as well as  topical  congestion exists, this mode of
 depletion avails but little.  In ipany instances it proves
 injurious.  When local congestion exists alone, without
 producing  general excitement, topical  evacuation may  .
 be advantageously practised.   Remove congestion when
 thus existing, and provided the irritation  be also remo-
 ved, it does not necessarily return.  But if, at the same
 time, fever prevail, its return is almost certain.
   Local bloodletting is  performed by  leeching or cup-
 ping, applied immediately to  the  place of congestion.
 It is employed chiefly in superficial affections, those that
 are deep-seated being beyond its reach.
   To produce on congestion, which is necessarily local,
 the effect of depletion, genered blooding must be carried
 to such an  extent, as greatly to weaken the action of the
 heart.   Should it  induce  fainting, unless in   cases
 where peculiar  circumstances forbid such  an effect, it
 will be the more beneficial.  If it be not pushed so far
 as to reduce very materially the force of the circulation,
 it is worse than useless.   It wastes the vital fluid, and
 detracts from the energy of the powers of  nature, with-
 out in  any degree  weakening the disease. Let this evac-
 uation, then, be regulated, not by the quantity of blood
 drawn, but by the  effect produced.
  Under the influence of general bloodletting,the capil-
 lary vessels of the congested part  can be  emptied only
 by their own action.  That they may  succeed in their
 efforts to empty themselves, all obstructions to their suc-
 cess must be, as much as  possible, removed.  But the
 chief obstruction is the action  of the heart, which pre-
serves a plenitude of blood not only  in them, but in  all
the large vessels leading to them and from  them-  Re- 
a io
movB that plenitude, and thejr will empty themselves of
their superabundant fluid.
  It is a well  known property  of the capillaries, that
they continue to act long after the heart, lungs, and oth-
er large organs have ceased.  They even act after oth-
er parts are dead.   When  the  heart itself is no longer
capable of dilatation or contraction, its capillaries act.
  In general bloodletting, then, let  the blood flow until
Syncope has occurred, or at least until the heart has be-
come greatly enfeebled  in  its action.  Under these cir-
cumstances, the congested capillaries, finding no longer
any hindrance from the fulness of  blood in the adjoin-
ing larger vessels, empty themselves,  by contraction, of
their superabundant fluid.   Thus freed from preternatu-
ral distension, they have time, before the heart recovers
its full force of action, to acquire such a degree of tono
and vigour, as may enable  them to protect themselves
from another congestion.
   To illustrate this doctrine by a familiar example.
   Bleed an opthalmic patient  until he faints.  The ca-
pillaries of the inflamed and reddened tunica adnata
 will immediately  so  far empty themselves, as to  res-
 tore that organ to its natural colour.
    Let the topical congestion be visible in any other part
 of the body, the effect will  be  the same.   Let syncope
 be brought on, and the external capillaries  generally
 will empty  themselves,  by contraction,  of their  blood,
 and induce that paleness which overspreads, in faintingt
 not only  the lips, cheeks,  and forehead, but the entire
 surface of the body.
    The loss of blood, like the amputation of a limb, or
 the forcible  and  unnatural  removal of any other  ele- 
811
mentary part of the body, is, in the abstract, an evil, an#
should never be recommended or submitted to, except
as  a preventative of something  worse.  To produce^
therefore, the desired effect, with as slight an expendi-
ture of blood as possible, it is found expedient, where it-
is not forbidden  by peculiar circumstances, to perform ve-
uesection with  the  patient in  a sitting  or standing
posture.  With the body thus placed, the abstraction of
a pound of blood,  produces a stronger effect, than thfe
drawing of twice that amount, when  the  position is re-
cumbent.
   Under this head  I shall only further remark, that.
bloodletting  is not  a curative remedy.   It is only palli-
ative and preparatory,  weakening morbid action, miti-
gating  pain  and  suffering,  awakening  susceptibility,
piaoing disease  under  the control of nature, and facil?
itating the operation of other remedies.
  In this place,  as not being altogether foreign from the
present division  of  our subject,  may be mentioned an-
other remedy which is often efficacious in the removal
of congestion.   It  is  the application of  cold water to
the part affected.
  This would seem to operate in a  threefold manner.
