A TREATISE ON THE SCARLATINA ANGINOSA; WITH AN APPENDIX, CONTAINING OBSERVATIONS ON THE PRACTICE WITH SALT and VINEGAR. By THADDEUS CLARK, MEMBER OF THE CONNECTICUT MEDICAL SOCIETY. Doctrina vana est, ratio m accesserit. NORWICH: PRINTED BY THOMAS HUBBARD. M,DCC,XCV.  TO Dr. ENEAS MUNSON, PRESIDENT of the Connecticut Medical Society. The following pages are respectfully in- scribed by his unknown friend, THE AUTHOR. Lebanon, August 10th, 1795. PREFACE. SOME part of the following Treatise was written last April, principally, for the a- musement and improvement of the author. He has lately made considerable addition to it, and subjoined an appendix with which it is offered for publication. It is fashionable for Authors to tell their motives for publishing, among which, a re- gard for the public good never fails of find- ing a place, though the principle acted upon, may have been wholly an object of self in- terest, or to gratify a spirit of vanity. Whe- ther, or not, the succeeding pages will be of any advantage to the world, a point, that may seem almost beyond the limits of the ambition of a young man in the situation of the author, time must determine. A firm persuasion rests upon his mind, that they can do no hurt. The appendix never would have been seen, was not the author positive, that the article there considered, has met with no more success in its career to same, than what would have attended any insignificant arti- cle palmed upon the community with the same address and under similar circumstan- ces. To those who may be disposed to rank the step I have taken among the impruden- ces (v) ces of youth, I will acknowledge, that the imperfections of the performance are ma- ny, and had the author no view but such as relate to literary credit, he would have with- held it perhaps, at least, a year or two from the public eye, that it may have felt the in- fluence which the ripening hand of time pos- sesses over every literary production. I appeal to the candour of my brethren and fathers of the profession, and a kind, and indulgent public. Though, from all, it is impossible for me to expect a favorable re- ception: with the candid and ingenuous, I hope, and believe, it will be unnecessary for me to disclaim a bad motive. To objections, there exists this one gene- ral reply: it is a land of liberty. A2 A TREATISE ON THE SCARLATINA ANGINOSA. THIS disorder, vulgarly known by the name of Canker Rash, is now epidemic in various parts of New-England, and is, generated, both by a peculiar state, or con- stitution of air, and contagion. That we may have a clear comprehension. of the disease, the Prophylactic scheme and the method of cure, it will be necessary to make some observations relative to I. The nature of general predisposition, II. The properties and operations of conta- gion and contagious Diseases in general, and III. The specific contagion, and nature, of the SCARLATINA ANGINOSA. I shall then lay down the Prophylaxis, and conclude with the history of the Disorder and the method of cure. I. The nature of general predisposition. As I have said above, the Scarlatina, like many other diseases, is produced, both by a peculiar constitution of air, and contagion. That it is generated by contagion, will not be controverted. That it is produced by a peculiar condition of air, is deducible from (7) from instances, that obtain where the sub- jects have not been exposed to infection. Notwithstanding some people have been dis- posed to deny the fact, observation leaves- no room for dispute in my mind: and who, upon the supposition that the disease is whol- ly communicated by contagion, can give a- ny probable reason why it is not constantly present? Here the great question arises, what is that peculiar state of air? It is a hard ques- tion to answer. From inexplicable causes, there are changes, and conditions of air dis- tinct from those that relate to the seasons of the year, and perhaps independent of any material alteration of its sensible qualities. ‖ According to particular constitutions of air, we see particular diseases prevail, but more at some places than at others, and in some seasons than in others. Of those conditions of air that have been productive of disease, some may produce the same by operating primarily on the living solids, affecting such a change in the constitution as to lay the foundation of a disorder by which, in cer- tain instances, a specific contagion may be generated, others, it is probable, by supply- ing the body with the particles of a pecu- liar matter fluctuating on the surface of the earth ‖ See Lind on diseases of hot climates, p. 227, 228 Sydenham's works Chapter 2. on epidemic diseases. (8) earth in certain places. The latter idea, may appear old-fashioned to some in our days, but I think it will bear the examina- tion of all who are not too wise to attend to the observations of sydenham. Those general causes that operate on some persons to such a degree, as, to pro- duce a specific disorder, will, in subjects in a less degree affected, produce a state of pre- disposition: thus, in the Scarlatina, a pecu- liar state of air not subject to investigation, is a general predisponent cause, and strictly speaking the only one. In some few instan- ces this predisposition, as hinted above, will proceed to actual disease: and in propor- tion to it, will be the liability in the subject to receive the disorder by contagion. This predisposition will be different in different subjects, agreeably to varieties of constitu- tion, and the action of causes, that may fa- vor or oppose the influence of the predispo- nent cause.— That such a state of air is not the mere flight of fancy, seems evident from facts that have met the observations of many prac- titioners, of which, a principal one is the cotemporary prevalence of kindred disea- ses. While the Scarlatina Anginosa is epi- demic, other diseases frequently partake of its character. The instances of this kind mentioned by Doctor Rush in his first vol- ume of Observations and Enquiries, page 154 (9) 154, and which he refered to the operation of the contagion of the Scarlatina Anginosa, might with more propriety perhaps, be re- fered to the action of a peculiar state of air. During the prevalence of the disease, many persons are often attended with symptoms similar to what take place in the Canker Rash, such as inflammation and tumefaction of the tonsils, white sloughs in the fauces, and eruptive appearances on the skin, with or without any affection of the throat, as well in persons who have, as those who have not had the prevailing disease. The above symptoms, I have observed to be no uncom- mon attendant upon what we call a cold. Those cases of the Scarlatina, in the produc- tion of which, I had no reason to think that contagion had any hand, likewise followed exposure to the causes of this common com- plaint, or some irregularities. Every disorder in our world has had a beginning, and, relative to its origin, is, doubtless the result of the combined action of a greater or less number of natural cau- ses. The small-pox, that dreadful scourge of men, was introduced about the year five hundred. It was probably brought into ex- istence by a very extraordinary concurrence of natural causes; such an assemblage of morbid agents, as has seldom, if ever since obtained; hence the life of the disease, de- pends (10) pends perhaps, upon the perpetuity of con- tagion in the world. Among the above mentioned morbid agents, may, without doubt, be ranked a peculiar state of air. This idea is supported by rational inference from indisputable fact. That the small- pox, measles, and other distempers, were under the government of the atmosphere, was well known to Doct. Sydenham and many others since his day. Particular conditions of air, have a sensi- ble influence on these diseases, rendering them more or less epidemic, regulating the degrees of their violence, and exalting or mitigating the force of contagion. What the other causes are, which in connection with a proper constitution of air, would be sufficient, again to bring these disorders in- to life, will forever evade human enquiry. Considering the connection there is be- tween human maladies, and