It evacuates or abstracts the matter of heat, when it su-
perabounds, promotes absorption by its action on the
lymphatics, and  stimulates  the overloaded and disten-
ded vessels  to contract,  and relieve themselves from
their superabundant blood.   It is important,  however,
to observe, that unless directed with judgment and skill,
the application of this remedy is likely to do mischief.
When the congestion is intense,  it should never be em-
ployed.   In tbe  incipient and declining  stages of the 
212
affection, it is safe and efficacious; but hazardous and
inadmissible when the complaint is at its height.   There
are few modes of practice  by  which quackery  doo»
more mischief, than by the indiscriminate application of
cold water to inflamed eyes.
   The employment of warm water in cases of conges-
tion is often a safer  and more efficacious mode of prac-
tice.  This remedy produces its effects also by stimula-
ting the  overloaded vessels, augmenting their action,
and thus enabling them to free themselves from their su-
perabundant contents.  It  also  excites secretion and
absorption, both of them auxiliary processes in the remo-
val of congestion.
   Secretion, as a mode of evacuation, contributes to the
removal of congestion in a  twofold way.  It depletes
generally, or acts  locally and immediately  on the con-
gested vessels, abstracting gradually a part of their con-
tents.
   In the former mode, every secretion  necessarily  acts
according to its extent, the amount  of the secreted fluid
being so much abstracted from the volume of  the blood.
But the secretions that deplete most copiously and pow-
erfully, are the cutaneous, the urinary, and the alimen-
tary, the latter including those by the liver and pancreas.
   Considered in the  abstract, these may act indirectly
in the removal of any topical congestion, by at once re-
ducing the force of the circulation,  and diminishing the
amount of the circulating fluid.  They act also, to a cer-
tain extent, as revulsives, in relation both to circulation
and excitement.  An  augmented degree of circulation
and excitement in the skin, operates  necessarily,  be-
cause in conformity to a principle of nature, by way of 
                        213
revulsion from internal parts.  -The  surplus of excite-
ment and circulation accumulated in the skin, is so much
drawn from other organs.
   When congestion is seated in the liver, the secretion
of bile diminishes it directly, by abstracting immediate-
ly from the contents of the overloaded vessels.   Hence,
in gastric and hepatic affections, preparations  of mer-
cury and  antimony afford relief, not merely, nor even
chiefly, by  evacuating the contents of the stomach and
bowels, but by promoting Secretion when  defective, and
correcting  it when morbid.
   If the congestion be in the lungs, the secretion from
the mucus  membrane that lines them, operates  in the
same way  towards  its removal.  And if it be  in the
fauces, the  same effect is produced on it by the secretion
of mucus from the investing  membrane.   If it be deep-
seated in the midst  of muscle  and cellular substance,
and cannot be otherwise made to disappear, nature in-
stitutes, for its  removal,  the secretion of pus.   Of ail
these processes, the  object and effect are precisely the
same; to carry off congestion.   And, in most instances,.
the end is attained by  an augmented secretion from the
part in which the congestion  is situated.
  Revulsion,  ft  has been  already adverted to,  as  a
principle in the economy of animated nature, that action
and circulation are not only  associated, but are in pro-
portion  to  each other.  If to this  principle a  few ex-
ceptions  exist,  they are to be received as exceptions,
and nothing  more.   Moderate excitement in a part \s
accompanied by  moderate  circulation,  excessive  ex-
citement, by superabundant circulation, and an  extinc-
tion of excitement, by an extinction of circulation. 
214
   Another principle is, that the human constitution is
Capable of sustaining, at the same time, a given amount
of cxqitenwnt, and no more.  If, therefore, it be  exces-
sive in one part, it will be defective in another; and if
it be  produced in a high degree in any  part, where it
has not before been  preternatural, it will be diminished
in another where it hasbeen so.  Preternatural excite-
ment, then, in one part, draws such excitement from an-
other.  This is what we mean by the term  revulsion.
To illustrate it by example.