the alterations of seasons, climates, changes in society, and the customs, manners, and employments of life, how great must be the nursery of disea- ses? Many complaints of which we are ig- norant, were known to the ancients, and we have but little reason to conclude, that the catalogue of possible diseases is yet com- pleated. II. Under the second head, I am to say something concerning "the properties, and operation (11) operation of contagion, and contagions dis- eases in general." Contagion is the product and seed of cer- tain maladies, and is the peculiar matter, by which its appropriate disorder is com- municated from one person to another. Our knowledge of the properties of infec- tion, must be grounded wholly upon obser- vation of the operations of infectious disea- ses, among which a great variety obtains. Of these, some, as many of the exanthemat- ics, have this in common with themselves: when thoroughly impressed upon the system, they rarely, some say never, are communi- cated more than once to the same person. This is owing to some strong impressions made on the living solids by the action of the morbific matter, by which a radical change in the constitution is effected: to explain which satisfactorily, would require some time and good intellects. Other diseases observe no limits in the number of their at- tacks. It is to the difference in the nature of the generative matter, that we are to attribute the diversity of infectious diseases. Every disorder begets its own species, however va- rious the constitutions on which it is grafted. Contagious diseases differ, in possessing greater, or less actions on the solids and flu- ids; and diseases of the same name; in the degree of this action and the quantity and concentration (12) concentration of the matter generated in the habit, from natural, accidental, or habitual varieties of constitution. So small is the quantity of infectious mat- ter imbibed into the system, that little, or no danger might be apprehended from its ac- tion on the solids independent of a previous action on the fluids. When the seeds of a disease are sown in the body, a process, similar to what I shall state takes place. The infectious miasmata absorbed, first operates on the fluids, changing them more or less to a condition like its own, and when this change has proceeded so far as to throw the system into disturbance, the disease com- mences. Thus we see, a course of time is taken up, by, what, for the sake of perspicu- ity, I will call a state of fermentation, which, in all disorders, is longer or shorter (though in the infectious exanthemata it is general- ly pretty uniform) according to the state of constitution, the nature of the infection, and, as causes may intervene to favor, or re- tard the same. This change of the humors is flow at its commencement, but increases in vehemence as its cause increases, till "the little leaven has leavened the whole lump." The disturbance accordingly is small, and imperceptible at first, the symp- tomatic stage comes on, and the disease breaks forth to light. The greater the ac- tion (13) tion of the morbific matter § has been, and the longer, the larger quantity of infection will be generated, and the greater will be its concentricity, and the liability in the dis- order to be transmitted. By a law of the constitution, that part of the juices that is un- fit for the purposes of nature, and all foreign matter in the circulation, are cast off at the emunctories. When any quantity of conta- gion is generated, it begins to be discharged. By its stimulus, the action of the vital pow- ers is raised. and if the excitement of the vis vitæ be properly regulated, neither too high, nor too low, the matter will all pass off leav- ing the subject in a state of convalescence. If the excitement be too high, the matter will be hurried on toward the surface, and the small orifices of the exhalents being con- tracted by means of sthenic Diathesis which increases the density of the solids, it will pass off with difficulty, part making its way, part in the exanthemata, catching, upon the skin, producing in the small-pox an erup- tion plentiful in some measure proportiona- bly to the morbid general and local diathe- sis, and in the Scarlatina, a correspondent efflorescence. If the matter be carried to the surface faster than it can be transmitted, B it § I make use of this old fashioned word as some may call it, because I know of none that is more expressive. (14) it must accumulate; the great advantage of cold air in the small-pox consists more espe- cially in its removing sthenic diathesis from the surface, by which the exhalents are re- laxed, and a free egress afforded the accu- mulating matter. If the excitement be too low, the matter will not be sufficiently propelled. A large proportion of it remains behind. Part, however escapes at the skin; part gets no farther than the surface and collects there; an unusual quantity, falls upon parts nearer the feat of vital motion, such as the fauces, stomach and bowels, or organs of respira- tion. That part that remains in the circula- tion, continues its baneful influence, and un- der the operation of this, with the concur- rence of increasing debility and heat, the tendency of the humours to dissolution, is rapid. The disorder gains ground, and the ability of the constitution to grapple with it, every moment diminishes. For a farther explication of the Phœno- mena of contagions diseases, we must take into view the several species of debility to which the system is liable, direct, indirect, and mixt, when the two former are united in the same subject; and the causes, either accidental, or such as exist in the consti- tution, as may vary them. More, relative to this, will be added directly. I proceed now to say something concern- ing III. The (15) III. The specific contagion, and nature, of the Scarlatina Anginosa. "The contagious miasmata of exanthe- matic diseases" says Mr. Brown, "contri- bute some, though not much, to sthenic dia- thesis." The matter of some diseases, con- tributes more than that of others, and the matter of the same, as I have hinted before, may contribute more to sthenic diathesis in one person than in another. To explain the difference there is in the effects of the application of substances to an- imal bodies we must turn our attention to the fundamental principles of living systems. These are incitability, and irritability; which, notwithstanding their intimate con- nection, and general, united operation, ex- ist in some measure, independent of each o- ther. These, together, in organized sub- stance, constitute what has been called the VITAL PRINCIPLE: the EXCITABILITY, or ca- pability of excitement or life of Mr. Brown, and, without being subject to the laws by him prescribed to excitability, are, what distinguish animate, from inanimate matter. The conditions of these are stamped by na- ture's plastic hand, and in no two persons since the creation perhaps were exactly a- like. It is this that fixes the particular tem- peraments or constitutions of animals, and upon their diversity, depends the diversity of constitutions, among mankind. Though their (16) their conditions are fixed by nature, they are not immutably fixed: for these principles are under the influence of innumerable cau- ses, consequently their conditions must be, in a greater or less degree, constantly fluc- tuating. A given stimulus applied to per- sons, different in respect to these, however similar they may appear, must possess an un- equal force of action. Thus the stimulus of contagion applied to persons of different excitability in relation to it, may be attend- ed with consequences widely different. As the state of the fluids originally depends upon, and follows that of the abovemen- tioned principles in the solids, we may here see another cause of the difference in the op- eration of contagious diseases among man- kind: the natural state of the blood, may, in some people, be more favorable to the ac- tion of particular contagion than in others. In similar constitutions, there is no doubt but the contagion of the Scarlatina Angino- sa contributes less to sthenic diathesis than the contagion of the