   The excitement  of  the  brain, by  fear or anger, re-
moves the excitement  and  pain of tooth-ache; the ex-
citement  of the stomach by  an emetic, by  laudanum,
by water as hot  as it can be swallowed,  or by  coffee,
removes the pain and  excitement of sick head-ache;
the excitement of the skin, by  a  sinapism or an epispas-
tic, relieves or cures preternatural  excitement and pain
in the pleura or  the peritoneum;  and external excite-
ment produced by warmth, caustic, or actual  burning,
mitigates or removes the internal pain and congestion of
rheumatism.   The excitement of the brain, by a senti-
ment of ambition and  a love of battle,  has often re-
moved the abdominal excitement productive of inter-
mitting fever, scurvy, and other  diseases of the chylo-
poietic viscera.  Thus, seamen  rendered unfit for duty,
and even confined to bed, by those complaints, have,, on
coming in sight of an enemy, left  their hammocks,
stood at  their quarters, and worked their  guns during
action, and recovered rapidly after the victory achieved
by their valour.   This interesting spectacle was exhib-
ited by many seamen, and several officers, of the Ameri-
can squadron, that, under the command of  Commodore 
                        215
 Perry, triumphed so gloriously, on  the waters of Lake
Erie, over a foe superior both in  numbers  and equip-
ment.  Even  to  excite  the  feet by the  heat of a fire,
cures, not unfrequently, the excitement of colic.  It is to
be remembered, that in all these cases, the remediate ex
citementproduced, as well  as that which it removes, i*
accompanied by congestion.  It  appears,  then, from
the foregoing facts, that, on the principle of revulsion,
congestion within is  relieved or cured  by  congestion
ivithout.    Preternatural   excitement  and  congestion
in the head, are also relieved or  cured, by the same
affections in the. feet.  To all practitioners these things
are familiar.
   On this topic I shall only further observe, that, to act
revulsively,  remedies must  rarely be employed during.
the existence of fever.  In  the treatment of the febres
and phlegmasia? of Cuilen, the removal,  or  at  least a
very marked reduction,  of febrile excitement  should
always precede the application of blisters. Nor, during
iheprevalence of fever, can  any other kind of local ex-
ternal excitement prove efficacious, in the removal  of
congestion and pain.   On  the contrary,  it  usually ag-
gravates them.
   Stimulation.  It is only  in cases  of  great languor,
torpor, and debility, when the system, exhausted by the
violence or continuance of  disease, has sunk into a state
 of collapse, or when it is overwhelmed and paralysedby
 the force of the original morbid impression, that this
 remedy should be employed, for the removal of conges-
 tion.  1 mean particularly  for the removal of congestion
 in febrile  affections.  When no  such affection exists,
 stimulants of some kind may be always  employed. 
                         2 lb-
   Cases ot  exhaustion and collapse we have in the ad-
vanced stages of severe attacks of bilious, typhus, and
others fevers.  Cases of  e>ppressiem we find in the  com-
mencement of the malignant or congestive form  of the
same, complaints.
   In the treatment of inflammatory congestion, accom-
panied by a general affection, stimulation is not admis-
sible.   It should be employed  only to arouse into action
the vessels  of the congested  part, when they are too
feeble and torpid  to maintain  the  circulation of the
blood.  It is with this  view that brandy, wine, opium,
and  other powerful stimulants, are  administered  in the
oppressed and exhausted states of fever.
   Another  analogy between  diseases is, that, as  they
are all produced,  so are they  cured, by  irritative  and
sensative impressions on  the  solids, not by any medi-
cation of the fluids.  Although it  is, perhaps,  possible,
that, in  a debilitated and disordered condition  of the
digestive and assimilative powers of the  system, certain
medicinal substances may, unchanged in their qualities,
gain admission into the  blood, the event  is a very  rare
exception to the general rule,  and  can never prove  trib-
utary to the  restoration of health.   On the  contrary,
the effect of foreign substances, thus admitted into the
circulation,  must  be  necessarily injurious.   If intro-
duced during health, they deteriorate  the blood, and
cannot, therefore, restore its healthful qualities, by be-
ing  mingled with it in an unsound condition.  The  only
effect of such admixture must necessarily be, to render
its condition more unsound.   A foreign and  dead sub-
stance floating in  the blood, is like a foreign  substance
thrust into the flesh.   It must irritate and do  mischief. 
217
Dead and living matter cannot remain harmoniously and
healthfully in contact.