smail-pox: hence the disposition of this last disease to sthenic dia- thesis must be greater than that of the form- er. As the stimulus of the infections matter of the Scarlatina is very small in itself, the general tendency of this malady will be to asthenic diathesis: hence it is evident, why cold, which is generally so beneficial in the small (17) small-pox, is always less so, and commonly detrimental in the Scarlatina Anginosa: not- withstanding, when assisted by the more powerful operation of other exciting pow- ers, such as heat, more than common exer- cise or a full sanguine habit; or a strong tendency of constitution to inflammation, circumstances, under which, even a Typhus will be in a degree inflammatory, indirect de- bility may take place. At certain seasons, this is not an uncommon event. During the inflammatory state of the air that obtain- ed about the time the yellow fever prevail- ed at Philadelphia, Doctor Rush observes, that the symptoms of the Scarlatina Angi- nosa were so violent as "frequently to re- quire two bleedings." What light may be derived from the fol- lowing facts, it is refered to the inquisitive Physician to say. The Scarlatina is more readily communi- cated to children than adults, goes harder with females than males, the relaxed, than the robust, the infirm than those in the vig- or of health. As persons often have the eruption with- out any affection of the fauces, so they may have the affection of the throat without any efflorescence, and instances of both have been derived from the same source of infec- tion. Again, when a person has had the disorder exempt from any affection of the B2 fauces (18) fauces, he may afterwards have this affec- tion, and often very seriously, but without any efflorescence. So likewise a person may have the affection of the fauces at one time, and the remainder of the disease, if I may be allowed the expression, afterwards. But, it is not every breaking out, or sore throat, that is to be called by the name of the disease under consideration. We are next led to enquire, whether the disorder can be twice communicated to the same person? Though such instances are rare, I have no doubt but that they have existed. There are some cases that have fallen under my observation, limited as it has been, that make for the affirmative. Those who are much exposed to infection, in whom the former impressions were slight, the disorder superficial, or, in other words, if the expression is admissible, in whom the seeds of the disease were not thoroughly diffused through the system, are the candi- dates for this second attack. In this way, persons may be twice affected by the small- pox. The contagion of the Scarlatina, and of all disorders, is received into the system, either immediately by the absorbents of the parts in contact; or being drawn into the fauces and lungs in the act of respiration, it lodges in the moist cells or beds of mu- cous with which these surfaces are stored, and (19) and some part, perhaps, may pass directly through the inhaling vessels into the circu- lation; or being taken into the stomach with the drink or food, or in the common act of deglutition, proceeds in the route of the channel of nourishment. PROPHYLAXIS. The indications of the Prophylactick scheme are A To anticipate Predisposition. B To prevent the application of conta- gion and diminish its force. C To prevent absorption. D To secure a mild type of the disease. A "To anticipate Predisposition." Noth- ing more can be said under this head, than what would be proper in laying down the Prophylaxis of every disorder. Pay the strictest attention to the non-naturals. B "To prevent the application of conta- gion, "it may be well, if possible, to avoid it. Care should be taken to wash up the spits of the sick: and to remove the filth of the natural passages to some unfrequented place, or under ground. A variety of methods have been practised to destroy the force of contagion, and these have been used, with little, or no regard to the difference of contagious diseases. That some distinction is necessary is a rational supposition. Rush says, that in the Yellow fever that prevailed at Philadelphia, there did (20) did not appear to be any advantage in the use of common preventatives. He was ap- prehensive that some of them were detri- mental by affording a vehicle to the infec- tion. "I am disposed" says he "to believe, that garlick was the only substance that was in any degree useful." Burning of gun- powder, tar, and especially vinegar: fre- quently applying a handkerchief dipt in vinegar or spirit, or impregnated with the fumes of camphire, vinegar, or volatile salts, to the mouth and nose, will answer a good purpose: but whether or not, these things are advantageous by absorbing and destroying the fluctuating particles of infec- tious matter, is yet a question that requires proof. Let the floor be often sprinkled with vin- egar, and the air be kept grateful by the fumes of agreeable aromatick substances; but, especially, let attention be paid to pre- serve a free circulation of air, all which would be necessary were we only to con- sult the comfort of the patient. C "To prevent absorption." Perhaps the success of the means recommended un- der the foregoing head, depends in some measure, upon an operation referable to this third indication. The attention is here drawn to a certain balance there is be- tween the exhalent and absorbent systems. The more uniformly free the action of the (21) the exhalents, the less will be the tendency to absorption. The means that suggest themselves are a General. b Local. a It is a point of consequence, in those who are constantly exposed to keep the ac- tion of the perspiring vessels uniform; for if their functions be at one time consider- ably increased, and again left to languish, or fall as far below par as they had been raised above, such sudden increase of perspiring force, will augment the subsequent liability to absorption. Under this head may be recommended the use of aliment easily di- gested, frequently, and in quantity sufficient to keep the vital powers from flagging, with the occasional exhibition of such other things as shall perfectly preserve the tone of the stomach. Moderate exercise, punctual- ity in guarding against, or defending the constitution from the effects of too much heat, cold, and a damp air, and a steady, se- rene state of mind. b Local, or the use of such things, as, when applied to the surfaces on which the contagion lights, wash off the collecting mi- asmata, and discharge it from the system, or stimulating the small perspiring vessels, in- crease their vigour and help secretion. Let the bowels be kept in a soluble state, and after exposure for some days, a gentle aperient (22) aperient, such as castor oil, or manna may be exhibited, and if the stomach be foul, a little ipecac, to cleanse the first passages. Let those who are exposed, often rinse their mouths and throats with detergent washes and gargles, in which is a portion of Spt. Salis. I shall make no apology for transcribing at this place a passage from the London Magazine for October 1759. "To the author of the London Magazine. Sir, The following simple remedy for the Scarlet fever with ulcerous soar throat, generally prevents persons from catching it, and is also of great service in curing it. I hope therefore you will publish it for the public good, as it may save the lives of ma- ny persons, for the distemper is rise in ma- ny villages in Wiltshire and the neighboring counties. Take a pint of water, two large spoonfuls of brandy, a little sugar, and twelve drops of the spirit of Sea-salt, so as to make it grateful. Let this quantity be drank every day by a man or woman, and let children drink of it as free as possible for their con- stant drink. Let them likewise wash their mouths with it several times in a day ta- king care to spit it out again. This will prevent their catching it: but when they have this disorder, they must take a much greater quantity of it every day, and gar- gle (23) gle their mouths and throats very often with it" In the catalogue of preventatives, tobac- co, in the several modes of using it, must not be overlooked. Whether