  In many diseases the blood is  doubtless deteriorated
in its qualities.   But the morbid change in it  is pro-
duced not by the immediate influence of the causes of
disease, but by the deranged action of the solids.  Nor
can its  soundness  be restored in any other way, than
by removing such  derangement, and restoring to  the
solids their healthful functions.  The deleterious con-
dition of the blood is  but a symptom of disease, and-,
like  other symptoms,  disappears when the disease is
eradicated—when its proximate cause, congestion, is re-
moved.
  To prescribe remedies with a  view to their immedi-
ate action on the blood, is like 'an effort,  in fever, to re-
move the hot skin, the  parched  tongue,  or  the  aching
head, without removing the disease itself.  It resembles
the fatal error of the mariner, unskilled in  his  profes-
sion, who, to change the course of his ship, and prevent
her from dashing on a  reef or a sand-bar, shifts a sail,
instead of  altering the direction  of the rudder;  or the
practice of an ignorant agriculturist,  who,  with  a view
to the destruction of a deleterious shrub or weed, con-
tents himself with plucking a leaf, or lopping a branch,
instead  of cutting up the plant by the  roots.
  The  last  analogy between diseases  which  I shall
mention, I  deem important on  the  score  of practice.
It is, that after  the  most skilful  and successful employ-
ment of the most appropriate and active remedies, we
must rely, ultimately, on the recuperative powers of na-
ture, for the complete solution of existing congestion. Of
every complaint, whether severe «r  otherwise,  this is
                        Dd 
218
true.   The physician never uteres a disease, but, acting
m r<j'y an ancillary part, aids nature in the important
process.   His true course of practice is, so far to weak-
en disease, aS to bring it under the  control  of nature,
and then interfere with remedies no  farther,  except to
Tegulateanl  palliate symptoms.  For that  purpose he
nest hold himself on the alert until convalescence is
complete.
   But if is more  especially in chronic diseases  that the
physician must trust to the powers of nature,  and be-
come hiu^elf her observer  and auxiliary.
   iM these complaints it  is rare that the remediate  sub-
stances have an immediate and specific effect on  the
congestion or proximate cause of tbe disease.   In some
instances they certainly have.  But, in  general, their
efficacy  defends chiefly on their salutary operation on
the system  at large.  In  this way  they  invigorate the
powers of nature, and  these powers remove the com-
plaint.
   B-tween the treatment of acute and chronic diseases,
the difference in this  respect is striking.   In the former,
t le  strength of the complaint is to be so reduced, as to
be rendered inferior to  the powers  of nature.  In the
litter, the powers of nature are  to be  raised to a su-
 periority over the complaint.
   slence, in chronic  practice,  the importance ofeve^
 r  thing that can invigorate the system,  including diet,
 clothing, exercise, air, sleeping and waking, and the gen-
 eral regulation of the intellect, more especially the reg-
 ulation of the passions.
    Between  the diet requisite in the  treatment of acute
  and chronic diseases, I apprehend that the difference is 
219
not always made an object  of sufficient attention, even
by  practitioners of high respectability.   In the former
case, the diet can scarcely be too bland, light, and mod-
erate in quantity.   In the latter, it should also be bland;
but it must be nourishing  and restorative, and given  in
such quantity as to strengthen  the  system.   In acute
disease, animal food of "every description  is inadmissi-
ble.   In chronic disease, where  no fever prevails, cer-
tain kinds and forms of animal food are not only admis
sible, but often necessary.   The object to be  attained,
in the two schemes of practice, being held in mind, the
means can never be mistaken.   In acute  diseases,  ac-
tion is to be reduced, in chronic, power is to be invigora-
ted.   But to  effectuate  these two objects,  kinds and
forms of diet not only different  but opposite are essen-
tial.  It must not, however, be forgotten, that in the use
of diet, as well as of the other non-naturals, the habits
and mode of  life of  the patient should be carefully con-
sulted.
  If, then, according to the views contained in the fore-
going disquisition, diseases exhibit analogies so numer-
ous and striking, in what, it may be asked, do  they dif-
fer from each other? Or does it follow that they do not
differ at all, but that the doctrine of the unity of disease
is true.
  I answer, the  doctrine refered to is not true.  Dis-
eases do differ from each other, and the chief sources of
their difference appear to be  as follows.   1. A  differ-
ence of remote cause.  2. A difference in the particular
tissue or structure in which the disease in  situated.   3.
A difference in the general organization,the functions, (d)
and sympathies, of  the part diseased.   It need  scarcely 
220
^e  observed,  that  thcs3 three causes,  under all the
changes and combinations, of which they are, suscepti-
ble,  are competent to the production of an immense
variety of disease.
  Different poisons or deleterious substances, as those
of small pox, measles, influenza, and scarlatina, acting
on the same tissue, suppose  it fo be the mucous mem-
brane of the alimentary canal, must produce necessari-
ly different morbid  impressions, awaken  different kinds
and  degrees of sympathy, and give rise to different gen-
eral results.  This proposition,  resting on the converse
of the axiom, that  similar causes, acting under similar
circumstances, produce, of necessity, similar effects, may
be thus constructed into  another axiom,  that dissimilar
causes, acting under  similar circumstances produce dis-
similar effects.  1 might even add, that, for the most part,
if not always, dissimilar causes acting under dissimilar
circumstances, produce dissimilar effects.
   The same deleterious  cause, throwing its action on
parts differing  in structure,  susceptibility, and power,
must necessarily  give rise to  different affections. Thus,
although produced in each case by mechanical violence,
atmospherical influence, or any other identity of cause,
congestion and inflammation  are exceedingly different,
both in  appearance  and  result,  according as they are
situated in the serous, mucous, cellular, or fibrous mem-
branes.  And still further differences arise, when they
have their seat  in the cutaneous,  the   osseous, or the
lymphatic  system,  the discrepancy of result correspon-
ding, in every case, with the  discrepancy of structure,
susceptibility, sympathy, and power of the part affected.
   When organs differently constructed,  performing dif- 
221
ferent functions,  possessing and  exercising different
sympathies, and therefore  of different uses in the econ-
omy of the  system, receive  an injury from  the same.
cause, the issue again is necessarily different
   Let the organ  injured  be the brain, the lungs, the
stomach, or the uterus,  and the  lesion be produced by
mechanical  violence.  It  need  scarcely  be  observed,
that, in each case, the morbid affection will be different.
In one instance, coma, delirium, or madness will appear;
in another, deranged  respiration, with its deleterious ef-
fects on the blood, and  the system at large; in the third,
derangement of the digesfive system, with its  dismal as-
semblage of concomitants and consequences, and, in the
fourth, intense pain,  and suspended  or disordered men-
struation, with all the distressing sympathetic affections
that derive their existence from uterine disease.
   Is the morbific  impression made on the eye, the ear,
the nares,  or  any of the organs  of  generation in the
male?   Again must  the  disease,  arising from this im-
pression, be different, according to the part in which it
has its seat.   In fine, wherever  there  exist,  in the hu-
man body, difference of structure,  susceptibility, func-
 tion, and sympathy, there must necessarily be exhibited
different diseases, whether they  be  produced by the
 same or by different  remote causes.
    The differences of disease  produced  by the causes
just recited, may be  considered specific, radical, and im-
 mutable.   Being the offspring of nature, in her ordina-
 ry course of operation, nothing but  a  change in that
 course can abolish them.   To expect their extinguish-
 ment, on any  other  ground, would  be to look for ver-
 dure and fragrance  in the depth of winter, or ice and
 snow amid the fervours of June. 
222
   Other  causes,  consisting in difference of age, sexr
 temperament, idiosyncrasy,  occupation,  mode  of life,
 and place of residence, if they do not give rise to differ-
 ent diseases, produce, at least, great variety in the same
 disease.   These, although  too  generally  regarded as
 matters of minor importance, deserve,  notwithstanding,
 the most serious consideration of the practitioner of med-
 icine.
   Another very fertile source  of variety in disease, is
 the peculiar condition of the constitution at the time of
 attack.   If it be  sound, the  complaint will present one
 character; if shattered, a very different one.
   A scorbutic dysentery  differs materially from one in
 which no  such diathesis prevails.  The same  disease
 will be in  many respects exceedingly different in dyspep-
 tic subjects, and  those   that  are not dyspeptic—dif-
 ferent where the liver is the  seat of some chronic affec-
 tion, and where it is not.