the infection of the small pox, measles and Scarlatina may be received into the circulation, in a person who has not previously been infected, and again dis- charged without inducing disease: or whe- ther any adjustment of the constitution, may anticipate its impressions and render it innoxious, with many of the faculty is yet problematical. That this may be the case relative to other contagions diseases, is cer- tain: and why will not the same fact ap- ply to exanthematic disorders? A young Lady was inoculated with the infection of the small pox: the part where the matter was applied, inflamed, suppurated and dis- charged, and some slight symptoms of gen- eral affection obtained. (Whether these, were more than the effects of imagination is doubtful) matter taken from the ulcer thus produced, in another person generated the genuine Small-pox. Hardly a doubt of the former person's having had the disor- der subsisted, when she was re-inoculated and had the disease regularly. If the in- fection, may thus be discharged from apart of the body, why not, by the same powers, when, received into the general circula- tion? Numerous (24) Numerous have been the instances of persons who have been inoculated for the small pox, and continued in the hospital with a class of infected patients during the course of the malady, who, on the supposition of their having had the disease, at some future time, exposing themselves to its infection, have been unexpectedly cut off by the disor- der in a natural way. Frequent escapes from the small pox in persons, who had been, for a long time, con- stantly and eminently exposed, can hardly be accounted for, without admitting the supposition, that the contagious miasmata of this complaint "may be received into the circulation and again discharged without inducing disease." The same observation will apply to the Scarlatina Anginosa.‖ Some directions relative to the point a- bove considered will be found under our next indication, which is D "To secure a mild type of the dis- ease." Under this head, directions for the strictest attention to the non-naturals are in- dispensible. Since the disorder so naturally inclines to debility, the exposed, ought by all means to avoid debilitating causes. If any ad- justment of constitution is attempted by in- ward ‖ See Rushes Medical enquiries and observations Vol. 1st. Page 157. (25) ward applications, should the object be; rather to incline the system to sthenick diathesis? In regard to this, great caution is necessary: Perhaps nothing can properly be recommended at this place, more than what may be found under the third indica- tion. It is obvious, that, in laying down the Prophylaxis, Physicians ought to be gov- erned in some degree, by observation of the common tendency of the epidemic; for at different seasons, the disease puts on dif- ferent types. As considerable part of the danger arises from the affection of the fauces, it may seem as though some instructions in refer- ence to this might not be amiss: but here again we are anticipated by what has been said under the third indication. It is wor- thy of notice, that those means which are useful for the prevention of the disorder are calculated to render it mild. A difference in the severity of the disor- der arises from a greater and less degree of action in the contagion on the general mass. In some instances, as before hinted, this ac- tion, or fermentation, as it may be called, is so small as to afford no security against a second attack, or perhaps be entirely anti- cipated. What those causes are that favor this action, what can be done to counteract it, or whether any thing more than the strictest regularity in exercise, eating, drink- C ing, (26) ing, avoiding heat, and a cold and damp air, merits the inquiry of practitioners. Says an eminent author, when treating of the disorder under consideration, "when the contagion of the disease has been re- ceived into the body, a purge has prevented its being excited into action, or rendered the disorder mild throughout a whole fami- ly." This compares very well with the recommendation in the second part of our third indication; and from it, it seems ev- ident, that the advantage of a purge before the commencement of the complaint, con- sists in part, only, in its removing the col- lecting contagion from the first passages. A mild aperient, by unloading the bowels, will serve to remove any incipient supernat- ural heat or agitation in the circulation from the action of infection absorbed into the system, and to solicit the discharge of the morbilic matter from the body. For this purpose, a small portion of calomel will be preferable to what was directed under the third indication. Doct. Rush recommends calomel mixed with Ipecacuhana. Atten- tion, to prevent any, the least degree of de- bility is necessary; and to this end, the operation of the medicine should be follow- ed with a gentle paregorick. I now proceed to the history of the dis- order, which I shall consider under three heads. A THE (27) A THE MILDER SCARLATINA, OR SCARLA- TINA ANGINOSA SIMPLEX. B THE SCARLATINA ANGINOSA. C THE SCARLATINA ANGINOSA MALIGNA. I make this arrangement solely for the sake of convenience: the complaint to be treated of under each of these heads is spe- cifically the same, and differs only accord- ing to varieties of seasons, difference of constitutions, and circumstances that attend. That the different Species, or rather modifications of this complaint, are not essentially different is evident from this ob- vious fact, to wit, they have been all pro- duced from the same morbid source. If this fact be admitted, and I know it is in- disputable notwithstanding the distinctions of Doct. Cullen, and his reasonings to the contrary, the argument must be conclusive. I shall treat of the disease in the order of the several divisions as above. A THE MILDER SCARLATINA, OR SCARLA- TINA ANGINOSA SIMPLEX. This species ob- tains, when the efficient causes supervene upon the most favorable state of constitution, and under the most favorable circumstances. The complaint is inflammatory, and attend- ed with symptoms in proportion to its vi- olence, that are common to inflammatory complaints; such as pain in the head, back, and limbs, accompanied with agues, fever of the continued kind, thirst, nausea, and (28) and some white Sloughs, more or less, on the fauces, with inflammation of the ton- sils; though the affection of the throat is never alarming, and, sometimes, none at all. An efflorescence upon the skin makes its appearance on the second or third day. The face swells, and sometimes the limbs, the patient begins to itch, and the scarf skin to cast off in branny scales which appear successively. The eruption commonly shows itself first on the neck and breast, and extends to the extremities, soon after which, the patient begins to recover, unless cir- cumstances, have taken place to disturb the tendency of the disease. B The SCARLATINA ANGINOSA. The caus- es that dispose to a more malignant type, are 1st. Great concentricity in the contagion. 2dly. Causes that incline the system to a morbid state: a putrid disposition favors much the fatal tendency of the disease. 3dly. Causes that increase the agitation of the humours, the action of infection-, and the tendency of the excitement to di- rect or indirect debility. But for general causes, we are to look to the air, the universal modifier of diseases. In parts near Philadelphia, and in many places in New-England, during the sultry, peculiar state of air that pervaded the con- tinent, and contributed to the preparation of the yellow fever in that city in 1793, the Scarlatina (29) Scarlatina put on its most malignant appear- ances. The complaint, under this division, be- gins, with chilliness, languor, oppression at the pit of the stomach, pain in the head and back, nausea, vomiting, soreness of the throat, and, frequently, many, commonly delusive, inflammatory symptoms. Faint- ness, dejection of spirits, and, sometimes, a purging, come on. To these may be added an inflammation of the membrana mucosa. The inflammation of the tonsils is of a shin- ing redness, and the tumefaction of the fau- ces has a puffy appearance. White sloughs spread over the throat and mouth, and verge to an ash colour, or black, as the disorder inclines to a more malignant state. The breath is fetid: the throat loaded with slime or mucus, which, from its glutinous quali- ty, and the soreness of the parts, is discharg- ed with difficulty. The respiration is some- times not much affected, though often labor- ious. The tongue is moist, especially to- wards the root: the eye reddish: the count- enance full, flushed, and bloated, though sometimes sunk. The nostrils are inflam- ed, and discharge a thin acrid humour that excoriates the lip. The patient is often comatose, or he lies restless, watchful and delirious. Great heat obtains. These are some of the principal symp- toms, that have been known to take place- in different subjects. The (30) The fever that attends in these cases, ex- cept at the beginning, when frequently it is continued and inflammatory, is common- ly of the remittent kind, with an exacerba- tion in the after part of the day, and, now and then, again, in the succeeding morning. Sometimes however it is a Typhus. Sometimes a sweat succeeds an exacerba- tion of fever. The efflorescence on the skin, makes its appearance about the third day. It often shows itself only on the neck and breast, though frequently it is general. If the disease is-violent, and no relief is afforded, the symptoms increase. If no Di- arrhœa had previously obtained, it will come on at this time. "The patient be- gins to throw about his arms and legs, ly- ing in a state of great inquietude," or he be- comes lethargic, The constitutional pow- ers fail. Great prostration of strength takes place. The breathing grows mere laborious, the swallowing more difficult, and about the fifth or sixth day, death, by suffocation, concludes the tragedy of dis- tress. C The Scarlatina Anginosa Maligna, in its name conveys the idea of its charac- ter. The causes that dispose to it, are such as induce an extremely morbid tendency of constitution, with great concentricity in the contagion: or such causes as greatly as- sist the action of the infectious matter. There (31) There is great prostration of vital strength, oppression at the precordia, and dejection of spirits. The fever that attends, is a Typhus of the worst kind. The pulse is frequent and irregular. The ulcers of the fauces are livid, ash-coloured or black. Purple petechia frequently make their appearance very early in the disease, and so violent is the disorder in some instances, that it equals the plague, the most furious of all diseases, in its tendency to dissolution. In such ca- ses, very little can be expected from hu- man exertion. § § Some part of the above description is taken from Doct. Wallis's ART OF PREVENTING DIS- EASES AND RESTORING HEALTH. Doct. Sydenham has given us a history of the Scar- latina, that prevailed as an Epidemic unaccompanied with an affection of the throat: at least, he has said nothing about any such affection. An instance of such an Epidemic, Doct. Cullen says, he never had seen in the whole course of his practice; but, as he acknowledges, implicitly, that he had seen some in- stances where there was no such affection, may we not have reason to conclude, though contrary to the conclusion of this great man, that the disease of Syd- enham, was of the same nature of that of which we have been treating? I have known whole fam- ilies of children affected, when the Scarlatina An- ginosa was first making its appearance among us, that had, some but very little, and others no affection of the throat at all; and there can be no doubt but these cases, were instances of the genuine SCARLA- TINA ANGINOSA; for, from them, the malady in its (32) Favorable Symptoms. If the disorder is of the most simple kind: and, if not, if the sloughs be white, and the efflorescence be general, permanent and florid: if the coun- tenance be lively, and no great debility ob- tains, a favorable issue may be expected. Unfavorable symptoms. But if there be great prostration of vital strength: if a de- lirium or diarrhœa comes on, and the af- fection of the throat be extreme: but more especially, if the ulcers are livid, ash col- oured, or black, the countenance become cadaverous, the eruption disappear or be- come dark coloured, purple spots show themselves, tears flow involuntarily, and the nose bleeds, the worst may be feared. The indications of cure are A General. B Particular. A The GENERAL INDICATIONS OF CURE are a To diminish Sthenick Diathesis. b To promote the determination to the surface. c To support the vital powers. a To its full dress of symptoms, was transmitted by indis- putable descent. Query. Was the Scarlet fever of Sydenham principally produced by the impres- sions of a strong constitution of air in other respects healthy? or was it such an Epidemic, as no one, or very few, have seen since his time? To conclude, was it not a high degree of the complaint at this moment Epidemic in various places, and vulgarly known by the name of RASH? (33) a To diminish Sthenick diathesis. In the mildest, and most simple cases, medical help is not much required. In sanguine habits, if the pulse be strong; or if symptoms be- speak a highly inflammatory state, notwith- standing what has been written to the con- trary, a moderate quantity of blood may be taken from the arm. In this disorder, though evacuations are many times proper, and sometimes indispensibly necessary, still they are to be recommended with caution, and executed with a sparing hand. Perhaps no disease bears purging when intended for the purpose of reduction more illy than this. Small doses of nitre, any mild drink acidu- lated with vegitable acid. Elixir Vitriol, or spirit of salt, and free dilution is almost al- ways sufficient to answer this indication. b As soon as the pulse begins in the least to subside, and in many instances, from the first dawning of the disease, this indication takes place: viz. To promote the determi- nation to the surface. The common people and nurses for the most part, have but this one indication, which, in their mode of expression, is to "drive it out". A solution of Emetick Tartar has been recommended; but from the liability to produce a lax state of bowels attached to its use, it is not always to be trusted. The object seems, attainable by the use of warm diaphoretic (34) diaphoretic drinks, and the exhibition of such things as will tend to preserve, or in- crease the tone of the stomach and bowels, such as mild tonicks or astringents; infu- sion of saffron, mari-golds, blazing star- root, camomile flowers, a plant called "Canker weed," and many other things, celebrated among the common people, for extraordinary cures in the Canker. A moderate use of brandy, or West In- dia rum may be referred to this head. Judgment is necessary in the application of these things: more especially the latter which will not always be proper though a sparing use of them will sometimes agree, even, when the symptoms of inflammation are pretty well up. Relative to the former, the good women of the house and neigh- borhood may be left pretty much to them- selves; they will not be very apt to give too much of them. What might be expected from the occa- sional exhibition of small quantities of Laudanum? c To support the vital powers. Wine, Brandy, Peruvian bark, and the whole class of diffusible stimuli, come in play under this third indication. When the scheme recommended in the foregoing, is unsuccessful in answering the indication, and correcting the tendency of the systems to debility, these must be re- sorted (35) sorted to, and their use accomodated to the exigences of the constitution. When any regular, and marked remission of fever takes place, but little doubt can remain respect- ing the use of invigorants. In general, perhaps there is more danger of too mode- rate, than too liberal an application of them. B The Particular indications are d Such as relate to the general system. c Topical. d At the commencement of the disorder, or as soon as may be, a few grains of Ipecac should be exhibited, (unless the stomach has sufficiently evacuated itself) especially it the patient be attended with oppression and nausea. A small dose of Calomel