   The varieties in phthisis pulmonalis are numerous and
 striking.  That variety known to  be most  striking,
 as well as most irremediable, arises out  of a scrophulous
 diathesis.   To many other complaints, similar remarks
 are equally applicable.
   All these differences in the same disease,  are attribu-
 table to the different susceptibilities, powers and sympa-
 thies  of certain organs,  accordingly as tney  are in a
 sound or morbid condition.
   How far the peculiarities  of the several permanent
 varieties of the human  race may lay  a foundation for
different diseases, it is not my present purpose to haz-
 ard an opinion.   The subject, curious  in the science,
 and not  unimportant  in the  practice,  of medicine, de-
serves from pathologists more attention than it has here-
tofore received.
END OF  MEMOIR  HI. 
NOTES TO MEMOIR HI.
                 Note (a) page 202.
  In some dissections, in cases of hydrophobia, the only
congestion discovered, is represented to  have been  in
the pharynx, esophagus, and stomach.
  In  these  instances,  the nervous affection had been
either sympathetic, or the congestion of the spinal mar-
row, and of the nerves connected with it,  had been re-
moved by the contraction  of the engorged capillaries
(the vasa nervorum)  after  the heart had ceased to act.
For it is known that  the  capillaries do contract, for a
considerable time after the lungs have ceased to play,
the nerves and brain  to feel, or  the heart to move.
   In most dissections, in  hydrophobic cases,  the spi-
nal marrow  and nerves have been found congested.   A
preternatural dryness of the muscles, or rather of their
sheaths, is also reported to have been usually discovered.
This indicates a  deficiency in  the secretory  process,
destined to  moisten  those  parts.   The blood pressed
out of their  vessels, by morbid contraction, is probably
thrown on the nerves and spinal marrow.
                  Note (6) page 203.
   This  case of disease was altogether anomalous, and
 arose from an injury accidentally done to the  spinal!
 marrow, when the  subject  of it was running.   Post1
 mortem examination esiablished the fact.   Congestion
 in the nerves was scarcely so apparent, as to justify a
 positive assertion that it existed.
                   Note (c) page 204.
   This was remarkably the case with  the  late Mr. Pitt,
 It is understood that that great statesman planned and
 matured, in bed, his  most brilliant and effective schemes
 of finance and war.  Nor was it the mere  quietude and
 abstraction  of his chamber that aided his intellect.  All
 ether things being alike, his mental exertions  were not 
22.4
only attended with less labor, but  were more satisfacto-
ry to him, wh?n he was  lying in bed, or reclining on a
sjft, than when seated at his desk.  Hence, instead  of
writing himself, he often  lay and dictated to an amanuen-
sis.  And hence the process of '"consulting our pdlow,"
in matters of intellect, as well as of morals, is more im-
portant than it is  generally considered.
                  Note (d) page 219.
   Every organ has a twofold connection  with the sys-
tem; by function, and by  sympathy   Hence the ex;s-
tence, therefore, on this-ground, of a twofold source of
difference in disease.
   Suspend or derange  the process of digestion, and
from that suspension  or derangement alone will the sys-
tem suffer   But  it will also suffer, in various parts, the
heart, the lungs, the brain,  and the nerves, from the ex-
tensive range of powerful  sympathies,  which the stom-
ach possesses.  Hence,  in dyspepsia,  the sympathetic
affections  are  more troublesome and  distressing, than
those arising proximately from digestive derangement.
   Derange severely the condition  of the liver,  and not
only is the system  injured  by the  want, or the vitiated
character, of the  bile, but madness, hypochondriasis, or
severe  rheumatic affections, are produced by the sympa-
thies of that organ with  the other parts of the body.
  The same is true of the  brain, the kidneys, the skin, the
muscles, and  all  other  important  organs.   Derange
them, and mischief is done,  as well by the disorder of
their functions, as by that of their sympathies.
   Notwithstanding the importance of functional con-
nection between single  organs and the general system^
the great majority of diseases is  produced and  cured,
through the  medium of sympathy.  In no  case can dis-
ease of function be separated entirely from sympathetic-
disease.   Their connection  is as  indissoluble as that of
substance and shadow.
THE END 
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