should then be exhibited, after which, if any thing is required to be done, the bowels must be kept open by mild Clysters. Small doses of Calomel may be exhibited occasionally during the disease in the manner practised by Doct. Rush, and if there be the least ten- dency to a Diarrhœa, it must be checked with Laudanum. Let the Calomel be given in such a form, that, in its passage to the stomach, some part of it may readily catch, and stick upon the ulcers of the fauces; for nothing will contribute more to bring on digestion and heal the sloughs. It will likewise promote the discharge from the salivary glands. A slight (36) slight salivation, by the way, is no unfavor- able symptom. After the evacuation of the first passages, a quieting draught should be administered. Guard well the stomach and bowels. The diet should be light, consisting of bar- ley coffee or weak broths. e The affection of the fauces requires particular attention. An epispastick may, and ought to be applied as quick as possible to the part when the affection is considera- ble. In malignant cases, a cataplasm made of the bark and camomile flowers applied to the throat, and repeated once in four hours, has been highly extolled. The fauces ought frequently to be wash- ed with detergent gargles, in which is a portion of the spirit of sea salt. Rum lye; tincture of myrrh; an infusion of red rose leaves sweetened with honey, putting in a few drops of the spirit of sea salt, and a lit- tle brandy, may all be used to advantage. Steam the throat often with vinegar: or a mixture of vinegar, tincture of myrrh and honey; and let the fumes be applied as warm as can be borne. A syringe, used with care, if the sensibili- ty of the parts do not forbid, is very con- venient, and ought not to be overlooked. If a coma takes place, a large blister should be applied to the back, or smaller ones behind the ears. After (37) After the removal of the disease, there frequently remains a tumefaction, and hard- ness in the tonsils and submaxillary glands: this commonly will go off in time, and is easily subjected by discutient applications. A mild purge completes the cure. So diverse is the disorder at different sea- sons and in different places, and even in per- sons in the same neighborhood and time, that much depends upon the judgment of the Physician; whether any thing, or what, is necessary to be done. The inquisitive Practitioner is therefore refered to that re- serve of light and help, which every inge- nious Physician possesses in the resources of his own mind. D APPENDIX. THE Solution of salt and vinegar, as a remedy in the disease of which I have been treating, has been so much talked of in this eastern part of the state, that it requires some consideration. The use of salt as an article of medicine is not a new invention: Doctor Rush mentions its efficacy in the cure of Hæmoptysis: for the discovery of which he says we are indebted to an old Woman. To its tonick, invigorating effect relative to the first pas- sages, in a good measure, is owing its use as an article in the catalogue of condiments. Common salt has been noticed by various writers on the materia medica, and since its properties have long been ascertained, what reason can be given for its neglect in practice? From these, such inconveni- ences in relation to the human constitution are dedu- cible, (inconveniences not merely imaginary but con- firmed by experience) as will forever forbid a con- siderable use of it in almost every case. A Physician lately of considerable celebrity in Windham County, from reflection upon the antisep- tic quality of marine salt, took it into his head to make a trial of it in practice. His first essay was in a few cases of diarrhœas in which he was successful. How far this experiment was consistent with the principle laid down for the operation of his remedy let others judge. This however was not a new ex- periment. What farmer is there who has not tried it a hundred times upon sheep in the spring season, which are attended with a scouring soon after they are turned out to grass? But here candour obliges me to confess that the practice admits of more ex- cute than in some cases to which it has been applied, perhaps. (39) perhaps. Yet what shall we say of those, who pro- claim salt the cure-all of the consumption, and many other diseases opposite in their causes and types? Wretched are the shifts of ignorance! Miserable the resources of bigotry! * Upon the appearance of the Scarlatina Anginosa, salt was again resorted to by the above mentioned person. The solution of salt in vinegar began soon to be famed abroad. To consider the various cir- cumstances that contributed to spread its same, does not belong to this place. The following is the me- thod of preparing and exhibiting the solution, given by the gentleman by whom it was introduced. "To any quantity of vinegar put as much fine salt as the same will dissolve. To a table spoonful of the solution add a tea-cupfull of hot water, and let the patient if an adult, once in three hours sip it down as warm as he can bear it, for a child the dose must be somewhat less" † This like many other things by which the world has been imposed upon, has been cured up for a certain-cure. How far such extrava- gant encomium favours of Quackery and is incon- sistent with the dignity of the profession, all have a right to judge. Is it nor a fixt principle in medicine, that no one thing is sufficient in diseases that admit, not only of different, but opposite indications? So * So great has been the prejudice for salt with some persons, that, there is source a disorder incident to the crazy human from, for the removal of which it has not been recommended. For a great variety of complaints it has been denominated a certain Cure: but more relative to this by and by. Not only the sick have been directed to take it, but persons in health to prevent sickness. whole families of children have been known to be drinking salt- water at once for no other reason, than, that children were apt to have worms; those who could not drink it were directed to "eat nubs of salt." "Lord what is man" † It would have been well had the advocates of the solution ne- ver exceeded the bounds here set for its exhibition; but in must instances it has seemed thought the rule adopted was by flattery or by force to pour down as much as could be got down. (40) So numerous are the certain-cures that have insulted the credulity of mankind, that, at this day, it is with difficulty we withhold our suspicion from the hon- esty or intellects of those who palm them upon the world. At any rate, if this title fails of conveying an idea of insignificance, no ingenious Physician will fail of suspecting the virtues of the medicine to which it is attached. What must a candid mind think of one, who in the enthusiasm of a crazy faith in an indifferent article, should say, "a Doctor is a fool that looses patients in the Canker Rash." "Let me be called in season and I will be guillotined for every patient I shall loose" ? When Jugglers and mountebanks proclaim the "sovereign efficacy" * of their nostrums, though deception is a branch of their profession, they are in some measure excusable on the grounds of their general inacquaintance with the principles of the healing art. But who are Jug- glers? and what are mountebanks? When Physi- cians, and those who call themselves regular Physi- cians swagger, and pour forth such extravagant boasts of the "sovereign efficacy" of favorite reme- dies as bully common sense—what?—write not my pen the stigmatizing sentence, and while humanity weeps over the frailties of men, Charity pour thy healing balm. Perhaps no disorder puts on a greater variety of forms, or requires more variety in the method of treatment than the disease in question. I shall endeavor to prove, notwithstanding the praises that have been bestowed upon salt and vinegar, and the patronage it has met with from various or- ders * Said a gentleman, who was lately called to arrest the mortality in a neighboring town, "you shall see" (to a number of the faculty in consultation,) "you shall now see the sovereign efficacy of salt and vinegar. Here is a boy just taken with the Canker Rash, and in a day or two he shall be able to drive plough." The next day the boy died, and about that time two others in the same family under his immediate care. (41) ders of people, that such praises may have been be- stowed, and such patronage lavished, and the medi- cine possess very little merit. Mankind in general, are incapable of judging of the real virtues of medicine: and this must always be the case, so long, and in proportion, as they are destitute of the knowledge of the nature of diseases, and the principles of Physic, a good understanding of which is requisite to distinguish accurately between the necessary symptoms of complaints, and the con- sequence of the action of things given for remedies. Thus, the credit of salt and vinegar, rests almost, if not altogether on the opinions of such as are incapable of judging of its merits; For I know of know dis- interested Physician of reputation, that holds it in any great estimation. In investigating the sources of prejudices relative to medicine and cures that occur to daily observa- tion, much is to be refered to the amazing power of novelty; much also to the feelings of the sick and their connections. A person is taken sick with a particular disorder—apprehension arises in the minds of all concerned—a Physician is called to administer relief—the disorder, agreeably to its nature increases —apprehension rises to anxiety.—We easily are made to believe what we wish to prove true. Just as the malady under a judicious method of cure be- gins to give way, or some favorable change, from the action of unknown causes. or the mere energy of life, takes place in the constitution, a new Doctor is sent for, or some favorite insignificant simple is ex- tolled and administered, and runs away with the whole honor of the cure. "We easily are made to believe" I said "what we wish to prove true." A drowning man will catch at a draw, and though a straw a thousand times has failed, it will be caught at with eagerness. The supposed cure is noised a D2 broad; (42) broad: neighbor tells it to neighbor, and cousin to cousin: the disorder breaks out again and again: twenty good old matrons come round and tell what cured cousin Jonathan's or Mr. Tracy's child: The medicine is tried, and perhaps the patient gets well: if so, a GREAT CURE is performed, whether the article given had any operation or not: but if the patient dies, it makes no odds, for Caprice is ever ready with an excuse: perhaps the medicine was not given soon enough, or the patient had worms or some other disease in connection: thus, though, the osten- sible means every day prove unsuccessful, the bub- ble brightens and delusion spreads. With respect to merit, it is the perpetuity of suc- cess, and this alone that can substantiate the claim of any medicine: for so liable are even Physicians to deception, that in making deductions, it is often as necessary to distrust facts as theories. We shall see by and by, whether or not the solution has this distinguishing mark enstamped upon its character. Who is there but has heard of the great same of tar-water? This was once cried up for a certain cure of almost every disease, and though serviceable in many, it has now fallen into difuse, as every other, inconsiderable medicine will, the character of which so far out runs the truth. Not many years ago, a poor man in London, being in a declining way and unable to procure lodgings, took up his abode in a horse-stable. Recovering, what he owed to strength of constitution and the goodness of heaven, was, by the multitude, attributed to the "sovereign efficacy" of stud-horse effluvia. All the stables that could be procured, were presently fixed up for the reception of consumptive noblemen and opulent citizens. Do we hear of any such cures in our days? That ignorance of the principles of the healing art, which incapacitates for judging of the opera- tions (55) tions of medicines, and prevents a seasonable detec- tion of the absolute insufficiency of some, joined with an obstinate blindness which is inseparable from vulgar prejudice, prevents a like observance of their effects when positively detrimental. Such, are causes, that, in no small degree, have contributed to preserve the credit of the solution. It may be to our purpose to mention, that, at the very time Salt and Vinegar was preached up in these parts, with more than popish enthusiasm, and its use in many instances established with inquisitional rig- or, the same game was played off in the County of Berkshire (Massachusetts) with West India Rum. A swaggering Practitioner boasted that he was master of the "throat distemper:" despising all medicines he used nothing but rum. The disorder happened to be of a malignant type and very mortal. People were infatuated as they usually are in such cases, and the tricks and noise of the braggadocio procured him an immense accession of business. Business, we may observe, is the only object of empiricism, for ignoble minds are incapable of principles of general benevolence. For a while, so great was the rage for rum, that its advocate had, at one time, one or two persons under him, who were not bred to the profes- sion. as Journeymen, who made it their business to retail strong water to the gaping, frightened children of the mountains. As rum is no bad medicine, its- use was frequently no doubt attended with advan- tage. It not seldom, however, proved unsuccessful. At any rate, it ought never to have been the subject of implicit confidence: and no other article that ever the creation afforded. So long as diseases of the same name, are so different in character, and the constitutions of men are so various, it is folly, it is an insult upon reason, it is quackery, to pretend, that exactly the same method of cure is applicable to all. The (44) The use of rum at length fell to its proper sphere, and how long will it be, before salt and vinegar shall be little known but as an article of diet? Pity sighs o'er the weakness and imperfections of mankind: at the many instances of folly, deception, absurdity, and want of discernment in the better in- formed part of the community, conscious of the dig- nity of human nature, a noble principle of the foul hides its face and blushes. From the foregoing, this plain inference arises viz. from vulgar assertions, the general reception of any medicine, the temporary applauses of the more discerning part of the community, and the in- temperate decisions of even Physicians themselves, no conclusions relative to its virtues, can, without great caution be drawn. Much has been said about the extraordinary suc- cess of the solution. Such, success, for arguments sake, I am willing to admit, and even this goes not to a demonstration of the efficacy of the CATHOLI- CON. Humanity may have reason perhaps to shud- der at the idea, that too many Physicians, even at this day, have not a right understanding of the Disease I have been considering, and that a pernicious meth- od of cure may have been the consequence of their want of information. Bad treatment, may make a mild disease mortal. How far such practice may be applied to Physicians in these parts, I am unable to say; but the above sentiment is corroborated by a reflection on the custom of too indiscriminate bleed- ing, puking, and purging, unhappily prevalent among many Physicians. The pretended success, may, in some instances, be owing to the neglect of a method of cure less safe than the method assumed. Another circumstance is worthy of consideration: It is well known, that the Scarlatina Anginosa, in these parts, in the spring, summer and autumn of 1794 when the (45) the credit of the solution was upon the increase, was generally, of the mild, more simple, inflammatory kind. Cases of this description, will do well enough under almost any treatment, and the more simple the practice, the better. I have known several families of children, who have recovered without the aid of either crocus or salt. Some have got well, even in spite of means used to prevent it. Many have been the great cures performed upon subjects that never required medical help, and would have done better without the assistance they received. Yes, done bet- ter without the use of the things exhibited: I repeat it, that mankind may learn how miserably they may be imposed upon by practice, and how inadequate they are to judge upon short acquaintance even of the success of practitioners. At this day (July 20) there are frequent instances where very little is necessary to be done. It is idle to tell of cases where patients have been "put upon their legs in two days time;" innumerable have been such instances where salt and vinegar was not thought of; and as many where the patients were not taken off their legs. To make safe inferences, an impar- tial knowledge of facts is requisite. Why don't they tell us of the many instances in which it procured, not only not the least evidence of relief, but on the contrary, by its operation, induced the most horrid signs of distress and anguish, and almost, if not quite superceded the advantage of constitutional strength? For aguments sake I have admitted that "extraor- dinary success" has attended the use of the solution. Except for arguments sake, I should have done it with many grains of allowance. I know much has been said to make it out, and most people have been disposed to believe: but from whom have we the ac- count of this extraordinary success? From profes- sed advocates, persons strongly interested, or blind- ed (46) ed by ignorance or prejudice, and even from these, sometimes, with such liberties with language as al- most afford ground for suspicions relative to vera- city. Vain are the pretences, That "the Physician was not sent for soon enough," "the solution was left uncovered," "something got into it" "the pa- tient could not be made to take enough of it," "re- lapsed," "had worms," or "some other disease in connection." Subterfuges like these must meet with contempt unless built on the strongest founda- tions: Yet shifts as ignoble have been practiced, and the authors of them, after repeatedly loosing the sub- jects of their pickling scheme, thus dressing up con- science in a straight waist-coat, have had the courage to say they "never lost a patient." Why should ex- cuses like the above, he allowed the advocates of the solution, when none is admitted for any other mode of treatment? What shall we say of such, who, to save their own credit, possess a happy dexterity in imposing the ho- nor of death upon others? To ascertain the powder and virtue of any medi- cine, it ought to be taken alone, and certainly, no other remedy is necessary in cases where one indivi- dual article possesses, "sovereign infallible efficacy." Relative to the practice with salt and vinegar, as far as my acquaintance extends, this has not been the case. The bark, wine, brandy, epispasticks, lauda- num, and other things, possessing incomparably more virtue than the solution, have been called in to help out the cure and keep up the credit of salt and vinegar. In the effects of the joint operation of all these, or several of them and the solution, who, in the name of common sense, without immediate inspiration from above, can tell how much is to be refered to the action of any one of them? But, it may be an- swered, such trial has been made.—Yes, and if the patient (47) patient had good luck, he lived through it; what more can be said? A want of confidence in your salt and vinegar in one single instance, betrays a cowardice, a distrust of its "sovereign efficacy" not much to its credit. "Do you depend upon it" said a gentleman of the faculty to an advocate of the solution. "do you depend upon it Doctor?" " We depend up- on it" say he "with other-things." I will say one thing father respecting the great success of salt and vinegar: as far as my observation has gone, more have died under the use of it than un- der any other method of cure. Alas! all medicines are fallible, and the sons of apostate Adam are yet subject to the curse pronounced upon him from the mouth of avenging Deity, "dust thou art, and onto dust thou shalt return." The argument drawn form the antiseptick quality of the solution is too frivolous to need a serious re- futation. Let no one imagine that I mean to stigmatize the solution as altogether an unsafe or pernicious medi- cine. I will only observe here, that its true merit falls infinitely short of the character which has too generally been given it, and the confidence of which it has been the subject. Fatal may have been this confidence in some instances, by preventing recur- rence to means, more worthy of dependence. The following observations relative to the use of the solution. are predicated on actual experiment. The medicine is a tonick, and as a tonick solely, can we expect any benefit from its general operation; But its invigorating force is very small in comparison to many things which have not half the in- conveniences attendant on the use of salt and vinegar. Those cases in which any the least advantage, can be expected from the use of the solution, are such as remote from a malignant tendency, where the diathesis is not so high as to reader a moderate tonick in- applicable, or so low as to require more invigorating power. Still, in such cases it is not superior to a thousand things, which have been, and are still used, and which in general are much more agreeable; in extreme cases, it is dangerous placing much dependence upon it, unless (48) unless it be with "other things." As a gargarism, it is inferior to most that are in use; but for fumigation, the solution has a claim to notice. When the throat is loaded with mucus, it wonderfully as- sists its discharge from the fauces; but a syringe with any pleasant, detergent wash will do this, without producing the inconveniences that result from forcing down the ulcerated throat, so large a quan- tity of acrid saline liquid. When given in the quantity prescribed, it must often be, not only a harsh, but an unsafe medicine. Among the inconveniences that are attached to the use of the solution, and which most uniformly and necessarily attends. I must not forget to mention that of an insatiable thirst. Of all bodily affections, per- haps there is none, not even excepting that of pain itself, more wast- ing to the vital strength than this. The patient must drink the more, it. will be said; where free dilution is necessary he may; but where it is not, what must be the consequence? There have been repeated instances, where the practice with the solution has been driven to extremity under proofs of the most ex- quisite distress in the unhappy patient. To see it forced down an infants, throat, when under the necessity to hold its hands by main strength to keep it from tearing out its tongue, must occasion sensations from which the benevolent mind must revolt. "Who would think of using it on a raw sore ?" said a gentleman of the faculty; "I should not on a horse" replied a farrier. To inferences of ill consequences attendant on the use of the solution, we are helped by a knowledge of diseases that depend on too saline a state of the juices. I have observed in several instances, that persons, who had taken large quantities of the solution, con- tinued a long while convalescents. I had lately under my care a person who past through the ordeal more than five months ago. A child who had been drenched off, remained sometime weak, and disordered and then died. Upon dissection, the finishing stroke appeared to be the HYDROCEPHALUS INTERNUS. To conclude, after all the boasted excellence of salt, and vinegar, it is fallible, and though a little of it may sometimes be attended with advantage, as a general medicine it it unworthy of dependence, and merits but little more attention, than just to prevent its doing mischief. The business of introducing new medicines to public use. rela- tive to the health and happiness of society, is serious and impor- tant. Every such article ought to undergo a thorough examination, and any person has a right to enquire into the merits of salt and vin- egar. The man who discovers a new road to health, alas! so numer- ous are the ways to Death. deserves well of society. Happy is he, who, as the winter of life advances, can set down, and reflect on former times, with a soothing consciousness of his having saved the lives of many of his fellow creatures. FINIS